BENEFICENCE and AUTONOMY BENEFICENCE Beneficence is the doing of active goodness, kindness, or charity, including all actions intended

to benefit others. It is a principle of medical ethics according to which a person should do good to others, especially when one has a professional duty to do so. In bioethics, the principle of beneficence refers to a moral obligation to act for the benefit of others. Not all acts of beneficence are obligatory, but a principle of beneficence asserts an obligation to help others further their interests. Obligations to confer benefits, to prevent and remove harms, and to weigh and balance the possible goods against the costs and possible harms of an action are central to bioethics. Beneficence may be considered to include four components: ( ! one ought not to inflict evil or harm (sometimes called the principle of nonmalifecence!" (#! one ought to prevent evil or harm" ($! one ought to remove evil or harm" and (%! one ought to do or promote good. AUTONOMY &utonomy is a concept found in moral, political and bioethical philosophy. 'ithin these conte(ts, it is the capacity of a rational individual to make an informed, un)coerced decision. In moral and political philosophy, autonomy is often used as the basis for determining moral responsibility for one*s actions. In medicine, respect for the autonomy of patients is an important goal of deontology, though it can conflict with a competing ethical principle, namely beneficence. &utonomy is also used to refer to the self) government of the people. INSTANCES AND OCCURRENCE OF THIS ETHICAL DILEMMA +hese kind of ethical dilemmas are very common in the ward. &nd as a student nurse, it is very difficult to decide which is really the best thing or the best decision to make. +he principles of beneficence vs. autonomy often occur in the area. +his can take place if the situation re,uires you to do your duty by doing what is right for the patient and not inflicting them any harm however, the patient itself refuses and re-ect any of your interventions because also of some personal reasons. In this situation, it is very difficult to decide what is the best thing to do. It is difficult whether to choose beneficence vs. autonomy. &nd even if you opt in any of the two, the dilemma will still not be solved. .atients sometimes make decisions that are unsafe, such as refusing treatment, medication or life saving procedures. +he nurse finds herself in an ethical dilemma because not giving the needed treatment goes against beneficence and giving it ignores patient autonomy. +his also happened many times during our /eadnursing rotation. +here was this one patient who really needs to undergo a certain procedure because his test shows some problem. +o prevent obstruction of the circulation and in order that the function of the several structures of the the body shall be resumed, the said procedure is necessary but the patient refused. 'ith the same patient also refused to receive a certain medication because of personal reasons even if they are very capable of buying and even very young and has a really big chance to recover from his condition.

+his situation happens many times when we really need to do certain actions to prevent any harm and to do good in our patients that we forget their right to decide. TRUTH TELLING +ruth)telling, or veracity, can be defined as the avoidance of lying, deception, misrepresentation, and non)disclosure in interactions with patients or relevant to patient care. Why is it a big dea ! Being honest with patients about their diagnoses is a relatively new addition to the ethics of health care. 0ntil recently, doctors often avoided telling patients the full e(tent of serious diagnoses, particularly when there were limited treatment options. In addition, in some cultures, it is customary to hide a serious diagnosis from the patient for fear that he or she will lose hope or become demorali1ed by the information. 'hy is it so essential to avoid misrepresentation and nondisclosure of information2 .rima facie wrong: lying is viewed as an inherent wrong3something that we naturally consider unethical. Barrier to .atient &utonomy and Informed 4onsent: it is inappropriate for a doctor to lie because it precludes the patient from making an informed decision and providing informed consent, thereby trampling over the patient5s autonomy. If the doctor provides improper or insufficient information, the patient will not possess ade,uate information to make the most personally meaningful decision. 6estroys patients trust: If the doctor lies to the patient and the patient later finds out about the betrayal, the patient will be less likely to trust the physician in the future. +his destroys the foundation of an effective patient)physician relationship, in which the patient trusts the doctor to provide appropriate information regarding diagnosis, prognosis, and treatment. &ccordingly, if one patient tells another patient about his7her e(periences with mistrust, then this may lead to a slippery slope in which other patients may subse,uently mistrust their physicians, leading to countless shaky patient)physician relationships. 8ost patients want to know: &ccording to one survey, 9%: of patients said they ;would want to know everything< about their medical condition, ;even if unfavorable.< =ven more patients wanted to know about a diagnosis of cancer. +herefore, it is inaccurate for doctors to think that their patients want to be spared the bad news. >ying is impractical: One lie will naturally lead to another, creating a web of deceit. ?urthermore, other members of the healthcare team may notify the patient at some point during the course of illness, leading to the patient5s resentment at not having received the information directly from the physician in the first place. 'hat happens if a family member declares that the patient should not receive any information about the diagnosis, perhaps due to cultural reasons2 &lthough a family member may wish to uphold the cultural values of protecting the patient from bad news, the doctor must ensure that these wishes also reflect those of the patient. +herefore, the doctor must e(plicitly ask the patient how he7she wishes to

receive the information, if at all. It is important to confirm the family member5s re,uest with the patient in order to uphold patient autonomy3after all, there may be some cases in which the patient still chooses to receive the information, regardless of the family member5s re,uest. A"e the"e any e#$e%ti&ns t& t"'th(te ing! One e(ception involves the patient who directly tells the physician that he7she does not want to receive any information regarding his7her diagnosis. In this case, it is ethical to withhold information because the patient does not wish to receive it, thereby upholding patient autonomy, or free will to decide. One must never assume that the patient prefers nondisclosure, but rather one must ascertain these wishes through direct conversation with the patient. +his can be achieved by asking the patient how he7she wishes to receive the information before the test results even arrive, thereby allowing both the patient and physician to plan the logistics of breaking possible bad news ahead of time. &nother e(ception involves a mentally unstable patient who may put himself7herself in harms way after receiving the bad news. In this e(ample, a doctor may be -ustified in delaying the disclosure of information until after the patient5s mental health improves and7or the patient possesses appropriate psychiatric backup. INSTANCES AND OCCURRENCE OF THIS ETHICAL DILEMMA >ike any other ethical dilemmas, this type also often happens in the ward. It happened to us recently when the family re,uests the 6octor and the staffs to avoid relying to the patient the diagnosis and results of the tests done. +he patient has last stage of 4ancer and according to the 6octor, there5s nothing he can do to save the life of the patient. @till, the family doesn5t want the patient to be aware of her condition even if the patient is really curious and always asking about the results of his test, etc. +he patient also is on her right mind.