Health Professional Codes

While beneficence is important to many philosophical and religious systems of ethics, it is central to the health professions. The Hippocratic Oath clearly states that the physician's actions are "for the benefit of the sick" (see Appendix for this and other codes and oaths). The Declaration of Geneva begins with a pledge to "consecrate" one's life to "the service of humanity." The 1980 "Principles" of the American Medical Association (AMA) opens with the declaration that these principles are established "primarily for the benefit of the patient." The International Code for Nurses devised in 1973 begins with a broad-ranging assertion of beneficence. The "fundamental" responsibility of the nurse, it states, is to promote and restore health, alleviate suffering, and prevent illness. While duties to specific persons are recognized, the obligation to perform beneficent actions is seen as universal, because the need for nursing services is universal.

The U.S. Code for Nurses of 1976 differs from all physician codes in recognizing that services not only should promote good but also should be guided by the values of those served. The first principle in this formulation asserts the "self-determination of clients." As noted above, self-determination, or autonomy, is frequently seen as a limiting factor in gauging the extent of beneficence, yet this factor is rarely mentioned in the ethical formulations of health professionals. For example, the practice of soliciting consent from patients was evident in medical practices in the United States in the eighteenth century. Yet these solicitations were not commensurate with today's notion of informed consent.

Consent was sought in the eighteenth century primarily to enhance therapy rather than to encourage independent decision making by patients (Faden et al.). Jay Katz presses this point by asserting that consent is largely "alien" to medical thinking, which prefers "custody" over "liberty."

Still, claims for the modern uniqueness of informed consent should be viewed with caution, especially when they tend to valorize an "autonomy model" over a "beneficence model" (Faden et al.). It would be anachronistic to believe that eighteenth-century physicians worked with the mid-twentieth-century concept of consent. Yet it is too sweeping and dualistic to believe that, by default, they were under the sway of a "beneficence model." Medical practices, or moral practices more generally, do not lend themselves to easy encapsulation into models, just as beneficence as a practice is not identical with the philosophical principle of beneficence.

While all versions of professional ethics agree that the acceptance of a patient or a client creates a specific obligation of beneficence, some codes go further and talk of a general duty to seek the public good in matters of health. Here the 1847 Code of the American Medical Association is notable. Chapter III of that code enumerates "Duties of the Profession to the Public." Among those listed are vigilance for the welfare of the community, counsel to the public on health matters, and advice about epidemics, contagion, and public hygiene. Twentieth-century medical codes tend to be more parsimonious in their interpretations of what beneficence entails.

Not even the more generous beneficence in the 1847 AMA Code, however, takes it to cover what Charles Fried calls "the duty to work for and comply with just institutions" (p. 129). Fried here follows and extends the thinking of Kant, who saw beneficence in terms of a duty of mutual aid. Such aid is required because all persons (including ourselves) will at some time need the help of others, so to neglect aiding others would be self-defeating. The societal and public policy implications of beneficence in healthcare are poorly worked out at present. The issues that require attention include general programs of prevention, medical assistance to specific groups (such as AIDS patients), and healthcare for the indigent and uninsured. Most proposals for a more equitable healthcare system in the United States build on notions of justice as an independent principle rather than deriving their justifications from an extension of duties of beneficence.

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