Abstract

This research project highlights the theoretical value and practical application of the principle of beneficence, trying to underscore its meaning and primary role in medical ethics and bioethics. The linguistic clarification of this principle distinguishes “benevolence” from “beneficence” and attempts to specify what is meant by the expression “patient’s good” and the term “good”. On the one hand, this analysis points to the complexity of the nature of the words and meaning referred by the principle of beneficence. On the other hand, it underlines the presence of descriptive and value elements in the expression “patient’s good”. A survey of the descriptive and prescriptive content of the principle of beneficence brings about an inquiry into the foundation of the obligation to act for someone else’s good — both within medical practice and moral experience in general. Furthermore, this underlines the different justifications of that obligation during the main phases of medical ethics and bioethics. It also notes a weakening in the concept’s normative strength due to a gradual change from understanding it in terms of duty, to a formulation that appeals to the vocabulary of principles. In this way, beneficence becomes understood with reference to, and in contrast with, the other principles of biomedical ethics, especially the principle of autonomy. After analyzing the conflicts among the principles, this work discusses the inadequate theoretical consistency of the principle of beneficence within that setting and argues for the necessity of its reformulation. In order to reach this goal, the weak links of the Hippocratic-paternalistic and the libertarian-autonomy approaches are exposed, as well as their erroneous descriptions of the principles of beneficence and autonomy. On account of this, I refer to the normative model called “beneficence-in-trust”, proposed by E.D. Pellegrino and D.C. Thomasma. Through a phenomenological and teleological approach to the clinical encounter, this model locates the ends of medicine in acting for the patient’s good. Expressed in these terms, the principle of beneficence is grounded on a particular human relationship that will remain constant over time in medical practice despite the unavoidable modifications of medicine and its goals