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Non-Maleficence In Medical Ethics (Simply Explained)

Non-Maleficence In Medical Ethics (Simply Explained)

Updated on: December 3, 2023
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Written By Dr Ollie

Every article is fact-checked by a medical professional. However, inaccuracies may still persist.

Non-maleficence is a fundamental principle in medical ethics which dictates that medical practitioners have a duty to do no harm or allow harm to be caused to a patient through neglect. 

This concept is closely connected to beneficence, another core principle in medical ethics that focuses on promoting the well-being of patients.

Both principles serve as a foundation of ethical decision-making in healthcare, ensuring that patient safety and welfare are prioritised.

What Is Non-Maleficence?

You’ve almost certainly heard the maxim “do no harm” before. It’s possibly the most famous principle of medical ethics.

This principle, often considered inseparable from beneficence, necessitates a careful balance between potential benefits and risks associated with any medical procedure or treatment.

Non-Maleficence Pixel Infographic

Derived from the Latin “primum non nocere,” which translates to “first, do no harm,” non-maleficence upholds the responsibility of medical practitioners to constantly evaluate their actions and ensure the welfare of their patients.

While both non-maleficence and beneficence require acting in the best interest of the patients, non-maleficence focuses on the mitigation and prevention of harm.

In practical applications, non-maleficence may entail withholding specific treatments or interventions that could potentially cause more harm than good.

Medical professionals need to judiciously weigh the risks and consequences before administering a particular therapy or procedure, considering alternative options that might yield more suitable outcomes.

LEARN MORE: My comprehensive guide to the four pillars of medical ethics

The Difference Between Non-Maleficence And Beneficence

The distinction between non-maleficence and beneficence lies in their objectives.

While non-maleficence aims to prevent harm and adverse outcomes, beneficence seeks to actively promote good and improve the patient’s situation.

In medical practice, healthcare professionals must weigh the potential risks and benefits of various treatments and interventions to establish a balance between these two principles.

Adherence to non-maleficence requires careful consideration across all aspects of healthcare, including medical training, informed consent, truth-telling, and confidentiality.

A nurse comforts an older man sat in a chair at the hospital
A nurse comforting a patient in hospital

Upholding this principle demands that every medical action and decision be thoroughly evaluated to minimise risks and negative consequences for the patient.

In some cases, opting for no treatment at all may be the most ethical course of action, highlighting the importance of non-maleficence in guiding medical professionals’ responsibilities and obligations.

Why Is Non-Maleficence Important?

As doctors (and indeed any healthcare professional), we’re ultimately here for the benefit of patients.

We’re not here to test out some new and exciting treatments our team has developed in a laboratory. We’re not here to show off what a brilliant surgeon we are by performing a really difficult operation and we’re not here to only treat patients when we feel like it.

Non-maleficence as an ethical principle does a great job of reminding us, at the end of the day, no harm should come to patients as a result of our actions.

Our job is to relieve suffering so we’re not doing our jobs properly if more harm is coming to people.

Furthermore, non-maleficence upholds patients’ trust in their healthcare providers.

As patients entrust their lives and well-being to professionals, it is imperative that medical practitioners maintain that trust by prioritising patients’ safety.

Non-Maleficence Interview Question Examples

In this section, I’ll discuss some examples of interview questions that address the principle of non-maleficence in medical ethics.

These questions are designed to test a medicine applicant’s understanding of this ethical principle and how it applies to various clinical scenarios.

Performing An Amputation

A 62-year-old diabetic patient presents to the vascular team in hospital. As a result of neglecting his diabetes medications over the years, he’s damaged the nerves and blood vessels in his foot to the point of requiring an amputation. However, the patient doesn’t want the operation and is desperate to keep his foot. How would the principle of non-maleficence play into your medical decision-making here?

This is actually quite a common scenario that I’ve seen in hospital a few times before.

Poorly controlled diabetes can essentially kill the nerves and blood vessels in peoples’ feet, making them extremely vulnerable to damage and infections.

If a serious infection does occur in the damaged feet, it can potentially be life-threatening if it spreads to the rest of the body.

Points you could discuss include the fact that an amputation is in itself causing harm to a patient- you’re chopping one of their feet off after all!

However, it could also be argued that leaving the foot there may very well actually do more harm to the patient in the long term- if they were to get a serious infection and die.

Bilateral Hip Fractures

A 92-year-old comes into hospital after falling over at home. She’s got bilateral hip fractures. Prior to the fall, she wasn’t particularly well with a range of serious chronic health problems. In order to fix her hips, she needs a big operation. However, such an operation on an elderly co-morbid patient such as herself carries a serious risk of death on the operating table. What should a doctor looking after her consider?

This is another very real scenario that sadly often has extremely poor outcomes.

In order to fix a broken hip, patients need an operation usually to put some metal in the hip to fix it back together.

However, such operations are a big ordeal for the body, and elderly or otherwise unwell patients are at a high risk of dying during the operation.

The alternative of not fixing the hips with metalwork condemns a patient to months in bed carrying a high risk of developing a serious infection.

Unfortunately, there aren’t really any good options for a doctor here in order to ‘do no harm.’

Neither option is particularly promising so it’s vital to clearly lay the options out to a patient and their family so that they can make an informed decision.

Administering Chemotherapy

A 54-year-old lady is undergoing chemotherapy for breast cancer. The chemotherapy is necessary to treat her cancer but is giving her horrible side effects. She feels nauseous all the time, has no energy, has painful joints and generally finds herself a lot more irritable than normal. How does the principle of non-maleficence play into how you as a doctor are treating this patient?

Chemotherapy is a classic example of a ‘necessary evil.’

Any patient who’s undergone rounds of chemotherapy will tell you how horrible it is.

From the nausea to the pain to losing all your hair, there’s nothing nice about it. However, it’s still a lot more desirable than having cancer.

We as doctors are doing harm to this patient by giving them chemotherapy- thus directly contradicting the principle of non-maleficence.

However, we’re also hopefully saving them from increased future harm- potentially dying from breast cancer.

In cases where chemotherapy may be of limited benefit, there’s never a clear answer as to whether living a slightly longer but unpleasant life may be better than a shorter, side-effect-free life.

Balancing Non-Maleficence With Other Ethical Principles

Within medical ethics, non-maleficence is one of the four main guiding principles, alongside beneficence, autonomy, and justice.

Balancing these principles is critical to ensuring ethical decisions are made within healthcare settings.

Beneficence

Non-maleficence and beneficence are often considered as two sides of the same coin.

Non-maleficence dictates that healthcare professionals should avoid causing harm to patients, while conversely, beneficence requires providers to actively promote the well-being of individuals under their care.

Balancing these principles entails considering the potential risks and benefits associated with various treatment options and then choosing a course of action that minimises harm while maximising benefits.

Healthcare practitioners should maintain open communication with patients, discussing potential adverse effects and ensuring they understand the anticipated outcomes of various treatments.

Autonomy

Autonomy, the respect for a patient’s right to make decisions about their own healthcare, is another vital ethical principle.

This often involves prioritising informed consent and respecting patients’ choices, even when those choices might not align with a practitioner’s recommendations.

Balancing non-maleficence with autonomy can sometimes be challenging, as respecting a patient’s wishes may lead to outcomes that professionals believe to be harmful.

However, the key is to provide thorough, accurate information to patients, fostering engagement in the decision-making process.

By doing so, healthcare providers empower patients to make informed decisions while still adhering to the principle of non-maleficence.

Justice

Justice in medical ethics pertains to the fair and equitable distribution of healthcare resources and treatments.

Balancing non-maleficence with the principle of justice requires healthcare practitioners to consider the broader implications of their decisions for the wider patient population.

In situations with limited resources, such as hospital beds, staff, or funding, doctors must make decisions on prioritising patient care.

These decisions can sometimes lead to the exclusion or limitation of care to some patients, potentially causing harm.

Providers must strive to allocate resources in a way that optimises the overall well-being of the community, without causing undue harm to any individual.

This requires continuous reflection on the availability and distribution of treatments, as well as an evaluation of how utilising resources for one patient may impact the access or options available to others.

Legal Aspects Of Non-Maleficence

The principle of non-maleficence gives rise to several legal aspects, including malpractice cases and regulatory oversight.

Malpractice Cases

When healthcare professionals breach the principle of non-maleficence in their practice, they may face legal consequences in the form of malpractice cases.

Two lawyers discussing a case outside of court
Two lawyers discussing a case outside of court

Medical malpractice occurs when a practitioner’s negligence or failure to adhere to the standard of care leads to injury or harm to a patient. These cases often involve:

  • Misdiagnosis or delayed diagnosis
  • Surgical errors, such as operating on the wrong body part or leaving surgical instruments inside the patient
  • Medication errors, including incorrect dosages or wrong prescriptions
  • Inadequate or improper aftercare

Patients who have been harmed due to a healthcare professional’s violation of non-maleficence can seek compensation through lawsuits.

They must prove that a duty of care existed, the duty was breached through negligent actions, and the breach directly caused the harm suffered.

Regulatory Oversight

To protect patients and ensure healthcare providers uphold the principle of non-maleficence, regulatory authorities such as the GMC oversee the medical profession. These organisations are responsible for:

  • Granting licenses to qualified healthcare professionals
  • Monitoring and ensuring adherence to ethical guidelines and the principles of medical practice, including non-maleficence
  • Investigating complaints and disciplinary cases against medical practitioners who violate their professional obligations

Regulatory oversight aims to maintain high standards of patient care, protect public safety, and improve professional competence.

This is achieved through continuous professional development, peer evaluations, and adherence to guidelines set by medical associations and governing bodies.

Final Thoughts

Non-maleficence is a crucial principle in medical ethics that guides healthcare professionals to prioritise patient safety and welfare.

It requires a careful balance between potential benefits and risks associated with any medical procedure or treatment and upholding this principle demands that every medical action and decision be thoroughly evaluated.

Ultimately, non-maleficence reminds us that as healthcare professionals, we are here to relieve suffering, and we must always strive to not do harm to our patients.

About the author
After studying medicine at the University of Leicester, Dr Ollie now works as a junior doctor in London. His interests include medical education and expedition medicine, as well as having a strong belief in the importance of widening access to medicine.