ABSTRACT
Beneficence is an action and benevolence an attitude, of good towards another person. It seems almost an insult to have a whole chapter on, doing good, in a book for medical students and doctors. Surely no one would be in the medical profession if they did not at least want to do good for patients, even though they may also have many additional motives, such as making money and having a high status in society. The corollary of doing good is avoiding or preventing harm (non-maleficence). In some ways, doing harm or failing to prevent it is more serious and culpable than failing to maximize benefit. The Hippocratic obligation ‘to do no harm’ can also be understood as a ‘fallback position’ when the treatments of the time could do very little good, and could be rephrased as ‘if you can’t do any good at least don’t do any harm’. Nowadays the situation is very different in that many of our treatments are so powerful that they nearly all have potential for harm. There is no longer a duty just to do whatever we can; rather, we need to ask whether we should do what we can do, when there is a real chance of making the patient worse. Any treatment decision is a balance between the potential for good and the potential for harm and this is particularly relevant to major surgery or chemotherapy in the elderly in which there is a significant mortality rate.
