4-Benefit and Harm - Handout

01/09/2015

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Benefit and HarmA MA LIA MU H AIMIN

DEPARTMENT OF BIOETHICS, SCHOOL OF MEDICINE

UNIVERSITAS JENDERAL SOEDIRMAN

01/09/2015 BIOETHICS AND HUMANITIES 1

Das Experiment (2001)The Experiment (2010)

The Stanford Prison Experiment...


Learning Objectives

Students should be able to identify benefits and harms in daily settings andhealth care settings

Students should be able to evaluate harms and benefit in daily settings andhealth care settings

Students should be able to justify decisions taking harms and benefits intoaccount

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Why do you study?

Why do you studymedicine?

BenefitWhat is a health benefit?Why do we see a doctor? Health

Care

Relief of suffering Prevention of disease, illness, disability

Psychological benefit Enhancement

etc.

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Are health benefits only available to “unhealthy” people??

Health benefits are available to people who do not presently suffer from anydisease

Prophylactic treatments or disease prevention programs vaccination

Restoring proper physical functioning treating results of non-disease eventssuch as broken legs and brain injuries

the social context of a physical condition


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What is the concept of health?The WHO definition of “health”:

“A state of complete physical, mental, and social well-being and notmerely the absence of disease or infirmity”

Too narrow or too wide?? the WHO definition is often criticized for being too wide; it is encompassingmany situations that are not disease related and that can expand the area ofwork of medical doctors


What is harm?= bahaya, kerugian, kemalangan, kerusakan

Examples...

ovarian cyst surgical procedure, delivering cancer diagnosis, …

Interpretations of “harm”?

physical harm

psychological harm

moral harm (harm to interests, harm as unfairness, harm as disrespect)

social/economic harm (consequences for social role, stigmatization)


Primum non nocere

“above all do no harm”

Surgery, chemotherapy, drugs/medications, etc.

What justifies them is the net balance of benefit over the harm which thetreatments inevitably involve

Any clinical intervention has to be undertaken only after the completion of arisk of harm/likelihood of benefit calculation

Where the risk of harm outweighs possible benefit, then the treatment isnot indicated


Will uncertainty ever be eliminated??

In ancient medical ethics, an important moral principle is ‘above all dono harm’ continues to be used as an important ethical principle incontemporary health care.

Can a physician avoid harm?

What is the distinction between expected and unexpected harm?

Who determines what counts as harm?


In health care practice it is important to evaluate benefits andharms!!

Difficulties of measuring harms and benefits in individualpatients, may involve:

The assessment of degrees of harm and benefitThe social context of physical and mental sufferingThe subjective nature of suffering


Questions:


Can you think of any (previous) technology that you think is toorisky to be used now?

If you can, think about the current technologies we use in thatarea for that goal?

Looking back, do you think the current technology causes harmsalso?

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CONCLUSION

A fundamental way of reasoning that people have is to balance doing goodagainst a risk of doing harm

Assessment has to be made between risk of harms and potential benefits fordifferent individuals

Always ask: who benefits and who is at risk of harm?

Important for resource allocation; when time or material resources are scarce


Reference

UNESCO. Bioethics Core Curriculum. UNESCO, 2008. Available at:http://unesdoc.unesco.org/images/0016/001636/163613e.pdf

UNESCO Bangkok. A Cross Cultural Introduction to Bioethics. Eubios Ethics Institute, 2006.Available at: http://www.eubios.info/ccib.htmhttp://www.unescobkk.org/rushsap/resources/shs-resources/ethics-resources/bioethics-documentation-centre/bioethics-textbook/



4-Benefit and Harm - Handout

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