Nonmaleficence is the principle of "do no harm.

" It emphasizes the

obligation to avoid causing harm or inflicting unnecessary suffering. This
principle guides ethical decision-making by encouraging actions that minimize
risks and potential harm, even when pursuing beneficial outcomes.
● Avoid causing harm or inflicting unnecessary suffering.
● Take steps to prevent harm and minimize risks.
● Be cautious when facing situations with potential negative consequences.
● Choose the course of action that does the least harm while achieving a
positive outcome.
 •primum non nocere,
3. NONMALEFICENCE • which means, above all (or first) do no harm
(Beauchamp and Childress, 2001).

● Nonmaleficence comes from a Latin words: ‘non’ to mean ‘not’;

‘malos’ from which ‘male’ is taken to mean ‘bad/evil’ and
‘faceo’ from which ‘fic’ comes which means ‘do/make’.
● Thus the term nonmaleficence means not to make or to do bad or
to make evil things intentionally.
● So, in medicine, nonmaleficence means not to inflict harm which is
not different from ‘not doing evil or bad things’.
● This principle requires a person to prevent or refrain from any sort
of actions that eventually causes harm to patient and more
importantly when the action is never been justified.
 The principle of nonmaleficence can be applied in one’s own common
language, that it is often called ‘negligence’, that is, if one imposes harm or
become careless and produces unreasonable risk of harm upon another. So to
provide a proper standard of care that avoids or minimizes the risk of harm is
supported not only of common conviction of morality but also of laws of the
society as well. (In view of professional model of care one may be morally and
legally blameworthy if one fails to meet the best standard of due care to the
patient. This implies corresponding consequence to one’s own action, and this
is term as ‘negligence’.) There are criteria on determining negligence:

1. The professional must have the duty to the affected party

2. The professional must breach that duty
3. The affected party must experience a harm
4. The harm must be caused by the breach of duty
MALPRACTICE and NEGLIGENCE
if one imposes harm or become careless and
produces unreasonable risk of harm upon
another
 Issues AGAINST THE PRINCIPLE OF
NON-MALEFICENCE:

1. Abortion: Harm against an embryo/fetus

2. Euthanasia: Harm against a sick person
A. ABORTION
It is the process of deliberately terminating pregnancy with the resulting death of an entity or it is a
process of deliberately terminating pregnancy at any stage of its development.

Types of abortion:
1. Direct abortion or induced: it a kind of abortion with the intentional of immediate purpose of ending
or destroying the fetus at any stage of after its conception.
2. Indirect abortion is a process of terminating pregnancy directly in which the moral object of the
action is the therapy of the mother and the death of the fetus is a side effect that is inevitably
unavoidable effect. Ex., removal of pathological tube containing a fertilized ovum in an ectopic
pregnancy, removal of the cancerous gravid uterus. This act is justified by the principle of double
effect. Obviously direct abortion violates the principles of natural reproduction.
Bioethical Issues:
Perhaps the basic bioethical question to raised with regard to abortion is "personhood"
1. When does “person-hood” begins?
2. What about an ectopic pregnancy and anencephalic infants? How are we going to consider these
cases in abortion issue?
3. What is the principle of inviolability of life? How does abortion go against this catholic principle?
B. EUTHANASIA
One’s values regarding life and death are reflected in how one
dealt with the dying. If one cannot bear to see suffering, then one
resorts to an “advance” death, such in euthanasia, suicide, or
physician assisted suicide. If one sees life as the highest value with
death as a form of human defeat, or if one is overly influenced by
available new technology and biological idolatry then one does
everything to prolong life beyond one’s one time and this is known
as dysthanasia. On the other hand, if one sees death as the
culmination of a good life, to be valued only until its natural end, one
looks for a good death this is orthothanasia.
1. Euthanasia means an action/omission which of itself or by intention
causes death, in order that suffering may be eliminated. It
procures/imposes death before one’s time.
2. Dysthanasia is the delaying or postponing death beyond its natural
time by all means available.
3. Orthothanasia, also known as passive euthanasia or natural death,
is an ethical concept and medical practice that involves allowing a
terminally ill or suffering patient to die naturally, without aggressive
medical interventions or life-sustaining treatments. Unlike active
euthanasia, where medical professionals take active steps to end a
patient's life, orthothanasia involves refraining from interventions that
would artificially prolong the dying process or life when there is little
hope of recovery.
Withholding Treatment and Withdrawing Treatment

Many health care professionals and the family feel guilty when treatment is withdrawn (stopped) and
withhold (not started). Both withholding/withdrawing treatment are bioethical issues which can be acted
upon or justified by the following conditions:

1. When the case is irreversible any form of treatment will not benefit the patient
2. When death is imminent or when patient is already dead

When the condition is such that any intervention will not benefit the patient, then treatment is not
obligatory. Thus, we have to respect the patient’s call for a dignified death. On the other hand, caring
must surround the person until the time of death. For example,

An elderly man suffered from several major medical problems, including cancer, with no
reasonable chance of recovery. Comatose and unable to communicate, he was being kept
alive by antibiotics to fight infection and by intravenous (IV) line to provide nutrition and
hydration. No evidence indicated that he had expressed his wishes about life-sustaining
treatment while competent, and he had no family members to serve as surrogate
decision-maker. The staff quickly agreed on a ‘no code’ or ‘do not resuscitate’ order, a signed
order not to attempt cardiopulmonary resuscitation if a cardiac or respiratory arrest occurred. In
the event of such an arrest, the patient would be allow to die. The staff was comfortable with
the decision because of the patient’s overall condition and prognosis and because not
resuscitating the patient could be viewed as withholding rather withdrawing treatment.
 Ordinary and Extra-ordinary Treatments
1. ORDINARY TREATMENT comprises of the provision of necessities of life that usually
pertain to food, normal respiration and elimination process. Hence like intravenous fluids,
nasogastric tube feedings, indwelling catheters, are some among the many considered
ordinary and necessary measure of treatment and may be sustained even if the case is
irreversible.
Thus, all measures considered to be ordinary may be sustained until the time of death.
2. EXTRA ORDINARY TREATMENT comprises of the use of aggressive modalities vis-
à-vis the capacities of the family or maybe some family who can very well afford it, continue
to give extra ordinary measure. But this means do not necessarily offer any benefit to the
patient. This is also a way of artificially prolonging the life of the patient.
Obviously, this extra ordinary measure loads the patient with more burden and fatigue and
are in fact a hindrance to letting the patient go in peace and dignity.
Traditionally, the rule on extraordinary treatment can be legitimately be forgone,
whereas, ordinary treatment cannot be legitimately be forgone. This may also lead
towards accounting whether death was letting die or perhaps killing
 Killing and Letting Die
Letting die’ is ‘prima facie’ acceptable in medicine
under two conditions:
1) a medical technology is useless (medically futile)
and
2) patients (or valid surrogate/proxy) have validly
refused a medical technology, that is, letting a patient
die is acceptable if and only if satisfies the condition of
futility or the condition of a valid refusal treatment
(note, honoring one’s own valid refusal or a useful
treatment is here as Beauchamp and Childress contend
is letting die and not killing, this may be debated).
In ordinary language ‘killing’ is a causal action that deliberately
brings about another’s death. For example, in automobile
accidents, one driver killed another even when no awareness,
intent, or negligence was present. Whereas, letting die is the
intentional avoidance of causal intervention so that disease,
system failure causes death, as to the case of Karen Ann Quinlan
(Beauchamp and Childress, 2001).

‘Killing’ has been conceptually and morally connected in medicine

to unacceptable acts (Beauchamp and Childress, 2001).
Generally, act of killing is not regarded as absolutely wrong, e.g.,
in self-defense, call of duty as police officer etc.
 Case Analysis:
A 76-year-old widow was admitted to a nursing home for several years already. In the
past she had experienced repeated transient ischemic attacks, caused by reduction or
stoppage of blood flow to the brain. Because of the progressive organic brain
syndrome, she had lost most of her mental abilities and had become disoriented. She
had also thrombophlebitis (inflammation of a vein associated with clothing) and
congestive heart failure. Her daughter and grandchildren visited her frequently and
loved her deeply. One day, she suffered a massive stroke. She made no recovery and
remained nonverbal, but she continued to manifest a withdrawal reaction to painful
stimuli and exhibited some purposeful behaviors. She strongly resisted a nasogastric
tube being placed into her stomach to introduce nutritional formulas and water. At
each attempt, she thrashed about violently and pushed the tube away. When the tube
was finally placed, she managed to remove it. After several days, the staff could not
find new sites for inserting IV lines and debated whether to take further ‘extraordinary’
measures to maintain fluid and nutritional intake for this elderly patient who had failed
to improve and was largely unaware and unresponsive. After lengthy discussions with
nurses on the floor and with the patient’s family, the physician in charge reached the
conclusion that they should not provide further tube feeding. The patient had minimal
oral intake and died quietly the following week.