Beneficence

The act of promoting or doing good. Beneficence is a key value of biomedical ethics. In radiological protection it is to increase the direct and indirect benefits for individuals, communities and the environment.

ICRP Publication 138, 2018

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Excerpt from ICRP Publication 138, 2018

3.1. Beneficence and non-maleficence

(37) Beneficence means promoting or doing good, and non-maleficence means avoiding causation of harm (Frankena, 1963). These two related ethical values have a long history in moral philosophy, dating back to the Hippocratic Oath, which demands that a physician do good and/or not harm (Moody, 2011). They were formalised in modern biomedical ethics in the late 1970s following the publication of the so-called ‘Belmont Report’ (DHEW, 1979) and the related seminal work of philosophers Tom Beauchamp and Jim Childress (Beauchamp and Childress, 1979). The Commission has not previously used the terms ‘beneficence’ and ‘non-maleficence’, but they are central to the system of radiological protection.

(38) In its most general meaning, beneficence includes non-maleficence (Ross, 1930). Beneficence and non-maleficence can also be seen as two separate values. This publication treats them as a single value. By developing recommendations seeking to protect people against the harmful effects of radiation, the Commission undoubtedly contributes to serving the best interest of individuals and, indirectly, the quality of social life. This is achieved in practice by ensuring that deterministic effects are avoided and stochastic effects are reduced as far as achievable given the prevailing circumstances. Non-maleficence is closely related to prevention, which aims to limit risk by eliminating or reducing the likelihood of hazards, and thus promote well-being.

(39) In a narrower sense, beneficence includes consideration of direct benefits for individuals, communities, and the environment. The deliberate use of radiation, although coupled with certain risks, can undoubtedly have desirable consequences, such as the improvement of diagnostics or therapy in medicine, or the production of electricity. These have to be weighed against the potential harmful consequences. Similar considerations also apply to existing and emergency exposure situations.

(40) A key challenge for beneficence and non-maleficence is how to measure the benefits, harms, and risks. In radiological protection, this involves consideration of both their individual and societal aspects. From the viewpoint of evidence-based medicine and public health, a more comparative analysis of medical factors that affect health is needed, including not only radiation but also other exposures. In addition, a variety of social, psychological, and cultural aspects need to be considered, and there may be disagreement on what matters, or on how to value or weight these factors. Nevertheless, it is recommended that such an assessment be transparent about what was included, recognise disagreements where they arise, and go beyond a simple balancing of direct health impacts against economic costs. In this respect, it is worth recalling the WHO definition of health: ‘Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’ (WHO, 1948). As discussed in Section 4, participation of stakeholders other than radiological protection experts is a key part of such a holistic assessment.

(41) An evaluation of beneficence and non-maleficence must also address the question of who or what counts in evaluation of potential harms and benefits, including, for example, future generations and the environment. As mentioned previously, protection of the environment is now included in the primary aim of the system in [[ICRP Publication 103]. One could ask whether environmental harm is being avoided for the sake of people (an anthropocentric view), or whether the environment is being protected for its own sake (a non-anthropocentric approach) (ICRP Publication 91. ICRP does not endorse any specific approach, and considers both to be compatible with the value of beneficence and non-maleficence. In ICRP Publication 124, it is recommended that the evaluation of actual and potential consequences of human activities involving radiation should include, and integrate, effects on both humans and the environment, ensuring that the overall outcome results in more good than harm.