It seems to happen all year, but you are certain that it becomes more frequent during the holiday season. At both the office and home, you receive a continual barrage of letters, phone calls, and e-mails beseeching you to donate as much money as possible for apparently worthwhile causes. There are multiple requests from legitimate, prestigious institutions including those that conduct research to treat incurable diseases. Petitions from religious organizations of all denominations arrive in your mailbox each week. Not only do your college and professional school alma maters perpetually seek more funds to erect that new library and preclinical laboratory, but now your spouse’s and your children’s schools have you in their sights. And most disturbing are the photos of those adorable, endearing youngsters. These are children from lands plagued by famine whose forlorn gazes tug at your heart for your contributions to provide them with everything from surgery for their birth defects, to schoolbooks, to a cup of milk. All are very authentic essentials, and you sincerely wish you could donate bountifully to all of them. After all, you not only well know—and appreciate—that you are blessed to live in this “land of plenty,” but you understand that you are privileged to make a good living in orthodontics by helping people each day. But when you think of your litany of expenses and commitments, coupled with a less-than-robust economy, you are jerked back to reality and must concede that you cannot do it all. How can you justify this remorse, despite your “good fortune of birth”—and the hard work—that brought you all that you have? More precisely, what is your duty toward these worthwhile and authentic requests?
Some ethicists combine the principles of beneficence and nonmaleficence as a single principle, but others delineate them with distinction. First, nonmaleficence (inflict no harm) requires strict prohibition of action, whereas beneficence (do good) suggests positive, constructive action. As examples, contrast these adages: “first do no harm” (nonmaleficence—a prohibition of a negative action) and “see your dentist twice a year” (beneficence—encouragement of a positive action). Second, nonmaleficence often supports the prohibition of an action from a legal perspective, but beneficence incurs no legal repercussions if a person neglects to perform a benevolent act. Recall the classic biblical example of beneficence in the parable of the Good Samaritan. A traveler from Jerusalem is beaten and robbed by vicious highwaymen and left on the roadside to die. He is then ignored by several travelers who offer no help. A passing Samaritan later stops to aid him, comforting him and taking him to a local inn to recover from his injuries. Although the first 2 travelers could not be indicted for their failure to offer aid to the wounded man, the Good Samaritan electively acted with beneficence, intending to “do good.”
“Impartial adherence” is a term that further distinguishes nonmaleficence from beneficence. Nonmaleficence requires impartial adherence because it is an obligatory duty (a universal responsibility in the act of health care delivery) involving refraining from inflicting harm. Beneficence, in contrast, is an elective act and is extended voluntarily.
The elective aspect of beneficence does not universally excuse a person from helping others, however. Specific beneficence is afforded to those who depend on us, such as children, our patients, and our friends, and it is expected of us. An example is our mandatory responsibility to report child abuse when we encounter it. General beneficence, however, can be discretionary, depending on a number of variables such as the urgency of the need or the availability of resources.
Each request you receive for financial assistance tugs on your heartstrings to a different degree. You only wish that you had the resources to be generous enough so that you could satisfy every request—and then some. But you realize that your level of beneficence cannot exceed your abilities. Your responsibility, therefore, is to prioritize your beneficiaries as fairly as you can. Just as in life, unfortunately, that’s the best you can do.