Non- maleficence, “First do no harm”

Non -maleficence is a principal of bioethics, which is concerned with emphasising  the importance of not inflicting harm intentionally when treating a patient and trying to reach a positive outcome (“Ethical Considerations in the NICU”, 2017) .

The reason for me reflecting on this topic is due to an event which occurred a couple of weeks ago. Myself and a fellow physio student went to see a patient together. This patient had suffered multiple gunshot wounds and had undergone a laparotomy the day before we saw him, along with other medical procedures. After conducting the objective and subjective follow up assessments the patient complained of severe/excruciating pain in his left arm (his left arm was in a backslab and had two gunshot wounds). Prior to seeing the patient the treatment plan was to sit the patient over the edge of the bed. After explaining the plan to the patient he became extremely anxious and was reluctant to assist with the mobilization. Myself and my colleague decided not to mobilise the patient and rather leave him in the bed due to the pain he was experiencing in his arm even though the rest of his body may have benefited from him being mobilised.

I understand that as physiotherapists we need to push our patients through their pain limits to achieve many of our treatment goals and most of the time after doing so we see improvement in our patients well being. However, on the other hand when pushing a patient to hard we are conscious of the fact that we as a physiotherapist are “inflicting harm”, and thus one could say that the treatment should be deemed as non-malefinecne.

With this in mind I  would like to raise the question, when is our practice as a physiotherapist deemed non-maleficence and do we consider a patients pain levels when making this decision?

Ethical Considerations in the NICU. (2017). Medscape. Retrieved 1 April 2017, from http://www.medscape.com/viewarticle/811079_5

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3 Replies to “Non- maleficence, “First do no harm””

  1. Interesting question addressed. I believe that in performing a treatment that causes pain in the patient, it is possible to follow the principle of non-maleficence when it is coupled with the principle of conscious autonomy. That is, if after clarifying the need for the intervention and its negative consequences the patient accepts the therapy, we are not committing any harm.

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  2. Não causaremos dano ao paciente a partir do momento em que permitimos que ele participe da tomada de decisões do que é melhor pra ele. No caso de um paciente que não possa responder por si, é necessário orientar a família e ela tomará a decisão melhor para o paciente.

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  3. Hi
    I hope you are well. Your post is well written and structured. I felt it was quite relate-able to situations I have been in. As a student I am always questioning my decision and wanting to push my patient because that is what we are taught. Many of times, this becomes my downfall as I have conflict to not harm the patient or to make sure I have my pt on their feet as soon as possible.
    Your post is logical, clear and concise. You give your opinion, have a rhetorical question-which makes the reader ponder and lastly you have literature. I would like to know how is this related to ethics? What makes you decide when to push the patient? Could the patient be given pain meds which would help ease the anxiety?

    The picture is appropriate to the content and title. It definitely caught my eye. With regard to your tags, could you add the University and appropriate categories
    I wish you the best for this year

    Kind Regards
    Ammaarah (UWC)

    Like

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