Nonmaleficence, Professionalism, and the Medical Relationship

AbstractDoes the principle of nonmaleficence in medicine need updating? And if so, what should such an updating look like? This article engages with these questions by critically discussing the relation-centered view of nonmaleficence presented by Christopher Crenner and Skylar Bird. It contends that an adequate account of the principle must do two things: It must establish the integrity of the principle as one that is distinct from the more general principle of beneficence, and it must show it to have sufficient content to warrant its inclusion as a fundamental principle in clinical medical ethics. The proposal to focus on relational harms in the medical relationship is a good one, but such a proposal must be integrated into a more comprehensive account of the principle of nonmaleficence. This more comprehensive account relates relational harms to medical professionalism and derives the content of the principle of nonmaleficence from the standards of acceptable medical practice. After clarifying this more comprehensive view of medical nonmaleficence, the article concludes by responding to an important autonomy-based objection to it. This response raises large and difficult questions about the nature and point of medical practice in modern societies.