Clinical Ethics: Due Care and the Principle of Nonmaleficence

In Clinical Ethics, Robert Timko argues that the moral dilemmas of clinical medical practice can best be resolved within a framework of prima facie duties, and that the most stringent duty is that of nonmaleficence. Timko shows that respect for individual autonomy and the principle of beneficence are inadequate for the moral practice of medicine since simple adherence to either principle may be insufficient for the provision of "due care." Clinical health care practitioners should know and understand their clients' perceptions of illness and suffering and their life-plans and values if they wish to avoid bringing further harm to their clients. Additionally, Timko argues that the prevention of harm is best served and "due care" best provided if the clinical relationship is defined within the framework of a covenantal agreement between health-care practitioners and the moral community. Intrinsic to his argument is the belief that it is not only permissible to limit a client's autonomy, but that is sometimes obligatory to do so. In terms of a community's overall good, paternalistic interventions appear to be justifiable and sometimes necessary. Finally, Joan Hoff provides an insightful commentary on the logic of a communitarian ethic as the foundation for a just health-care system and the understanding of virtue and responsibility in health-care practice.