## 1. The Concepts of Beneficence and Benevolence




The term *beneficence* connotes acts or personal qualities of
mercy, kindness, generosity, and charity. It is suggestive of altruism,
love, humanity, and promoting the good of others. In ordinary language,
the notion is broad, but it is understood even more broadly in ethical
theory to include effectively all norms, dispositions, and actions with
the goal of benefiting or promoting the good of other persons. The
language of a *principle* or *rule* of beneficence refers
to a normative statement of a moral obligation to act for the others'
benefit, helping them to further their important and legitimate
interests, often by preventing or removing possible harms. Many
dimensions of applied ethics appear to incorporate such appeals to
obligatory beneficence, even if only implicitly. For example, when
apparel manufacturers are criticized for not having good labor
practices in factories, the ultimate goal of the criticisms is usually
to obtain better working conditions, wages, and other benefits for
workers.




Whereas *beneficence* refers to actions or rules aimed at
benefiting others, *benevolence* refers to the morally valuable
character trait--or virtue--of being disposed to act to
benefit others. Many acts of beneficence have been understood in moral
theory as obligatory, as determined by *principles of
beneficence* that state moral obligation. However, beneficent acts
also may be performed from nonobligatory, optional *moral
ideals*, which are standards that belong to a morality of
meritorious aspiration in which individuals or institutions adopt goals
and practices that are not obligatory for everyone.




Exceptional beneficence is commonly categorized as
*supererogatory*, a term meaning paying or performing beyond
what is obligatory or doing more than is required. This category of
extraordinary conduct usually refers to high moral ideals of action,
but it has links to virtues and to Aristotelian ideals of moral
excellence. Such ideals of action and moral excellence of character
need not rise to the level of the moral saint or moral hero. Moral
excellence comes by degrees, and not all supererogatory acts of
beneficence or benevolent dispositions are exceptionally arduous,
costly, or risky. Examples of less demanding forms include anonymous
gift-giving, uncompensated public service, forgiving another person's
costly error, and complying with requests to provide a benefit that
exceeds the obligatory requirements of ordinary morality or
professional morality.




It is generally agreed that ordinary morality does not require
beneficent acts that involve severe sacrifice or maximum altruism, such
as a physician's putting herself, without protective drugs and
equipment, in a life-threatening condition in an epidemic in order to
provide medical care. Such extraordinary beneficent conduct
typically derives from moral ideals rather than norms of obligation,
although the line between obligations of beneficence and ideals of
beneficence is often difficult to draw. Saintly and heroic beneficence
(and benevolence) are at the outermost end of a continuum of beneficent
conduct and commitment. This continuum is not merely a continuum
mapping the territory *beyond* duty (supererogation). It is a
continuum of beneficence itself, starting with weak obligatory
beneficence (e.g., helping a stranger with mild disabilities enter a
room with an extremely heavy door) and then moving on to strong
obligatory beneficence (such as rescuing a person in danger when the
danger is not severe for the rescuer). The continuum of obligation is
the first half of the continuum, which runs from weak obligations
(e.g., such as conscientiousness in attending to a friend's welfare) to
strict obligation (as in the obligation to aid someone sitting next to
you who has been injured in an automobile accident when you have not
been injured). The continuum then moves to the domain of ideals of
beneficence that are morally nonrequired, exceptionally virtuous, and
the like. An absence of any level of obligatory beneficence--from
weak to strong--constitutes a defect in the moral life. But a
failure to perform high-level acts of supererogation such as heroic
acts of self-sacrifice to benefit others cannot be accounted a defect.
Beneficence is best understood as spread across this full continuum,
despite the considerable controversy that exists about where obligation
ends and supererogation begins on the continuum.




A celebrated example of beneficence that rests somewhere on this
continuum, and yet is controversial and difficult to locate just where
on the continuum, is the New Testament parable of the Good Samaritan.
In this parable, robbers have beaten and left half-dead a man traveling
from Jerusalem to Jericho. A Samaritan tends to his wounds and cares
for him at an inn. The Samaritan's actions are beneficent and the
motives benevolent. However, they do not seem--on the information
given--to rise to the level of heroic or saintly conduct. The
morally exceptional, beneficent person may be laudable and emulable,
yet neither a moral saint nor a moral hero.


## 2. The Place of Beneficence in the History of Ethical Theory




The history of ethical theory shows that there are many ways to
think about beneficence and benevolence. Several landmark ethical
theories have embraced these moral notions as central categories, while
proposing strikingly different conceptual and moral analyses. Prime
examples are found in the moral-sentiment theory of David Hume, where
benevolence is the central "principle" of human nature in
his moral psychology, and in utilitarian theories such as John Stuart
Mill's, where the principle of utility is itself a strong and
very demanding normative principle of beneficence. In these writers
beneficence is close to the essence of morality. Other writers,
including Kant, have given less ascendency to beneficence, but still
give it a central place in morality.


### 2.1 Hume's Theory




Hume's moral psychology and virtue ethics make motives of
benevolence all important in moral life. He argues that natural
benevolence accounts, in great part, for what he calls the origin of
morality. A major theme is his defense of benevolence as a principle in
human nature, in opposition to theories of psychological egoism. Much
in Hume's moral theory is directed against Bernard Mandeville's (and
likely Hobbes's) theory that the motive underlying human action is
private interest and that humans are naturally neither sociable nor
benevolent. Hume argues that egoism rests on a faulty moral psychology
and maintains that benevolence is an "original" feature of
human nature. Benevolence is Hume's most important moral principle of
human nature, but he also uses the term "benevolence" to
designate a class of virtues rooted in goodwill, generosity, and love
directed at others. Hume finds benevolence in many manifestations:
friendship, charity, compassion, etc. Although he speaks of both
benevolence and justice as social virtues, only benevolence is a
constitutive *principle* of human nature. Rules of justice, by
contrast, are normative human conventions that promote public utility.
The virtues of benevolence and justice are therefore extraordinarily
different virtues in Hume's ethics.




In his inquiries into the principle of self-love, Hume does not
reject all aspects of the egoists' claims about the absence of
impartial benevolence in human motivation. He acknowledges many motives
in human nature and uses metaphors of the dove, wolf, and serpent to
illustrate the mixture of elements in our nature. Principally, he sees
human nature in the domain of moral conduct as a mixture of benevolence
and self-love. Whereas the egoist views human nature as limited to
motives such as survival, fear, ambition, and the search for happiness,
Hume regards persons as motivated by a variety of passions, both
generous and ungenerous. He maintains that these elements vary by
degree from person to person. Lacking distinctive information about a
particular individual, we cannot know whether in that person
benevolence typically dominates and controls self-love, or the
converse.


### 2.2 Mill's Theory




In *Utilitarianism*, John Stuart Mill argues that moral
philosophers have left a train of unconvincing and incompatible
theories that can be coherently unified by a single standard of
beneficence that allows us to decide objectively what is right and
wrong. He declares the principle of utility, or the "greatest
happiness" principle, to be the basic foundation of morals:
Actions are right in proportion to their promotion of happiness for all
beings, and wrong as they produce the reverse. This is a
straightforward principle of beneficence and potentially a very
demanding one. Mill and subsequent utilitarians mean that an action or
practice is right (when compared with any alternative action or
practice) if it leads to the *greatest possible* balance of
beneficial consequences (happiness for Mill) or to the *least
possible* balance of bad consequences (unhappiness for Mill). Mill
also holds that the concepts of duty, obligation, and right are
subordinated to, and determined by, that which maximizes benefits and
minimizes harmful outcomes. The principle of utility is presented by
Mill as an absolute principle, thereby making beneficence the one and
only supreme or preeminent principle of ethics. It justifies all
subordinate rules and is not simply one among a number of basic
principles.




Mill's theory of morality is welfare-oriented at its core because
moral rightness is determined by goodness, which is itself to be
understood in terms of the welfare of individuals. It is a
consequentialist theory because the moral rightness and obligatoriness
of actions are established by their beneficial results. It is an
aggregative theory because a judgment about right or obligatory action
depends on an appraisal of the effects of different possible actions on
the welfare of all affected parties, which entails summing positive
benefits and negative effects over all persons affected. Beneficence
has rarely occupied such a central role in a moral theory.


### 2.3 Kant's Theory




Kant rejects the utilitarian model of a supreme principle of
beneficence, but he still finds a vital place in the moral life for
beneficence. He seeks universally valid principles (or maxims) of duty,
and beneficence is one such principle. A motive of benevolence based on
sentiment--highly admired by Hume--is morally unworthy in
Kant's theory unless the motive behind benevolent action is a motive of
duty. The motive likewise cannot rest on utilitarian goals.




Kant argues that everyone has a duty to be beneficent, i.e. to be
helpful to others according to one's means, and without hoping for any
form of personal gain thereby. Benevolence done from friendly
inclination he regards as "unlimited" (a term subject to
different interpretations, but meaning at least "having no
boundaries in potential scope"), whereas beneficence from duty
does not place unlimited demands on persons. Nonetheless, the limits of
duties of beneficence are not clear and precise in Kant. While we are
obligated to some extent to sacrifice some part of our welfare to
benefit others without any expectation of recompense, it is not
possible in the abstract to fix a definite limit on how far this duty
extends. We can only say that everyone has a duty to be beneficent,
according to that person's means, and that no one has an unlimited duty
to do so.




Kant here anticipates, without developing, what would later become
one of the most difficult areas of the theory of beneficence: How,
exactly, are we to specify the limits of beneficence as an obligation?
Neither Kant, Hume, nor Mill has a precise answer to this question.


## 3. Is Beneficent Action Obligatory or Merely a Moral Ideal?




As discussion above about the continuum of beneficence indicates,
deep disagreements have emerged in moral theory regarding how much is
demanded by obligations of beneficence. Some ethical theories insist
not only that there are obligations of beneficence, but that these
obligations sometimes demand severe sacrifice and extreme generosity in
the moral life. Some formulations of utilitarianism, for example,
appear to derive obligations to give our job to a person who needs it
more than we do, to give away most of our income, to devote much of our
time to civic enterprises, etc. It is likely that no society has ever
operated on such a demanding principle, but it does seem embraced, at
least abstractly, by a number of moral philosophers--arguably even
in Kant's theory of the categorical imperative (although, as previously
mentioned, Kant seems to deny such scope to obligatory
beneficence).




By contrast, some moral philosophers have claimed that we have no
general obligations of beneficence. We have only duties of beneficence
that derive from specific roles and assignments of duty that are not a
part of ordinary morality. These philosophers hold that beneficent
action is virtuous and a commendable moral ideal, but not an
obligation, and thus that persons are not morally deficient if they
fail to act beneficently. An instructive example is found in the moral
theory of Bernard Gert, who maintains that there are no moral rules of
beneficence, only moral ideals. The only obligations in the moral life,
apart from duties encountered in professional roles and other specific
stations of duty, are captured by moral rules that prohibit causing
harm or evil. In Gert's theory, the general goal of morality is to
minimize the causation of evil or harm, not to promote good. Rational
persons morally should act impartially at all times in regard to all
persons with the aim of not causing evil, he argues, but rational
persons are not morally required to act impartially to promote the good
for all persons at all times.




Those who defend such a beneficence-negating conclusion (regarding
obligation) do not hold the extreme view that there are no obligations
of beneficence in contexts of role-assigned duties such as those in
professional ethics and in specific communities. They acknowledge that
professional and other roles carry obligations (or duties, as Gert
prefers) that do not bind persons who do not occupy the relevant roles.
They claim that the actions one is obligated to perform within the
roles are merely moral ideals for any person who is not in the specific
role. That is, these philosophers present beneficence not as a general
obligation, but as a role-specific duty and as institutionally or
culturally assigned.




In rejecting principles of obligatory beneficence, Gert draws the
line of obligations by presenting a sharp contrast between beneficence
and nonmaleficence. That is, he embraces rules of obligation that
*prohibit causing harm* to other persons, even though he rejects
as obligatory all principles or rules that require *helping*
other persons, which includes acting to prevent harm to them.
Accordingly, he accepts moral rules such as "Don't kill,"
"Don't cause pain or suffering to others," "Don't
incapacitate others," "Don't deprive others of the goods of
life," and the like. His theory therefore makes nonmaleficence
central to his theory of moral obligation while denying that
beneficence has a place in the theory of obligation.




However, the mainstream of moral philosophy makes both not-harming
and helping to be obligations, while preserving the distinction between
the two. This literature can be confusing, because some writers treat
obligations of nonmaleficence as a species of obligations of
beneficence, although the two notions are very different. Rules of
beneficence are typically more demanding than rules of nonmaleficence,
and rules of nonmaleficence are negative prohibitions of action that
must be followed impartially and that provide moral reasons for legal
prohibitions of certain forms of conduct. By contrast, rules of
beneficence state positive requirements of action, need not always be
followed impartially, and rarely, if ever, provide moral reasons that
support legal punishment when agents fail to abide by the rules.




The contrast between nonmaleficence and beneficence notwithstanding,
ordinary morality suggests that there are *some* rules of
beneficence that we are obligated to follow impartially, such as those
requiring that we make efforts to rescue strangers under conditions of
minimal risk to ourselves. Even some legal punishments (as they exist
in some legal jurisdictions) for failure to rescue strangers may be
justifiable. Significant controversies have arisen in both law and
moral philosophy about how to formulate and defend such requirements,
but one influential idea has been to argue that a person P has an
obligation of beneficence to help another whenever the other is at risk
of significant loss of or damage to some basic interest; P's action is
necessary (singly or collaboratively) to prevent this loss or damage;
P's action (singly or collaboratively) is likely to prevent the loss or
damage; and P's action does not present significant risks, costs, or
burdens to P while the benefits that the rescued person can be expected
to gain outweigh any burden that P is likely to incur.


## 4. The Problem of Over-Demanding Beneficence




Some philosophers defend extremely demanding and far-reaching
principles of obligatory beneficence. Peter Singer's theory has been
the most widely discussed account. Singer has throughout his career
been interested in how to reduce the evils of global harm and
suffering in the most effective manner. In his early work, Singer
distinguished between preventing evil and promoting good and contended
that persons in prosperous nations are morally obligated to prevent
something bad or evil from happening if it is in their power to do so
without having to sacrifice anything of comparable importance. The
argument is that serious shortages of housing, food, and healthcare
are harmful to human life and welfare and are preventable. If person P
has some capacity to prevent these evils--for example, by
donation to aid agencies--without loss of comparable item(s) of
importance, P acts unethically by not contributing to the alleviation
of these shortages. Accordingly, in the face of preventable disease
and poverty we are morally obligated to donate time or resources
toward their eradication until we reach a level at which, by giving
more, we would cause as much suffering to ourselves as we would
relieve through our gift. This demanding principle of beneficence
requires us to invest heavily in rescuing needy persons in the global
population; merely donating at the level of local communities and
nation states is insufficient. However, Singer leaves it open what
counts as being of comparable importance and as being an appropriate
level of sacrifice.




Singer's principle implies that morality sometimes requires us
to make enormous sacrifices. The demand is placed not only on
individuals with disposable incomes, but on all reasonably well-off
persons, foundations, governments, corporations, etc. All parties have
moral obligations to refrain from spending resources on nonessential
items and to use the available resources or savings to lend assistance
to those in urgent need. Frills, fashion, luxuries, and the like are
never to determine expenditures, and one is to give to the needy up to
the point that one (or one's dependent) would be impoverished. Singer
does not regard such conduct as an enormous moral sacrifice, but only
as the discharge of a basic obligation of beneficence.




Singer's proposals have struck many as overly demanding,
impracticable, and a significant departure from the demands of ordinary
morality. This assessment has generated a number of criticisms, as well
as defenses, of demanding principles of beneficence such as the one he
proposes. Critics argue that a principle of beneficence that requires
persons, governments, and corporations to seriously disrupt their
projects and plans in order to benefit the poor and underprivileged
exceeds the demands of ordinary moral obligations and has no plausible
grounding in normative moral theory about obligations. They argue that
the line between the obligatory and the supererogatory has been
unjustifiably erased by such a principle. In effect, the claim is that
Singer's aspirational moral ideal is an attempt to redraw
established lines in morality that distinguish between moral obligation
and supererogatory moral ideals.




In response to criticism Singer has attempted to reformulate his
position so that his theory of beneficence does not set an overly
demanding standard. He maintains that no clear justification exists for
the claim that obligations of ordinary morality do not contain a
demanding principle of beneficence, in particular a strong
harm-prevention principle. He apparently would explain the lack of
concern often shown for poverty relief as a failure to draw the correct
implications from the very principles of beneficence that ordinary
morality embraces and that utilitarian moral theory justifies. Later in
his series of publications on the subject, Singer has attempted to take
account of objections that his principle sets an unduly high standard.
He has not given up his strong principle of beneficence, but he has
suggested that it might be morally wise and most productive to
*publicly advocate* a lower standard--that is, a weakened
principle of beneficence. He therefore has proposed a more guarded
formulation of the principle, arguing that we should strive for
donations of a percentage of income, such as 10 per cent, which amounts
to more than a token donation and yet also is not so high as to make us
miserable or turn us into moral saints. This standard, Singer suggests,
is the minimum that we ought to do to conform to obligations of
beneficence.




Controversy continues in philosophy about how to analyze and
evaluate the commitments of a principle of beneficence, including how
to formulate limits that reduce required burdens on agents' life plans
and make meeting the obligations of beneficence a realistic
possibility. Various writers have noted that even after many persons
have donated generous portions of their income, they could still donate
more while living decent lives; and, according a strong principle of
beneficence demands that they should donate more. Recent ethical theory
shows that establishing the theoretical and practical standards of
donation and sacrifice is challenging, and perhaps an impossible
ideal.




However, it does not follow that we should give up a principle of
beneficence. It only follows that establishing the moral limits of the
demands of beneficence is profoundly difficult. Liam Murphy has
discussed a number of "limited principles of beneficence"
and has proposed to fix the limits of individual beneficence to meet
global problems of need by using a cooperative principle of fairness in
which, in any given circumstance, it must first be determined what each
reasonably affluent person must do to contribute a fair share to an
optimal outcome. An individual is only required to aid others
beneficently at the level that would produce the best consequences if
all in society were to give their fair share. One is not required to do
more even if others fail to act on their fair-share obligations of
beneficence, and it would be an unfair imposition of responsibility to
ask more of them. Unlike act-consequentialism, this theory does not
demand more of agents when non-complying agents fail to do their
part.




Murphy's cooperative principle is intuitively attractive, but it may
not have the necessary moral punch to address issues such as global
poverty. Murphy seems right to suggest that large-scale problems
requiring beneficence should be conceived as cooperative projects, but
his limit on individual obligations seems unlikely to have a practical
effect of increasing international aid and the like beyond present
commitments and levels. If, as is to be expected in virtually all
situations of global poverty, others fail to comply with their
fair-share obligations of beneficence as set out in this demanding
theory, it is not clear why each person's obligation is set only by the
original calculation of a single fair share. This is not to say that
Singer's approach is superior. The more demanding a principle is, the
less likely are people to comply with its demands. Also, at an
intuitive level, Murphy seems right that an individual's obligations of
beneficence should not increase to fill gaps merely because others are
failing to meet their obligations.




Singer has defended his arguments about beneficence, with a somewhat
sympathetic response to Murphy. Singer seems concerned with which
social conditions will *motivate* people to give, rather than
with attempting to determine obligations of beneficence with precision.
He responds to critics such as Murphy by conceding that perhaps the
limit we should *publicly advocate* as a level of giving is no
more than a person's fair share of what is needed to relieve poverty
and the like. Unless we draw the line here, we might not be able to
motivate people to give at all. A fair share seems to be a lower
threshold of one's obligations than the obligations Singer originally
envisaged, but more realistic. The emphasis on motivation is presumably
intended to provide a more subtle and convincing approach to increasing
charitable donations even though the nature and limits of beneficence
should be set by his utilitarian moral theory, as he has always
proposed.




Wherever the line of precise limits of obligatory beneficence is
drawn, the line is likely to be revisionary of ordinary morality.
Singer's proposals, unlike Murphy's, represent a revision of ordinary
morality's requirements of beneficence. A variety of proposals
regarding the limits of beneficence have been made by philosophers, but
no agreement exists on even a single general principle. Given this
situation, some now doubt that ethical theory and practical
deliberation are equipped to establish precise conditions and limits of
obligations of beneficence, especially when confronting problems of
global poverty.


## 5. Liberty-Limiting Beneficence: The Problem of Benefit Paternalism




A much-discussed issue about beneficence descends historically from
Mill's *On Liberty*, where Mill inquired into the nature and
limits of justifiable social control over the individual. He argues
that the measure of a person's liberty--or personal
autonomy--is the measure of the person's independence from
influences that control the person's preferences, thoughts, and
behavior. Various principles commonly assumed to be *moral*
principles have been advanced to justify the limitation of individual
liberties. Joel Feinberg, who was philosophically close to various of
Mill's views, appropriately called these principles
"liberty-limiting principles." Mill defended the view that
only one principle validly limits liberty. Feinberg called it *the
harm principle*: A person's liberty (or autonomy) is justifiably
restricted to prevent harm to others caused by that person. Feinberg
agreed with Mill that the *principle of paternalism*, which
renders acceptable certain acts intended to benefit another person when
the other does not prefer to receive the benefit, is not a morally
acceptable liberty-limiting principle.




The term *paternalism* has its roots in the notion of
paternal administration--government as by a father to administer
in the way a beneficent father raises his children. The analogy with
the father presupposes two features of the paternal role: that the
father acts beneficently (that is, in accordance with the interests of
his children) and that he makes all or at least some of the decisions
relating to his children's welfare, rather than leaving them free to
make those decisions. On this model, "paternalism" may be
defined as the intentional overriding of one person's known preferences
or choices by another person, where the person who overrides justifies
the action by the goal of substantially benefiting or avoiding harm to
the person whose preferences or choices are overridden. (Both
"benefiting" and "avoiding harm" can generally,
though not always, be understood as forms of beneficence.) An act of
paternalism, then, overrides moral obligations to respect autonomous
choice on grounds of beneficence.




Philosophers divide sharply over whether some restricted form of
paternalism can be justified and, if so, on what basis. One plausible
beneficence-based justification of paternalistic actions places
benefits on a scale with autonomy interests and balances the two: As a
person's interests in autonomy increase and the benefits for that
person decrease, the justification of paternalistic action becomes less
cogent; conversely, as the benefits for a person increase and that
person's interests in autonomy decrease, the justification of
paternalistic action becomes more plausible. In this account preventing
minor harms or providing minor benefits while deeply disrespecting
autonomy lacks plausible justification; but actions that prevent major
harms or provide major benefits while only trivially disrespecting
autonomy have a plausible paternalistic rationale.




Though no consensus exists over the justification of paternalism,
virtually no one thinks that benefit paternalism can be justified
unless at least the following conditions are
satisfied:


* A person is at risk of a substantial and preventable harm or loss
of a benefit.
* The paternalistic action has a strong likelihood of preventing the
harm or obtaining the benefit.
* The projected benefits of the paternalistic action outweigh its
risks.
* The least autonomy-restrictive alternative that will secure the
benefits or reduce the risks is implemented.




Debates about benefit paternalism have also emerged in public policy
contexts. Often health policies have the goal of avoiding a harm or
providing a benefit in a population in which most affected parties are
not consulted. Some percentage of the population will not support the
policy because they are given no choice in the matter, whereas others
will approve the policy. In effect, the policy is intended to benefit
all members of a population without consulting the specific preferences
of the individuals affected--all the while foreseeing that many
individuals will in fact reject the imposed control that the policy
exerts over their lives.




So-called libertarian paternalists (or neopaternalists), principally
the team of Cass Sunstein and Richard Thaler, have argued for
government and other institutional policies intended to protect or
benefit individuals through shaping, steering, or nudging their choices
without altogether disallowing or coercing those choices. These writers
recommend policies developed by public and private institutions to
"nudge" people to the advancement of their welfare without
coercively making them to do so, while purportedly preserving their
autonomy. These policies pursue values that an intended beneficiary
allegedly already holds, at least implicitly, but does not realize
because of limited capacities, limited resources, or limited
self-control. Here the individual's own *stated* preferences,
choices, or actions are deemed unreasonable in light of *other*
values the person is believed to embrace. Since they already embrace
these values, their autonomy is not violated despite the paternalism at
work.




This conception must confront two major problems: The first is
conceptual. It is head-scratching how a libertarian can be a
paternalist in the standard senses of these terms. Genuine libertarians
firmly support freedom of choice, freedom of contract, and the like,
which seems to lack any firm support in "libertarian
paternalism." Second, what an informed and competent person
chooses to do generally supplies the evidence of his or her true
values, not some hidden value that contradicts what they choose. For
example, if a politically conservative man fails in one election to
support the platform of a party whose platform he has always wholly
supported and has often said he will always support, he seems in some
respect committed to his party's platform, but his departure from
the platform in this case seems to be the best evidence we have of his
true values now on the particular matter of which political positions
he supports. It would be improper to assert that he supports the
current platform of the party he has always supported in the past.
Similarly, a justified paternalism must have adequate evidence of any
assumption it makes about an individual's deepest beliefs or
hopes and whether they are misguided in any given case.


## 6. Beneficence in Biomedical Ethics




Since the late 1970s, principles of beneficence have been a mainstay
of the literature of biomedical ethics. Persons engaged in medical
practice, research, and public health appreciate that risks of harm
presented by interventions must often be weighed against possible
benefits for patients, subjects, and the public. Their professional
obligations are deeply informed by their commitments to prevent or
reduce harm and to produce a positive balance of goods over inflicted
harms.


### 6.1 Biomedical Research Ethics



The principle of beneficence plays a foundational role in the
framework of research ethics and federal regulations in the United
States (and beyond). This principle's prominence is
historically traceable to the publication of the *Belmont
Report* in 1978 by The National Commission for the Protection of
Human Subjects of Biomedical and Behavioral Research. The *Belmont
Report* has provided the basic moral framework for research ethics
in the United States. This commission was established in 1974 by the
U.S. Congress with a charge to discover and publish the basic
principles of human research ethics and also to "consider" the
boundaries between biomedical research and accepted medical practice.
The commission found that beneficence is one of only three basic
principles of research ethics. This principle soon became and remains
today one of three canonical principles in American research ethics
governing research funded by the federal government.




The three basic principles are (1) respect for persons, (2)
beneficence, and (3) justice. In this context, the principle of
beneficence is understood as an abstract norm that includes derivative
rules such as "Do no harm," "Balance benefits against risks," and
"Maximize possible benefits and minimize possible harms." This
principle is satisfied in the research context by intentionally
refraining from causing injury and by assuring that risks stand in
reasonable relation to probable benefits. As one major demand of
beneficence, the National Commission required that during the course of
the ethical review of research protocols there be arrayals of data
pertaining to benefits and risks and of alternative ways of obtaining
the benefits (if any) sought in the research. It also demanded that
systematic and nonarbitrary presentations of risks and benefits be made
to subjects, as part of the informed consent process, and that
assessments of risks and safeguards be considered by ethics committees
when they evaluate whether research protocols are justified.


The National Commission demanded that, to fulfill obligations of
beneficence, research subjects not be asked or allowed to consent to
more risk than is warranted by anticipated benefits and that forms of
risk incommensurate with participants' previous experience not be
imposed in the case of groups such as children. The moral concern is
that some subjects, notably children, would be overburdened and
possibly disturbed or terrified. However, the commission recognized
that risks must be permitted during the course of many forms of
research, including pediatric research, in order for investigators to
be positioned to distinguish harmful from beneficial outcomes. Today,
the problem might be expressed in terms of the need for investigators
to determine the safety or effectiveness of a therapy or diagnostic
tool under investigation in a study.


This understanding of beneficence and its role in protecting human
subjects is deeply embedded at the core of research ethics in many
countries.


### 6.2 The Ends of Medicine




Beneficence has played a major role in a central conceptual issue
about the nature and goals of medicine as a social practice. If the end
of clinical medicine is healing, which is a goal of beneficence, then
arguably medicine is fundamentally a beneficent undertaking, and
beneficence grounds and determines the professional obligations and
virtues of the physician. Authors such as Edmund Pellegrino write as if
beneficence is the sole foundational principle of professional medical
ethics. In this theory, medical beneficence is oriented exclusively to
the end of healing and not to any other form of benefit. The category
of medical benefits does not, for Pellegrino, include items such as
providing fertility controls (unless for the prevention and maintenance
of health and bodily integrity), performing purely cosmetic surgery, or
actively helping a patient to effect a merciful death by the active
hastening of death.




This characterization of the ends of medicine allows Pellegrino to
limit severely what counts as a medical benefit for patients: Benefit
in medicine is limited to healing and related activities such as caring
for and preventing injury or disease. This thesis is controversial.
Even if healing and the like are interpreted broadly, medicine does not
seem to many in bioethics to have such precise boundaries. If
beneficence is a general moral principle and if physicians are
positioned to supply many forms of benefit, there is no manifest reason
why physicians' hands are tied to the single benefit of
*healing,* even in their role as medical professionals. The
range of benefits that might be considered relevant seems broader and
could include prescribing pharmaceutical products or devices that
prevent fertility (where there is no healing-related purpose),
providing cosmetic surgery for strictly aesthetic (by contrast to
reconstructive) reasons, helping patients write realistic living wills,
complying with terminally ill patients' requests for
physician-assistance in dying by hastening death, and the like. If
these are bona fide medical benefits, how far does the range of
benefits extend? If a physician runs a company that manufactures
powered wheel chairs for the elderly, does this activity supply a
medical benefit? When physicians consult with an insurance company
about cost-effective treatments that save their patients money, is this
activity a beneficent component of the practice of medicine?




Controversy over the ends of medicine requires decisions about what
is to count as the practice of medicine and, derivatively, what counts
as medical beneficence. Controversy appears not only in the literature
of biomedical ethics, but also in some split decisions of the U. S.
Supreme Court--notably in *Gonzales v. Oregon*, a case
dealing with physician-hastened death. The majority decision in this
case asserts that there is no consensus among health care professionals
about the precise boundaries of *the legitimate practice of
medicine*, a legal notion similar to the medical-ethics notion of
the proper ends of medicine. The court notes that there is reasonable
disagreement in the community of physicians regarding the appropriate
process for determining the boundaries of medical practice and that
there is also reasonable disagreement about the extent to which the
government should be involved in drawing boundaries when physicians
themselves disagree. This court opinion allows that, depending on state
law, a physician may legitimately assist in various ways to help bring
about the death of a terminally ill patient who has explicitly and
competently requested this assistance from the physician.


### 6.3 Harms and Benefits in Health Care




A health professional's conception of both harm to and benefit for a
patient can differ sharply from that of the patient, but the health
professional's understandings of benefits also often depend on the
patient's view of what constitutes a benefit or a worthwhile risk.
Different patients take different views about what constitutes a harm
and a benefit, and when each view is reasonable it is morally
unacceptable to maintain that the notions of medical benefit and harm
are independent of the patient's judgment.




Physician-hastened death by request of the
patient*--*controversially characterized as
physician-assisted suicide--is again a prominent example of this
problem. Physicians and nurses have long worried that patients who
forgo life-sustaining treatment with the intention of dying are killing
themselves and that health professionals are assisting in their
suicide. These worries have recently receded in significance in
biomedical ethics, because there is now a consensus in law and ethics
(in the U.S. and far beyond) that it is never a moral violation to
withhold or withdraw a medical treatment that has been validly refused.
This consensus began to be developed with the case of Karen Ann Quinlan
in 1976 and eventually was formed around U. S. Supreme Court decisions,
especially the Cruzan Case of 1990. The writings of numerous
philosophers and lawyers contributed to the formation of this
consensus. A clear part of the consensus is that it is a moral
violation *not* to withhold or withdraw a validly refused
life-sustaining treatment. If death is *hastened* in this way by
a physician's omission or action, there can be no moral objection to
what has been done, and a physician's cooperation can rightly be viewed
as merciful and benevolent.




However, this problem has been replaced by another: Is it harmful or
beneficial to help a competent patient who has requested help in
causing a *hastened* death? In addition to vexed questions about
the purported distinction between killing and letting die, this issue
presses the question of what counts as a benefit and what counts as a
harm. Is requested death in the face of miserable suffering a benefit
for some patients while a harm caused to other patients? When is it a
benefit, and when a harm? Is the answer to this question determined by
the method used to bring about death--for example, withdrawal of
treatment by contrast to use of lethal medication?


### 6.4 Social Beneficence and Public Policy




A number of controversial issues in biomedical ethics concern how
public policy could, and should, change if obligations of social
beneficence were given more strength in policy formulation than they
have traditionally been afforded. The foundations of public policy
regarding organ procurement provide an instructive example. Established
legal and policy precedents in many countries require express consent
by a decedent before death or by the family after death. A near
absolute right of autonomy to decide about the disposition of organs
and tissues has been the prevailing norm. However, this approach
impairs the efficient collection of needed tissues and organs, and many
people die as a result of the shortage of organs. The scarcity of
organs and tissues and the inefficiency of the system have prompted a
spate of proposals for reform of the current system of procurement,
with the goal of creating more space for social beneficence.




One policy proposal with a notably strong social-beneficence
commitment is the *routine retrieval* of organs and tissues. In
this system of procurement, a community is permitted to, and encouraged
to, routinely collect organs and tissues from the deceased, unless the
dead person had previously registered his or her objection to the
system with the state. The routine retrieval of tissues and organs from
the deceased is regarded by many as unjustified on traditional grounds
of respect for autonomy. However, advocates of the policy of routine
retrieval argue that members of a community have an obligation to
provide other persons with objects of lifesaving value when no cost to
themselves is required. That is, the justification is based on
beneficence, not respect for autonomy.




The debate is likely to continue for many years about whether
beneficence or respect for autonomy should prevail in public policy
governing organ retrieval. Advocates of the current system argue that
individual and family rights of consent should retain dominance.
Advocates of routine retrieval argue that traditional social priorities
involving beneficence in conflict with autonomy have been wrongly
structured. Meanwhile, most contributors to the literature on the
subject agree that the present situation of low-level organ-procurement
is morally unsatisfactory and in need of some significant measure of
reform.


### 6.5 Social Beneficence and Social Justice




Some of the most important issues in the ethics of health and health
care today are widely classified as issues of social justice. However,
at the hands of many writers, social justice is notably similar to
social beneficence. For example, perhaps the most important moral
problem in global ethics is how to structure both the global order and
national systems that affect health so that burdens are avoided,
benefits are provided, and then both are fairly distributed using a
threshold condition of equitable levels of health and access to health
care. Globalization has brought a realization that problems of
protecting health and providing beneficial services are international
in nature and that their alleviation will require a restructuring of
the global system.




John Rawls's *A Theory of Justice* has been enormously
influential in advanced work on these problems in biomedical ethics.
Rawls argues that a social arrangement forming a political state is a
communal effort to advance the good of all in the society. His starting
assumptions are layered with beneficent, egalitarian goals of making
the unequal situation of the naturally disadvantaged members of society
both better and more equal. His recognition of a positive societal
obligation to eliminate or reduce barriers that prevent fair
opportunity and that correct or compensate for various disadvantages
has implications for discussions of both beneficence and justice in
health care.




Rawls himself never pursued these health-centered issues, but his
theory has influenced many writers on moral problems of health and
biomedical ethics, including Norman Daniels, Martha Nussbaum, and the
team of Madison Powers and Ruth Faden. One of Daniels' main questions
is "How can we meet health needs fairly under reasonable limits
to resources committed to the task?" The "fairly"
part of this formulation may be justice-based, but the notion of
"reasonable limits to resources" is closely tied to the
problems of the limits of beneficence mentioned previously. Daniels
argues that because health is affected by many social factors, theories
of justice should not center entirely on access to health care, but
also on the need to reduce health inequalities by improving social
conditions that affect the health of societies, such as having clean
water, adequate nutrition, and general sanitation.




Powers and Faden view the well-being of the worst-off members of
global society as the proper starting point for a practical theory of
justice, but their theory can also be expressed as an argument from
social beneficence. The sweep of global poverty and its impact on
health and welfare is a major topic in the theories of Singer and
Powers and Faden. The consequences of extreme poverty for health are
well-documented, and these consequences inform Powers and Faden's
theories of both basic well-being and justice. Their theory also
identifies unfair patterns of advantage and unfair relations of power
such as subordination, exploitation, and social exclusion that are
rooted in unjust social-structural conditions. Among other things,
their theory assesses the degree to which institutional structures can
be expected to fulfill the mandates of the theory.




Recently, "capability theory" has, at the hands of
various writers from several disciplines, merged concerns of justice
and beneficence. This type of theory focuses on distributions intended
to enable persons to reach certain functional levels essential for a
flourishing life that is protected by social institutions. The idea is
to start with an understanding of health and individual well-being and
then to connect that account to basic capabilities for achieving levels
of functioning essential to well-being--through, for example,
proper nutrition and access to health care. Some core capabilities are
bodily health, ability to play, ability to affiliate socially, freedom
of movement, and adequate educational level. Amartya Sen and Martha
Nussbaum are advocates of a capabilities theory.




Some writers closely connected to bioethics and health policy have
moved beyond capabilities theory with a twist toward beneficence and
well-being. Powers and Faden provide a theory closely connected to
global health policy. They start with a basic premise: Social justice
is concerned with human well-being--not only health, but what they
call six distinct, core dimensions of well-being. The six are health,
personal security, reasoning, respect, attachment, and
self-determination. Each of these dimensions is an independent concern
of justice. While this list of six dimensions is in some respects
similar to Nussbaum's--for example, "attachment"
resembles what Nussbaum calls "affiliation"--Powers
and Faden reject the language of capabilities as misleading and wide of
the target of theories of justice and beneficence. Theirs is a list of
essential core dimensions of well-being, not core capabilities. Being
healthy, being secure, and being respected are desirable states of
being, not merely capabilities or functionings. For example, we want
not merely the *capability* to be well-nourished, but to
*be* well-nourished.




In this theory the justice and beneficence of societies and of the
global order are to be judged by how well they effect these well-being
dimensions in their political structures and social practices. The job
of global justice and beneficence is to secure a sufficient level of
each dimension for persons and to alleviate the social structures that
cause the corresponding forms of ill-being. This theory of well-being
and its place in moral theory and social policy can be expressed in
terms of the roles of both social beneficence and social justice.


## 7. Beneficence in Business Ethics




Business ethics is a second area of applied ethics in which
questions about beneficence have emerged as central. Hume's immediate
successor in sentiment theory, Adam Smith, held an important view about
the role and place of benevolence that has influenced a number of
writers in business ethics. Smith argued that the wealth of nations and
the well-being of their citizens are dependent upon social
cooperation--fundamentally, political and economic
cooperation--but that this realm is not dependent on the
benevolence of moral relations. Smith proposes that it would be vain
for us to expect benevolence in market societies. In commercial
transactions the only successful strategy in motivating persons is to
appeal to personal advantage: Never expect benevolence from a butcher,
brewer, or baker; expect from them only a regard to their own interest.
Market societies operate not by concerns of humanity and benevolence,
but from self-love.


### 7.1 Corporate Beneficence




Several problems in business ethics are attempts to come to grips
with Smith's view. Discussions of the role of the corporation in
society and the very purpose of a corporation as a social institution
are examples. It is not disputed that the purpose of a for-profit
corporation is to make a profit for stockholders, but there is an
intense debate about whether maximizing stockholder profits is the
*sole* legitimate purpose of corporations--as Milton
Friedman and others have argued--and whether truly beneficent
corporate conduct is justifiable. This question is normative, but Smith
also raises questions of moral psychology: Is it reasonable to expect
benevolent acts from members of the business community? Does
beneficence have any place in the world of business as we know it?




Corporate social programs often appear to involve a mixture of
limited beneficence and self-interested goals such as developing and
sustaining relationships with customers. An example is found in public
utilities' programs to help customers pay for electricity, gas, oil,
phone service, and the like. These programs sometimes decrease rather
than increase corporate profits. They are, in effect, a form of
corporate philanthropy. The programs locate and attempt to remedy the
root causes of bill nonpayment, which typically involve financial
distress. The programs also seek to rescue people in the community who
are in unfortunate circumstances because of industrial injury, the ill
health of a spouse or child, drug dependency, and the like. The company
may even pay for consumer advocates, who are social workers trained to
deal with customers and their problems. These programs, by design, make
life better for various members of the community who have suffered
misfortune. They may not be entirely motivated by benevolence, however,
because they may be heavily designed to achieve a positive public image
as well as to receive payment for overdue bills.




Some firms have charitable programs that seem to be cases of pure
beneficence--that is, not ones admixed with forms of outreach that
will help the company. Money is taken directly out of profits, with no
expected return of benefits. It has been questioned, however, whether
programs of even this description are instances of pure benevolence. In
the precedent U. S. case of *A. P. Smith Manufacturing v.
Barlow* (1953), a judge determined that a beneficent charitable
donation to Princeton University by the A. P. Smith Co. was a
legitimate act of beneficence by responsible corporate officers.
However, the judge acknowledged that such beneficence may not be pure
beneficence, but rather an act taken in the interest of the corporation
by building its public image and esteem. In effect, the judge suggests
that such a gift, while beneficent, may not derive from entirely
benevolent motives. If beneficent acts by corporations are nothing more
than clever ways to maximize profits, then these actions seem to
satisfy Friedman's conception.




Whatever the truth about businesses' motives, a separate question is
whether businesses have obligations of beneficent action. Stakeholder
theory answers in the affirmative. In the classical
profit-to-stockholder view, stockholders' interests were supreme, but
this view often lost sight of the interests of other stakeholders,
particularly those whose efforts are necessary for a firm's survival
and flourishing. Who deserves to benefit from corporate income? A
stakeholder is any individual or group that can affect or benefit, or
be affected by or benefited by, a business organization. Stakeholders
who can be affected by corporate activities include customers,
employees, suppliers, owners, local communities, subcontractors,
consultants, and stockholders. Stakeholder theory is commonly regarded
as a theory of corporate responsibility--the theory that managers
of a firm have obligations to a specified group of stakeholders. Many
of these obligations are ones of beneficence, especially with regard to
employees and other stockholders. Benefit packages for employees
provide a standard example. Stockholder theory, by contrast, is the
theory that managers have obligations--conceived as fiduciary
duties--only to stockholder interests. In contemporary business
ethics it is commonly held that corporate responsibility requires some
form of stakeholder inclusion, but this perspective has not been
developed in adequate detail as a theory of corporate obligations of
beneficence, because there may be additional obligations of beneficence
to contribute to social awareness and public policy even if the
affected community is not truly a stakeholder.




Do corporations have obligations of beneficence to some larger
community? Many corporations have answered yes to this question. In a
statement of "The Johnson and Johnson Way," the Johnson and
Johnson Company credo, it is said that Johnson and Johnson is
responsible to the communities in which it thrives, and indeed to the
world community. The company asserts an obligation to be good citizens,
including offering the support of charities, the encouragement of civic
progress, the bettering of public health, and the improvement of
education. Johnson and Johnson and other companies assert that they
have obligations to these ends, but to many writers in business ethics
this claim of obligations is either misguided or overstated. They
regard such moral demands as broad moral ideals or institutional
commitments, especially if they reach out to the world community.


### 7.2 Corporate Benefit-Paternalism




Paternalism is often found in the practices of business and in
government regulation of business. For example, many businesses require
employees to deduct money from their salary for a retirement account;
they may also deduct salary money to pay for a life insurance policy.
If employees do not want these "benefits," they are not
free to reject them. Paternalism is here assumed to be an appropriate
liberty-limiting principle. Another commonplace example comes from the
construction industry and the chemical industry. If an employee wishes
not to wear a particular suit, mask, or other protective device, the
company (and perhaps also the government) will compel it anyway, often
(though not always) for paternalistic reasons.




An ongoing example of paternalism is the restriction for
paternalistic reasons (there might be other reasons as well) of various
pictures, literature, or information--often violent
depictions--on the internet, in bookstores, and in video stores.
Customers may wish to purchase or receive information about these
products, but paternalism thwarts their preferences. Arguments are put
forward maintaining that those exposed to violent conduct will harm
*themselves* by such exposure--for example, pornography
might reinforce their emotional problems or render them incapable of
love and other distinctively human relationships.




A classic problem of paternalism in business ethics derives from the
principle of *caveat emptor*--Latin for "let the
buyer beware." This property-law-derived principle is a general
principle governing sales: A buyer is responsible for determining any
unfitness in a product and is not due any form of refund or exchange
unless the seller has actively concealed the unfitness. The buyer is
free to make the purchase or not make it. Paternalistic restrictions on
purchasing have the objective that buyers not harm themselves or not
fail to receive benefits that they otherwise might not receive. For
example, the control and inspection of pharmaceutical products and
controlled substances-through government policies and licensed
pharmacies--has often been justified by appeal to paternalism.
Many believe that the Food and Drug Administration (FDA) in the U.S. is
fundamentally a paternalistic agency that operates to protect the
public even while some members of the public do not want or approve of
the protections afforded.




As the marketplace for products has grown more complex and the
products more sophisticated, buyers have become increasingly dependent
upon salespersons to know their products and to tell the truth about
them. An enduring question in business ethics is whether a
salesperson's role should be viewed as that of paternalistic protector
of the interests of the buyer. Suppose, for example, that a consumer
wants a sprinkler system in his yard to water his grove of evergreens.
He loves the sound and look of sprinklers. However, these sprinklers
are worthless for appropriate watering of the roots of his evergreens:
The owner needs drip-hose for his large collection of pine, spruce,
cedar, and cypress. Should a salesperson insist on selling only
drip-hose, refusing to sell sprinkler heads; or should the salesperson
acquiesce to the customer's preference for sprinklers?




Traditionally salespersons have not viewed their obligations of
beneficence in this way, but perhaps paternalistic beneficence would be
a commendable change of practice.