When Beneficence Confronts Non-Maleficence: Reconciling the Bioethical Challenges of Doing Good and Avoiding Harm in Risk Communication

Abstract

Risk communication is critical to the patient-provider relationship that informs the health outcomes of patients. Healthcare providers (HCPs) often employ this form of communication when informing patients about their treatment choices. This collaborative process often informs the process of shared decision-making in which patients and HCPs work together to preserve the interests of the patient and attempt to maximize the benefit for the patient. Both parties consider both the patients values and preferences as well as scientific evidence during the decision-making process. Much of the existing literature identifies the roles risk perception and risk communication theory play in how people disseminate, process, and use information. This paper explores the intersection of the disciplines of risk perception theory, risk communication theory, and the ethical principles central to medicine (i.e. beneficence, non-maleficence, autonomy and justice), specifically as they relate to measles, mumps, rubella (MMR) vaccinations. HCPs often find that their obligation to uphold these principles may be difficult as they often conflict during healthcare delivery. Furthermore, these principles may conflict when communicating the risks and benefits of vaccines. Using the MMR vaccine as a case study, this paper is an ethical analysis based on bioethics principles of HCPs and their communication of the MMR vaccination, with recommendations for future communication that could result in improved clinical decisions and health outcomes. Included in this paper is an inspection of the risk perceptions of parents who are responsible for their children’s health decisions, varying attitudes and behaviors toward the vaccinations as well as the meaning of the bioethical principles in the context of risk communication guidelines. The novel contribution of the paper is a proposed resolution for minimizing the conflict between the aforementioned principles during communication. Communication templates were developed based on different parental positions about the MMR vaccine. These templates will ideally facilitate communication between HCPs and patients and inform the shared decision-making process. HCPs will become more aware of the role ethical principles play during communication and ideally strive to uphold them while treating patients. Most importantly, the research, analysis, and recommendations will enhance the clinical decision-makers’ understanding, experience, and level of confidence. Additionally, information provided in this paper support clinical decisions that have direct impact on patient health and public health.