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 Analyze why patients are sometimes reluctant to complain about their health care. What could be some reasons for the reluctance to complain? How can medical providers encourage patients to express concerns about their health care? How can confidence to complain be developed among patients? 

Beneficence and Nonmaleficence

Beauchamp & Childress (2009) cite, “beneficence is a group of norms pertaining to relieving, lessening, or preventing harm and providing benefits and balancing benefits against risk and cost” (p.13). Health care organizations often employ risk benefit analysis data as a means to weigh the risk of harm associated with creating a new service sector. An example would be a long-term care organization offering their patients in-house physical therapy and the benefits of such to both their patients and the health care organization, with the possible harm associated with a new service and an increase in malpractice law suits. It is important to note that decision makers employ a vast array of analysis centered on both qualitative and quantitative data before final decisions are made. Nonmaleficence is a necessary component regarding physical therapy departments and centers on the caregiver not inflicting harm (Beauchamp & Childress 2009). A primary example would be residents receiving physical therapy (PT) after knee or hip replacement surgery. The physical therapist must be conscious of the possibility of inflicting harm through over rotation and weight bearing issues. The question often remains for many facilities, are the risks and costs of inflicting possible harm outweighed by the benefits of possible positive health care outcomes for their residents and the surrounding community. Long-term care organizations often juggle beneficence and nonmaleficence issues as they try to provide improved access and quality health care to their residents.

In-House vs. External Physical Therapy

Over the next twenty years the baby boomers will expect a greater degree of services and in-house physical therapy departments will be no exception.
Applying principles of beneficence, the physical therapy departments are responsible for a vast array of duties regarding the emotional and physical stability of the residents. These duties include strategic care plans coordinated with RN’s in order to reduce the possibility of inflicting harm (nonmaleficence) and seeing to resident family needs such as long-term care education, and realistic expectations of care.  Physical therapy department’s primary objective is to present to the resident and their family easy access to quality short and long-term care physical restoration processes. Yet a consistent component of care pertaining to  nursing homes often centers on the emotional rehabilitation process that is often needed after joint replacement surgeries, falls resulting in fractured hips, legs, and arms. With proper PT (physical therapy), nutrition, and emotional guidance, the residents are often able to return home within 30 to 90 days. If long-term care organizations did not offer in-house physical therapy, many residents such as individuals on Medicaid would not have the monetary means to obtain therapy outside of the nursing facility. Therefore, the administrator and board of directors must weigh the issues of beneficence and nonmalefience in terms of offering such services or negating such service in light of possible litigation issues upon injuries succumb via the in-house PT department. Regarding this particular case, facilities often employ cost/benefit analysis in order to determine the appropriate course of action. Questions remain, centering on beneficence and nonmalefience, do the costs of possible litigations, accidentally inflicted harm outweigh the benefits for both the facility (increasing census based on offering in-house PT) and the residents who cannot afford to leave the facility and seek private physical therapy. There must be a way to assign risk levels to a particular vulnerability that takes multiple factors into consideration. Gapenski (2006) cites, “the most interesting part of risk assessment is that each and every circumstance you encounter will require its own customized criteria to properly determine a rating” (p.12). The answers seem to fall within shades of gray, applications of both beneficence and nonmalefience will undoubtedly influence decision makers as they struggle with cost-benefit analysis, yet implement moral applications to balance the avoidance of harm, yet also take specific actions (physical therapy) that will benefit the residents/patients..


Beauchamp, T., Childress, J. (2009). Principals of Biomedical Ethics. New York, NY. Oxford University Press.

Gapenski, L.C. (2006). Understanding health care finance management. Washington, DC. Health Administration Press.

Dr. Robert C. Smiles, Ph.D. Assistant Professor, University of Arizona Global Campus