Unit 4

Benefit and harm


What is a health benefit?

a. Problems in determining what is a health benefit; this is not always related to disease states
b.The WHO definition of health as a possible solution of these problems

What is harm?

a. Similar problems of identifying what is harm
b. Hippocratic injunction ‘above all do no harm’
c. Distinction between positive and negative harm

How do we evaluate benefits and harm in practice?

a. Dimensions of comparing harms and benefits in individual patients
b. Significance of these dimensions for making treatment choices


I... as in Icarus / (H. Verneuil, 1979)

After the recently re-elected President of a fictitious state has been assassinated, one of the members of the investigation committee is given the task of investigating the case. In the course of his search he is confronted with Stanley Milgram’s famous experiment, recreated in this film. In the first part of the experiment, the experimenter announces the true meaning behind the experience, destined to explore how people act when legitimate authority orders to act against a third party. In Milgram’s own words the purpose is to ’find when and how people defy authority when pitted against clear moral imperatives.’ The results of the experiment indicate that two out of three people go on to administer electric shockwaves that are considered dangerous.

Ethical Issues
Informed Consent forty years after Migram’s experience. Which are the new ethical standards for the use of deception in research?

COMMENT IBIS (International Bioethics Information System)

Milgram’s experiment: an analysis from the point of view of Ethics / IBIS (International Bioethics Information System)

Miguel Benasayag, an Argentine psychologist living in Paris, included in his book Utopie et liberté: Les Droits de l’Homme une ideologie? [Utopism and liberty: the Rights of Man, an ideology?] (Editions La Découverte, París, 1986. Spanish edition: Eudeba, August 1998) a chapter on the problem of obedience to authority, and in it he analyses Milgram’s experiment from the psychoanalytic perspective.

The ’torturer’ in Milgram’s experiment finds himself in no way confronted to the same option as the ’real’ Argentine torturer ever was; contrary to this last one, he finds himself in the presence of person who has volunteered to undergo torture and willing to suffer for the greater common good (in this case scientific knowledge) and of an experimenter who reminds him continually that he is doing it for that good. (Eudeba, p.55) For Benasayag, the theoretical conclusions that Milgram extracts from the experiment are founded on an a priori experiment, and the choice of the subject lies on ’renunciation’ in favor of scientific discourse. The case of the Argentine military torturer is very different and would correspond to a different type of obedience to criminal orders. "The other type of obedience is that of the military torturer of the Argentina of the Generals: in this case there is no renunciation, and the State, by hypothesis, cannot provide the torturer with a discourse that would justify his act. His only justification is the ’law of the strongest’, the dual relationship." (page 58).