The concept of beneficence in contemporary bioethics.

The main interpretations of the concept of beneficence are analysed together with their philosophical references. In particular, Ross' and Frankena's positions are presented, since they have especially influenced the formation of the paradigm of principlism which have dominated anglo-american bioethics, throughout the last decade: in this paradigm, clearly exemplified by the "Belmont Report" and by the classic "Principles of Biomedical Ethics", beneficence is considered one of the few basic principlcs and is generally distinguished from utility. Preference utilitarianism is instead based on a conccpt of enlarged beneficence as an absolute principle, understood as equivalent to the principle of utility; on the other hand, libertarians consider beneficence as altogethcr secondary to autonomy, which is the true foundation of morality. In this last position the idea of good is substantially removed, while in utilitarianism it seems to assume the subjective outline of well-being. While mixed deontologism retains some substantial content for the idea of good, the least unsatisfactory attempt is Pellegrino and Thomasma's. These authors reformulate the principle of beneficence in the attempt to avoid patemalism, which is considered its necessary outcome by a large part of contemporary reflection. In particular, they set out four levels of good, which allow to avoid the absolute identification of beneficence with clinical indications and, on the other hand, to maintain the distinction between beneficence and autonomy, without reducing the former to the mere execution of a patient's freely expressed preferences.