# Motivation and emotion/Book/2022/Beneficence as a psychological need

* Multimedia presentation (3 min)

## Overview

Beneficence is a psychological need for many individuals amongst many situations. Participating in beneficial pro-social behaviours increases individual wellbeing while creating grounds for creating meaningful relationships. Beneficence is defined as 'good behaviour', involving the connotation of doing good for others, including moral obligation (Figure 1). Self-determination theory argues that wellbeing is influenced by the satisfaction of innate psychological needs. Psychological needs are defined as critical resources that are essential to overall human wellbeing. It [what?] has been shown to be an integral psychological nutrient that is essential for the individual's capacities to adjust, perform integrity, and grow. Kohlberg constructed the Theory of Moral Development in an attempt to explore how children develop their moral reasoning. This development becomes detrimental [say what?] to the foundations of morality within individuals, and implies their likelihood to participate in beneficial behaviours. Beneficence as a moral obligation has been found to be both rewarding, but demanding. Kant's System of Duties argues that the duty of beneficence is not unlimited, [grammar?] he states that pursuance and security are essential necessities for a happy life. Creating limitations of beneficence is highlighted, in order to protect one's own wellbeing and success in their life. Mill's theory states a principal of 'greatest happiness', which are the basic foundations of an individual's morals. Mill considers actions 'right' when they promote the individual's happiness and wellbeing, pertaining that beneficence can be considered a psychological need. Acting pro-socially promotes the individuals[grammar?] overall feelings of wellbeing. Maslow's Hierarchy of Needs conceptualises several needs that need to be met in order for the individual to attain optimal potential. Beneficence loosely fits under the psychological need of belonging and connection, according to Maslow. Beneficence is a direct source of enhanced feelings of happiness for individuals, pro-social behaviour activates several neurological pathways, which promote the autonomic nervous system as well as certain regions of the human brain.
* Focus questions:
* How do you determine a psychological need?
* How can beneficence be predicted?
* Where can beneficence take place?

## What is a psychological need?

Psychological needs are broadly defined as critical resources that are essential to well-being (Molix & Nichols, 2013), however, are not necessarily considered a biological necessity (Rivera, 1985). Psychological needs are a psychological nutrient that is essential for human adjustment, integrity, and growth (Ryan, 1995). Kias Grawe (2004; 2007) developed a theory of mental functioning, with a particular driver that is not considered 'mainstream' in psychology. He described the goals that a person forms and pursues during his or her life ultimately serve as the satisfaction of distinct basic psychological needs. Grawe defined the key 'basic psychological needs' as the core of his consistency theory, where he states that human behaviour is driven by meeting these basic needs. Beneficial behaviour is dictated by motivational schemas, which are neural networks that are created to satisfy basic psychological needs. Pro-social behaviour can be approach driven through cortical processes, or avoidance driven through limbic processes (Mattingly et al, 2012). It is important to define basic psychological needs according to different psychological theories when considering the motivators for participating in beneficial behaviour.

## What is beneficence?

Beneficence is defined as an act of charity, mercy and kindness. This behaviour involves the connotation of doing good for others, including moral obligation (Kinsinger, 2009). Beneficence involves acts of kindness, generosity, charity, love and humanity, often individuals will embody internal virtue for acts of charity as a moral obligation (Murphy, 1993) (Figure 2).
Two American philosophers;[grammar?] Beauchamp and Childress (1994), formulated ethical principals that are universal for health professionals and are applicable in any culture or society. The four principles are 'respect to autonomy', 'justice', 'non-maleficence', and 'beneficence'. Beneficence implies that all professionals have the moral imperative of doing the right thing for their patients. It is seen as a principle that health professionals provide the best care that they can, to the best of their ability, in order to protect the rights of patients, prevent harm, and remove any conditions that may cause harm (Pellegrino, 1988). Health professionals have a duty of care that extends to not only patients, but colleagues and society as a whole (Nolan, 2013).
There are two components that make up the concept of beneficence. The first involves the moral imperative of doing what is best for the patient. Non-maleficence is the prime factor of the first component, which involves inflicting the least harm possible on the patient to reach a beneficial outcome. The second component is the policies used within healthcare, this implies that the patient's wellbeing is improved and they are provided with optimal safety and care (Avant & Swetz, 2020).
Beneficence that is performed on the base of independence can be seen as harmful (Rivera, 2011)[for example?]. Independence has been proven to interfere with the construction of values, beliefs and choices[factual?]. This affect[grammar?] can also be present when autonomy of action is not specifically set with boundaries. Therefore, affecting the willingness and likelihood of the individual participating in pro-social behaviour (Rivera, 2011)[grammar?].
Beneficence improves the wellbeing of both the giver of beneficence and the receiver of beneficence[grammar?]. Beneficence has been demonstrated as a psychological need for not only health care professionals, but humans in general (Pieper & Thompson, 2016).

## Beneficence as a motivator

Motivation for engaging in pro-social behaviour differs across all individuals (Bagci, 2018). For some, it comes naturally, and the need to help and care for others provides a satisfying sense of purpose, which meets basic human needs. For others, their motivation for beneficence may be an external influence or praise for partaking in certain behaviours (Manthous, 2012). The question stands whether extrinsically motivated beneficial behaviours can really be considered beneficence at all.

### Extrinsic motivation

Extrinsic motivation consists of a set of methods and procedures that have been carefully structured to implement the strategic plan in practice (Reiss, 2012). Extrinsic motivation is the desire to participate in an activity with the intentions of meeting an external goal, receiving praise and approval, receiving award or payment, or avoiding punishment. This incentive is also described as strategic motivation, as individuals engage in certain behaviours for personal gains, rather than for enjoyment, or the wellbeing and goodness of others. Incentives need to have value placed on them in order to motivate the individual to participate in pro-social behaviours (Vallerand & Ratelle, 2002).

### Intrinsic motivation

Intrinsic motivation is the act of engaging in behaviour for its satisfaction rather than for a positive consequence. When an individual is intrinsically motivated, they are driven by the fun or challenge of the task rather than external products, pressures or rewards, the behaviour itself is described as it's own reward (Fishbach & Woolley, 2022). Also referred to as Altruistic motivation, altruistic individuals are not motivated by any external sources of praise or rewards, instead they are concerned about other's needs (Alger & Weibul, 2017) (Figure 3). Intrinsic motivation is the most common instigator for pro-social behaviours, acts of kindness, generosity and care for others is often an internal and morally driven behaviour.
* Did you know?
* Beneficence comes from the Latin word benefactum, meaning "good deed."

## Self-determination theory

It is suggested that beneficence inherently improves an individual's wellbeing. However, self-determination theory argues that increased wellbeing is mediated by the satisfaction of innate psychological needs. The role of intrinsic motivation, where an individual engages for the inherent rewards, plays a major role in Self-Determination Theory. According to the theory, humans become self-determined when their universal psychological needs are met. Much like physical needs, psychological needs are considered an objective phenomena where deprivation or satisfaction of needs have significant and measurable effects on the individual (Deci & Ryan, 2012).
Self-determination theory has two key assumptions:
* The need for growth drives behaviour. The first assumption of self-determination theory is that the human need for growth drives an individual's behaviour. Gaining new experiences and attaining mastery and skills is essential for the development of a cohesive sense of self.
* Autonomous motivation is important. Although many people are motivated by external rewards, such as money and prizes; self-determination theory explores internal motivators such as the need for knowledge or independence.
Ryan and Deci (2017) (Figure 4) created a mini-theory of self-determination known as the basic psychological needs theory. Autonomous motivation plays a major role in the moral behaviour of humans, and can be used a a predictor for pro-social behaviours. This theory postulates a positive relationship between intrinsic motivation and three basic psychological needs.

### Autonomy

Autonomy is the ability to feel in control of behaviours and decisions that the individual faces every day involving self-initiation and self-regulation of one's behaviour. An individual's feelings of autonomy are enhanced when given choices and can easily govern their own behaviour. Autonomous motivation is perceived to be consistent with intrinsic goals or outcomes, the individual will feel control of what they do, when they do it, and who they do it with.
Individuals with low autonomy often feel controlled or threatened by others. External and objective rewards can reduce feelings of autonomy. For example, if someone engages in intrinsically motivated behaviour and then receives an extrinsic reward, then autonomy can be incapacitated.

### Competence

Competence can be used to describe someone who has sufficient qualities to perform a given task. Competence is the state of having intellect, judgement, skill, etc. When an individual feels competent, they feel capable to interact effectively with their environment and they have the necessary skills for achieving set goals. Feelings of competence enhance when the individual is challenged with a new task and has the complete skills needed for success. Feelings of competence can decrease if the individual feels that a task is too challenging or if they receive negative feedback.

### Relatedness

Relatedness refers to an individual's sense of attachment to other people, as well as a sense of belonging amongst others and within social groups. Without relatedness, the individual can lose self-determination as they would lack social support. Feelings of relatedness are enhanced when the individual feels cared for, supported, and respected in their inclusive environment. Feelings of relatedness can decrease due to experiences of criticism or competition.
Relatedness highlights the importance of relationships and connection in order to fulfil self-determination. Feeling a sense of belonging and attachment to other people contributes significantly to meeting individual needs. It is suggested that high quality relationships satisfy all three psychological need (Deci & Ryan, 2012).

## Beneficence in different settings

Beneficence can take place in many different settings. The act of beneficence can be performed without the individual realising it's value as pro-social behaviour, [grammar?] some argue that it is even a part of human nature (Miller, 2004). Acts of beneficence are performed on a daily basis, driven by both strategic and altruistic motivation. Beneficence can be seen in the community, in relationships and particularly in health professions such as nursing and psychologists.

### Community

Many instances of beneficence take place in the community (Figure 5). This can include acts of charity, fundraising and volunteering within the community. Some individuals may contribute to beneficence in the community for extrinsic reasons, such as praise from others, for job opportunities, or for publicity. Others may demonstrate altruistically motivated beneficence, where the individual could feel helpful, fulfilled, or contended after acts of beneficence to help those in need (Thunder, 2015) (Figure 8).
Religion is also a major motivator for acts of beneficence among many individuals (Quine, 2002). Preventing harm and removing harm (and evil) are both valued in many religions and are considered types of beneficence. For example, in the Qur'an, Prophet Muhammad ordered his companions to do charity daily. He claims that any person who inflicts harm on their neighbour is not a true believer of god. Karen Armstrong (2007) stated that "in practical terms Islam means that Muslims had a duty to create a just equitable society where the poor and vulnerable are treated decently. The early moral message of the Qur’an is simple: It is wrong to stockpile wealth and build a private fortune, and good to share the wealth of society fairly by giving a regular proportion of one’s wealth to the poor”. It is palpable that through religion, individuals are motivated to perform acts of beneficence, in order to be devoted to their god and/or their deity.

### Relationships

Beneficence is an underlying foundation of many personal relationships (Sticker & van Ackeren, 2018). This form of beneficence often comes naturally as the individual cares for, and seeks to improve the well-being of the other. Beneficence in relationships can look like acts of service, such as helping the other mow their lawn, or giving gifts. In relationships, the act of 'love' involves beneficence, but sometimes can become demanding within personal relationships. When considering extrinsic and intrinsic motivation, some individuals may engage in beneficence when in a relationship setting with the intention of receiving something in return (Pratto & Walker, 2001). These intentions within personal relationships can become exhausting for the other and demand severe sacrifice and generosity. This contradicts the purpose of having a mutual, respectful, and caring relationship. Therefore, overriding the true meaning behind beneficence[grammar?].
Intrinsically motivated beneficence in relationships improves the wellbeing of both parties, supporting the concept of beneficence as a psychological need for humans.

### Health professions

Throughout all health professions, beneficence is one of the four pillars of ethics and is understood as the principle of requiring practitioners to provide the best possible care to the best of their abilities. Beneficence requires the health professional to act for the benefit of their patients and pronounces a moral obligation to protect the right of others and prevent harm (Kelleher, 2014). Beneficence is crucial in healthcare because it is paramount for the professional to be able to consider individual circumstances, and understand that what might be best for one patient, may not be best for another. When making medical decisions, professionals are encouraged to consider the following questions for their patients' wellbeing and outcomes:
* Will this option resolve this patient’s medical problem?
* Is it proportionate to the scale of the medical problem?
* Is this option compatible with this patient’s individual circumstances?
* Is this option and its outcomes in-line with the patient’s expectations of treatment?
(Wear, 1998), (Figure 6).
While health professionals are obliged to practice beneficence, which may suggest extrinsic motivation; Many uphold the moral responsibility to do right by their patients and care for them the best they can. Many health professionals claim that they enjoy their profession because of the rewarding and gratifying experience of providing their patients with acts of beneficence (Deriba, Sinke, Ereso & Badacho, 2017). Inferring that while health professionals have the obligatory responsibility to do the best by their patients, many are still intrinsically motivated to help, support and care for those in need[grammar?].
* Case study:
* A 76 year old female cancer patient is counting her last breaths in the oncology ward. She is unable to tolerate any simple procedure due to her pain tolerance and her nutrition is very poor as she denies any offer of food. The patient continues to remove her naso-gastric tube as she claims it is prolonging her suffering and she wishes to die. Her daughter is requesting that staff continue to reinsert her tube as her mother is becoming dehydrated, and that they do everything possible to keep her alive for another week, as the son of the patient is supposed to be arriving in a week. The doctor has written do not resuscitate orders, as well as no reinsertion of the naso-gastric tube if the patient is refusing. As the patient's primary nurse, I am hesitant to do anything other than comfort measures, as she wishes to die in peace. I want to ensure acts of beneficence for my patient and continue to do what is best for their overall wellbeing.

## Theories of beneficence

[Provide more detail]

### Kants'[grammar?] system of duties

Immanuel Kant (Figure 7) argues that every human has a duty to be beneficent throughout their life. Kant explains that beneficence is moderated by other obligations, such as securing happiness as a parent, or special obligations as a friend. In Kant's theory, morality has absolute authority, where the duty for beneficence is not unlimited. Beneficence can imply that the individual sacrifices everything, but Kant states that essential aspects of one's own life are a duty to secure and pursue. These boundaries moderate how much morality will demand from a well-off individual (Kant, 2017).
Kant recognises four categories of duties:
* Perfect duties towards ourselves
* Perfect duties towards others
* Imperfect duties towards ourselves
* Imperfect duties towards others
Kantian ethics are a set of moral principles that apply to all human beings, regardless of context or situation. Kant supports that moral standards will predict beneficial behaviours, but there needs to be a limit of beneficence before the individual begins to impair the outcomes of one's own life.
* If you hide an innocent person from violent criminals in order to protect his life, and the criminals come to your door asking if the person is with you, what should you do?
* Kantianism would have you tell the truth, even if it results in harm coming to the innocent person.

### Mill's theory

John Stuart Mill argues that philosophers have created incompatible theories that can be unified by a single standard of beneficence, which allows individuals to decide what is objectively right and wrong. Mill's theory declares the principle of utility, or "greatest happiness" principle, to be the basic foundation of morals. Actions are considered 'right' when promoting happiness and wellbeing, and 'wrong' when they produce the opposite. Mill's theory of beneficence is a very concise and straight forward perspective, offering a very narrow definition of beneficence. Mill also holds that the concepts of duty, obligation, and 'right' are overcome and are determined by; 'Right', which maximises and benefits outcomes, or 'wrong', which includes harmful outcomes.
Mill's theory of morality (1863) is solely welfare oriented, because moral 'rightness' is determined by goodness, which is understood in terms of the welfare of individuals. This pertains that beneficence is a psychological need, in the sense that acts of beneficence, or 'rightness' are essential to the individual's wellbeing.

### Kohlberg's theory of moral development

American psychologist Lawrence Kohlberg constructed the theory of moral development (1963). Expanding upon Jean Piaget's previous work, but narrowing down on explaining how children develop moral reasoning. Kohlberg argues that moral development is a continual process that occurs throughout the entire life-span and that moral logic is moulded by seeking and maintaining justice. The theory outlines six stages of moral development within three different levels:
Level 1: Pre-conventional Morality
Stage 1: obedience and punishment
Stage 2: individualism and exchange
Level 2: Conventional Morality
Stage 3: developing good interpersonal relationships
Stage 4: maintaining social order
Level 3: Post-conventional Morality
Stage 5: social contract and individual rights
Stage 6: universal principles
During the process of moral development, the likelihood of participating in beneficial behaviour can be shaped and increased/decreased, depending on the moral standards that are implemented through socialisation in many different environments.
* Kohlberg believed that only 10-15% of people actually reach the post-conventional stages (Kohlberg, 1985). One study found that the first four stages were seen as universal across many populations across the world. While stages five-six were extremely rare in all populations (Keung Ma, 2013).

### Maslow's hierarchy of needs

Maslow's hierarchy of needs (1987) states that there are five basic, universal psychological needs that have to be met in order for the individual to attain optimal potential (Maslow, 1943). When altruistically motivated, beneficence is an underlying factor of the 'belonging and love' psychological need, which is the third most basic human need according to Maslow. As discussed within beneficence amongst different settings, the act of 'love' involves beneficence within a personal relationship.
When an individual displays extrinsically motivated beneficence, it may be an indicator for their esteem towards oneself. Maslow's hierarchy of needs is useful to understand basic human psychology, however; does not consider nor recognise individual or cultural differences. People may experience needs in different orders or have other prioritised psychological needs for themselves. Beneficence is loosely involved in the need for belonging and may not be a psychological need for many individuals. However, Maslow's hierarchy of needs pertains beneficence as a component of a basic psychological need.

## Neurological perspective

Decisions to act pro-socially activate the reward centres in the human brain (Martela & Ryan, 2015). Beneficence is a direct source of enhanced feelings of wellness and promotes overall wellbeing. Bellucci et al used 600 neuro-imaging studies to identify which brain regions were activated across different types of pro-social behaviours. He found that empathy networks partially overlap when acting pro-socially, such as dorsal posterior and middle cingulate cortex. Pro-social behaviour also activates the ventromedial prefrontal cortex and the dorsolateral prefrontal cortex. Findings suggested that when an individual part takes in prosocial behaviour, they are mentalising and empathetic, which then gives them the ability to understand others' needs and therefore, increases their motivation to help (Bellucci REF). The act of beneficence also involves processes such as valuation, planning, and cognitive control. Cutler and Campell-Meiklejohn tested difference when engaging in extrinsic and intrinsic giving. Strategic had a greater activity in striatal regions, and altruistic had greater activity in the posterior pre-frontal cortex.

## Conclusion

Psychological needs are essential for human adjustment, integrity, and growth. Any factor that contributes to the promotion of wellbeing and happiness in an individual can be described as a psychological need. Beneficence has been demonstrated to produce positive responses in humans and improve overall wellbeing, therefore, can be constituted as a psychological need. Morality is a useful predictor for the likelihood of an individual participating in pro-social behaviour. Moral development is an on-going and easily influenced process, where humans construct their own personal limit for giving to others. Self-determination theory implies that psychological needs must be satisfied to obtain optimal value of life, but, as Kant stated in his system of duties; it is empirical for individuals to limit the amount that morality can demand from themselves, to protect their own security and pursuance in life. 'Right' and 'wrong' actions have been constructed by Mill, claiming that morality is solely welfare oriented.
Psychological needs can be complex to determine. Maslow's hierarchy of needs conceptualises basic human needs that are vital for the mental survival of humans. 'Love and belongingness' is the third most crucial, basic psychological need according to Maslow, where beneficence is involved in the development of these relationships. Beneficence can be identified in many contexts, including personal relationships, community setting, and professional settings. While beneficence is an obligatory act for health professionals, it is also a morality built devotion to helping others, becoming an intrinsically motivated behaviour for many.
Examining many different theories and constructs of psychological needs, overall the definition proposes a resource that promotes an individual's wellbeing. Acts of beneficence improve feelings of happiness in an individual's life. Supporting the concept of beneficence as a psychological need, neurological studies surrounding pro-social behaviour have proven that acts of beneficence activate reward centres and are a direct source of feelings of wellness, confirming that beneficence can be defined as a human psychological need.
* Focus questions:
* How do you determine a psychological need?
* How can beneficence be predicted?
* Where can beneficence take place?