  Beneficence has played a major role in a central conceptual issue about the nature and goals of medicine as a social practice. If the end of clinical medicine is healing, which is a goal of beneficence, then arguably medicine is fundamentally a beneficent undertaking, and beneficence grounds and determines the professional obligations and virtues of the physician. Authors such as Edmund Pellegrino write as if beneficence is the sole foundational principle of professional medical ethics. In this theory, medical beneficence is oriented exclusively to the end of healing and not to any other form of benefit. The category of medical benefits does not, for Pellegrino, include items such as providing fertility controls (unless for the prevention and maintenance of health and bodily integrity), performing purely cosmetic surgery, or actively helping a patient to effect a merciful death by the active hastening of death.