Do No Harm
Of all the Hippocratic writings the Oath, in spite of its shortness, is perhaps the most interesting to the general reader and also to the modern medical man. The idea of not doing the patient harm is within the Oath, but the phrase “Do No Harm” is not. Whatever its origin, it is a landmark in the ethics of medicine. It is a declaration that the purpose of medical knowledge is solely for healing. The Oath is the oldest known written work that speaks to Biomedical Ethics. And the idea that it expresses is still at the center of all bio-ethical debates today.
Do No Harm.
This seems so easy and so readily apparent. What is there to discuss? Yet, in the world of medicine, there are many layers to the idea of not hurting people.Defining harm is complex and convoluted. It is part of why ethical questions are difficult to answer.
The question of what is harm has many answers. Some philosophers, such as Epicurus, think harm is necessarily experiential. In other words, you must experience something bad to be harmed. According to this view, money secretly stolen from a bank account or a symptom-free cancer are only harms if the victim is aware of them. In this view, ignorance is bliss.
Other philosophers disagree with this view. Imagine if your friends were paid actors pretending to be your friends. Despite their behavior, your ‘friends’ actually despise you. If you believe in non-experiential harms, you might say you are harmed by having false friends – even if you never know the truth about their friendship-for-hire. And if this is the case, then you can be harmed by the cancer you never knew you had, or the affair you never discovered.
Non-maleficence, which is derived from the maxim “Do No Harm”, is one of the principal precepts of bioethics that all healthcare students are taught in school and is a fundamental principle throughout the world. Another way to state it is that, “given an existing problem, it may be better to do nothing, than to risk causing more harm than good.” It reminds the health care provider that they must consider the possible harm that any intervention might do. It is invoked when debating the use of an intervention that carries an obvious risk of harm but a less certain chance of benefit.
But Non-maleficence is not where this ends. Because there are clearly times that doing nothing will cause harm. Medical Neglect is defined as: failure of a health care provider or caregiver to observe due care and diligence in performing services or delivering medicine or other products so as to avoid harming a patient. This can be intentional or accidental, but the result is the same. A person needed care that was not given. Because the care was not provided, harm occurred. This is Medical Malpractice, or the Improper, unskilled, or negligent treatment of a patient.
Most would agree that the first and most obvious implication of “Do No Harm” is the absence of violence. A doctor can’t punch his patient in the face. Nope, doesn’t matter how much of a jerk the patient is. No punching. But what obligation is there to the environment? Is a doctor responsible for keeping his location of practice safe? How far out does this reach? The expectation in America is that we are required to keep our locations of practice safe. It is our duty to prevent violence. That means we can’t allow guns and knives to be carried about. And we can’t allow people to hurt themselves or others while they are on our property.
But what about on a societal level? Do doctors owe something to keeping the community safe? There are some who feel that they do. As providers of care, they hold an important role in the community. Community leadership and education is an expectation even though it is not a legal requirement. But does this fall under the idea of “Do No Harm?” If people do not know what services are available, they will not use them and will have poor outcomes. Harm will be the result.
And there are some who feel it is the doctor’s duty to be an advocate within the political arena. Their patients are often too sick to fight for their own rights. Does that make it their obligation then? Some feel that it is. There has been a strong push for doctors to unite in finding solutions for better distribution of health care.