First do no harm

Principle of medical ethics

First do no harm is a fundamental principle of medical ethics that emphasizes the importance of non-maleficence in healthcare. This principle is often associated with the Latin phrase "primum non nocere", which means "first, do no harm." Although the phrase is not explicitly found in the Hippocratic Oath, it is widely regarded as a core tenet of medical practice.

Historical Background

The concept of "first do no harm" can be traced back to the Hippocratic Corpus, a collection of medical texts attributed to Hippocrates, an ancient Greek physician. The Hippocratic Oath, a seminal document in medical ethics, underscores the physician's duty to avoid causing harm to patients. While the exact phrase "primum non nocere" does not appear in the original texts, the sentiment is reflected in the oath's commitment to beneficence and non-maleficence.

Principles of Non-Maleficence

Non-maleficence is one of the four principal tenets of medical ethics, alongside beneficence, autonomy, and justice. It requires healthcare professionals to refrain from actions that could cause harm to patients. This principle is particularly important in situations where medical interventions carry significant risks or side effects.

Application in Clinical Practice

In clinical practice, "first do no harm" serves as a guiding principle for decision-making. Physicians must weigh the potential benefits of a treatment against the risks of harm. This involves:

• Conducting thorough risk assessments before recommending interventions.
• Considering alternative treatments that may pose fewer risks.
• Ensuring informed consent by discussing potential risks and benefits with patients.

Criticisms and Challenges

While "first do no harm" is a noble ideal, it can be challenging to apply in practice. Some criticisms and challenges include:

• Complexity of Medical Decisions: Medical decisions often involve complex trade-offs where some harm may be unavoidable to achieve a greater benefit.
• Subjectivity of Harm: What constitutes "harm" can be subjective and vary between patients and contexts.
• Evolving Medical Knowledge: As medical knowledge evolves, treatments once considered safe may later be found harmful, and vice versa.

Also see

• Hippocratic Oath
• Medical ethics
• Beneficence
• Autonomy
• Justice (medical ethics)
• Informed consent

References

• Beauchamp, T. L., & Childress, J. F. (2019). Principles of Biomedical Ethics. Oxford University Press.
• Gillon, R. (1994). "Medical ethics: four principles plus attention to scope." BMJ, 309(6948), 184-188.