What is Do No Harm?

John Spacey, updated on December 18, 2019

Do no harm is a principle of bioethics that is also commonly used in areas such as sustainability. The principle is typically interpreted to mean that your actions should not cause injury or injustice to people. The principle, in its strictest sense, can also be applied to inactions.

Origins

The term do no harm is often attributed to the Hippocratic Oath and may have been inspired by the passages from this document highlighted here:

I swear by Apollo the physician, and Aesculapius, and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgment, I will keep this Oath and this stipulation—to reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this Art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others. I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion. With purity and with holiness I will pass my life and practice my Art. I will not cut persons laboring under the stone, but will leave this to be done by men who are practitioners of this work. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further from the seduction of females or males, of freemen and slaves. Whatever, in connection with my professional practice or not, in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times! But should I trespass and violate this Oath, may the reverse be my lot!
~ Hippocratic Oath, 400 BC original, translation from Greek by Francis Adams (1849).

There is also a similar phrase in the Hippocratic Corpus:

The physician must ... have two special objects in view with regard to disease, namely, to do good or to do no harm.
~ Epidemics, Book I, Sect. 11, translation by Francis Adams (1849).

First, do no harm

The phrase "First, do no harm" and Latin equivalent primum non nocere are considered modern misquotes of the Hippocratic Oath that may date to the 1860s. However, to be clear, the original Hippocratic Corpus states the similar phrases noted above.

Criticism

Do no harm is criticized as a bright line rule that isn't helpful in dealing with the grey areas and nuances of real life situations. The difficulty with interpreting do no harm can be explored with a thought experiment:

A surgeon must cut a patient in order to save them. This cut certainly harms the patient as it could become infected. However, the surgery may be the only hope that the patient will survive. As such, does do no harm apply to each action or the most likely end-result?

Alternatives

The actual text from the original Hippocratic Corpus may serve as a more useful principle. For example, the phrase "to do good or to do no harm" is a more complex rule that may be applied to grey areas and nuances.

Overview: Do No Harm
Type	Bioethics Business Principle
Definition	The principle that actions should not cause injury or injustice to people.
Criticism	Do no harm can be criticized as an overly simplistic bright line rule that isn't helpful in navigating the nuances and grey areas of ethical dilemmas.
Status	Largely absent from modern equivalents of the Hippocratic Oath such as the AMA Code of Medical Ethics and the British General Medical Council's Good Medical Practice. However, the phrase "first, do no harm" is often referenced in academic papers and it is considered an important concept in medical ethics.
Related Concepts	Precautionary Principle Sustainability