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First, Do No Harm

John W. Pinkerton


“First, do no harm.”  Not exactly what one would expect to appear on a coat of arms, but it's an expression which I adopted while I was teaching.  Early on as a teacher, I realized that teachers have tremendous potential to be a positive or a negative force on the children under their tutelage.

The truth is that we all have tremendous potential to do good or harm.  Usually we do not intend to do harm, but by not thoughtfully looking at the unintended consequences of our decisions, we often do harm in spite of our good intentions.

Primum non nocere is Latin for "first, do no harm." Non-maleficence, which is derived from the maxim, is a fundamental principle of healthcare givers worldwide. All healthcare students are taught this maxim in schools  throughout the world.  Basically it means that it may be better not to do something or to do nothing than risk causing more harm than good.

“Do no harm” is an expression that more of us should adopt or at least we should store as a consideration in our decision making processes.

Often we do harm through careless behavior.  Perhaps it's just a careless word.  Racist, sexist, homophobic words casually used can cause harm.  Being a classroom teacher for twenty-five years made me sensitive to the misuse of such words.  I know that people who use such terms are often attempting to be humorous, not harmful.  However, place yourself in the position of a minority, a woman, or a gay and imagine how these words would, if nothing more, hurt their feelings.  First, do no harm.

I'm not a PC person.  I often insult people, not carelessly, but intentionally.  But my insults are aimed not at their race, gender, or sexual preferences.  It's much more likely to be aimed at their foolish behavior.

As a nation we seem compelled to try to right wrongs: it's just who we are.  It's our nature.  However, perhaps we should adopt a foreign policy which includes the caveat “first, do no harm” and the question, “What might be the unintended consequences?”  Our efforts in the Middle East, although well-intended, have probably done more harm than good.  Perhaps we should leave the Middle East with the exception of Israel to their own devises.  It is doubtful that they can screw it up any more than Western civilization has.  Perhaps we need energy independence and a departure from this region…but first, we need to look for unintended consequences.

The new healthcare law is an example of doing something which did not need to be done and has caused more problems than it has solved.  The old healthcare system was far from perfect and did need some tweaking, but the new law has made keeping your current insurance plan, staying with your doctors, and lowering your costs increasingly difficult.   Probably the only people who have benefited from the new law are those who have preexisting conditions.  That could and probably should have been addressed as a stand-alone issue. 

“Do no harm” requires that we look ahead at the consequences of our actions.

“First, do no harm,” is not nearly as energetic as “Full steam ahead” or “Damn the torpedoes,” but it should be somewhere in our individual consciousness and, for that matter, part of our collective considerations.

Here are a few actions which have resulted in unintended consequences: the world-wide banning of DDT has led to more deaths, not fewer; the Stranger Danger Campaign may be making children less safe; the lengthy FDA approval process may be causing more deaths, not fewer; increasing state cigarette taxes may reduce tax revenues, not increase; technological advances intended to save labor  and reduce stress and drudgery has led to information overload and more stress;  “Prohibition” instead of reducing alcohol consumption forced the production and distribution of alcohol into the hands of organized crime; the “War on Drugs” led to the same thing.  The United States is not the only country suffering from unintended consequences: importing rabbits into Australia for sport led to rabbits becoming a nuisance; in India placing a bounty on rat pelts lead to rat farming.  All of these actions had good intentions, but the results have been more harm than good.

So the conclusion is that “First, do no harm” must be mated with being able to anticipate unintended consequences.  These tasks are not easy ones, but they are necessary ones if we wish to live in a world which makes sense.

Some people feel that they are powerless; not true.  Each of us has the power to do good and bad, but we must consider what harm our actions may result in and just as important what may be the unintended consequences.

We must remember that the road to Hell is paved with good intentions.