Primum Non Nocere

Physicians maxim

Physicians maxim

Graduating from medical school we all raised a hand to take the Hippocratic Oath including the promise to “abstain from doing harm.”  Close to “primum non nocere except it is translated from Greek, not Latin. 

Primum non nocere is a Latin phrase that means “first, do no harm.” The phrase is sometimes recorded as primum nil nocere.[1]

Non-malfeasance, which is derived from the maxim, is one of the principal precepts of medical ethics that all medical students are taught in medical school and is a fundamental principle for emergency medical services around the world. Another way to state it is that, “given an existing problem, it may be better not to do something, or even to do nothing, than to risk causing more harm than good.” It reminds the physician and other health care providers 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.

As a surgeon, I needed to consider every proposed treatment to be sure that the chance of benefit outweighed the chance of making the patient worse.  Many cancers can be removed for long term survival.  But if it has  spread to distant sites, removing the primary tumor (with few exceptions) does more harm than good.  Of course other interventions may provide help, chemotherapy, radiation or now newer modalities of immunotherapy.  But sometimes  “…given an existing problem, it may be better not to do something, or even to do nothing, than to risk causing more harm than good.”

We in the United States are currently debating whether we should intervene in Syria.  Is it Dogs of warbetter to strike yet another Muslim people with huge American missiles?  To teach the treacherous Assad a lesson re: chemical weapons?  Or would unleashing the dogs of war without knowing what might follow, be doing more harm than good?  Should we do something or nothing?  What are the long term consequences of either course of action?  No one really knows.

So far we have not intervened in Syria in a major way.  That could change quickly.  But we

Israeli Army Paid For With U.S. Tax Dollars

Israeli Army Paid For With U.S. Tax Dollars

have intervened in Israel/Palestine.  Without a national debate.  Over a long time. With no public outcry.  We have funded a military machine annually at over three billion dollars for many years.  One side only.  The other state has no army at all.  It now negotiates from a position of weakness.  It wants to stop the military occupation that denies freedom to its people.

But this doesn’t make headlines in America.  In fact, most of us don’t even hear about the plight of Palestinians.  The killings and imprisonment remain hidden to us.  Being evicted from land and demolition of homes seems not to diminish our American support of the oppression.

Wouldn’t it be better to stop and think?  What are we in the U.S. doing that makes the problem worse?  That keeps peace at bay despite years of talking.  We actively support only one side.. Perhaps “primum non nocere” applies.  First, do no harm.  Stop funding the oppression, and seriously consider:  “… it may be better not to do something, or even to do nothing, than to risk causing more harm than good.”


About lpjohnson6

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3 Responses to Primum Non Nocere

  1. Jeff Nguyen says:

    Some might say we have intervened already in Syria via the CIA’s funding of the rebels including al-Qaeda. The difference is now they want to make the American public complicit in the bloodshed.

  2. lpjohnson6 says:

    I agree, Jeff. We are involved, but not at the level of bloodshed we could cause by a massive rocket launch. To do no harm doesn’t imply doing nothing, although in some cases, that could be the best course to take. I would favor every non-military action we can take to stop the war and begin some kind of negotiations. Lloyd

  3. Not all nations, countries, tribes, peoples take an oath such as you present with the medical profession. I firmly believe nothing, in this present world, happens until something happens based around Jerusalem. 1 Pet 2:8.

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