The principle of ethics that means to do no harm is called Nonmaleficence. This concept represents a foundational duty in professional ethics, particularly in medicine and healthcare. It requires practitioners to avoid inflicting injury, suffering, or deprivation on those under their care, whether through intentional action or negligence. Nonmaleficence establishes a baseline standard of conduct, ensuring that all professional decisions prioritize the patient’s safety.
Defining the Principle of Nonmaleficence
Nonmaleficence is an active obligation to minimize the risk of harm, and its modern interpretation extends far beyond simple physical injury. Harm in this context is understood broadly to include psychological distress, financial hardship from unnecessary procedures, and the prolongation of suffering. Healthcare professionals must engage in a rigorous process of risk assessment, carefully weighing the potential burdens of any treatment against the anticipated benefits for the patient. A treatment is considered to violate nonmaleficence if the risks and burdens it imposes are judged to outweigh any potential positive outcomes.
The principle further distinguishes between harm caused by commission and harm caused by omission. Harm by commission involves an action taken by a professional that directly results in a negative outcome, such as performing a procedure incorrectly. Conversely, harm by omission occurs when a failure to act, such as neglecting to prescribe a necessary medication or monitor a patient properly, leads to injury or suffering. Both types of failure violate the duty of nonmaleficence.
This ethical framework supports specific moral rules in clinical practice, including the obligation to refrain from causing pain, incapacitating a patient, or depriving them of the fundamental goods of life. It requires that medical treatments are administered only by individuals with the appropriate training and expertise, thereby protecting patients from harm resulting from incompetence. The core function of nonmaleficence is to act as a threshold for all treatment decisions, eliminating options that are likely to cause more overall damage than improvement.
The Historical Foundation of Do No Harm
The concept of avoiding harm is deeply rooted in the history of medicine, tracing back to the practices of ancient Greek physicians. The most recognized historical expression of this duty is the Latin phrase primum non nocere, which translates to “first, do no harm”. This phrase is frequently associated with the Hippocratic Oath, one of the oldest documents establishing ethical standards for medical practitioners.
While the exact phrase primum non nocere does not appear in the original Greek text of the Hippocratic Oath, the document clearly contains the underlying sentiment. The Hippocratic Corpus, which includes the Oath, instructs that a physician must have two objectives regarding disease: “to do good or to do no harm.” This established an ancient dual responsibility for physicians to both benefit the patient and abstain from causing injury.
The popular Latin maxim primum non nocere gained prominence in American and British medical culture in the 19th century, becoming a summary of the enduring ethical expectation. Its integration into subsequent medical codes of conduct cemented the idea that avoiding harm forms the minimum requirement for any professional intervention. This historical evolution confirms the obligation to protect the patient remains a fundamental principle guiding medical conduct.
Nonmaleficence Versus Beneficence
Nonmaleficence is often considered alongside its complementary principle, Beneficence, in ethical decision-making, though the two represent distinct obligations. Nonmaleficence is characterized as a negative injunction, meaning it is a duty to refrain from an action—specifically, the duty not to inflict harm. Beneficence, in contrast, is a positive injunction, representing the duty to actively help the patient, provide a benefit, and promote their overall welfare.
The two principles can sometimes come into conflict, forcing practitioners to balance temporary harm against greater long-term good. For instance, a painful surgery or an aggressive chemotherapy regimen clearly causes short-term suffering and physical harm, which raises concerns under nonmaleficence. However, if that intervention offers the only realistic chance of curing a life-threatening condition, the active duty of beneficence to restore health is judged to outweigh the temporary harm. In such cases, the harm is necessary and unavoidable to achieve a significant benefit.
Nonmaleficence is considered a stronger commitment in clinical practice than beneficence. While a healthcare provider may choose among several beneficial treatment options, they must always uphold the requirement of doing no harm. Balancing these two principles highlights the complexity of medical ethics, ensuring that any unavoidable harm is justified by a proportional and achievable benefit.