How would the world change if it was common practice to make “First do no harm” (Primum non nocere) a first principle in all that we do (not just medicine)?
It wouldn’t be possible to realize this ideal perfectly since most actions entail mixes of benefits and harms that vary across contexts and stakeholders.
Still, starting with “First, do no harm” might help us anticipate/mitigate more unintended harms before we create real ones…
From wikipedia:
“It is often said that the exact phrase “First do no harm” (Latin: Primum non nocere) is a part of the original Hippocratic oath. Although the phrase does not appear in the AD 245 version of the oath, similar intentions are vowed by, “I will abstain from all intentional wrong-doing and harm”. The phrase primum non nocere is believed to date from the 17th century.”
Another equivalent phrase is found in Epidemics, Book I, of the Hippocratic school: “Practice two things in your dealings with disease: either help or do not harm the patient”. The exact phrase is believed to have originated with the 19th-century English surgeon Thomas Inman.
Here is a translation (by W.H.S Jones) of the Hippocratic Oath, also from wikipedia:
“I swear by Apollo Healer, by Asclepius, by Hygieia, by Panacea, and by all the gods and goddesses, making them my witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture.
To hold my teacher in this art equal to my own parents; to make him partner in my livelihood; when he is in need of money to share mine with him; to consider his family as my own brothers, and to teach them this art, if they want to learn it, without fee or indenture; to impart precept, oral instruction, and all other instruction to my own sons, the sons of my teacher, and to indentured pupils who have taken the Healer’s oath, but to nobody else.
I will use those dietary regimens which will benefit my patients according to my greatest ability and judgment, and I will do no harm or injustice to them.[6] Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly I will not give to a woman a pessary to cause abortion. But I will keep pure and holy both my life and my art. I will not use the knife, not even, verily, on sufferers from stone, but I will give place to such as are craftsmen therein.
Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bond or free. And whatsoever I shall see or hear in the course of my profession, as well as outside my profession in my intercourse with men, if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets.
Now if I carry out this oath, and break it not, may I gain for ever reputation among all men for my life and for my art; but if I break it and forswear myself, may the opposite befall me.”
https://en.wikipedia.org/wiki/Hippocratic_Oath
Additional thoughts on the potential power and pitfalls of using “harm avoidance” as a priming or framing device for decision-making (from a dialog in a separate location) spurred by a suggestion that I read a wikipedia post on “The Liberal Paradox” (pasted in below):
While the examples in the post point out real paradoxes, the experiences and beliefs of real people are generally more nuanced and malleable than those of the people presented in these examples. In the real world, when we’ve reached the point where Lude and Prude are more interested in undermining each other’s happiness than in pursuing their own, we are all lost because we have lost much of the basis for “assuming” that someone else can pursue their own “positive intent” which is different from our own “positive intent” without harming us.
It seems like much of what goes wrong in the real world contains variations on Julian Blau’s “nosiness” dilemma. In most cases, Bob and Alice don’t really care all that much about the color of each other’s houses unless someone has goaded into thinking that color is harmful to them…
—
I suppose I think we might be able to use “First do no harm” more as priming principle more than as a planning tool.
100% avoidance of harm would be paralyzing, but 0% avoidance of harm would lead to unnecessary disasters and misery. Of course, in the real world, people do at least give cursory consideration to potential harms as well as benefits when they make decisions. It’s just a matter of how broad and deep the exploration goes.
I wonder if promulgating quick and dirty “First do no harm awareness” settings (on a scale of 1-10) might lead to better results as a trend. Often, it seems that the setting is too low (e.g. cases where no one asks the question at all or there are no regulations), and in some cases the setting is too high (e.g. cases where people are so afraid of doing harm that they do nothing new at all or when excessive regulation stifles useful innovation).
—
Perhaps we’d also have to use “First do no harm” together with a shared commitment to the principle of “Assume positive intent.” We’d probably still end up with problems like gridlock and nosiness, but they might be more pleasant form of gridlock and nosiness;).
(Side note: Very entertaining to see Tim Walz use the phrase “mind your own business” as a liberal (in the American political left-of-center sense) principle. Having grown up in a small midwestern town with a mix of conservatives, liberals and libertarians, I can relate to this use of the phrase, and I’ve wondered why Democrats don’t use this sort of “common sense” sounding language more often.)
While math, symbolic logic and economic theory comprise a fantastic toolset, they may not save us from the paradoxes. We probably just have to keep trying with the foreknowledge that the paradoxes will keep on popping up to remind us that we have screwed things up again…
—
My interest in putting more focus on “harm avoidance” comes from personal intuition rather than logic or intellectual tradition.
We’ve evolved to experience guilt, but social and economic structures seem to run away from it rather than embracing it as an adaptive survival response.
Would consistent, rigorous priming for “harm avoidance” nudge “selfish actors” to notice the potential for guilt in ways that reduce harm? Or would the actors just end up in endless doom loops of hesitation or resentment because exploring potential harm is too complex and painful for most of us to cope with?
For example, we often talk about minimum wages in terms of “benefits” to the economy as a whole or wage earners in general, it might be just as valid to consider minimum wages in terms of “harm reduction” for real suffering individuals.
The same might apply for a small business owner who is NOT struggling with extremely low profit margins BUT is trying to decide how low a wage can be justified. If you think about this question in terms of abstract economic benefits, you solve this problem with one set of calculations. If you add “harm avoidance” to the calculus, you might end up using a different set of calculations.
© Dana Cogan, 2024, all rights reserved.