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' () is a
Latin Latin (, or , ) is a classical language belonging to the Italic branch of the Indo-European languages. Latin was originally a dialect spoken in the lower Tiber area (then known as Latium) around present-day Rome, but through the power of the ...
phrase that means "first, do no harm". The phrase is sometimes recorded as '. Non-maleficence, which is derived from the maxim, is one of the principal precepts of
bioethics Bioethics is both a field of study and professional practice, interested in ethical issues related to health (primarily focused on the human, but also increasingly includes animal ethics), including those emerging from advances in biology, med ...
that all students in healthcare are taught in school and is a fundamental principle throughout 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 healthcare personnel to 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. Non-maleficence is often contrasted with its
corollary In mathematics and logic, a corollary ( , ) is a theorem of less importance which can be readily deduced from a previous, more notable statement. A corollary could, for instance, be a proposition which is incidentally proved while proving another ...
, beneficence.


Origin

The origin of the phrase is uncertain. Some early versions of the
Hippocratic Oath The Hippocratic Oath is an oath of ethics historically taken by physicians. It is one of the most widely known of Greek medical texts. In its original form, it requires a new physician to swear, by a number of healing gods, to uphold specific e ...
include the promise "to abstain from doing harm" ( el, ἐπὶ δηλήσει δὲ καὶ ἀδικίῃ εἴρξειν) but do not include the precise phrase. Perhaps the closest approximation in the
Hippocratic Corpus The Hippocratic Corpus (Latin: ''Corpus Hippocraticum''), or Hippocratic Collection, is a collection of around 60 early Ancient Greek medical works strongly associated with the physician Hippocrates and his teachings. The Hippocratic Text corpus ...
is in ''Epidemics'': "The physician must ... have two special objects in view with regard to disease, namely, to do good or to do no harm" (book I, sect. 11, trans. Adams, el, ἀσκέειν, περὶ τὰ νοσήματα, δύο, ὠφελέειν, ἢ μὴ βλάπτειν). According to Gonzalo Herranz, Professor of Medical Ethics at the University of Navarre, ''Primum non nocere'' was introduced into American and
British British may refer to: Peoples, culture, and language * British people, nationals or natives of the United Kingdom, British Overseas Territories, and Crown Dependencies. ** Britishness, the British identity and common culture * British English, ...
medical culture by Worthington Hooker in his 1847 book ''Physician and Patient''. Hooker attributed it to the
Paris Paris () is the capital and most populous city of France, with an estimated population of 2,165,423 residents in 2019 in an area of more than 105 km² (41 sq mi), making it the 30th most densely populated city in the world in 2020. S ...
ian pathologist and clinician Auguste François Chomel (1788–1858), the successor of Laennec in the chair of medical pathology, and the preceptor of Pierre Louis. Apparently, the axiom was part of Chomel's oral teaching. Hooker, however, was quoting an earlier work by Elisha Bartlett who, on pages 288–289, says "The golden axiom of Chomel, that it is only the second law of therapeutics to do good, its first law being this – not to do harm – is gradually finding its way into the medical mind, preventing an incalculable amount of positive ill.” However, Hooker used neither the specific expression, nor the traditional Latin phrase. A detailed investigation of the origins of the
aphorism An aphorism (from Greek ἀφορισμός: ''aphorismos'', denoting 'delimitation', 'distinction', and 'definition') is a concise, terse, laconic, or memorable expression of a general truth or principle. Aphorisms are often handed down by tr ...
was reported by the clinical pharmacologist Cedric M. Smith in the April 2005 issue of ''
The Journal of Clinical Pharmacology ''The Journal of Clinical Pharmacology'' is a peer-reviewed medical journal that covers the field of pharmacology. The editor-in-chief is Joseph S. Bertino, Jr. ( Bertino Consulting). It was established in 1961 and is currently published by John W ...
''. It addresses the questions of the origin and chronology of appearance of the maxim. Rather than being of ancient origin as usually assumed, the specific expression, and its even more distinctive associated Latin phrase, has been traced back to an attribution to
Thomas Sydenham Thomas Sydenham (10 September 1624 – 29 December 1689) was an English physician. He was the author of ''Observationes Medicae'' which became a standard textbook of medicine for two centuries so that he became known as 'The English Hippocrate ...
(1624–1689) in a book by
Thomas Inman Thomas Inman (27 January 1820 – 3 May 1876) was a house-surgeon to the Liverpool Royal Infirmary. In his lifetime he had numerous medical papers published. He was also an amateur mythologist, and wrote ''Ancient Pagan and Modern Christian Symbo ...
(1860), ''Foundation for a New Theory and Practice of Medicine''. Inman's book and his attribution were reviewed by an author who signed simply as "H. H." in ''
The American Journal of the Medical Sciences ''The American Journal of the Medical Sciences'' is a monthly peer-reviewed medical journal. History The journal was established in 1820 as the ''Philadelphia Journal of the Medical and Physical Sciences'' by Nathaniel Chapman. A new series was ...
'', also in 1860. An American surgeon, L.A. Stimson, used the expression in 1879 and again in 1906 (in the same journal). That it was in common use by the 20th century is apparent from later mentions, such as by the prominent
obstetrician Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period. As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a surgi ...
J. Whitridge Williams in 1911, as well as detailed discussion of its use in a popular book authored by Dr. Morris Fishbein, editor of ''
The Journal of the American Medical Association ''The Journal of the American Medical Association'' (''JAMA'') is a peer-reviewed medical journal published 48 times a year by the American Medical Association. It publishes original research, reviews, and editorials covering all aspects of biom ...
'' in 1930. The article also reviews the various uses of the now popular aphorism, its limitations as a moral injunction, and its increasingly frequent use in a variety of contexts.


See also

*
Ahimsa Ahimsa (, IAST: ''ahiṃsā'', ) is the ancient Indian principle of nonviolence which applies to all living beings. It is a key virtue in most Indian religions: Jainism, Buddhism, and Hinduism.Bajpai, Shiva (2011). The History of India – ...
* Cobra effect *
Ethics Ethics or moral philosophy is a branch of philosophy that "involves systematizing, defending, and recommending concepts of right and wrong behavior".''Internet Encyclopedia of Philosophy'' The field of ethics, along with aesthetics, concerns m ...
*
Meta-ethics In metaphilosophy and ethics, meta-ethics is the study of the nature, scope, and meaning of moral judgment. It is one of the three branches of ethics generally studied by philosophers, the others being normative ethics (questions of how one o ...
*
Non-aggression principle The non-aggression principle (NAP), also called the non-aggression axiom, is a concept in which aggression, defined as initiating or threatening any forceful interference (violating or breaching conduct) against either an individual, their propert ...
*
Non-violence Nonviolence is the personal practice of not causing harm to others under any condition. It may come from the belief that hurting people, animals and/or the environment is unnecessary to achieve an outcome and it may refer to a general philosoph ...
*
Nursing ethics Nursing ethics is a branch of applied ethics that concerns itself with activities in the field of nursing. Nursing ethics shares many principles with medical ethics, such as beneficence, non-maleficence and respect for autonomy. It can be distingu ...
*
Physician, heal thyself Physician, heal thyself (, ), sometimes quoted in the Latin form, , is an ancient proverb appearing in Luke 4:23. There, Jesus is quoted as saying, "Ye will surely say unto me this proverb, 'Physician, heal thyself': whatsoever we have heard done ...
*
Principle of double effect The principle of double effect – also known as the rule of double effect; the doctrine of double effect, often abbreviated as DDE or PDE, double-effect reasoning; or simply double effect – is a set of ethical criteria which Christian philosop ...
*
Principlism Principlism is an applied ethics approach to the examination of moral dilemmas that is based upon the application of certain ethical principles. This approach to ethical decision-making has been adopted enthusiastically in many different professi ...
*'' ...First Do No Harm''


References


External links


Article presenting various views on the principle of "Do no harm"
{{Medical ethics Ethical principles Medical ethics Latin medical words and phrases History of ancient medicine Nursing ethics