First, Do No Harm….
As a nurse and a healthcare professional, one of the most common retorts used against us is the phrase “First, Do No Harm.” It’s often used in a reference to the individual claiming that we, as healthcare professionals, have taken oaths to have our first and foremost focus to “do no harm.”
The reality is, most nurses don’t take oaths, or swear to uphold an ethical statement or belief. Those who do, most often recite the Nightingale Pledge, an ethical pledge dedicated to Florence Nightingale. Florence Nightingale was a nurse during the Crimean war, who challenged many of the existing practices in medicine of that day. She was a stickler for hygiene, both for nurses and for their patients. She advocated for increasing the light in the field hospitals, and encouraged compassionate care.
Yet when we go through the entirety of the Nightingale Pledge, we see nothing about the phrase, do no harm.
“ I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician in his work, and devote myself to the welfare of those committed to my care.”
So Why the focus on “First, Do No Harm”?
When I think of the entirety of what nursing is and what it is to be a nurse, my first and primary focus wouldn’t be to “do no harm,” nor would my first concern be to prevent all harm. As a nurse, my first focus would be to provide evidence based care to promote healing and will be beneficial for the patient and family. To care for the individual and family as I would want my family to be cared for. While the desire to do no harm is a noble goal, medical interventions are not without risk, even those which are the most benign. This is especially true in the case of Hospice and Palliative Care, where often the interventions we provide to give comfort are themselves hastening the individual’s death. But maybe their definition of harm doesn’t include these types of scenarios, so let’s look at what they feel “harm” is.
So what is Harm?
If our first and foremost goal is to “do no harm,” wouldn’t it be important to define harm?
If we look to those who malign healthcare professionals, we can easily see that the definition of harm, in their view, is any undesirable outcome, despite the intentions of the healthcare professional. The unrealistic expectation of perfection, believing that any risk of possible adverse outcome is too great, and is henceforth against the code of “do no harm.”
So what they are defining as harm is any negative consequence, despite the original intentions of the individual. This is an extreme form of privilege, one where the individual is unable to accept any risk for harm, even when the intervention needed carries an acceptable risk. In medicine, nothing is without risk, but we will talk about this in a moment. For now, let’s just muse on the level of privilege where the individual seeks to put all risk on another and is so risk averse, they’re unwilling to even take on the smallest risks for the benefit of another.
The phrase which highlights and illustrates this perfectly is one I have heard countless times in the past few decades, “I won’t light my child on fire, to save yours.”
This phrase seeks to communicate that partaking in the specific risk of vaccination is as certain to do harm as intentionally burning your child. This couldn’t be the furthest thing from the truth. In reality, the risks of vaccinations are infinitesimally small. Hence the need for those whose privileged positions allow them to refuse vaccines, necessitates the need to lie, obscure, and amplify the risks, so their selfishness isn’t so plainly displayed.
Why else would we have deliberate lies such as this post. Where the lie is harmful to the mother who lost their child, as well as the fear the post can bring to women of childbearing years.
They also need to inflate the “long-term effects of vaccines without considering the actual long term effects of the disease itself.
We even see them deliberately creating misinformation about fertility risks: https://www.onevaxxednurse.com/2020/12/sars-cov-2-vaccine-and-concerns-for-fertility/
You could peruse our blog and find many instances which show how unethical these individuals are with their claims, propaganda, and lies. And what is really sad is they don’t care about the harm caused, as long as they continue to keep their privileged position.
I hesitate to make the comparison to slavery, and the desire of the privileged slave owners to have slavery continued, but the similarities between the two do exist. The privilege being used is at the expense of those who are our nation’s most vulnerable and those who are minorities. Often persons of color are the ones who bear the burden of the privileged, which is not too different than the past.
But I digress.
As healthcare professionals, our commission is to follow evidence based therapies which are of benefit and avoid whatever is “mischievous and deleterious.”
“I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous.”
Since every therapy is not without risk, the pure avoidance of “harm” is an unreasonable and unrealistic goal. Avoidance of harm would mean that we wouldn’t attempt any treatments with risks.
Taking a Tylenol is not without the risk of liver damage and liver failure, yet failing to treat a high fever is not without its own risks.
If we fail to embark on surgical exploration for a perforated bowel, due to the risk of having a colostomy or ileostomy (a possible harm), yet without the surgery the patient could very well die of Sepsis, we take on a higher risk without intervention.
If we fail to treat an infection with antibiotics due to the harm of anaphylaxis, the patient may further worsen and die.
“First, do no harm” is not the first goal of the healthcare professional. Having it as our first goal would limit any and all possible treatments and therapies, as none are without risk. Having this as the pinnacle guiding principle would prevent any and all potential interventions.
But “First, Do no harm” isn’t the first “command” given to healthcare professionals. Our first command is to follow the course of treatment which we understand to be of the best benefit for the patient. Oftentimes, this path has risk of harm, at times we must inflict harm for the greater good. This is the pinnacle of our pledge, the pledge to seek the greater good, to use our best understanding to the benefit of the patient.
So Why the Focus on “Do No Harm?”
The intent behind the focus on “do no harm” is the desire to limit and muzzle healthcare professionals in what is evidence based care. Their goal is to add guilt to healthcare professionals who recommend the path which holds the most benefit, attempting to vilify the nurse or doctor. It’s an explicit attempt to blame them for all of the risk potential, and to give themselves a scapegoat excuse for refusing any intervention, no matter how minimal the risk.
This is especially true of those who are anti-vaccines. While vaccines are exceptionally safe, with serious adverse events often being less than 1 in 100,000 and often closer to 1:1,000,000 patients, these individuals are unwilling to partake in this minimal risk and are very quick to blame when the rare outcome occurs. This is why they’re so eager to manipulate the facts and malign doctors and nurses, blaming them for their own consciences injustices. Often the true cause to blame is genetics, not the healthcare professional performing their duties to bring the most benefit.
So the next time you hear someone attempt to malign and limit a healthcare professional with their unrealistic expectations, just remember that the individuals doing so aren’t looking out for your best interest. They’re selfishly seeking this for their own, despite the harm their actions will have on others.