Wednesday, August 12, 2009

Re: Faith Works 8-15

Faith Works 8-15-09
Jeff Gill
When Ethics Meet Policy, "First, Do No Harm"
There is a medical saying that often is attributed to the Hippocratic Oath, which in Latin is "Primum non nocere" or more familiarly, "First, do no harm."
Going back 2400 years, the Hippocratic Oath is one of the very oldest professional ethics, and a version of it is still said by new doctors. The original version is theological in that it is sworn in the name of Greek gods, mainly Apollo and the lesser divinities Asclepius and his daughters Hygieia and Panacea (the staff of Asclepius is the symbol of medicine still, the snake entwined around a rod).
In fact, the Hippocratic Oath doesn't quite have this phrase, although "never do harm" is close. You might even notice that the once common phrase "primum non nocere" is Latin, and Hippocrates was a Greek physician.
The root source of "First, do no harm" seems to come from a Latin translation of one of Hippcrates' books, called "On Epidemics." The line in question goes "As to diseases, make a habit of two things--to help, or at least to do no harm." It's also possible that the Roman physician and pharmacist Galen started the aphorism, but he may have been loosely quoting Hippocrates himself.
It's good advice and a solid basis for ethical thinking, whoever came up with it first. If ethics, especially practical or "lived" ethics is the process of applying basic principles of what is good to what one must do, "first, do no harm" is not a bad place to start. It acknowledges that for all one's skill, knowledge, and training, you still have limits – if you have reason to believe that taking an action you have in mind is more likely to do harm, more than the slight possibility to do good that motivates you to go forward, then stop.
In working with disease and injury and sickness there will always be risk, but an ethical doctor (so says this principle) will not take a risk simply on the off chance that it might help. If the alternative to risk is death or serious injury, then you take your chance, but still with humility and an understanding of your own limitations. A gangrenous leg is a terrible thing to lose, but dying of gangrene is worse, so a surgeon does "no harm" in amputating the limb to save the life.
Much of the anxiety and outright fear around the current debate over health care and a national policy or plan goes back to how one calculates the essential ethic of "first, do no harm." Many critics and political leaders argue that we have a case of gangrene on our hands, with a limb of excessively bloating costs and expectations endangering the whole body. Radical surgery, they say, is not harmful, but necessary.
Other pundits and polemicists say not so, there is an injury and even a systematic illness here, but lesser treatments targeted at the specific cause of what's wrong with the body politic are what's called for. Some even claim that once under the anesthetic and the knife the patient will lose not one but two legs out of an excess of caution or extremes of zeal to cure the problem.
No one is saying that our current health care situation is just an ingrown toenail, but somewhere between that and gangrene is the diagnosis, and then the debate over the proper cure. And over it all hangs the words of . . . well, maybe Hippocrates: "First, do no harm."
How does your religious faith inform your ethical stance on personal treatment, and public policy? I suspect this subject will be discussed around more than a few coffeepots before and after worship this Sunday around Licking County.
Jeff Gill is a writer, storyteller, and supply preacher around central Ohio; he is not a doctor and has never played one on TV.  Send him your diagnoses at or follow Knapsack

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