Nonmaleficence = do no harm

No one wants to be Maleficent. The Hippocratic Oath, Florence Nightingale Pledge, medical ethics, nonmaleficence--a rose (with thorns) by any other name. Bottom line: do no harm. This also proves a handy guideline for teaching, parenting, friendship, taekwondo sparring, and other interpersonal interactions or activities.
Is somebody going to get hurt? Then no. Or, if hurt is inevitable, what option will do the least amount of damage while providing maximum benefit? Vancomycin may leave an elderly patient's hearing and kidney function in ruins, but at least the patient will still live to buy hearing aids and go through dialysis. Some bleeding risk from anticoagulant medications outweighs the risk of a massive heart attack--bleeding can be stopped, whereas dead heart muscle can no longer be convinced to do its job.

Just like beauty in math is defined by minimal complexity and maximal applicability, nonmaleficence means minimal harm and maximal benefits. However, there is one other, significant factor to consider--patient preference. Nobody should force or persuade patients to pick a course of treatment or action that they do not want, even if it's "for their own good." Because otherwise, what's the bloody point of free will? And what about quality of life (which can go down the toilet really fast)? Also, what about happiness, or if one doesn't believe in happiness, at the very least, sidestepping sheer misery?

Many decisions in life are difficult. Yet, considering how short human lives are, why do people choose to remain in situations or relationships that make them miserable? Chronic unhappiness is in itself a health risk. The inflammatory responses of the body reacting to stress and toxic relationships are strongly correlated with higher blood pressure, risk of heart disease, and depression. In fact, unhappiness and negativity are not only toxic to a subject's health, much like secondhand smoke, they're also toxic to those around them.

Sometimes, martyrs end up not just sacrificing their own happiness, but that of those who care about them as well. So nonmaleficence isn't so straightforward after all, when one considers the whole person--lifestyle, preference, finances, living situation, in addition to symptoms and disease process or whatever "makes sense" logically. Ask first.


  1. I love everything you say here.

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