A common slogan in medical ethics is "first do no harm" ("primum non nocere"), which means that physicians are obligated to act in ways that will not intentionally cause harm to their patients. This maxim is often seen as a basic principle of medical ethics, and many argue that it should be followed even when there are other considerations such as justice or beneficence.
Others argue that it may not be enough to simply avoid doing harm; instead, healthcare professionals must also seek to promote justice by taking into account social and structural factors that contribute to disparities in health outcomes. In this article, I will discuss both sides of the argument and examine whether morality demands the pursuit of justice beyond merely avoiding harm.
Let's define what we mean by "justice." Justice refers to fairness and impartiality in the distribution of resources, rights, and opportunities. In the context of healthcare, this could include ensuring equal access to quality care, addressing systemic racism and discrimination in the healthcare system, and promoting policies that reduce health disparities between different groups.
If one group has better access to healthy food options than another due to socioeconomic factors, then it would be unjust to provide them with poor-quality treatment. Similarly, if certain communities face higher rates of police violence and trauma, they deserve specialized support for their mental health needs.
Some argue that focusing on justice can distract from the more pressing goal of preventing harm. After all, doctors have an important role in providing care and treating individuals based on their current circumstances, regardless of broader social issues. They might focus too much on advocacy rather than immediate patient needs, which could lead to delays in care and missed opportunities for early intervention.
Many people believe that justice is too vague a concept to base medical decision-making on, since there are often competing values at play (such as autonomy versus beneficence).
Focusing on justice may create a sense of obligation or guilt among healthcare providers who feel pressured to take on additional burdens beyond their professional duties.
Neglecting justice is not only morally wrong but also bad for public health. If we don't address structural inequalities, then we will never achieve true equality in health outcomes.
Racial minorities tend to experience worse health outcomes overall compared to white Americans, even after controlling for income level. This suggests that racism itself is a significant factor contributing to disparities, meaning we need systemic change to address this issue.
Justice ensures that everyone has a fair chance at achieving wellness - something that benefits us all in the long run. Promoting justice helps build trust between patients and providers, encourages innovation through collaboration across disciplines, and prevents further damage caused by unjust systems.
"first do no harm" should be seen as just one aspect of medical ethics. Healthcare professionals must also consider how they can promote justice within their field. While avoiding harm is important, it is insufficient without seeking ways to correct systemic issues. We should strive towards both goals when providing quality care for our patients and creating lasting change for future generations.
Is it ethically enough to “do no harm,” or must morality demand the pursuit of justice?
Firstly, there is significant debate about what constitutes "harm" and whether actions that cause minimal or indirect harm are acceptable under moral standards. Secondly, justice is also a complex concept with various definitions that often intersect with political and social contexts. Therefore, the notion of "doing no harm" may not be sufficient for addressing broader ethical concerns related to power dynamics, social injustice, and collective responsibility.