Non-maleficence

Non-maleficence means to do no harm.

This principle is of historical antecedence. It is related to the famous Hippocratic ethics charge of ‘primum nil nocere’: first of all, do no harm’.

The principle of non-maleficence – do no harm – asserts that a healthcare professional should act in such a way that he or she does no harm, even if this runs contrary to the request of the patient.

Examples of the principle of non-maleficence in practice:
An example of a non-maleficent action would be stopping a medication known or believed to be harmful, or refusing to give a medication to a patient that has not been proven to be effective.

Within public health, there are often occasions where degrees of harm are ‘traded off’ against the possibilities of greater harms. For example, banning smoking in public places may cause inconvenience to individual smokers but will prevent greater harm through acting as a general disincentive to smoking among the wider population.

Another example is the vaccination of children. Inserting a needle into a child’s arm can cause short-term distress, especially if it is the arm of a baby or toddler. Additionally, all vaccinations have the potential to can produce severe – if very rare – side effects. Vaccinations, however, generally provide excellent protection against severe infectious diseases, and thus, for most doctors and patients, the known benefits far outweigh either the minor harm inflicted when giving the injection, or the very small risk of an adverse reaction taking place.

However, the application of non-maleficence is not always straightforward and it often creates ethical dilemmas. In many medical situations, non-maleficence must be balanced against the principle of beneficence, with sometimes quite subjective ‘trade offs’ taking place. For example, many beneficial medications also have serious side effects and so the risks and benefits profile must be very carefully considered by doctors and by their patients. Assuming, on the basis of non-maleficence, that the doctor is willing to prescribe the medication, it might then ultimately be the patient who must decide whether the benefits outweigh the risks before consenting to treatment.