The term "nonmaleficence" derives from the ancient maxim primum non nocere, which, translated from the Latin, means "first, do no harm." Professionals in the health sciences, and in public health practice in particular, have a tradition of utilitarian approaches, meaning that the greatest good should be accomplished through any public health action. Obligations not to harm others (e.g., through theft, disablement, or killing) are clearly distinct from, and usually more stringent than, obligations to help others (e.g., by providing benefits, protecting interests, and promoting welfare). For example, the obligation not to injure others is a societal expectation, whereas the act of rescuing someone in danger is generally considered a heroic act.
In public health research and practice, professionals intervene through asking people to participate in research by, for instance, answering questions, submitting themselves to vaccination or screening programs, through issuing health advisories, or through legislation. Under the utilitarian theory of ethics that serves as the foundation for public health, the duty not to cause harm through any intervention is interpreted to mean that any given intervention must result in more good than harm on a population basis. In medical practice, what the physician does for a patient should have a greater chance of benefiting than harming the patient. Both applications of the duty not to harm are supported by rigorous risk-benefit analyses, often based on studies of effects of animals (e.g., toxicological research of new drugs). They are enforced through regulations under administrative law designed to protect the public health interest, as well as through codes of professional practice.
A common public health concern involving the principle of doing no harm involves product safety. Harms can arise when manufactured products are used by consumers. The crucial question is whether or not adequate knowledge existed before the product went to market about the potential for harms to occur. If the manufacturer did not take precautions (e.g., adequate product testing) to ensure safety, the duty to cause no harm would have been breached because, with due care, harm could have been prevented. The breach would be real regardless of whether or not harm was intended.
The actions of individuals can also be contrary to the principle of nonmaleficence. For example, the leading cause of death in North America among people aged eighteen to thirty-four is accidental injury. The majority of these injuries involve motor vehicles. If a driver should fail to obey the speed limit or drive while intoxicated, he or she is placing other drivers in a dangerous situation. While there is no specific intent to harm, reasonable care was not taken to avoid harm. Breach of the obligation to cause no harm in the absence of a specific intent to harm is called "negligence" and may be treated as such under the law.
COLIN L. SOSKOLNE
LEE E. SIESWERDA
(SEE ALSO: Beneficence; Codes of Conduct and Ethics Guidelines; Ethics of Public Health)
Beauchamp, T. L., and Childress, J. F. (1994). Principles of Biomedical Ethics, 4th edition. New York: Oxford University Press.
Did this raise a question for you?