Do NO Harm vs DO Know Harm

Not infrequently, members of the medical community, in explaining their opposition to MAID, cite the Hippocratic Oath and in particular the clause "Do No Harm.' The notion is that giving the equivalent of a poison to a patient, even at that patient's request, would constitute a stark violation of the vow doctors take. And it is true that the traditional translation from the ancient Ionic Greek of the putative text of Hippocrates, a 5th century BC physician, does recite:

"I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course.

However, the oft cited phrase "Do No Harm"  (Latin: Primum non nocere) does not appear in the earliest known Latin version of the Oath dating to AD 245 but rather first appears in a much later 17th century Latin translation. Clearly, though, the intent is well captured in the phrase: "I will abstain from all intentional wrong-doing and harm". For some, then administering a lethal dose of medicine or even writing a prescription for such would be an ethical trespass.
It is of course interesting to hear 21st century physicians basing their moral objections on the wisdom of an ancient Greek who invoked, as his justification for his creed, the will of the many pagan gods: Hippocrates explains it as such:

I swear by Apollo Physician, by Asclepius, by Hygieia, by Panacea, and by all the gods and goddesses, making them my witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture.

One can only hope that modern physicians interpret the Hippocratic Oath with some forgiveness: among other things, surgery is strictly prohibited in Hippocrates judgment:

I will not use the knife, not even, verily, on sufferers from stone...

A far more pertinent question when examining the morality of MAID is to ask if the physician is doing more harm in writing a lethal prescription for a mentally competent, physically terminal patient at the patient's request or, rather in ignoring or refusing the request. Should the physician use the hoary words of Hippocrates to turn his/her back on the dying plea of a patient, counseling instead prayer, hospice, pain killers etc? If  the doctor learns subsequently that the patient then took matters within his hands with a gun or by jumping in front of a train, has not a greater harm been committed? Is the doctor's ultimate duty to the patient and not to a largely outdated and inappropriate professional code of behavior?
In 10 US jurisdictions, and at least 5 foreign countries, doctors are legally authorized to accede to their patients end of life requests by writing MAID prescriptions. They do so out of compassion, understanding and empathy. But also out of a sense of professional responsibility and an understanding that abbreviating suffering, and providing relief and comfort from the agonies of a terminal cancer or ALS far from constituting a harm, is a positive good.
There are of course doctors who find any number of medical procedures objectionable, whether it's cosmetic plastic surgery, to abortion to gender reassignment surgery, to "pulling the plug" on a life-sustaining machinery at the patient's request. It is their absolute right to refuse to participate in activities that are inconsistent with their moral compass. But should doctors be punished if they don't share those moral objections and choose to accede to a patient's request once the diagnosis of a very limited lifespan is evident and where the doctor feels he/she is acting in the best interests of the patient?
There is arguably a greater  harm in refusing to help a patient at end of life who seeks only to end the suffering with dignity, at the time and place and surroundings of their choosing. For doctors and other medical practitioners who preach the mantra of Do No Harm, let us ensure that they do know the harm they maybe doing.

Photo of Edmund Tiryakian

Edmund Tiryakian

Ed Tiryakian, J.D., MBA, founded Dying Right NC in 2015 and is its Executive Director. He previously worked in international banking in Asia before retiring to his native NC.He believes End of Life issues are one of society’s most pressing challenges as we all live longer and the medicalization of the dying process continues to conflict with the individual’s right to choose his or her end.