In Part I of the blog post, Say Doctor – You Promised to What?, we talked about the history of physician oaths and pledges and found that neither the older versions or the modern actually include the off-quoted phrase ‘do no harm’.
So where DOES the phrase ‘do no harm’ come from? – And what does it mean for Death with Dignity?
‘Do no harm’ is perhaps more correctly associated with the field of Medical Ethics. In today’s world, a physician’s oath or pledge is taken by medical students as part of their induction into the medical profession. Medical ethics is the moral conduct and principles (or code) that defines the essentials of behavior for the practicing physician on an ongoing basis and can be used to determine a course of action given conflicting choices for patient care. Historically, they are most likely born from the same early professional writings (i.e. the Hippocratic Oath) and are closely intertwined.
Medical Ethics has been heavily influenced by Islamic, Jewish and Christian scholars. The first code of medical ethics, Formula Comitis Archiatorum was published in the 5th century and the first book dedicated to Medical Ethics, Conduct of a Physician was written in the 9th Century by an Islamic physician and scholar, Ishaq ign Ali al-Ruhawi. The term ‘medical ethics’ was coined by English physician and author, Thomas Percival, who put forward a physician’s code in 1803 describing the requirements and expectations of medical professionals. Percival’s code heavily influenced the first code of medical ethics adopted by the American Medical Association in 1847.
Current medical ethics is influenced by increased secular and legal approaches to the practice of medicine based on the outcome of court cases such as Roe vs. Wade that reflect changing societal values and morals. It is important to note that (just as there is no universal physician’s oath or pledge), various medical associations may take a different stance on controversial areas of medical practice such as abortion and euthanasia or medically-assisted ending-of-life. So in that sense, one can make the case that (in practice), controversial treatment plans are based on whatever school of medical ethics the treating physician or healthcare provider decides to follow.
Medical ethics relies on the interplay of four values for patient care:
· Autonomy - the patient has the right to refuse or choose their treatment,
· Beneficence - acting in the best interest of the patient,
· Non-maleficence - to not be the cause of harm (or to do no harm)
· Justice – or the distribution of health resources.
No one value takes precedence over another – all must be considered. In many cases, the values may be in conflict with one another. For instance, autonomy and beneficence when a patient refuses life-saving transfusions based on religious beliefs. Or, more to the point – autonomy, beneficence and non-maleficence when determining compassionate ending-of-life.
We believe any person diagnosed with an incurable condition that will result in unbearable physical and/or mental pain should be able to predetermine at any time following his/her diagnosis, a point at which they feel their loss of quality of life and/or dignity will have deteriorated enough to proceed with medically assisted ending of life. Our position upholds the values of medical ethics - autonomy - by allowing the individual to pre-determine an acceptable level of medical intervention and care; and both beneficence and non-maleficence - by not prolonging life when it has become unbearable to the patient due to pain, suffering and loss of dignity.
“Do no harm”, should not be taken as an excuse to prolong a patient’s life based on the opinion, believes or morals of some other person, practitioner, institution or association. To do so ignores the principle of patient autonomy and craftily switches beneficence with non-maleficence by prolonging a life of pain, suffering and indignity against the patient’s wishes under the guise of ‘doing no harm’.