Please let me start off by asking some questions.
Is do no harm interchangeable with do good?
Who determines what is good and what is harmful?
Does the care provider determine if something is good for someone else or does the receiver of the service determine if it’s good or harmful?
These questions are always in my mind. I think when I became a nurse years ago I didn’t consider these so frequently but now after many years of international work I ponder them sometimes all day.
Two very important aspects of my life are my faith and my profession as a nurse. In my mind they are inseparable. I have personally received healing and hope through my faith and therefore have a desire to share those with others. So my faith journey was a significant motivation to study medicine/nursing. I desired to give back some of what I had been given in my life (to whom much is given, much is expected) and also in hope of helping people along the path of healing.
So as I started out as a young nurse working in the US the lines of doing good and doing harm seemed pretty black and white. I would follow the doctor’s orders for the patients I would provide care to in the hospital and I would automatically interpret those orders as the medical team doing good for that patient. But as I started providing health care internationally, over time, those lines blurred some and things became more grey.
Yes sometimes the choice is automatic; give the medicine to the patient and the patient will be cured. But over time, in various cultures and settings, the automatic or good choices may become a slippery slope leading to harm.
Let me explain…
As I look back on our desire to serve people in desperate situations in Africa, I had to ask how much dependence have I created in giving out free medicine to address every sickness for years. I have enabled people to not pay for meds and over time taken the value out of the medicine. Medicine in that setting became something easily available and free and things in that category seem to be taken for granted and lose value. If every ailment can be cured by visiting the local health center then why invest in our personal health or take care of ourselves, etc?
So should I have not giving medicine for free and rather asked people to pay in some form? Even with a chicken or some produce from their garden? Even people living in extreme poverty? Would this have attached some value to the medicine and helped them feel more empowered to make good health choices?
So overall the question remains-
With the intention of doing good for people in desperate situations, by giving free medications for many years did I create dependence and leave them with less dignity, less empowered and more like a dependent refugee than when I started?
As I return to my faith and nursing profession I recognize that both the Bible and bioethics touch on doing good and doing no harm.
The scriptures in the Bible speak of good frequently.
Let us not grow weary in doing good. Galatians 6:9
God made us to do good works, which He planned in advance for us to live our lives doing. Ephesians 2:10
So then, as we have opportunity, let’s do what is good toward all men, and especially toward those who are of the household of the faith. Galatians 6:10
In addition, in medical care this concept is addressed.
The concept of non-maleficence is used in bioethics and is embodied by the phrase, "first, do no harm," or the Latin, primum non nocere. Many consider that should be the main or primary consideration (hence primum): that it is more important not to harm your patient, than to do them good. So in summary, don’t do anything if it will cause harm. In the original text of the Hippocratic Oath, it states "I will abstain from all intentional wrong-doing and harm.”
In bioethics all practitioners when given an existing problem, have to weigh if it may be better not to do something, or even to do nothing, than to risk causing more harm than good. It is a reminder to healthcare workers to consider the possible harm that any intervention might cause.
I recently consulted a friend who is a new physician, asking her what she had to concede to or sign off on as she graduated medical school. She sent me a document called A Modern Hippocratic Oath which did not specifically use the words “do no harm” but gave many practical ways for physicians to do good and not cause harm.
As a society we kind of know or define what is doing harm. But is it possible to actually do harm when we do something with good intentions?
In the past, as I look back on many years of international work there are situations when this question is very grey. I think my intentions were always good, honestly as I search my heart, but culturally I didn’t know that things would end up in certain ways in certain situations. I blame that on my own naivety and also on cultural differences. But I am broken-hearted about those situations and honestly embarrassed. They haunt me.
The reason why I am asking these questions is that as we refocus on our work and make plans moving ahead, I/we want to do good and undoubtedly we don’t want to do harm. I am not expecting perfection but rather just to begin work with the end in mind. Looking forward to see how our actions now will affect people long term.
In history we never look back at situations and say “well that was done with good intentions”. We rather just look back at the outcomes; good or bad.
As we set goals moving forward- Afghanistan and Haiti are on our minds and hearts. International aid has kept many people alive in these two countries but have we done them good long term? Have we caused harm through creating horrible dependence and therefore have left people in these countries weaker than they were before?
My desire and prayer is that anything I/we do in the name of good or with the intention of good does not cause harm now or in the future. May I/we not be remembered for our good intentions but rather for our good actions.