In his otherwise excellent August editorial, "Informed Consent: A Delicate Balance," Dr. Michael Glick, like so many others, asserts incorrectly that the concept, "First, do no harm" has its origins in the Hippocratic Oath (
JADA 2006;137[8]:1060, 2, 4
). While often so cited, and generally believed to be a major component of the oath, the phrase does not appear in the document.
The confusion may have its basis in the fact that, during the time of Hippocrates, doctors often administered (for a price)fatal potions to dispatch unwelcome individuals to their heavenly reward. Hippocrates strongly disapproved of these Hellenic hit menand, as a result, included in his oath the phrase, "I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect."1
"First, do no harm" is a distortion of a phrase from the Greek physician’s other major works, the Hippocratic corpus. In his treatise, "Of the Epidemics," he declares, "Practice two things in your dealings with disease: either help or do not harm the patient."2
As a result, any suggestion that "doing no harm" comes first is mistaken. Hippocrates insists that the primary role of practitioners is to help the patients, but only if unable to help should they then take care not to harm.
The significance of the distinction should not be minimized. If a modern health professional believes that treatments are acceptable so long as they "do no harm," then it follows that ineffective treatment is ethically permissible. Overtreatment, superfluous tests and unneeded procedures would be justified, so long as no demonstrable harm results. Since a professionthat foolishly clings to such a concept will ultimately face a justified storm of public indignation, practitioners are urged to avoid such practices.
While Hippocrates is entitled to enduring credit for being the first to effectively organize disease and medical care scientifically, he certainly is the wrong person to reference in an editorial on informed consent, because he would vigorously disagree.
In the oath, the acknowledged Father of Medicine paternalistically vows to treat his patients, "according to my ability and judgment; I will keep them from harm and injustice."2 Should there be any doubt regarding this doctor-centered view of patient autonomy, Hippocrates goes on to explain in his dissertation "Decorum," "Perform your medical duties calmly and adroitly, concealingmost things from the patient while you are attending to him. Give necessary orders with cheerfulness and sincerity turning his attention away from what is being done to him; sometimes reprove sharply and sometimes comfort with solicitude and attention, revealing nothing of the patient’s future or present condition, for many patients through this course have taken a turn for the worse."3
Our profession is enhanced when this Hippocratic concept of the doctor/patient relationship is soundly rejected.
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