Doing Harm

Electric Skeptic

Well-known member
This started in the context of a discussion about a doctor who was refusing to treat patients who met a certain criteria.

Another poster said "so much for 'do no harm...'.

To that I replied "Ummm...by not seeing patients, he is by definition doing no harm."

The original poster disagreed, stating "Yes, he is....he is discriminating."

So there are a few questions here, and I'd like opinions.

- is not treating a patient 'doing harm' within the context of the Hippocratic Oath?

- I agree that a doctor refusing to treat patients who met a certain criteria is discriminating. But is discriminating per se 'doing harm'? This ties in with the question above.

- A linked question to the one above - is discrimination in this context always wrong?

- is not rendering aid to a person in need of it harming them?
 

docphin5

Well-known member
All right I will bite.
This started in the context of a discussion about a doctor who was refusing to treat patients who met a certain criteria.

Another poster said "so much for 'do no harm...'.

To that I replied "Ummm...by not seeing patients, he is by definition doing no harm."

The original poster disagreed, stating "Yes, he is....he is discriminating."

So there are a few questions here, and I'd like opinions.

- is not treating a patient 'doing harm' within the context of the Hippocratic Oath?
No, but he might be censured by the medical association and lose his license to practice medicine for denying medical care.
- I agree that a doctor refusing to treat patients who met a certain criteria is discriminating. But is discriminating per se 'doing harm'? This ties in with the question above.
No. I don’t think it would be considered ”doing harm” in a court of law, just denying care. But it would require a legal opinion and I am not a lawyer.
- A linked question to the one above - is discrimination in this context always wrong?

- is not rendering aid to a person in need of it harming them?
IMO, it is not harming them but denying aid when possible.
 

Algor

Well-known member
This started in the context of a discussion about a doctor who was refusing to treat patients who met a certain criteria.
Caveat: Do no harm is not part of many Hippocratic oaths, and is not taken as a tenet of practice, but as an aspirational ideal. If you are always to avoid doing harm, you can hardly do surgery etc. Everything has risks.
Another poster said "so much for 'do no harm...'.

To that I replied "Ummm...by not seeing patients, he is by definition doing no harm."

The original poster disagreed, stating "Yes, he is....he is discriminating."

So there are a few questions here, and I'd like opinions.

- is not treating a patient 'doing harm' within the context of the Hippocratic Oath?
Deliberate neglect (ie abandonment of established responsibilities towards a dependant without ensuring care) is treated as a form of abuse, but outside urgent aid, no physician is compelled to treat anyone with whom they have no prior relationship/burden of care.
- I agree that a doctor refusing to treat patients who met a certain criteria is discriminating. But is discriminating per se 'doing harm'? This ties in with the question above.
Discriminating on what grounds? (e.g. at its absurd limit, a gynaecologist can discriminate on the basis of biological sex, a gerontologist or neonatologist by age etc. ). Discrimination is unethical if it breaks the law, full stop. The outer boundaries of ethical behavior are determined by law: inside the law, particulars matter a lot.
- A linked question to the one above - is discrimination in this context always wrong?

- is not rendering aid to a person in need of it harming them?
Depends on context. If someone needs urgent aid (ie there is a rationally ascertainable threat to life or limb) then witholding it is unethical. So long as the reasons for not treating are ethical (see under "What are the grounds of discrimination?") and care is not urgent, one may withhold. In general, one tends to err on the side of compassion, rather than witholding care on grounds of rational self interest, but that is a subcultural and personal value that we try to preserve.
 
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Electric Skeptic

Well-known member
Caveat: Do no harm is not part of many Hippocratic oaths, and is not taken as a tenet of practice, but as an aspirational ideal. If you are always to avoid doing harm, you can hardly do surgery etc. Everything has risks.

Deliberate neglect (ie abandonment of established responsibilities towards a dependant without ensuring care) is treated as a form of abuse, but outside urgent aid, no physician is compelled to treat anyone with whom they have no prior relationship/burden of care.

Discriminating on what grounds? (e.g. at its absurd limit, a gynaecologist can discriminate on the basis of biological sex, a gerontologist or neonatologist by age etc. ). Discrimination is unethical if it breaks the law, full stop. The outer boundaries of ethical behavior are determined by law: inside the law, particulars matter a lot.

Depends on context. If someone needs urgent aid (ie there is a rationally ascertainable threat to life or limb) then witholding it is unethical. So long as the reasons for not treating are ethical (see under "What are the grounds of discrimination?") and care is not urgent, one may withhold. In general, one tends to err on the side of compassion, rather than witholding care on grounds of rational self interest, but that is a subcultural and personal value that we try to preserve.
Thanks for your response. But the question wasn't about whether or not withholding aid or treatment was ethical or not; it was about whether or not it 'does harm'.
 

Algor

Well-known member
Thanks for your response. But the question wasn't about whether or not withholding aid or treatment was ethical or not; it was about whether or not it 'does harm'.
OK. I thought it was aboutthe ethics because it was predicated on the Hippocratic oath.

If it's about harm per se, then the comments about when it is necessary to not withold treatment (necessity, illergality, prior relationship of care) still hold as qualifying for harm. That done, it depends on what kind of harm. Personal psychic harm to the patient, and social harm due to an erosion of trust in institution/profession can come if the refusal is seen to be unfair ,and the degree of harm will depend tightly on how widely seen (socially) or deeply felt (personally) the perceived injustice is OTOH, harm can also come by attempting to aid when the desired aid is not medically indicated. A lot of specifics are required to give an answer, but yes, harm can come by discrimination, but again, discrimination on the basis of what?
 

Komodo

Well-known member
This started in the context of a discussion about a doctor who was refusing to treat patients who met a certain criteria.

Another poster said "so much for 'do no harm...'.

To that I replied "Ummm...by not seeing patients, he is by definition doing no harm."

The original poster disagreed, stating "Yes, he is....he is discriminating."

So there are a few questions here, and I'd like opinions.

- is not treating a patient 'doing harm' within the context of the Hippocratic Oath?
I'd say yes, unless one is adopting a woodenly literal interpretation of the oath, and ignoring its implicit purposes. The implicit purpose of the oath is to motivate doctors to do their best for their patients' health; the doctor who is in a position to give helpful treatment, but refuses to do so, knowing that such treatment is necessary to the patient's health, is not doing their best for the patient's health, and so is harming the patient, within the context of the oath. This is the case whether the motive for not providing care is discrimination against the patient's race/gender/sexual orientation, or whether the doctor just doesn't like the patient personally. Generally, refusing to concede that the language of an oath or a contract comes with implicit requirements, as well as the explicit ones, is almost always an act of bad faith.

It's hard for me to see how this is different in principle from parents saying that not providing food for their children is, literally speaking, not doing them harm.
 

Algor

Well-known member
I'd say yes, unless one is adopting a woodenly literal interpretation of the oath, and ignoring its implicit purposes. The implicit purpose of the oath is to motivate doctors to do their best for their patients' health; the doctor who is in a position to give helpful treatment, but refuses to do so, knowing that such treatment is necessary to the patient's health, is not doing their best for the patient's health, and so is harming the patient, within the context of the oath. This is the case whether the motive for not providing care is discrimination against the patient's race/gender/sexual orientation, or whether the doctor just doesn't like the patient personally. Generally, refusing to concede that the language of an oath or a contract comes with implicit requirements, as well as the explicit ones, is almost always an act of bad faith.

It's hard for me to see how this is different in principle from parents saying that not providing food for their children is, literally speaking, not doing them harm.
I’m in broad agreement here, but physicians have to have some discretion in accepting patients, for any number of reasons.
 

SteveB

Well-known member
This started in the context of a discussion about a doctor who was refusing to treat patients who met a certain criteria.

Another poster said "so much for 'do no harm...'.

To that I replied "Ummm...by not seeing patients, he is by definition doing no harm."

The original poster disagreed, stating "Yes, he is....he is discriminating."

So there are a few questions here, and I'd like opinions.

- is not treating a patient 'doing harm' within the context of the Hippocratic Oath?

- I agree that a doctor refusing to treat patients who met a certain criteria is discriminating. But is discriminating per se 'doing harm'? This ties in with the question above.

- A linked question to the one above - is discrimination in this context always wrong?

- is not rendering aid to a person in need of it harming them?
Is this about the doctor in the south who has refused to take care of patients who are refusing to get vaccinated?

Out here in the west, where I live, we have 3 doctors that I'm aware of who have left the world of insurance companies and have initiated what is known as
Concierge Care.

Patients must pay a fee up front, each year for normal care. All subsequent tests are extra.
Prior to the entrance of concierge service here, numerous doctors had refused to take on new Medicaid and Medicare patients due to the extremely low payments made by those two government agencies.

So, as this is an old issue here in northern Nevada, I don't think it's a problem.

There are many doctors who responded to that article and said they'd take the care for such patients on themselves.

I further think it falls under a similar pattern as doctors who refuse to engage in abortions.
 

Eightcrackers

Well-known member
This started in the context of a discussion about a doctor who was refusing to treat patients who met a certain criteria.

Another poster said "so much for 'do no harm...'.

To that I replied "Ummm...by not seeing patients, he is by definition doing no harm."

The original poster disagreed, stating "Yes, he is....he is discriminating."

So there are a few questions here, and I'd like opinions.

- is not treating a patient 'doing harm' within the context of the Hippocratic Oath?

- I agree that a doctor refusing to treat patients who met a certain criteria is discriminating. But is discriminating per se 'doing harm'? This ties in with the question above.

- A linked question to the one above - is discrimination in this context always wrong?

- is not rendering aid to a person in need of it harming them?
Hmm... some nice meat on these questions :).

My first instinct was that doctors do harm by not treating, but I think I've come away with the interpretation "don't make the patient worse by your actions", and no actions = no harm by one's actions.
In addition, I think there are instances where not treating reduces harm - terminally ill patients being caused additional pain merely to prolong their lives, for example.

To the issue of discrimination, could you provide some examples?
 

Electric Skeptic

Well-known member
Hmm... some nice meat on these questions :).

My first instinct was that doctors do harm by not treating, but I think I've come away with the interpretation "don't make the patient worse by your actions", and no actions = no harm by one's actions.
In addition, I think there are instances where not treating reduces harm - terminally ill patients being caused additional pain merely to prolong their lives, for example.

To the issue of discrimination, could you provide some examples?
The issue of discrimination came up in another thread where someone mentioned a doctor who has refused to treat those not vaccinated against Covid. That's what sparked this entire conversation there, where someone said "So much for 'do no harm...'" and I object that not treating someone was, by definition, not doing harm.
 

Algor

Well-known member
The issue of discrimination came up in another thread where someone mentioned a doctor who has refused to treat those not vaccinated against Covid. That's what sparked this entire conversation there, where someone said "So much for 'do no harm...'" and I object that not treating someone was, by definition, not doing harm.
Ok, interesting.
Did the MD work with a lot of severely immunosuppressed patients or something like that?
 

Komodo

Well-known member
I’m in broad agreement here, but physicians have to have some discretion in accepting patients, for any number of reasons.
Yes, but I'd say those would come under the heading of causing some harm in the interest of preventing greater harm, not that the refusal to accept the patient did no harm to that patient.

Does anybody know, by the way, why this instruction was part of the Hippocratic Oath to start with? Was the idea something like "don't experiment on patients with potentially deadly concoctions"?
 

Komodo

Well-known member
The issue of discrimination came up in another thread where someone mentioned a doctor who has refused to treat those not vaccinated against Covid. That's what sparked this entire conversation there, where someone said "So much for 'do no harm...'" and I object that not treating someone was, by definition, not doing harm.
I think you can make a case for such refusals, both on the grounds of justice and utility, but that one shouldn't claim the refusal did no harm to the would-be patient.
 

Algor

Well-known member
Yes, but I'd say those would come under the heading of causing some harm in the interest of preventing greater harm, not that the refusal to accept the patient did no harm to that patient.

Does anybody know, by the way, why this instruction was part of the Hippocratic Oath to start with? Was the idea something like "don't experiment on patients with potentially deadly concoctions"?
I have been told that it has more to do with “be generally trustworthy, safe and don’t bonk your patients” kind of thing. I should read more on this.
 
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