The Tribune was wrong. Medicine often involves a risk to the patient.
Please note: This version of the blog originally appeared as an op-ed in the Salt Lake City Tribune on December 10, 2017.
The Tribune was wrong. Medicine often involves a risk to the patient.
The Salt Lake Tribune published an editorial on Sunday Nov 12, 2017, “Medical professionals need to play a role in opioid crisis.” The first line reads, “First do no harm.” According to the editorial, physicians who prescribe opioids to treat pain patients may be violating the Hippocratic Oath, because “a doctor’s first concern is to not do anything to make things worse.”
However, the editorial got it wrong.
The Hippocratic Oath is not the origin of the phrase “First do no harm.” As N.S. Gill writes in Thoughtco, many people mistakenly believe that “First do no harm” is a quotation from the Hippocratic Oath. That is not the case.
But, more importantly, the creed does not say that doctors must never provide a clinical intervention that may benefit a patient without also triggering some degree of harm. If physicians had to live with such a code of ethics, they would be unable to provide almost all treatments offered in medicine.
As Harvard Health Publishing points out, that would mean no one would ever have life-saving surgery. Doctors wouldn’t be able to order CT scans, MRIs, mammograms, biopsies, or other tests that can turn up false positives; draw blood for fear of bruising; or provide vaccines that might cause side effects. Even aspirins are potentially dangerous treatments for some people. To avoid risk altogether, doctors would have to limit themselves to providing BAND-AIDs® and soothing words.
“First do no harm” isn’t about standing by idly and helplessly while someone suffers needlessly. It is an ideal that is better explained by the principles embedded in the philosophy of the Double Effect (DE).
According to the Stanford Encyclopedia of Philosophy, the Double Effect means that it’s acceptable if harm occurs in the course of trying to make a positive difference. An intent to do good or provide help must be the underlying motive. However, intent to do good is not sufficient. The potential for good must sufficiently outweigh the potential for harm.
DE often is used to explain why physicians have prescribed opioids, even knowing they can cause risk to patients. Doctors prescribe opioids, and sometimes at very high doses, with the intent to provide pain relief (which is “to do good”), because there are few other options available or affordable, and the risks of harm are manageable for most patients.
This is true for all medications and interventions, and not just for opioids. Opioids are not, themselves, evil agents, despite their somewhat checkered reputation among some laypeople, physicians, and lawmakers.
Most clinicians who treat terminally ill patients, the patients themselves, and patients’ families place a priority on a peaceful, pain-free death. Opioids are frequently necessary to provide that scenario at the end of life despite their potential to hasten death.
Providing opioids to ease end-of-life suffering passes the DE test, but it is still controversial. Furthermore, end-life-care is only one area in which the use of opioids is questioned.
There are some people who believe that opioids should not be prescribed because of the harm they may cause, regardless of their potential benefits to a patient.
As physicians, we are trained to heal. We become healthcare professionals because we want to provide compassionate care to the sick, the frail, and the dying. We take an oath, in part, to use our best judgment to evaluate the risk and potential benefits of all interventions. Intending to do good, knowing that adverse effects can occur with every intervention, is our ethical responsibility.
A mischaracterization of the phrase “first do no harm” must not prevent providers from caring for people, including providing them with medication that can adequately provide pain relief with acceptable risk.
Lynn R. Webster, MD is Vice President Scientific Affairs for PRA Health Sciences. He is a past President of the American Academy of Pain Medicine. In addition, he is the author of the award winning book, “The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us” (Oxford University Press). Visit him online at www.thepainfultruthbook.com. @LynnRWebsterMD
When a convict is facing execution for multiple murders, rape and even pedophilia, his execution will be as many have been stopped. THE REASON IS BECAUSE WE AS A SOCIETY DONT WANT THAT SUBHUMAN TO FEEL EXTREME PAIN AND SUFFERING. IN MOST CASES THAT PAIN WOULD LAST SECONDS AND THEN HE WOULD DIE.
30 PLUS MILLION MODERATET O SEVERE PAIN SUFFERERS OF MANY DIAGNOSES ARE NOT OFFERED THE SAME COURTESY OF COMPASSION.
WE NEVER MURDERED ANYBODY, WE ARENT ADDICTS BECAUSE OUR MEDICATION GENERALLY LASTS THE ENTIRE MONTH
AN ADDICT WOULD TAKE 90 TO 180 PILLS IN A WEEK, CHASING THE HIGH.
WHY IN THIS COUNTRY DO WE ALLOW A MURDERING SUBHUMAN TO LIVE FOR FEAR HE MAY FEEL PAIN WHILE THE 30 PLUS MILLION OF US ARE DENIED THE ONLY MEDICATION THAT REDUCES OUR PAIN TO A DEGREE THAT WE CAN HAVE A MUCH BETTER QUALITY OF LIFE. THE MEDICINE IS THERE WE WANT IT BECAUSE WEVE TRIED EVWRYTHING ELSE. CAN I GET AN ANSWER FROM ANYBODY. I DO BELIEVE OUR SYSTEMS PRIORITIES ARE MESSED UP HUGE. SOCIETY, THE DEA THE CDC I.SURANCE COMPANIES ALL PITY AND WANT TO COMFORT AND BE COMPASSIONATE.TO KILLERS AND JUNKIES, whileany of us are.bedridden again, killing ourselves because the pain is unbearable and treated like criminals while tue actual criminals are.treated with sympathy
AMERICA IS NOT AND WILL MEVER BE THE COMPASSIONATE COUNTEY WE OMCE WERE. OF ALL THE STATUES BEING TORN DOWN.
THE STATUE OF LIBERTY NEEDS TO BE HAULED AWAY.
WE SHOULDN’T WANTTHE FIRST THING PEOPLE TO SEE COMING INTO NY A BIG FAT LIE. AMERICA ONLY WANTS HEALTHY, STRONG ABLE BODY CITIZENS.
Amen, As someone who has lived with 9 spinal levels with severe degeneration and now being told that my pain medication will almost be cut off due to the CDC’s new rules I have to now choose go to street drugs like Heroine or end my life. Unlike some there is no way to fix my condition and I can’t find a doctor who wants to risk a possible malpractice suit. Most people like my husband of 22yrs really and truly don’t understand what this is like day in day out every second of the day and night you have some degree of pain. The only time I have and feeling of hope is when I think of the day I die and no longer have to suffer with this pain. The longer you have suffered the less tolerant you become. Even now I am settling my affairs so that my family does not have to deal with while they are grieving. It hurt us when we think of how we are going to hurt our families and friends but to ask anyone to live in this kind of pain is selfish and cruel. We will put an animal down and say it is humane thing to do for reasons less than what I am suffering with. So I believe that I should be entitled to the same courtesies.