primum non nocere

Primum non nocere is a Latin phrase that means "First, do no harm." The phrase is sometimes recorded as primum nil nocere. It is one of the principal precepts all medical students are taught in medical school. It reminds a physician that he or she must consider the possible harm that any intervention might do. It is most often mentioned when debating use of an intervention with an obvious chance of harm but a less certain chance of benefit. For at least the last century the phrase has been for physicians a hallowed expression of hope, intention, humility, and recognition that human acts with good intentions may have unwanted consequences. The origin of the phrase is not widely known, though it is often described as a Latin paraphrase by Galen of a Hippocratic aphorism (despite the fact that Galen also wrote in Greek rather than Latin). The closest approximation to the phrase that can be found in the Hippocratic Corpus is "to help, or at least to do no harm," taken from Epidemics, Bk. I, Sect. XI. According to Gonzalo Herranz, Professor of Medical Ethics at the University of Navarre, Primum non nocere was introduced into American and British medical culture by Worthington Hooker in his 1847 book, Physician and Patient. Hooker attributed it to the "Parisian pathologist and clinician Auguste Franois Chomel (1788-1858), the successor of Lennec in the chair of medical pathology, and the preceptor of Pierre Louis. Apparently, the axiom was part of Chomel's oral teaching." (Source: Herranz G. The origin of primum non nocere. British Medical Journal electronic responses and commentary 1 Sept 2002.) An alternative, but nihilistic, interpretation of primum non nocere denies the value of all treatments, since no intervention, no substance, no diet, no surgery, no advice, and even no deliberate inaction is without the possibility of harm if it affects a patient at all.

Primum Non Nocere

See also