Nonmaleficence: «first, do no harm»
- Principle
A doctor must not cause the patient avoidable harm or expose them to risks that no benefit justifies.
What it is
Nonmaleficence is the duty not to cause harm. It comes from the Hippocratic tradition: the oath promises to use the regimen for the benefit of the sick and keep them from harm, and the Latin phrase «primum non nocere» sums it up. It does not forbid all risk, since almost every treatment carries some; it forbids avoidable harm, unjustified risk, negligence and useless treatment. When a good act has a foreseen bad effect, it is analysed with the principle of double effect.
What it requires
- Do not kill or cause avoidable pain or suffering.
- Do not expose the patient to risks the expected benefit does not justify.
- Act with the competence and care good practice requires.
- Do not give futile treatments that only prolong suffering.
- Avoid tests and procedures without an indication.
In clinical practice
- Before a procedure, compare the possible harm with the expected benefit and explain it to the patient.
- Limiting treatment: withdrawing support that no longer offers benefit is not abandoning the patient.
- After brain death, the doctor is not obliged to keep organs functioning by artificial means (Law 23 of 1981, art. 13).
- Acknowledging and disclosing errors helps reduce harm and prevent it from happening again.
Limits and exceptions
- It is not absolute: surgery causes harm (the wound) to achieve a greater good; this is accepted if proportionate and consented.
- When the harm is a foreseen but unintended effect, the principle of double effect applies.
- The doctor's responsibility for adverse reactions goes no further than the foreseen risk, which the doctor must warn about (Law 23 of 1981, art. 16).
Test yourself
Think of the answer, then tap the question to see it.
Does nonmaleficence forbid every treatment that carries risk?
No. It forbids avoidable harm and unjustified risk; a risk proportionate to the expected benefit and accepted by the patient is ethically sound.
Is withholding a treatment ethically different from withdrawing it once it no longer helps?
No. Both are considered equivalent: if a treatment offers no benefit, there is no duty to start it or to keep it going.
What does Colombia's Law 23 of 1981 say about unnecessary tests and treatments?
The paragraph of article 10 says the doctor will not demand unnecessary tests or subject the patient to unjustified treatments.
Which principle applies when a good act has a foreseen but unintended bad effect?
The principle of double effect.
Connections
Educational content on ethics and health law; not legal advice. Laws and case law change: each page links the official text and says when it was last checked. For a real case, read the text in force and ask a lawyer or the medical ethics tribunal.
Sources: Greek Medicine: the Hippocratic Oath (translation by Michael North, 2002) (U.S. National Library of Medicine, 2002); WMA International Code of Medical Ethics (World Medical Association, 2022); Ley 23 de 1981, por la cual se dictan normas en materia de ética médica (Función Pública, Gestor Normativo (Colombia), 1981).
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Representative model, for educational purposes only.