Primum non nocere – First, to do no harm
Non-maleficence
This Latin phrase is often mistakenly thought to be part of the original Hippocratic Oath and is often cited as such. In modern terms, the phase non-maleficence may be more familiar.
Most of us who are health care providers, enter the field because we hope that we can help others heal. We want to heal not harm. We do not enter the field in hopes of becoming wealthy or wining a prestigious award.
In an attempt to minimize harm in the health care field as well as other service fields such a law, professional organization have been formed and are the legally recognized entity for licensing as well as formulating rules, tests and ethical guidelines for holding health care providers accountable. Some professional organizations may attempt to error on the side of caution by severely restricting the relationship between client/patient and health care professional. Others may be more flexible. Many of us have, by virtue of being licensed or credentialed, agreed to more than one set of ethical guidelines which may, at times, conflict. The generally accepted advice is to follow the most restrictive guidelines.
Health care professional, if not careful, may use the guidelines to restrict the relationship between them and/or their staff and the patient/client. They can also use those guideline and laws such as the Hipaa to limit their contact with family members of the client/patient. Frequently this does not serve the needs of the client/patient and, in fact, may do harm.
I think of myself as a system therapist/counselor or coach. I am acutely aware that all of us function in a multitude of systems – families, work, community organizations and an overall community. All of our active and passive behavior affects many others - directly or indirectly.
In order to effectively treat an individual, one must consider the following:
The answer to the above question will help determine when other family members need to be consulted and/or brought into the appointment with the patient/client.
The question is not what the ethical guidelines say or do not say. The question is not what the Hipaa law states. The question is what does one need to do to minimize the possibility of causing harm.
If a clinician does decide that primum non nocere dictates that one violate the letter of the ethical guidelines of one’s profession or a Hipaa law then one needs to clearly document the reason one was required by primum non nocere to do so. It is that simple. One may risk one’s license, but not one’s commitment to primum non nocere.
Written May 7, 2018
Non-maleficence
This Latin phrase is often mistakenly thought to be part of the original Hippocratic Oath and is often cited as such. In modern terms, the phase non-maleficence may be more familiar.
Most of us who are health care providers, enter the field because we hope that we can help others heal. We want to heal not harm. We do not enter the field in hopes of becoming wealthy or wining a prestigious award.
In an attempt to minimize harm in the health care field as well as other service fields such a law, professional organization have been formed and are the legally recognized entity for licensing as well as formulating rules, tests and ethical guidelines for holding health care providers accountable. Some professional organizations may attempt to error on the side of caution by severely restricting the relationship between client/patient and health care professional. Others may be more flexible. Many of us have, by virtue of being licensed or credentialed, agreed to more than one set of ethical guidelines which may, at times, conflict. The generally accepted advice is to follow the most restrictive guidelines.
Health care professional, if not careful, may use the guidelines to restrict the relationship between them and/or their staff and the patient/client. They can also use those guideline and laws such as the Hipaa to limit their contact with family members of the client/patient. Frequently this does not serve the needs of the client/patient and, in fact, may do harm.
I think of myself as a system therapist/counselor or coach. I am acutely aware that all of us function in a multitude of systems – families, work, community organizations and an overall community. All of our active and passive behavior affects many others - directly or indirectly.
In order to effectively treat an individual, one must consider the following:
- Does the patient/client believe it is safe to share very private information.
- Is the client/patient living in a safe home? Are they being abused in any way?
- Is the client/patient likely to cause physical harm to another person(s)? Is the duty to warm applicable?
- Is there reason to believe that a person is sexually abusing or otherwise harm a child?
- Is the patient/client’s ability to provide accurate and needed information to the clinician? Is the patient/client ability impaired by mental illness, dementia, substance abuse/addiction or another illness affecting cognitive functioning?
- Does racism, sexism, homophobia, cultural factors or other lifetimes traumas affect the patient/client’s ability to share information with the clinician?
- Is the patient/client unable to provide a safe home for a minor child and is there anyway the clinician can help to make that possible?
- Are recommendations for treatment consistent with the financial ability of the patient/client and his/her family?
The answer to the above question will help determine when other family members need to be consulted and/or brought into the appointment with the patient/client.
The question is not what the ethical guidelines say or do not say. The question is not what the Hipaa law states. The question is what does one need to do to minimize the possibility of causing harm.
If a clinician does decide that primum non nocere dictates that one violate the letter of the ethical guidelines of one’s profession or a Hipaa law then one needs to clearly document the reason one was required by primum non nocere to do so. It is that simple. One may risk one’s license, but not one’s commitment to primum non nocere.
Written May 7, 2018
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