First, do no harm... ?

Primum non nocere is a Latin phrase that means “first, do no harm”. Otherwise known as non-maleficence, it is one of the central tenets of bioethics, and is widely adopted in healthcare to handle the many difficult decisions therein.

Non-maleficence probably makes sense in healthcare, where there is perhaps a human tendency to over-intervene, and in an arena where severe outcomes to life and limb (and unintended consequences) can't always be predicted with certainty.

But more broadly in life, what do we do when faced with difficult decisions? Does the maxim of “first, do no harm” work? 

Consider the classic moral dilemma of the trolley problem. A trolley is headed down a track that will cause it to run over 5 people. If you throw the track switch, the trolley will switch to another track where it will only run over 1 person.

Non-maleficence might suggest, do nothing. Utilitarianism might suggest that we have a moral obligation to throw the switch. 1 death is better than 5.

A fairly significant majority of people polled across numerous surveys over the years say that they would pull the switch. 

But interestingly, in 2017, YouTube educator Michael Stevens conducted an experiment in which people were made to believe they were in charge of a rail switch, where there was a real decision to be made to either save 5 people at the cost of 1 person, or leave things alone.

It turns out that in this “real” situation, the majority of people chose not to pull the switch. So, whatever people might say in a survey, it seems the pitiless heart of utilitarianism might be too cold-blooded for most people to handle in real life!

Incidentally, this is not just a theoretical issue - it actually needs to be resolved. Autonomous self-driving cars will face this issue in practice. 

Does the algorithm prioritise the safety of the passenger or surrounding traffic? Vehicular traffic or pedestrians? Run into five people or swerve to hit one? An old couple crossing the street or a young mother with a baby stroller? Some human being is going to have to decide and code this!

To make things even more complex - most of real life isn’t quite as binary as the trolley problem. When we encounter a problem, it isn’t often the case that action or inaction will clearly make things better/worse. All we have is a sense of the possibility of things becoming better/worse.

Consider the situation where a job applicant knows that he does not meet the minimum educational requirements for an internal transfer that will enable him to embark on a desired career path. 

He has a few options. Apply for the role anyway, and possibly risk antagonizing his current supervisor. Or, spend time, effort and money to obtain the necessary qualifications, and apply for the role later. Or, stay in his current role, though it doesn’t match his career plans.

If he chooses to adhere to the maxim of “first, do no harm”, then he just stays put.

But if he chooses to act, there is a cost. Possible harm.

I imagine that a significant majority of readers will conclude that in most cases, “first, do no harm” is not the right path. But equally, I expect that if this were not just a mental exercise, many of us would choose the status quo. We know this, because people have to write books like “Who Moved My Cheese?” to remind us that we have to embrace change!

It’s the same for companies (or even organisations like churches and small groups). They may have a business that’s cruising along, but is not growing. They could choose to change or pivot, with all the attendant pain, friction, cost and effort that comes with re-organisation. There will be a dip. 

While there is no absolute assurance, the hope is that the dip will pay off in the longer run. But if they don’t evolve, then at some point, the company (or church, or small group) will glide to a halt. Which do we choose in theory, and which do we do in practice?

Consider a different scenario.

Before I got married, my then girlfriend and I signed up for a Marriage Preparation Course. After every session, we would smile at each other and at the pre-marital counsellor, hold hands and leave… and then have the most riotous quarrels!

Why? Because we didn’t realise there were so many things we disagreed about. How to manage money. How to relate to parents and parents-in-law. Views about children. Views about career. Where to live? Who’s responsible for household chores? And which chores? Practically every issue seemed like a break-up issue.

But today, my wife and I advise every couple who plans to marry – sign up for the Marriage Preparation Course. So many quarrels. So many painful words exchanged. So many break points. But totally worth it. 

All these painful quarrels enabled us to bring issues to the surface and resolve them. Even if the quarrels had caused a break-up, that would have been a good result. “First, do no harm” would not have been a good idea.

I suspect, again, that the vast majority of readers will agree with this in theory. Yet, in real life, so many choose not to go through rigorous marriage preparation, in order to avoid the immediate pain/harm.

Consider, finally, the issue of friendship. Suppose you have a friend who has a bad habit – smoking, adultery, overwork, etc. If you call him or her out on that bad habit, you could harm your friendship. If you choose to stay out, then your friend will likely face the consequences of his habit.

Most of us will agree that a true friend would call it out. But in reality, most of us don’t. We’d rather avoid the immediate “harm”. 

For Christians, the issue is often one of evangelism. Do we share our faith with our friends and family? It could hurt the relationship. But if we don’t… are we really friends and family?

The point is this. Imagine that the minimum velocity to drive a car over a gap in a bridge is 70 km/h. Life is cruising along at 60 km/h. If we do nothing, we know that we will (eventually) fail to bridge the gap. 

If we change things up, and switch gears down, we risk falling to 50 km/h and failing even more miserably. But given time (and if we act soon enough) there’s a chance that the increased acceleration will bring us above 70 km/h.

What do we choose? If the only way to get from 0 to 1 is first to get to -2, will we bite the bullet?

First, do no harm and stay at zero? Or Move Our Cheese?