Myth vs Fact: Is 'First Do No Harm' Part of the Hippocratic Oath?

The Origin of This Popular Medical Ethics Dictum

HippocraticOath.pdf
Wellcome Library, London Papyrus, fragment of Hippocratic oath: verso, showing oath.3rd century Collection: Archives & Manuscripts Library External Reference Oxyrhynchus papyri no. 2547 Copyrighted work available under Creative Commons Attribution only licence CC BY 2.0, see http://creativecommons.org/licenses/by/2.0/. Wellcome Library, London Copyrighted work available under Creative Commons Attribution only licence

It is commonly believed that the popular term "first do no harm" is taken from the Hippocratic Oath. However, when reading the translation of the Hippocratic Oath, you will find that the quote does not appear in the text.

So where does this saying come from?

What Does "First Do No Harm" Mean?

"First do no harm" is a popular saying that derives from the Latin phrase, "primum non nocere." The term is particularly popular amongst those involved in the field of healthcare, medicine or bioethics since it is a basic principle taught in health care providing classes.

 

The takeaway point of "first do no harm" is that, in certain cases, it may be better to do nothing rather than intervening and potentially causing more harm than good. 

Hippocratic Oath

Hippocrates was an ancient Greek physician that wrote many works, including the Hippocratic Oath. The ancient Greek text was written circa 500 B.C.E. and, true to its name, it was historically an oath taken by physicians to swear by the gods to conduct practice by specified ethical standards. In modern times, a modified version of the oath is often sworn by doctors upon graduation as a sort of rite of passage.

While "first do no harm" is often attributed to the Hippocratic Oath, the dictum does not actually come from the Hippocratic Oath verbatim.

But it can be argued that it does come from the Hippocratic Oath at least in essence. Meaning, similar ideas are conveyed in the text. Take, for example, this related section which has been translated as:

I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion. 

In reading the Hippocratic Oath, it is apparent that not harming the patient is explicit. However, it is not clear that "doing no harm" is the first concern of the Hippocratic physician.

Of the Epidemics

Of the Epidemics is a part of the Hippocratic Corpus, which is a collection of ancient Greek medical texts written around 500 and 400 B.C.E. Hippocrates was never proven to be the author of any of these works, but the theories do follow closely with Hippocrates' teachings.

Regarding "first do no harm",  Of the Epidemics is considered to be the more likely source of the popular saying. Consider this quote:

The physician must be able to tell the antecedents, know the present, and foretell the future - must mediate these things, and have two special objects in view with regard to disease, namely, to do good or to do no harm.