“First Do No Harm”

Since Friday evening, I have tried to figure out what bothers me (besides the obvious sting from the slap in the face of humanity that the cry “Let him die” brings) about the now infamous interaction between Ron Paul, Wolf Blitzer and audience members at the CNN – Tea Party Express Republican Debate. As a full disclaimer it is important to note that I am a nurse. Nurses care not about who has insurance, their administrators are the ones who care. Nurses want to give the best treatment and care possible for the problem that presents itself, regardless of ability to pay. In analyzing the dialogue from that perspective, I feel the most disturbing part of the interaction is based on the familiar words “First do no harm“.

Ron Paul graduated from Duke University School of Medicine. He then went on to serve as a surgeon in the air force during the Vietnam War. Ron Paul had to have seen young people die senselessly and tragically. As a physician schooled in western medicine, Ron Paul would also know the words “First do no harm.” The phrase is erroneously thought to be part of the Hippocratic Oath, an oath from an ancient Greek medical text.  This oath was often recited on graduating from medical school, as a reminder or commitment of sorts for the doctor as they entered a new phase of their education – that of learning to care for patients. A phrase in the Hippocratic Oath says “I will keep them from harm and injustice” and although the oath is no longer a part of medical education, the phrase “First do no harm!”is widely known and widely used.  Rooted in Latin, it forms the basis of medical ethics. Basically a physician is called to do good, and if he can’t do good, then at least don’t harm. It serves as a reminder that the possible harm of any intervention must always be considered before going through with the intervention.

This is where Ron Paul’s response to Wolf Blitzer bothered me. In the case that was presented, not intervening is the intervention, and not intervening causes harm. Not intervening causes a young man to die. The callous cry or jeer  “Let Him Die” should have been met with a strong response from Paul, a physician, with the words “First, do no harm”. The initial silence was an indictment, not only on him as a politician, but also as a physician and as a human being. His next words, that the hypothetical patient “should do whatever he wants to do” are equally indicting. Last time I checked, people who were being cared for in the intensive care unit of a hospital, didn’t necessarily have the ability to make decisions.

I understand the problem with the sky-rocketing costs in medicine. As a state government employee, I understand frustration with government waste and daily see the effects of inefficiency. What I don’t understand is his willingness to let jeers of “Let him die” from the audience win the moment. Let’s be clear, no one really remembers what he said after the loud jeers of “Let him die”. Even if he had something substantive to say, it was lost in the moment. As a politician, he has come a long way from his days in medical school and in this debate seemed to rewrite this well-known Latin phrase to say “First make sure that the patient has done all they can to help themselves. Only then will they be deemed worthy of treatment”.

No wonder he didn’t last long in the medical profession – letting people die is far easier than helping them to live.

2 thoughts on ““First Do No Harm”

  1. it is really scary that the question “Should we let him die?” prompted a cheer from some in the audience….

    you know how to get to the heart of the matter Marilyn! good job!


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