What is non-maleficence in health care?

Maleficence means doing harm to others, and so, non-maleficence means not doing harm. The idea of non-maleficence as a fundamental part of health care is thousands of years old. The phrase first, do no harm––which demands that non-maleficence take precedence over all other ethical concerns––is central to medical ethics.

Non-maleficence involves avoiding treatments whose risks are too great and outweigh any potential benefit. But it also entails not subjecting a patient to treatments that are pointless and would be ineffective.

Sometimes, non-maleficence can be tricky to navigate. Some treatments––for example, chemotherapy––that will ultimately benefit a patient can themselves cause pain, discomfort, and negative side effects. Without chemotherapy, many cancer patients would live much shorter lives, and so, it is seen as a life-saving measure and, therefore, an act of beneficence. However, while undergoing chemotherapy, patients can experience hair loss, nausea and vomiting, muscle and nerve problems, fatigue, infections, and anemia.

So, in the case of chemotherapy, a health care professional must do some measure of harm in order to bring about an ultimate benefit for the patient. For patients with early-stage cancer, the treatment would likely be worthwhile based on the likelihood of ultimate success. But for patients with late-stage, metastatic cancer, the benefits of chemotherapy might be limited and the harm could easily outweigh the benefits.

A health care professional must acknowledge that virtually any treatment or procedure comes with its own set of risks. The ethical dilemma that must be addressed with regard to non-maleficence is determining when an acceptable risk (in which the potential benefits outweigh the harm) becomes an unacceptable risk (in which the harm outweighs the benefits). Even a seemingly obvious principle of medical ethics––that of doing no harm to patients––can involve an extensive ethical gray area.