Abstract

KIE: The physician's duty of "primum non nocere," or avoiding harm to the patient, has often been given moral priority over other duties in discussions of medical ethics. In this article in a British Medical Journal series written for nonphilosophers on the philosophical foundations of medical ethics, Gillon takes issue with the prominence given the obligation of nonmaleficence over that of beneficence. He argues that risking harm is often necessary to obtain therapeutic benefit, and that always giving nonmaleficence priority over beneficence in clinical decision making results in "therapeutic nihilism." These two important principles should counterbalance one another in medical care, with due respect for patient autonomy.