First, Do No Harm

The phrase, “First, do no harm,” is often ascribed to the Hippocratic Oath. Though it is not part of the oath it appears in another ancient medical treatise attributed to Galen. Over thousands of years, it has come to embody the ethic of the medical profession. Every medical school graduate in this country accepts a version of the Hippocratic Oath, which is the foundation of the medical ethics that we practice daily. The recent reports that physicians and medical students have been identified as part of the terrorist group that is behind the attempted bombings in Glasgow and London brings a chill to the heart to those of us in the medical profession.

Every day, doctors, nurses, medical students and allied health professionals all over the world use their education, training, experience and skill to save lives and relieve suffering. From elaborate private clinics to makeshift jungle hospitals, dedicated practitioners work tirelessly to improve the lives of their patients. From our first experience working with patients, we are taught that we must be constantly vigilant about our decisions, both commissions and omissions, which may impact the health of our patients. It is unconscionable, abhorrent and inconceivable that anyone trained in the healing arts can believe that the taking of innocent lives can bring about a greater good.

Granted, there are bad apples in every profession, and that greed, corruption and dishonesty can occur at any level. The inhumane experimentation that occurred in German concentration camps by physicians in the name of science is a reminder of the fallibility of our profession. But for physicians, trained in the art and science of healing, maliciously taking hundreds or possibly thousands of lives including their own, strikes to the core of our profession: First do no harm! Because these individuals have not done their duty to improve lives instead of choosing to take them, how many will be deprived by the lack of care those individuals might have provided?

As I have discussed these events with colleagues, several interesting observations have emerged. One opinion that it is “about time” that the influx of marginally trained and questionably-motivated graduates of some foreign medical schools be looked at more carefully. Are these individuals really “doctors” in the sense that we in the US consider our care givers? Do they have the same sense of the sanctity of human life? The British face a shortage of physicians, and use foreign trained doctors to help man their system. Are they screened as carefully as they should be? How did these individuals reach their level of responsibility without some indication of a problem?

Another colleague questioned whether the experience of some foreign physicians, frequently trained in the worst of circumstances, allows them to have the same sense that every life is important, that we readily accept in this country. All are shocked by the nature of the acts.

I have several extremely competent and caring colleagues who are foreign-trained, and do not want to give the impression that all foreign-trained doctors are inferior in some way, but none of my foreign trained colleagues would consider the terrorist attempts in Great Britain to be the acts of a true Doctor of Medicine. We in the medical profession do not condone, support, sympathize or empathize with the acts planned and attempted by the accused terrorists, and have difficulty thinking of them as “doctors.” I can only assume that the doctors involved no longer consider themselves healers, and have accepted their role as terrorist fanatics. The two tasks are incompatible.

Every day my colleagues and I struggle with the “what if’s” that occur in our profession. What if we had detected that tumor earlier, what if we had a drug that would treat Alzheimer’s, what if the patient had come to us sooner with their symptoms of chest pain? I ask, what if these suspected terrorists had used their education and standing in their respective communities to work for an understanding between our cultures, and prevent, rather than cause terrible acts of violence against innocents?