Trigger Warning: Self-harm, Suicide.
When Hippocrates uttered the words “First, do no harm”, he probably thought he was being perfectly clear. After all, harming patients is the exact opposite of providing medical aid. Unfortunately, thousands of years later, the exact definition of causing harm is up for debate. With the massive rise in malpractice lawsuits brought against medical professionals in recent years, it is perhaps unsurprising that medics are becoming less willing to take even the smallest risk, choosing to do nothing instead.
There are times in healthcare when doing nothing is the right course of action to take. In most cases the common cold will burn itself out in a matter of days, and plenty of scrapes and bruises will heal on their own. Sometimes it is even worth seeing whether a patient’s condition stabilises before subjecting them to a particularly risky treatment. Occasionally there really is nothing that can be done beyond making a patient comfortable in their final days.
There are also times in healthcare when taking action as soon as possible will greatly improve a patient’s outcomes, such as diagnosing a cancer before it has metastasized. Even in cases where it is not necessarily a case of life or death, choosing to treat a disease rather than let it run its course will help someone maintain a good quality of life, although of course it is hard to measure the efficacy of something so subjective. I, among many others, am far too familiar with the consequences of subjective measures not being taken seriously.
When I contracted meningitis as a teenager, the local doctors surgery was closed for training, and the hospital wouldn’t take me unless my condition declined. I cannot help wondering how my life would have turned out had medical intervention been offered. If nothing else, it is impossible to convince any medic I meet now that I once had meningitis, because I was not given medical aid at the time.
About a year later I went to the GP and mental health services reporting a disconcerting emotional numbness, and the general lethargy and disinterest typically seen with depression. A diagnosis was refused on the basis that I would look it up and decide I had more symptoms, and proper treatment could not be given without a diagnosis. The result was that my depression declined unchecked, leading to two suicide attempts and a long-term battle with self-harm. Now I will likely be on anti-depressants for the rest of my life.
Throughout all of this I was presenting with extremely heavy and irregular periods, and intense pain in the lower abdomen that peaked and troughed throughout the month but never really went away. There was a family history of endometriosis but it was clearly just puberty, even when symptoms persisted on the contraceptive pill. It took over a decade to reach a diagnosis of endometriosis, and even with this diagnosis I have been repeatedly refused adequate symptom management. Given that it is impossible for me to get pregnant due to other medical issues, essentially rendering my reproductive organs a useless pain-generating object, I have begged for a hysterectomy. This has also been refused because I’m too young to make such a drastic decision. The horrifying truth here is that, without intervention, the endometriosis will likely keep spreading throughout my abdomen.
It would appear that in the medical setting, doing nothing and allowing harm to happen is not considered to be the same as actively causing harm, and as such deciding not to take action fits within the scope of the Hippocratic Oath. I beg to differ. The choice to do nothing is a valid choice, and sometimes it is the right choice, but it is still a choice. Doing nothing is an action that carries certain risks; it is simply a case of balancing those risks against the risks and benefits of the actions that could be taken instead. This of course is easier said than done, but I firmly believe that re-framing “first, do no harm” with an understanding of what it actually means to do nothing could save lives. I also have to believe that this opinion would be shared by Hippocrates himself.