Summary: All doctors take a Hippocratic oath that says, “First, do no harm.” Many policymakers and physicians justify the no use of opioids based on this doctrine since they say that opioids have the potential to cause harm. However, health experts warn doctors to avoid an oversimplistic approach to this doctrine. If the benefits from any intervention, including opioids, outweighs the risk, then its use is justified. It is worth understanding that any medical intervention poses some health risks.
The opioid epidemic is ongoing, and regulatory agencies are pressurizing doctors to avoid prescribing opioids. Therefore, many physicians have become hesitant, failing to provide sufficient pain relief to many patients. Most physicians say that, after all, it is their duty to “First do no harm,” as they have taken the Hippocratic oath.
That is theoretically true that doctors must try their best never to do any harm. However, oversimplification of this directive may harm patients in other ways. If an intervention does some harm but more good, it is justified. Thus, experts say that doctors should avoid that oversimplistic approach. Moreover, the directive does not say that doctors should never provide treatment that may cause some harm. It is a balancing act.
As health experts say, if we strictly follow the directive “do no harm,” it would not be possible to treat patients. Most of the lifesaving interventions would cause some harm. Even a CT scan or MRI does some harm. Vaccines can cause side effects, and so do most medications. Thus, doctors might need to limit themselves to soothing words if they want to avoid any risk.
Understanding the double effect philosophy
Health experts explain that “First, do no harm” is not about standing helplessly, especially when someone is going through severe pain. To better interpret this directive, we must turn to philosophy.
Almost all philosophical doctrines, whether western or eastern, say that some harm is justified if done with the best intention. Thus, double effect philosophy, as mentioned in the Stanford Encyclopedia of Philosophy, explains that some harm is acceptable if you are trying to make a positive difference. But, of course, good intention is insufficient to explain some action, and one must ensure that the benefits of any interventions would outweigh possible harm.
No one negates that opioids may cause some harm and pose certain health risks. However, doctors often need to prescribe them when other pain relief modalities have failed. Doctors may even sometimes need to prescribe opioids at high dosages. However, they know that it is the only way to provide pain relief and that, if any harm occurs, it is mostly not significant or manageable.
Doctors are faced with such a dilemma not only when prescribing opioids but just when considering any intervention. Yet, unfortunately, opioids have been unjustly demonized, creating fear among laypeople, lawmakers, and physicians.
Not prescribing opioids may cause harm
In many cases, doctors prescribe opioids when there is no other option, and not using these medications may cause significant distress to patients. Just consider people living with severe cancer pain and older adults living with chronic pain issues. Constant pain may hasten the desire for death in these people. On the other end, opioids may provide much-needed relief.
Of course, opioids are also needed in young people. However, doctors can avoid harm by prescribing them responsibly. But health experts warn that it should not mean aggressive tapering, leaving patients in much pain and distress.
Health experts further explain that the interpretation of “First, do no harm” is different for lawmakers and physicians. For lawmakers, it is essential to prevent anything that may do harm. However, for doctors, it is all about weighing various options and selecting the best option, even if it causes some harm. For doctors, the ability to provide significant pain relief may be more important in many clinical situations.
It is the ethical duty of doctors to help people heal, treat the sick, and even help dying individuals. Hence, misinterpreting “First, do no harm” may cause pain to the patients and prevent doctors from adequately fulfilling their duties. Doctors must understand that one-size-fits-all is not the right approach.
