Monday 6 July 2009

Member Care and the Hippocratic Oath, Part 4

The "Hippocratic Heart":
Doing Good and Avoiding Harm
Diego Rivera, The Vendor of Lillies

Non hay tan buen tesoro
como el bien facer
nin tan precioso oro
nin tan dulce placer.
Sem Tob, 14th century, Spain


Doing good is the greatest treasure,
Better than gold, better than pleasure.

“I will prescribe regimens for the good of my patients
according to my ability and my judgment
and never do harm to anyone.”

Hippocrates, 4th century, Greece

This portion of the Hippocratic Oath can be summarized in two words and also in two phrases: Benevolence—Do good and Nonmaleficence—Do no harm. So much of helpful and ethical health care practice is founded upon these timeless principles.
Applications for the "Hippocratic Heart"
1. Memorize. A suggestion: Do you know other languages besides English? If so, get an accurate translation of these two words and two phrases, especially in your heart language. Memorize them.
2. Competency. We practice within our level of competency (“ability and judgement”). We also acknowledge that we will be “stretched” at times in our practice, and may be called upon to help in ways that are not fully within our experiential, training, and certainly comfort zones. Is this OK? Consult with colleagues as much as possible in such situations. In addition and in general, get supervision as needed. Participate in peer supervision and group case consultations. These all help us in doing good (good practice) and avoiding ham (poor practice).
3. Love. The foundational principles of benevolence and nonmaleficence are clearly reflected throughout the New Testament. They can be seen as core principles founded upon the bedrock of “love”. Here are some quotes.
**Let love be without hypocrisy. Abhor what is evil; cling to what is good.
Romans 12:9
*Love works no evil to a neighbour. Love therefore is the fulfillment of the law.
Romans 13:10
**Let us not lose heart in doing good…let us do good to all people, especially those who are of the household of the faith.
Galatians 6:9,10
Reflection and Discussion
1. Primum non nocere--first, do no harm. Sometimes this principle is used without the accompanying principle of “doing good” What are your thoughts about the possible sufficiency of nonmaleficence?
2. Sometimes we are in situations when we are not sure of the best course of action or the best intervention/treatment. Nor are we able to foresee the consequences of our work. A classic example is if we help one person in a dysfunctional system, will that lead to positive change in the overall system as hoped or will it lead to greater problems for the healthier person and the system—e.g., the person may have to still reamain part of the dysfunctional system and may be dependent on the system as he/she tries to effect healthy change. Comment on such situations and give any examples in your life, practice, current international events, history.
3. It is helpful to make organizational applications of the principles of Benevolence—Do good and Nonmaleficence—Do no harm. For example, what practices can organizations put into place to make sure that leaders, staff, the ethos, policies etc. do in fact reflect these core Hippocratic principles?

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