Harm

As a keyword in health care, harm possesses the characteristics of what the rhetorician Richard Weaver (1953) refers to as a devil term. A devil term is a rhetorical absolute in a particular culture that when expressed causes almost universal revulsion. While there are a number of devil terms in medicine and the health humanities—such as suffering, objectification, and dehumanization—harm is a particular type of devil term: an ultimate one, or “prime repellent” (Weaver 1953, 222). Harm is also the foundation of several other key concepts in medicine, such as nonmaleficence (the duty not to cause harm), risk (the potential harm that might be caused directly or indirectly by a medical intervention), and even beneficence (which includes the positive moral duty to prevent harm). Finally, the often-quoted Latin dictum primum non nocere, commonly translated as “first, do no harm,” demonstrates that harm is not simply something that should be avoided but something the avoidance of which should in most cases take priority in medical practice. This status can be discerned in the manner physicians’ writings assume that evoking primum non nocere will end any further debate on a topic. So one can find primum non nocere used by physicians to argue against capitation (Thomison 1987), for routine digital rectal exams (J. A. Moran 1992), against physician-assisted suicide (Lema 1993), and for psychiatrists’ involvement in the state-sanctioned torture of prisoners (Kottow 2006).