The Grand Illusion
According to various accounts, one of the basic principles of the legendary Greek physician Hippocrates was, first, to do no harm. From what I’ve seen in my life, that prescription is valid as a first precept in just about everything.
That said, I suspect we all know people who feel that you’ve harmed them if you don’t do what they want. If you fail to cook a favorite food for a partner or guests, but you’re still feeding them, that’s not harm. If you refuse to go to bed with someone, it’s not harm. Both may occasion disappointment, but they’re not harm. Now… some people are so violent that your failure to meet their expectations can result in harm to you, and that’s another aspect of the “harm” issue, and one with which society has great difficulty handling.
And sometimes, failing to do something is harm. If you don’t throw a rope to someone drowning, that’s harm. If you fail to feed a starving child, that’s harm. And, equally, there are times when we don’t know honestly know whether not doing what someone wants will cause harm.
But, for all those possible exceptions and ambiguities, I suspect that most of us have a clear idea of what acts, or failures to act, will cause harm. So why do we often act in ways that harm others?
One big reason is that, in today’s complex world, we don’t recognize [or sometimes just refuse to acknowledge] acts, or failures to act, as harmful. As just one example, allowing coal-burning power plants and other fossil fuel burning industrial enterprises to emit high levels of pollutants does in fact harm millions of people. And yes, requiring present emissions controls will cause certain facilities to be less profitable or others to close. But the lost profits and jobs, especially in the United States, are small compared to the health impacts. Yet something like 30% of Americans are in favor of relaxing such controls. Why? Because a lost job is seen as far more important than a vague concern about health. Except, especially in areas like Salt Lake or the Denver Front Range corridor, those health concerns aren’t vague, not if you’re young or old or asthmatic, struggling to breathe. Although U.S. deaths from air pollution have decreased, something like 71,000 Americans died last year from the effects of air pollution. By comparison, there are only some 55,000 coal industry workers. Unhappily, a great number of them will likely also die young because of black lung disease. So, why, exactly, are so many people backing Trump’s harmful proposals to weaken air pollution standards in order to save the coal industry? At present, the employed U.S. workforce is around 130 million people. 55,000 coal workers are slightly more than four one-hundredths of one percent [.0004] of the workforce. Not only that, but in many areas, burning natural gas, while not ideal, emits far fewer pollutants and is less expensive.
Another reason for allowing harmful practices to continue us because those practices don’t harm us personally (or we don’t seem to think they do) and we believe they result in more material gain for us, and at least some of us assume that others also benefit, and, all too often, those who are harmed have neither the voice nor the power to stop the harm.
But all the rationalization and justification doesn’t mean that such harms don’t exist, only that we as a society have chosen to do nothing about them.
Just a quick comment on the coal vs. oil vs. natural gas issue: natural gas is not only cleaner and can be more cost effective, it is also very much an American natural resource, as very large amounts of natural gas are located in (under) our country. The only reason why it is not a more effective choice for vehicles is that the infrastructure (i.e., refueling stations available for highway traffic) is not currently adequate for replacing gas and diesel. That, and the influence of the petroleum industry which has an obvious reason to not want vehicular fueling to switch to CNG (Compressed Natural Gas).
BTW, Happy Holidays to all, and, once again, thanks to you, LM for all the great books that I enjoy so much.
“First, do no harm.”
It’s a nice thought but it is a fatuous thought – overly simplistic. It reminds me of the neo-Pagans who say “An it harm none, do what you will.”
Any action, taken to its final conclusion, will cause harm.
To borrow from LEM: the Farhkans admit that they are thieves but not liars. Any living being that survives to live another day has caused harm – either to another being, the environment, someone else’s economy, etc. Is our duty to not cause harm? Is it to cause the least harm possible while living as full a life as possible? What if it means that you have to restrict your experiences, comfort, or survivability?
If one wishes to limit the discussion to medicine, then let’s look at the concept of social justice in medicine. If Patient A needs a new liver and will die without one, is she more or less worthy because she killed her liver due to a tylenol overdose? What if the liver might help Patient B, who is also dying but he’s in trouble because of liver cancer? What if Pt A will die imminently (say, within a month or two) and Pt B is somewhat responding to chemo and that might buy him 6-8 months?
What if an insurance company decides that it will no longer pay for any disease related to tobacco use? How about 2nd hand smoke? What if the smoker is an ex-smoker with 20 years of no smoking and yet still gets lung cancer?
“First, do no harm” is easy when there are few choices in medicine such as the physicians of Hippocrates’ time in 400 BC. Things are a little difference 2500 years later.
Absolutely… do no harm is simplistic, but it’s a damned good basic principle, and like all good principles, needs to be just that — a good guideline, not an absolute.
While I generally agree, I fail to see how “not using coal” is a bad-deed-by-doing-nothing. Do you come to that conclusion because we started using coal before we know that is was (in large usage) harmful to the environment? Isn’t using coal simply a bad thing?
As far as I’m concerned, continuing to use coal is a bad thing. So is failing to do something to stop it. That was the point I was trying to make. Allowing coal-burning to continue is a bad thing.
unfortunately, your math appears to be weak: 4/100th of a percent is.04, not .0004, which would be 4/10000th of a percent. Otherwise I find myself in agreement.
No… you misread, or I wasn’t clear. .0004 of the number is 4/100th of one percent of that number.