Skip to main content
NCBI home page
The Yale Journal of Biology and Medicine logoLink to The Yale Journal of Biology and Medicine
editorial
. 1978 Nov-Dec;51(6):655–667.

Primum Utilis Esse: The Primacy of Usefulness in Medicine

Lawrence J Nelson
PMCID: PMC2595590  PMID: 752199

Abstract

The famous and oft-quoted maxim “Do no harm” should not be thought of as the first principle of medical ethics. The documents of the Hippocratic tradition and clinical experience indicate that a more appropriate and helpful first principle would be “Above all, be useful.” The concept of usefulness implicitly rests at the very heart of medicine itself and the physician-patient relationship. The failure to adhere to this concept undermines the physician-patient relationship, dissolves the distinction between quacks and physicians, and destroys the integrity of the medical profession. The determination of useful medical treatment belongs to both physicians and patients. Any decision to initiate, continue, or discontinue diagnostic or therapeutic action has both a medical and a personal value component; the former properly belongs to physicians and the latter to patients. Practicing medicine with the intent of producing benefit and being useful to the patient is far more fundamental than practicing medicine to avoid harm.

Full text

PDF
655

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Braunwald E. Coronary-artery surgery at the crossroads. N Engl J Med. 1977 Sep 22;297(12):661–663. doi: 10.1056/NEJM197709222971209. [DOI] [PubMed] [Google Scholar]
  2. Callow A. D., Resnick R. H., Chalmers T. C., Ishihara A. M., Garceau A. J., O'Hara E. T. Conclusions from a controlled trial of the prophylactic portacaval shunt. Surgery. 1970 Jan;67(1):97–103. [PubMed] [Google Scholar]
  3. Cassell E. J. Treating patients for both is the healer's art: Illness and disease. Hastings Cent Rep. 1976 Apr;6(2):27–37. [PubMed] [Google Scholar]
  4. Chalmers T. C., Block J. B., Lee S. Controlled studies in clinical cancer research. N Engl J Med. 1972 Jul 13;287(2):75–78. doi: 10.1056/NEJM197207132870205. [DOI] [PubMed] [Google Scholar]
  5. Chalmers T. C. Randomization and coronary artery surgery. Ann Thorac Surg. 1972 Sep;14(3):323–327. doi: 10.1016/s0003-4975(10)65235-6. [DOI] [PubMed] [Google Scholar]
  6. Collins V. J. Limits of medical responsibility in prolonging life. Guides to decisions. JAMA. 1968 Oct 7;206(2):389–392. [PubMed] [Google Scholar]
  7. Evens R. G. Computed tomography reflections on a controversy. N Engl J Med. 1978 Feb 9;298(6):334–335. doi: 10.1056/NEJM197802092980611. [DOI] [PubMed] [Google Scholar]
  8. Goodfield June. Reflection on the Hippocratic oaths. Stud Hastings Cent. 1973;1(2):79–92. [PubMed] [Google Scholar]
  9. Gordon R. S., Jr Clinical trials. N Engl J Med. 1978 Feb 16;298(7):400–401. doi: 10.1056/NEJM197802162980711. [DOI] [PubMed] [Google Scholar]
  10. Hiatt H. H. Lessons of the coronary-bypass debate. N Engl J Med. 1977 Dec 29;297(26):1462–1464. doi: 10.1056/NEJM197712292972611. [DOI] [PubMed] [Google Scholar]
  11. Hiatt H. H. Protecting the medical commons: who is responsible? N Engl J Med. 1975 Jul 31;293(5):235–241. doi: 10.1056/NEJM197507312930506. [DOI] [PubMed] [Google Scholar]
  12. Imbus S. H., Zawacki B. E. Autonomy for burned patients when survival is unprecedented. N Engl J Med. 1977 Aug 11;297(6):308–311. doi: 10.1056/NEJM197708112970605. [DOI] [PubMed] [Google Scholar]
  13. Ingelfinger F. J. Bedside ethics for the hopeless case. N Engl J Med. 1973 Oct 25;289(17):914–915. doi: 10.1056/NEJM197310252891712. [DOI] [PubMed] [Google Scholar]
  14. Jaffe N., Frei E., 3rd, Traggis D., Bishop Y. Adjuvant methotrexate and citrovorum-factor treatment of osteogenic sarcoma. N Engl J Med. 1974 Nov 7;291(19):994–997. doi: 10.1056/NEJM197411072911902. [DOI] [PubMed] [Google Scholar]
  15. Jonsen A. R. Do no harm. Ann Intern Med. 1978 Jun;88(6):827–832. doi: 10.7326/0003-4819-88-6-827. [DOI] [PubMed] [Google Scholar]
  16. Lewis H. P. Machine medicine and its relation to the fatally ill. JAMA. 1968 Oct 7;206(2):387–388. [PubMed] [Google Scholar]
  17. Mechanic D. Approaches to controlling the costs of medical care: short-range and long-range alternatives. N Engl J Med. 1978 Feb 2;298(5):249–254. doi: 10.1056/NEJM197802022980505. [DOI] [PubMed] [Google Scholar]
  18. Moertel C. G. A trial of Laetrile now. N Engl J Med. 1978 Jan 26;298(4):218–219. doi: 10.1056/NEJM197801262980413. [DOI] [PubMed] [Google Scholar]
  19. Parer J. T. Benefits and detriments of fetal heart rate monitoring. Semin Perinatol. 1978 Apr;2(2):113–118. [PubMed] [Google Scholar]
  20. Ramsey P. The ethics of a cottage industry in an age of community and research medicine. N Engl J Med. 1971 Apr 1;284(13):700–706. doi: 10.1056/NEJM197104012841305. [DOI] [PubMed] [Google Scholar]
  21. Ruffin J. M., Grizzle J. E., Hightower N. C., McHardy G., Shull H., Kirsner J. B. A co-operative double-blind evaluation of gastric "freezing" in the treatment of duodenal ulcer. N Engl J Med. 1969 Jul 3;281(1):16–19. doi: 10.1056/NEJM196907032810104. [DOI] [PubMed] [Google Scholar]
  22. Sandulescu C. Primum non nocere: philological commentaries on a medical aphorism. Acta Antiq Hung. 1965;13:359–368. [PubMed] [Google Scholar]
  23. Shannon T. A. What guidance from the guidelines? Hastings Cent Rep. 1977 Jun;7(3):28–30. [PubMed] [Google Scholar]
  24. Veatch R. M. Hospital ethics committees: is there a role? Hastings Cent Rep. 1977 Jun;7(3):22–25. [PubMed] [Google Scholar]
  25. Weinstein M. C. Allocation of subjects in medical experiments. N Engl J Med. 1974 Dec 12;291(24):1278–1285. doi: 10.1056/NEJM197412122912405. [DOI] [PubMed] [Google Scholar]

Articles from The Yale Journal of Biology and Medicine are provided here courtesy of Yale Journal of Biology and Medicine

RESOURCES