Do no harm versus the greatest good for the greatest number: health care and the clash of ethical imperatives.

Abstract

For two millennia, more or less, doctors all over the world have taken the Hippocratic oath to "do no harm." However, these words often have conflicted with social policy. Particularly in this century, some governments and other institutions have encouraged--or insisted on--placing the good of the state ahead of the duty to individual patients. Sterilizing "handicapped" and "feebleminded" persons in Germany long before the creation of the concentration camps is a prominent example of a program initiated under the guise of sacrificing few to improve the welfare of all. America likes to think it is fundamentally different from the Germany that carried out the sterilization program. However, the social and economic forces in Germany that placed national health above the principle of do no harm and encouraged doing the greatest good for the greatest number are similar to what is developing in America--a concordance between economic forces and a social philosophy that is willing to curtail access of some individuals to treatments that they need, want, and can pay for to achieve a hypothetical goal of better national health.