Psychiatrist Sabooh S. Mubbashar explores the complexities of the medical tenet “First, do no harm” and how its interpretation might negatively affect contemporary medicine. This phrase, often regarded as a vital element of the Hippocratic Oath, was actually a later inclusion. Mubbashar argues that taking this principle at face value makes most medical interventions problematic, as they intrinsically carry some level of harm. This disjunction may prompt clinicians to pursue excessively aggressive treatments, particularly in end-of-life situations, emphasizing intervention over the actual benefit to the individual.

In his conversation on The Podcast by KevinMD, Mubbashar stresses that the overly simplistic adherence to “do no harm” conflicts with patient autonomy and the anxiety of legal consequences, leading to choices that may be legally valid but lacking in clinical effectiveness. For instance, he points out instances where elderly patients suffering from severe dementia undergo invasive treatments with minimal advantage, causing increased distress instead. Mubbashar calls for a redirection from rigid compliance to potentially outdated principles towards a more nuanced comprehension of risk versus benefit, akin to what was originally intended in the true Hippocratic Oath. This perspective urges physicians to utilize their skills and discernment, acknowledging that ethical medical practices exist in complex shades rather than in unwavering declarations.

By addressing the challenges posed by defensive medicine and patient autonomy, Mubbashar promotes careful advanced planning and conversations regarding the quality versus quantity of life, particularly for at-risk patient demographics. By revitalizing this ethical dialogue, he aspires to align medical practices more closely with patient-centered results, minimizing suffering and enhancing the quality of care.