A few weeks ago, part of one of my molars broke off as I was eating an energy bar. I was in no pain, but obviously it needed to be repaired. My dentist ground off the top of the tooth and put a ceramic cap on it. Now the tooth hurts when I eat or drink. (Maybe “hurts” is too strong. It’s sensitive.) Have you heard the Latin expression “primum non nocere”? It means (literally) first do no harm. The word “first” might be misunderstood. It has logical rather than temporal significance. The expression is best translated as “Whatever you do, don’t make things worse” or “The most important thing is not to make things worse.” Making things better is important (that’s why the patient came to see you, after all), but it’s of less importance than not making things worse. Note the baseline. It’s the situation as it exists when the patient presents for treatment. The doctor’s job is to elevate you above the baseline and never to cause you to fall below it. My dentist made things worse—and got paid for it.

Addendum: The dictum can be cashed out in terms of principles. It says that the principle of nonmaleficence (not doing harm) is weightier than the principle of beneficence (doing good). This is the position of W. D. Ross, although (1) he speaks of prima facie duties rather than principles and (2) he speaks of stringency rather than weightiness. Ross says that the prima facie duty of nonmaleficence is more stringent than the prima facie duty of beneficence. Note that these are prima facie duties, not ultima facie duties. Ross is not saying that one may never harm others. He is not even saying that one may never harm another in order to benefit someone else. He’s saying that harming others must be justified, i.e., that there is a (strong) presumption against it. It might be permissible to inflict a minor harm on one person in order to produce a major benefit to another. Contemporary moral philosophers refer to the rule against harming others as an agent-centered restriction. Deontologists such as Ross accept, while consequentialists reject, agent-centered restrictions.

Addendum 2: Time to get back to my yard work. I took a break from sawing boards to write this post. (I’m tearing down the wooden fence around my property as preparation for having a new one put in. The sawed boards will keep me warm this winter.)