The Hippocratic Oath.
It’s the bedrock of medicine.
Tracing back to ancient Greece, its principles are still followed by doctors today. The text sets a baseline of ethical practices for treating patients.
When translated into modern English, the Hippocratic Oath is 377 words long. But just three of those words seem to garner outsize attention.
Do no harm.
The implication of these words is that physicians must weigh risks and opportunities. The benefit of a particular version of a treatment or intervention might not be worth the costs. Anything that risks harming a patient — even in the service of healing — should be avoided.
Doctors use this heuristic in their everyday practice. So do many other arms of the industry, such as pharmaceutical developers and even regulatory entities in Washington.
There’s a good reason why medical research takes so long to deliver greenlighted treatments. And there’s a good reason why doctors ask us a litany of questions before making a diagnosis.
Do no harm is that reason.
The Hippocratic Oath has built quite a reputation. But it might have become a victim of its own success.
The oath has worked such wonders in the medical field that other industries have sought to adopt it as well.
Do no harm is now part of the fabric of many types of companies. For instance, Google had the words Don’t be evil within its corporate credo for many years.
The rationale behind this shift is sensible enough. Companies are most effective and efficient when growth charts point up and to the right. Harm threatens that reality.
But in practice, it’s hardly ever that simple.
You see, in the medical field, results live on one axis — that of the patient. Physicians, pharmaceutical firms, and others aim to help the patient recover and function optimally.
This objective is inherently self-contained. Except for cases of infectious disease, the patient’s ailments don’t directly impact the community. So, those in the field can focus on the patient, free of competing interests.
There can be complications, of course — insurance billing quandaries, the price of treatments. But even those purveyors are grounded by a common North Star — the outcome of the patient.
If the patient doesn’t improve, the cost to the insurer skyrockets, and the legitimacy of the pharmaceutical treatment plummets. Neither outcome is good for business, so improved outcomes are critical.
Other industries are not set up with this alignment. The stakeholders operate on different axes and often compete for prominence.
Industry leaders must often walk a tightrope, balancing these interests in search of the most harmonious solution. Much like a blanket that’s too small to cover an entire bed, these solutions rarely make everyone happy.
Given this context, do no harm seems idealistic and nearly impossible outside the medical sphere.
Someone is going to get hurt. The question is who, and how badly.
When you think of famous figures in business, who comes to mind?
Warren Buffet, maybe. Or Henry Ford. Or maybe even John D. Rockefeller.
I doubt Milton Friedman will top that list.
But perhaps he should.
The late economist had an outsized impact on the world of modern business. Friedman’s accolades are vast, including a Nobel Prize. But one piece of his work stands above the rest — a 1970 New York Times article that introduced what came to be known as The Friedman Doctrine.
The Friedman Doctrine states that one priority stands out above the rest for corporations — to maximize return for shareholders. This philosophy — known as Shareholder Theory — posits that profit stands above all other corporate objectives.
In the half-century since this article was published, companies have taken Shareholder Theory to heart. Valuations have soared, innovation has skyrocketed, and many have gotten rich.
Shareholder theory has proven to be a worthy North Star for big business, and our entire economy.
But the gains of this philosophy haven’t been universal. Indeed, many parties have been harmed by Shareholder Theory.
Workers for one. Employees could once expect job security in exchange for performing their duties. But if those duties don’t lead to strong company stock results, those employees can find themselves replaced.
Sustainability is another victim. To maximize profits, companies tend to cut costs. And the cheapest option can often harm the environments of communities along the supply chain.
And social causes also find themselves maimed. Where a company stands on these issues has no import, according to the Shareholder Theory doctrine. Stock performance is where the bread is buttered.
With so many downsides at play, it should come as no surprise that some have vehemently opposed the Friedman Doctrine. And as this activism has picked up steam recently, it’s set up a dilemma for corporate leaders: Do what’s right for the community or do what’s best for shareholders.
Do no harm is out of the equation. Pick your poison has taken its place.
It’s tempting to shrug off the example of the business quandary. It might seem like a dilemma for executives in power suits to decide, rather than something that impacts our own lives.
Yet, we ignore this example at our own risk.
For we are living under the guise of a fantasy. One that tells us we can get what we want without anyone getting hurt.
This is simply not true.
In just about every aspect of our polarized society, our win is another’s loss. The burden of harm gets lobbed back and forth like a ping pong ball, depending on who’s in power and which way the wind is blowing.
Harm is unfortunate, but it can’t be fully avoided.
The sooner we accept this reality, the better. For it will allow us to mend fences with those who’ve been hurt by something that’s helped us, softening the blow for them as much as possible.
This fence mending should be our objective. It’s a North Star that provides some benefits to all, while staying in touch with reality.
So, let’s leave the Hippocratic Oath in the space where it belongs.
Do no harm is a noble ideal. But reduce harm is a goal we can attain.