First, Do No Harm #COVID19



The statement “First, do no harm”, or “Primum non nocere” is often incorrectly attributed to the Hippocratic Oath but is thought to be derived from "to abstain from doing harm" in the oath.

No time since 1918 has the medical community faced a challenge like the COVID-19 pandemic we currently face. Beyond the thousands of patients, Department Chairs with their HR partners are facing a different application of this phrase.

Many healthcare facilities are recognizing three main categories of employees to prioritize in accommodations.

  1. Our teammates that are over 65 are clearly at a greater risk of poor outcomes with this virus.
  2. Any employees that are immunocompromised may have challenges with normal disease and this virus is substantially more challenging than average.
  3. The last category of risk is more defined by the lack of information about what can and will happen, our pregnant employees. Early indications are that the virus may not transmit from mom to the baby. Many other questions about the ability to carry to term and the risk of neonatal exposure to COVID-19 (Neonates are testing positive) will likely remain unclear for an extended period of time.

Reports in the media and in one clinical blog are heavily focused on the incredible need for proper personal protective equipment (PPE) and challenges with having enough for healthcare providers. Ethical challenges around who gets what equipment is something that will likely be discussed for decades to come. We will lose teammates in this like the other countries that have been impacted ahead of the US.

Placing front line team members into care when meeting any of the above three categories should be addressed with both clinical need and ethical responsibility in mind.

Can you answer these three questions:

  • Is it helpful to place this employee into the risky environment? 
  • Is there truly nobody that does not fit the at-risk category that can perform the job? 
  • And as a manager, is this employee taking on additional risk because of some other reason? 

Recently I heard of an example at another institution where an immunocompromised employee was being required to take care of patients when more than a dozen other non-immunocompromised employees had no clinical duties. It was likely helpful to have someone in this case. It is not true that the immunocompromised employee needed to be there with so many other people who had no assigned patient care duties. The employee had an active complaint against their manager.These questions help identify the medical and ethical challenges and indicate where action needs to be taken.

Another recent example involves an employee returning from travel to China by way of New York (Both CDC travel restrictions).This employee is a clinician and manager. Though the institution had told employees they would be required to quarantine if they traveled, this manager was returned for clinical need. It was likely helpful to have another clinician available. This person was not at risk but one sick person can take down an entire front-line service team that includes at-risk personnel and patients. This person was a manager and should have considered that they could eliminate their own team as well as other teams they work with. We have an ethical responsibility as HR professionals to ensure our clinicians and patients still have someone there to take care of them. Especially if staffing can be arranged. 

It is unfortunate that so many examples like these continue to be brought forward as we barely begin to address this pandemic.

This is our time to be ethically responsible and remember how important it is to protect our employees, patients, and “First, do no harm.”



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