First, do no harm

Belisarius begging for alms

“Primum non nocere,” (first, do no harm) is a fundamental law drilled into medical practitioners and emergency medical technicians around the world. The principle dictates that, when faced with an existing issue, one must carefully select an action that does not cause more harm than good, even if that means doing nothing. It is intended to make the practitioner consciously consider the harm that any given action might cause.

A core principle of medical ethics, this dictum is equally applicable to a wide range of governmental policies and husbandry (the management and conservation of resources). A prime example: for many years we had a zero-tolerance policy regarding wildfires. Smokey Bear warned us to be careful and all fires were fought to a standstill. As a result, the natural process of undergrowth thinning was thwarted resulting in larger and more dangerous “crowning” fires. Further, certain species require fire as part of their lifecycle, the Giant Sequoia being a case in point. When it was observed in the 1960s that no new Sequoias were germinating due to fire suppression, it was determined that our fire suppression policies were causing harm. A more open-minded view now has us allow fires to proceed as a natural ecological process except where human lives or property are threatened.

In the political arena, we are not nearly as enlightened. Many government policies have been shown to inflict harm on the very constituencies they were intended to help. Some famous examples include housing policy which fueled the Great Recession of 2009, college grants and subsidies which fund a roaring inflation rate of tuitions, and generous welfare benefits which have led to a spectacular breakdown of the nuclear family, especially within the urban poor. These programs were all well intentioned; it is simply that the negative consequences were not adequately factored into the political calculus.

Why might this be? In a thought-provoking paper published earlier this year (“Concepts and implications of altruism bias and pathological altruism,” Proceedings of the National Academy of Sciences, April 9, 2013), researcher Barbara Oakley describes the concept of pathological altruism, that is, behavior that is intended to help but results in foreseeable harm. At root, as should be no surprise, is our very human desire to help combined with an almost innocent neglect of potentially harmful side effects.

We are wired to be empathetic, altruistic; the desire to help is in our DNA (with the exception of a relatively rare number of sociopaths amongst us). Early human clans survived more readily when they assisted each other. Altruism, therefore, is a natural tendency reinforced by evolution and subsequently enshrined in religious values. (Christianity, as one example, extols philanthropy and is well-known for its many charities).

But when it comes to the political process, when programs to help the poor or subsidize this group or that are debated, we tend to be overtaken by the emotional need to help and neglect the cold, scientific analysis of the reverberations our actions will actually create. Further, this altruism bias causes us to demonize anyone who dares suggest such an analysis. But in the end, it is the greatest good with the least harm that must be our goal, and reasoned analysis, without recourse to ad hominem attacks, is the only way to achieve that end.

Pathological altruism can be very dangerous. Dr. Oakley refers to the tens of millions of deaths caused in the twentieth century by appeals to altruism (Stalin, Hitler, and Pol Pot all cynically garnered support for their policies in that manner). She closes by proposing that pathological altruism is of such import that it should be the subject of focused scientific research. It is hard to disagree with that.