Doing No Harm

During a conversation with Research Director, Samer Araabi, last week, the concept of Do No Harm came up a handful of times. This three-word motto is a complicated principle that requires careful understanding of its definition and its application to real-life issues.

Accountability Counsel does not take unilateral positions on many specific issues, such as with the use or mining of coal. Instead, it focuses more on the needs of individual groups. If a community were to argue that a coal plant would best suit the community’s needs, then AC would support that.

But while simple statements such as “Do No Harm” seem universal and all encompassing, this same simplicity often allows for harms to fall through the cracks. The convoluted definition of words, the application to unique circumstances, and the lack of account for power structures are problems we are all quite aware of at Duke, especially knowing the difficulties of creating Hate and Bias Policy. Banning hate speech flat-out without careful subordinate clauses and diction to ensure its equitable enforcement and understanding would most certainly complicate, if not exacerbate, many of the problems Hate and Bias Policy seeks to address. It’s one of the many reasons Hate and Bias Policy has been deemed so difficult to enact, including the university’s proven lack of concern for marginalized people, and a powerful example of the impacts legal wording can have.

And to my understanding, almost every action in our society does some harm despite any intentions otherwise. Even the most seemingly vegan, ethically sourced decisions or products may carry underlying implications that create harm for certain groups around the globe. So how can Accountability Counsel do none of it ever?

In many ways, harm occurs earlier in the process than Accountability Counsel’s involvement. Often times, Accountability Counsel seeks to address instances of harm by facilitating conversations, providing legal support, and sharing valuable resources with communities that internationally financed development projects harmed. But what about the times in which AC creates harm?

To answer this question, I look to the protests happening in Raleigh, NC for the past 37 days. The range of attacks on the Black community addressed at these protests, from policing to SB168, has spurred dialogue about the racism manifested in other professions most intertwined with community needs. What about doctors, medical examiners, teachers, or lawyers?

Doctors take the Hippocratic Oath swearing essentially to do no harm, prevent harm, and treat the impacts of harm. As many people have come to learn, the medical industry does much to disadvantage and sometimes kill Black Americans, especially Black women. Failing to diagnose, maintaining inaccessibility, and stereotyping are typical harms brought about by doctors who swore to do otherwise. Unsurprisingly, taking the oath was never enough.

We are seeing this tragedy come to fruition once more with widely disparate rates of infection and deaths due to COVID-19 among poor, communities of color. Engaging with the messages put out by protestors, however, certain aspects of the medical industry are beginning to change. While systemic change among medical centers is not universal, many doctors, companies, and hospitals are considering their individual role in propagating white supremacy culture.

So, is the principle to Do No Harm enough for Accountability Counsel? While I’m certainly not one to decide, I will mention the ways they try to live out this principle equitably and in the present with supplemental ethical guidelines.

Harking back to my previous example, if a community were to demand a coal mine, but this time the decision was made without the input of any women, Accountability Counsel would ask them to please do so. While it would be problematic and paternalistic to tell a community a coal mine would not best suit their needs, there can’t be much wrong with ensuring that diverse perspectives informed the community’s decision.

On their own end, Accountability Counsel encourages much internal dialogue about its role and the space it operates within. Weekly articles and updates concerning the movement for racial justice, as well as flexible conversations about the impacts of our work, constitute a majority of the dialogue that exists across the entire organization.

I would like to add Do No Harm to my code of ethics, but I know engaging past the basic understanding of the words is essential to ensuring such a basic principle plays out equitably. Like Accountability Counsel, I have much to learn and I welcome dialogue and criticisms concerning my engagement with systems of oppression. I also know, like AC does, I must hear diverse perspectives and I must listen. It is imperative that, to do no harm, we first hear and see how we are harming.

Unfortunately, some harm is unavoidable for doctors, myself, and Accountability Counsel, but that doesn’t mean we shouldn’t try to reduce it. Instead, it means we must be even more careful, cognizant, and willing to listen. It means we must hear criticisms, adapt, improve, and move on. Doctors, police, and the President all take oaths, but that is only the first step. Next, we must critically engage with these oaths, apply them with an awareness of power, and adapt them to our society. How can we say Do No Harm if we are unwilling to acknowledge the harm in all we do?