Do No Harm, from Principle to Practice
From ancient times, the principle First, do no harm is about medical ethics, and up to now the Hippocratic Oath includes the promise "to do good, and to abstain from doing harm". Nowadays, it is also common practice for humanitarian evaluations to include a critical assessment of how an organisation / programme is living up to the principle of ‘Do No Harm’. Since 1994, this principle is part of the Code of Conduct of the major humanitarian NGO’s (including the Red Cross Movement). The Sphere Project (Humanitarian Charter and Minimum Standards in Humanitarian Response, first published in 2000) even starts with this same Protection Principle: Avoid exposing people to further harm as a result of your actions.
However, a practical guide about how to transform a principle into a workable practice is, as far as I know, only developed for the area of conflict sensitivity and peacebuilding. Here and there it is applied to develop a do-no-harm-framework related to gender. For example my own article of 1 October 2017: Gender analysis in the coffee value chain using the Do No Harm approach, written together with a colleague-consultant.
I learned a lot from writing this article and the related study involved.
- First of all, international standards are indeed indispensable to hold organisations accountable for their interventions, but a principle alone is by no ways enough: it needs translation into organisational behaviour in all layers. And this behaviour should continue to be subject to external independent check and balance (like the evaluations I do). Organisational automatic pilots are common pitfalls, making their targets, vulnerable people, the ultimate victims in the end.
- Another point I noticed is that the Do No Harm principle never officially reached the international developmental and business scene as a standard, to be included in normal monitoring and evaluation procedures. While of course everybody knows many examples of the devastating effects when this principle is not respected. See for example the article in Vice Versa magazine of 26 May 2017, Vrijdagmiddagborrel: do no harm by Marc Broere, about chocolate in Honduras and the un‐ethical behaviour of big international companies destroying smaller family farming businesses, thus weakening the cocoa‐sector. He concludes that the Do No Harm principle is present in the sector, but that the practice leaves too much to be desired.
- The encouraging thing I learned is that there is no need to reinvent the wheel: the Do No Harm approach as a framework is already developed (in the 1990’s by Mary Anderson and published by the organisation Collaborative for Development Action-CDA). And the tool developed by Marshall Wallace, ‘From Principle to Practice, A user’s guide to Do No Harm’, revised in 2016, is downloadable on www.principletopractice.org. So there is no excuse to not critically revise our own intervention practice, since Actions and Behaviour have Consequences (ABC). Interventions have an impact through resource transfers and through the messages sent by behaviour (Wallace 2016: 57). Impact can be positive or negative. Avoiding negative impact is a critical must in all planning and programming!
- Do No Harm is a negative statement as such. However, it is far more than avoiding harm and negative impact. In all the literature the principle appears at the same time as an active search to Do Good. Not in the meaning of ‘charity’, because in the name of charity I come across of harmful and negative impacts as well. But in the sense of ‘the cure must not be worse than the disease and the intervention must not destroy (or harm) that which it is meant to help’. Do Good needs knowledge, analysis, and professionalism. Because then, the story I started with would not have happened. I was taught about a similar case study as part of my developmental learning 30 years ago…in fact I was shocked during the evaluation. ‘Do Good’ is most of all the ethical standard that we consider the wellbeing of the other (person, organisation, society) from their perspective, apart from and beyond our intervention. To this end, the 7 steps of Wallaces ‘User’s guide to Do No Harm’ are very helpful and easy to apply. At its core is the analysis of dividing and connecting issues and actors, which should be done with local partners and regularly updated during project implementation.
My conclusion for HildeConsult: I will be more alert, not only preaching but also practicing the adagio: Do Good in the light of Do No Harm, and continue to facilitate others to do the same!