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Non maleficence

Non maleficence is the duty to avoid harming patients, often summed up as "first, do no harm".

Updated 12 October 2026 (1 minute read)

Summary

  • Almost every treatment carries some risk, so in practice it means the expected benefit should outweigh the expected harm.
  • Harm includes side effects, pain and distress. Doing nothing can also cause harm.
  • It covers harm done by others. A doctor who sees patients being put at risk has a duty to speak up.

Interview questions

  • Surgery always carries risk. How can a surgeon claim to do no harm?
  • What is the difference between beneficence and non maleficence?
  • You see a colleague make a mistake that could hurt a patient. What do you do?

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Cases that turn on it

Birthmarks mistaken for bruises Non maleficence Most Asian and Black babies are born with blue grey birthmarks that can look like bruises. In 2024 a mother in Hampshire was held overnight by police after her son's were taken as a sign of abuse. Edenfield Centre abuse scandal Non maleficence The Edenfield Centre is a secure mental health unit in Manchester whose patients are not free to leave. In 2022 a reporter working there undercover filmed staff mocking and mistreating them. Indi Gregory and best interests Non maleficence Indi was eight months old and had a disease with no cure. Her parents wanted treatment to continue, and a hospital in Rome offered to take her. Judges in England ruled that it was in her best interests to stop. Infected blood scandal Non maleficence More than 30,000 NHS patients caught HIV or hepatitis C from their treatment in the 1970s and 1980s. A public inquiry reported in 2024, compensation payments began that December, and no one has been prosecuted. Lucy Letby and the Thirlwall Inquiry Non maleficence Doctors at the Countess of Chester Hospital warned managers about a nurse after a run of unexplained baby deaths. Managers were slow to call the police and told the doctors to apologise to her. The public inquiry into what went wrong reported in September 2026. Martha's Rule and patient safety Non maleficence Martha Mills died of sepsis at 13 after her parents' worries were not acted on. Every acute hospital in England now has to offer the rule named after her, and it has been used more than 19,000 times.

More NHS hot topics, medical ethics case studies and medical school interview questions are in AlphaMED Resources, which we add to and update through the application cycle.