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Ian Webster

Primum non nocere (above all do no harm) is a basic principle in medicine.

In treating cancer, heart disease or diabetes, the harms of disease are balanced against the harms of intervening – mastectomy, amputation, chemotherapy and the side-effects of medicines. Minimising harm is the everyday work of a doctor.

There are tradeoffs too in public health – in preventing and responding to outbreaks of infectious disease – in which the downside for individuals is balanced against preventing harms in the whole community.

Harm reduction policies have measurable outcomes. They involve practical ethics: accepting people as they are, acknowledging their predicaments, focusing on the present and the future rather than the past. “Here and now” issues for real people.

They are non-judgemental, accountable, contestable and available for everyone to evaluate.

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