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Is there harm in silence?
  1. Joy Lyneham
  1. Correspondence to Dr Joy Lyneham, Faculty of Medicine Nursing and Health Science, PO Box 527, Frankston, Vic 3199, Australia; joy.lyneham{at}

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Trisomy 18 is a condition with a very high mortality rate and the fetus usually dies in utero or shortly after birth. Parents are usually advised to terminate the pregnancy but in Liam's 1 situation the parents did not want this. They understood that the baby would not survive; however, they wanted to ensure that their baby had all the life that was possible, even in utero. The aim of this paper is to highlight how a lack of communication, inadequate information, thoughtless words and actions resulted in a family experiencing preventable harm.

Beneficence is a core value of health professionals; doing good is the foundation of care. However, in certain circumstances this value is challenged by the competing value of non-maleficence (primum nil nocere); first, do no harm. The case of Liam is one such situation; the following is a brief discussion on some of the complex issues raised by this case. Medical ethicists often refer to the principle of primum nil nocere as finding a balance of benefits over harms of treatment. Beauchamp and Childress2 state that the obligation of non-maleficence is that one ought not to inflict harm.

What was ‘harm’ in this situation? An invasion of rights without justifying useful consequences is one type of ethical harm. If we also take into consideration the Buddhist view of ethical harm where the concept of intentionality emerges, the intent behind clinical actions taken need to be considered. The case of Liam clearly demonstrates that the parents had the right to have compassionate care, understanding of their decisions and adequate information; confusion over these issues caused ethical harm as well as significant physical distress. In the situation of a non-viable pregnancy, it is the patient's value on life that matters not the health professional's. From the beginning …

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  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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