{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T18:52:40Z","timestamp":1791139960194,"version":"4.1.0"},"reference-count":31,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:00:00Z","timestamp":1791072000000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Evaluation Clinical Practice"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale, Aims and Objective<\/jats:title>\n                    <jats:p>The maxim primum non nocere (\u201cfirst, do no harm\u201d) remains emblematic of medical ethics, yet much of modern therapeutics accepts foreseeable and sometimes near\u2010certain injury in pursuit of benefit: surgery injures tissue, chemotherapy produces systemic toxicity, and ablation and embolization achieve their effect through controlled destruction. This paper asks how such therapeutic injury is to be ethically understood, and whether non\u2010maleficence still describes the operative morality of clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>The paper proceeds by critical conceptual and ethical analysis rather than empirical study, situating the question within the literature that has sought to refine non\u2010maleficence\u2014principlism, the doctrine of double effect, proportionality reasoning, threshold deontology, and the ethics of risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Contemporary medicine is argued to operate not through literal non\u2010maleficence but through comparative harm management: the selection among competing, foreseeable harms under uncertainty. A distinct and growing class of interventions produces injury that is not a side effect but the therapeutic mechanism itself, a case the inherited frameworks address only obliquely. Comparative harm management is shown to describe the architecture of clinical decision\u2010making rather than to add a further criterion of justification such as proportionality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Non\u2010maleficence retains a regulative and cautionary value but no longer describes the operational morality of modern medicine. The physician is best understood not as a guarantor of freedom from harm but as a steward of proportionate therapeutic injury under conditions of uncertainty, vulnerability, and competing obligations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jep.70643","type":"journal-article","created":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T18:17:41Z","timestamp":1791137861000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond Primum Non Nocere: Therapeutic Injury, Comparative Harm Management, and the Ethics of Modern Medicine"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6706-4514","authenticated-orcid":false,"given":"Boris","family":"Nikolic","sequence":"first","affiliation":[{"name":"Department of Philosophy Heinrich\u2010Heine\u2010Universit\u00e4t D\u00fcsseldorf D\u00fcsseldorf Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,4]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.14132958"},{"key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1146\/annurev.pa.19.040179.002555","article-title":"Ethical Considerations in Cancer Chemotherapy","volume":"19","author":"Freireich E. 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