Should the first rule of medicine be not “Do no harm” but rather “Be kind”?

Wordsworth wrote in Tintern Abbey that the “best portion of a good man’s life” are “His little, nameless, unremembered acts of kindness and of love.” I understood this thought better when I read American lawyer Ken Schwartz’s account of his time in hospital with a lung cancer that eventually killed him: “moments of exquisite compassion” from some healthcare staff and “simple human touch . . . made the unbearable bearable.

But I know of no better account of the impact of “unremembered acts of kindness” than I read this morning in Oscar Wilde’s De Profundis, written while he was in prison. Before you read the brief passage below it is worth knowing some of the context. Wilde, the great writer and wit of the 19th century, was imprisoned for sodomy and gross indecency. He was brought very low in prison, and many of his friends deserted him. One person who stood by him was Ronnie Ross, an openly gay journalist who had been Wilde’s first male lover and later went with Wilde into exile and became his literary executor. It is Ross who raises his hat to Wilde.

“Where there is sorrow there is holy ground. Some day people will realise what that means. They will know nothing of life till they do,—and natures like his can realise it. When I was brought down from my prison to the Court of Bankruptcy, between two policemen,—waited in the long dreary corridor that, before the whole crowd, whom an action so sweet and simple hushed into silence, he might gravely raise his hat to me, as, handcuffed and with bowed head, I passed him by. Men have gone to heaven for smaller things than that. It was in this spirit, and with this mode of love, that the saints knelt down to wash the feet of the poor, or stooped to kiss the leper on the cheek. I have never said one single word to him about what he did. I do not know to the present moment whether he is aware that I was even conscious of his action. It is not a thing for which one can render formal thanks in formal words. I store it in the treasure-house of my heart. I keep it there as a secret debt that I am glad to think I can never possibly repay. It is embalmed and kept sweet by the myrrh and cassia of many tears. When wisdom has been profitless to me, philosophy barren, and the proverbs and phrases of those who have sought to give me consolation as dust and ashes in my mouth, the memory of that little, lovely, silent act of love has unsealed for me all the wells of pity: made the desert blossom like a rose, and brought me out of the bitterness of lonely exile into harmony with the wounded, broken, and great heart of the world. When people are able to understand, not merely how beautiful —’s action was, but why it meant so much to me, and always will mean so much, then, perhaps, they will realise how and in what spirit they should approach me. . . .”

Perhaps the first rule of medicine should not be “Do no harm” but rather “Be kind.”

Richard Smith was the editor of The BMJ until 2004