From Primum Non Nocere to Primum Succurrere: Reframing Surgical Ethics in Metabolic and Bariatric Surgery

The ethical practice of medicine has always existed within a dialectic of action and restraint, where healing often entails “controlled harm.” Nowhere is this paradox more pronounced than in metabolic and bariatric surgery (MBS), a domain in which the therapeutic imperative, to prevent the irreversible harm of inaction, frequently conflicts with traditional interpretations of medical ethics.
This editorial will examine the historical limitations of the “first, do no harm” principle in surgical contexts, explore how recent redefinitions of obesity strengthen the case for surgical intervention, address the ethical considerations sur rounding surgical innovation and access barriers, and pro-pose a new ethical framework better suited to contemporary metabolic surgery practice.