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Published in Print: November 7, 2007, as First, Do No Harm

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First, Do No Harm

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Although the pledge to “first, do no harm” is not officially a part of the Hippocratic oath, many physicians still live by it. The phrase, quite literally, represents a first principle of professional medical care. It means that the physician must first contemplate any potential detriment that an intervention might produce before having any confidence in its viability. In determining the merit of a medical intervention, the doctor balances the probability of harm against the probability of benefit. It is a smart way to frame the debate for an intervention and represents a healthy humility about the possibilities of success.

Unfortunately, school reformers and legislators have no equivalent obligation to weigh harm when fashioning school-based interventions. The result is a general failure to perform due diligence in advancing school improvement initiatives, leaving the schools with reform projects that carry unexamined potential to produce harm. The sad reality is that when it comes to school reform, the cure can be, and sometimes is, more harmful than the ailment it addresses.

In light of the upcoming reauthorization of the federal No Child Left Behind Act, the time is right for legislators to find their critical sensibilities and to, at a minimum, make no new authorizations without first deliberating over whether their initiatives might do harm to schoolchildren.

One good way to start this exercise is simply to ask where the law might already have perpetrated harm. For instance, developers of the Reading First programs, which are the first iterations of the evidence-based practices being legislated through NCLB, are confident that they can identify the best materials, curricula, and teaching strategies for all children, in virtually all places—all with the use of aggregate average effects taken from experimental designs. Teachers throughout the country are now being encouraged to use the evidence-based resources of Reading First programs to help lift reading achievement. But no one has ever asked whether the logic of identifying best methods through experimental research could in any way do harm to the education of young children. And while it might surprise some, anyone who understands schools knows that evidence-based instruction has a significant downside. Because Reading First programs aim to identify generic classroom strategies presumably applicable to all children, they tend to come at the cost of the teacher’s discretionary intelligence and creativity. And that could leave children with unresponsive and inappropriate instruction.

Teaching, we should remember, always inherits a local condition. It occurs in a particular dynamic that may or may not be in alignment with what the averages tell us. Operational answers to good teaching cannot be found in research studies that identify practices or methodologies believed to be portable to all classrooms. The answers are in the emergent judgments of the teacher, who is naturally obligated to follow some instructional plan, but who also understands that the “right” decision in a classroom depends on weighing particularistic factors related to the nature of the child, to available resources, to the defined purposes in the curriculum, to available evaluative evidence, to the subject matter at hand, and to a raft of other variables residing in the educational situation.

As the eminent education scholar Joseph J. Schwab described the classroom situation: “There are a thousand ingenious ways in which commands on what and how to teach can, will, and must be modified or circumvented in the actual moments of teaching. … Moments of choice of what to do, how to do it, with whom and at what pace, arise hundreds of times a school day, and arise differently every day and with every group of students. No command or instruction can be so formulated as to control that kind of artistic judgment and behavior, with its demand for frequent, instant choices of ways to meet an ever varying situation.”

By scripting the conduct of teachers, the NCLB-inspired Reading First programs can generate harm by closing down the discretionary space teachers need to make responsive and educationally sound judgments in the classroom. If we acknowledge this possibility, we can begin to see more modest possibilities in how programs such as Reading First might help inform teacher judgment, instead of scripting teacher conduct.

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Similarly, if we had weighed harm, we might have anticipated the manner in which NCLB has impoverished the school experiences of children attending Title I schools. We have known for years that school experiences in high-stakes-testing environments generally reduce themselves to what is being tested. The effect is that art, music, and such skills sets as critical thinking, creativity, cooperative behavior, and many others get short shrift in the classroom, primarily because such matters typically have little or no place on the exams. The architects of NCLB have designed an accountability system that denies children attending high-poverty schools a comprehensive, enriching, and life-enhancing education. Had we anticipated the possibility of such harm, we might have explored accountability routines for reading and math that did not carry the side effect of restricting the comprehensiveness of the school’s normative agenda in the lives of these children.


Perhaps the best approach to avoiding harm is to return No Child Left Behind to its historic moorings. Diane Ravitch, a former assistant U.S. secretary of education, recently editorialized about the need for the federal government to stick to its historic function, which is to collect and disseminate information about the condition and progress of education, write checks to help schools educate specific groups of students, and enforce civil rights laws. “Those are the principles,” she wrote, “that should be the underpinnings of the reauthorized NCLB.”

I agree, because such limitations on the federal function are in fact limitations on the extent of harm that the forces in Washington can have on local classrooms. Good schooling, to paraphrase Professor Schwab, is not developed in Washington and proclaimed to the masses. It arises at home, nurtured by teachers who know the children and their families, and who are under some state obligation to offer all of them a comprehensive (normative) education.

A little humility about the powers of research in the face of the complexities of teaching, and a greater appreciation for the powers of the teacher, might go a long way in protecting children from legislated harm. The law, as they say, can’t make my neighbor love me, but it can have some role in keeping him from perpetrating all kinds of harm against me. Those who are looking to reauthorize the No Child Left Behind Act should be reminded of this simple standard.

Vol. 27, Issue 11, Page 28

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