Emma often reflects on her dad’s advice, including “You don’t get to choose what cards you’re dealt”; “Sometimes you’re dealt a losing hand, and that really sucks. But if you always fold, you’ll have a pretty tough time in life”; “Keep your hand close to your chest”; and “Never get caught drawing dead.” In which instances in the book do you think Emma uses this advice to justify her actions?
Throughout the book McDonald paints the opioid epidemic as a complex problem. Her characters recognize that opioids can provide lifesaving pain relief, but that they can also cause lifelong addiction that endangers people. When Emma discovers that her colleague and friend Julia has been stealing opioids, she thinks, “[Addicts] needed help, not criticism and ridicule.” How does Emma’s opinion of using opioids for pain management evolve?
Nate once said of Josh and Emma, “You need him as much as he needs you.” Do you think this is an accurate assessment of their relationship as mother and son? Why or why not?
When Emma encounters someone from Moira’s church who expresses her sympathy for Josh and their family, Emma has a particularly negative reaction: “Thoughts and prayers.… Like that does any good.” Why do you think she has that reaction to the church’s response to Josh’s illness?
When Emma visits Julia and sees her in pain, Julia tells her, “I’m not an addict. Maybe I’m addicted, but I’m not an addict.” What do you think the difference is for Julia? Compare her addiction to that of other characters in the story, such as Ben or Violeta.
Nate often feels pressure to provide for his family, at times relying on traditional roles of masculinity and, in moments of failure, thinking, “What kind of man am I?” Why do you think Nate has this idea of fatherhood? How do you think Nate’s vision of fatherhood drives his actions?
Emma states that her job as a doctor is “to help people, not watch them suffer.” However, at times Emma’s actions cause her to do both. Discuss points when Emma’s actions cause unintended pain or suffering.
When thinking about her brother, Ben, and the anger and resentment that he developed during his life, Emma asks herself, “What makes people go to war with themselves?” What are the reasons that the characters in this book “go to war with themselves”? What commonalities do you think Ben and Emma have as siblings?
In Do No Harm, the family receives some small donations through a GoFundMe account set up to help pay for Josh’s treatments. Do you think GoFundMe accounts and community donations should play a role in paying for medical care?
Do you agree with Emma that “the ends justify the means”? Why or why not?
One of the overarching themes in Do No Harm is sacrifice. Emma sacrifices her oath as a doctor to save her son’s life. Nate sacrifices his life to protect Emma. Discuss other sacrifices that characters make. Which do you think are justified?
Did Emma’s final choice surprise you? Why or why not?