The Moral Weight of FIRST, DO NO HARM: A Conversation with Grace Malouf

Borrowed from the Hippocratic oath, the phrase “first, do no harm” has long stood as one of medicine’s guiding ethical principles.

In playwright Grace Malouf’s provocative new work of the same name, that principle is placed under intense scrutiny. Set within the worlds of elite medicine and professional sport, First, Do No Harm interrogates questions of bodily autonomy, medical ethics, identity and agency through the story of a family confronting a life-altering decision.

Unflinching yet sharply witty, the play refuses easy moral binaries, instead exploring the tensions between care and control, protection and autonomy, and personal rights versus public debate. At a time when conversations surrounding trans identities, competitive sport and medical intervention remain deeply contested, Malouf’s work positions theatre as a space for complexity, discomfort and critical discussion.

Grace Malouf is an AACTA-nominated screenwriter, playwright and entertainment lawyer whose work explores themes of agency, control and collapse through darkly funny storytelling. A graduate of NIDA’s MFA Writing for Performance program, she also holds degrees in Law (Hons) and Economics from the University of Queensland, as well as a Graduate Diploma in Legal Practice. She is a 2026 Griffin Studio Artist and recipient of the Katie Lees Fellowship for Playwriting. Her work has been shortlisted for the Griffin Award, longlisted for the Queensland Premier’s Drama Award, and presented at festivals including Bondi Feast, Anywhere Festival and NIDA’s Festival of Emerging Artists. Her latest play, First, Do No Harm, premieres at KXT on Broadway as part of NIDA’s New Writers, New Works season. Her screen work includes the multi-award-winning short film Writers in Love, which received an AACTA nomination, while her feature projects Minors and The Plot are currently in development.

As both a playwright and a lawyer, what initially drew you to exploring medical ethics through theatre rather than a more traditional legal or academic lens?

Grace: That was actually not my initial plan. I always thought that I’d follow in my parents footsteps and become a doctor, but when I forgot to sign up for the medical entrance exam in year 12, I had to pivot. I ended up being accepted into my second option; Economics and Law, which never really felt entirely right but I distracted myself by going on multiple exchanges and travelling extensively throughout my SEVEN year undergrad. On my third exchange, at Trinity College in Dublin, I studied Medical Law. I was immediately fascinated by the interaction between ethics and law. Law is about minimum standards – it sets the baseline below which behaviour cannot fall. Ethics, on the other hand, tells you what you should do; it’s the study of the right thing to do. We spent the semester trying to understand the tension between these two concepts. I loved this grey area, and the conversations I would have at the pub with classmates were so rich and meaty. This is what I loved about studying law – the plethora of stories and interesting concepts. The reality of being a lawyer, at least for me, was much drier. When I later became a playwright, I found that I could return to all of these concepts and stories and actually play with them. It’s SO much fun. I’m very lucky.

The play centres on questions of bodily autonomy, fairness, and access to competitive sport. Were there particular real-world debates or cases that sparked the idea for First, Do No Harm?

Grace: Very much so. The play was inspired by a case we studied in Medical Law – the investigation into medical negligence of Robert Smith. In the late 90s, Smith amputated the healthy limbs of two patients he believed to be suffering from Body Integrity Dysphoria (then “Body Identity Integrity Dysophoria”). BID is a rare condition where patients believe that a part of their body shouldn’t be there. Psychiatric intervention for this condition is ineffective. Now, nearly 30 years later, the best practice treatment for BID is deemed to be removing the part of the body that the patient cannot get along with. Patients tend to have excellent outcomes. That’s what the play is about – a 19 year old swimmer struggling with BID who wants to have his arm amputated. When I was initially developing the play with dramaturg Brett Sheehy AO, we thought it would be most dramatic to initially keep the audience in the dark about what was “wrong” with Alexei. We decided to lead the audience to believe that Alexei might be trans. This false analogy between two vastly different things is meant to exemplify how society’s acceptance of difference falls on a spectrum. The real life case of Lia Thomas then became very useful to me in the play – a trans woman who achieved notable success in the women’s competition despite recording slower overall times than she had competing as a man. Alexei, the play’s protagonist, is sort of obsessed with whether it’s “fair” for a character inspired by Lia Thomas to compete in the women’s competition, which leads his parents to think he’s trans. In actual fact, his focus is because of the question of “fairness” in swapping competitions as, if he became an amputee, he’d be wanting to compete in the Paralympics instead of the Olympics.

The title invokes the medical principle “first, do no harm.” Did your understanding of what “harm” means shift as you developed the work?

Grace: Absolutely; as did the concept of a “good outcome” for a patient. Sometimes when I was little and couldn’t sleep, I would come out to the TV room where my Dad (a surgeon) would be watching a video of an operation and I’d cozy up next to him and watch it through my fingers. So I think from a young age I had an understanding that medicine often involves “immediate harm” – by that I mean, in order to have a life saving operation, a patient must be cut open, which would otherwise be a harmful act. When I first learned about BID I was hyper-focused on “do no harm” as a principle of medical ethics and couldn’t understand how amputating a healthy limb could ever be ethically justified. But as it turns out, “do no harm” is actually one of four pillars of medical ethics. The others are “autonomy” – the right of patients to make their own decisions about their healthcare; “beneficence” – acting in the best interest of the patient; and “justice” – fairness and equality in the delivery of healthcare. Taken together, it’s a much more complex playing field. Both “harm” and “a good outcome”, I think, are far more subjective than I initially believed – and that ambiguity is exactly where the play lives.

The play tackles highly politicised conversations around trans inclusion and disability without seeming interested in easy answers. How did you approach writing a work that could hold complexity rather than certainty?

Grace: I don’t think I am certain about anything as a person. I see the world in very grey terms, and so naturally I think my writing lives in that space too. I’ve always been fascinated by inclusion and disability. My youngest brother has Down Syndrome and I have very distinct memories of when I actually realised that he was different. I was in year two and I was really excited to bring my cute little brother into school to show him off to my classmates but he was pointed at and ridiculed. Those interactions, which happened time and time again throughout my siblings and my childhood, used to make me quite angry. I think people are naturally quite scared of difference and we have an innate fear of the unknown, which is probably the stem of a lot of hatred in the world. In all of my work I try to get people to look at something and make a judgement, and then look again, and see that perhaps their initial reaction wasn’t quite right. I’m very much into “the more you know, the less you know”.

What responsibility do you think theatre has when engaging with issues that are socially and politically charged?

Grace: Well first and foremost, I think theatre’s responsibility IS to engage with issues that are socially and politically charged – I think that’s the entire point of it; to make audiences think and think differently. I believe in order to do that effectively a playwright has to either write about something they know intimately or alternatively, spend a whole heap of time researching. Research is a mammoth part of my practice. For this play, I read a bunch of academic papers and then stalked the authors and found that one of the internationally recognised experts in the condition actually practices out of St Vincent’s Hospital here in Sydney. Chris Ryan is his name; he’s a psychiatrist and professor and he’s been hugely generous with his time and an unbelievably helpful resource. We’re actually doing a panel discussion together after the Sunday evening performance – June 28. In addition to that, I interviewed a bunch of my Dad’s colleagues at the hospital; including an orthopaedic surgeon, in order to understand what the process would be like for a patient who wants a highly contentious procedure engaging with the medical industry. I spent a lot of time talking with my parents about it as well; how would a parent, who is also a surgeon, react to their child’s desire to amputate their own arm. The other world this play lives in is the competitive swimming world so I spoke with various Olympic swimmers, some of whom are parents as well, to understand how they would feel if their olympic hopeful child was in this position.

How conscious were you of audience discomfort while writing the piece? Were there moments you deliberately wanted audiences to sit in ambiguity or contradiction?

Grace: I was extremely conscious of audience discomfort and I sort of wanted this play to live partly in the eerie world and partly in the “HA HA” funny world. A big part of that eeriness is having the audience trying to figure out what the hell is going on with Alexei, the play’s protagonist. The play withholds Alexei’s actual condition from the audience for the first third, and the audience are instead led to believe that he may be trans. His Mother is very comfortable with this idea but doesn’t respect Alexei’s inability to talk about it. His Father, an Olympic gold medallist and winner of the Pierre De Coubertin award, doesn’t think it’s fair for trans women to compete against cis-women and also espouses some more conservative views. There’s naturally a lot of tension to play with here and turn into discomfort. The whole thing is sort of meant to be this hugely dramatic thought exercise – let’s take this thing that you’re inevitably going to have a very strong reaction to, and look at it from 50 different angles, and see if you ever feel differently about it.

What conversations are you hoping audiences continue having after they leave the theatre?

Grace: I’ve made a very intentional cut to the end of the play in the rehearsal period with the intention of broadening the conversations audiences have when they leave the theatre. I want audiences to speculate about the future of the characters after they’ve each had to make quite difficult decisions. It’s funny because the ending is quite horrific but I see it as a happy ending. I want audiences to fight about that exact point – is this a victorious ending or a tragic one? I want them to talk about blame, and parental responsibility, as well as bodily autonomy and fairness. We really wanted this to be a winter show so that audiences can go to a nearby pub, get cozy and continue the debate.

For audiences who may come in expecting the play to “take a side,” what do you hope they discover instead?

Grace: I’m hoping that audiences have a similar trajectory to me. I was initially horrified by the concept of wanting to amputate a healthy limb, but the longer I’ve sat with it (now seven years), the more I’m comfortable with it. In saying that, in my mind there is a real difference between the theory of the condition, which I can almost completely wrap my head around, versus the reality of amputating a limb, or causing your own blindness, or quadriplegia, which still makes me squirm. I think many things can be true at once. And I want the audience to feel that. It’s fascinating. Humans are fascinating.

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First, Do No Harm plays at KXT Broadway from June 24th to July 4th.

For tickets and more information, visit the KXT website.

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Header photo by Alexander Holiday