First, Do No Harm.

Papers Please meets Surgeon Simulator.

Here's a very rough game idea that's been bouncing around in my head for a while. Maybe it should be extracted from my head, with a tomahawk, by a crappy surgeon who only works with their left hand.


How I stumbled onto this idea:

Us "games as art" peeps have always been trying to merge gameplay and narrative, but to not much avail. That is, until Papers Please. The way it merges the two is brilliant, yet simple - have how you make gameplay decisions the same way you make story decisions. (Off the top of my head, I can think of two other games that do this - Spec Ops: The Line, and no-one has to die.)

I've been wondering how else to apply this formula. Y'know, without flat-out ripping off Papers Please.

I thought about other real-world jobs with morally ambiguous decision-making. Politically topical would be a bonus! Papers Please's satire of the TSA, immigration, and counter-terrorism is cutting.

Of course. Healthcare.

From the bureaucracy of healthcare costs, to the professional ethics of medicine, to the whole political shitstorms over abortions and euthanasia... goddamn this is a topic ripe for morally ambiguous decisions.

And what could be a better gameplay mechanic to go with this than the morbid slapstick humour of Surgeon Simulator?


How the game works:

The game UI consists of multiple mini-screens. You can interact with objects with your mouse/touch input, and drag things across screens. This is the same interface as Papers, Please.

And in each mini-screen, the objects have terrible physics -- the keystone to slapstick games like QWOP, Octodad, and Surgeon Simulator. Things flail around.

There would also be money + resource management involved, similar to Papers Please. But in this game, you'd buy resources for your woefully understaffed, underfunded hospital.

The kinds of slapstick that could happen:

Dragging a human liver into the kitchen fridge, because your hospital doesn't have anywhere else to store fresh organs.

Using a patient's blood to sign paperwork when you're out of ink.

Well, the organ's going to be un-useable by tomorrow anyway... and no one needs an organ right now... and I could save some money on dinner...

The kinds of moral choices one could make:

Deciding whether or not to let someone die peacefully, when their family will pay you lots of money to keep them alive, and in pain.

Taking in a known murderer as a patient, mortally wounded, and deciding whether to take justice into your own hands and let them die.

Three patients desperately need fresh organs, or they will die. One patient, who is non-lethally injured, has healthy organs. Do you kill one to save many?


There we go! A rough design sketch for First, Do No Harm.

Of course, easier said than done, but it's better said than never said at all. I might or might not ever create a prototype for this, but if you want to, be my guest! CC0-licensed everything, remember?

The most important thing is that I practice doing more Idea Dumps like this, where I take an inkling of an idea, flesh it out a bit, and push it out to the world. This will help me have better ideas, more ideas, and along the way, contribute the excess ideas to the global creative commons.

Or maybe I just really like the idea of stuffing organs into a fridge.