Refusing to save someone doesn’t count as a kill. Simply reload your save game after killing them and you’ll still earn the Do No Harm trophy at the end. This includes the cook in Crew Quarters and Alex. There are certain trophies that require you to do the exact opposite and kill a specific NPC. You can also use the Disruptor Stun Gun to stun humans instead of killing them. They will run towards you and have their heads explode – this is perfectly acceptable and does not void the trophy! If they die from attacks of other enemies or from environmental damage it does not count as a kill either. It’s okay if mind-controlled people kill themselves.
Do No Harm: Never kill any humans! This means allies (quest givers, security officers) and mind-controlled humans.It will still earn you No Needles in the end! This way you can also knock out the combat and skill-related trophies along the way. It’s okay to make a manual save, buy Neuromods to do a quick combat-related trophy, then reload the manual save. This will earn you the “No Needles” trophy at the end of the game.
No Needles: Do not install any Neuromods on your main save (meaning you can’t buy skills).