An Ancient Oath With Modern Significance
ABOUT 400 B.C.E., Hippocrates, a Greek physician commonly known as the father of medicine, wrote the Hippocratic oath. That noble ethical creed still guides the medical profession. Is that what you have been taught? If so, you are not alone. But is it strictly true?
The facts suggest that Hippocrates may not have been the author of the oath that bears his name. Furthermore, the medical profession today does not always subscribe to that creed as it was originally written.
Do we know who really wrote this ancient oath? And even if we do, does this oath have any significance for us today?
Did Hippocrates Write the Oath?
There are a number of reasons for questioning whether Hippocrates wrote the oath. One is that the oath commences with an invocation to a number of deities. Yet, Hippocrates is viewed as the first individual to separate medicine from religion and to look to physical rather than supernatural causes for illness.
Furthermore, several of the things that are prohibited in the oath were not at odds with the way medicine was practiced in Hippocrates’ day. (See the box on page 21.) For example, abortion and suicide were not censured by law or by most religious standards during the time of Hippocrates. Also, the adherent to the oath promises to leave surgery to surgeons. Yet, surgical techniques form part of the Hippocratic collection, the body of medical literature often attributed to Hippocrates and other ancient writers.
So although the question is still a subject of scholarly debate, it seems quite possible that the Hippocratic oath was not actually written by Hippocrates. The philosophy expressed in the oath appears to accord best with the Pythagoreans of the fourth century B.C.E., who espoused ideals regarding the sacredness of life and were averse to surgical procedures.
Fall and Resurgence
Regardless of who the author of the oath really was, what cannot be questioned is the significant impact the oath has had on Western medicine and, in particular, on the field of ethics. The oath has been called “the apex of the development of strict ethical concepts in medicine,” “the basis of the patient-physician relationship in the developed world,” and “the high-water mark of professional morality.” Back in 1913, Sir William Osler, a noted Canadian doctor, said: “It is of small matter whether this is of hippocratic date or not . . . For twenty-five centuries it has been the ‘credo’ of the profession, and in many universities it is still the formula with which men are admitted to the doctorate.”
However, the oath went through a period of disfavor in the early 20th century, possibly because of the scientific advancements then taking place. In the growing climate of rationalism, the oath may have seemed outdated and irrelevant. But even with the advances of science, there is a continuing need for ethical guidelines. Maybe that is why the oath has returned to favor in recent decades.
Oath-taking has again become an important part of many doctors’ entry into medical school or graduation from it. A 1993 survey of U.S. and Canadian medical schools indicated that 98 percent of the schools surveyed administered some sort of oath. Only 24 percent did so back in 1928. In the United Kingdom, a similar survey showed that about 50 percent of schools currently use an oath or declaration. In Australia and New Zealand, the figure is also about 50 percent.
Changing With the Times
But the Hippocratic oath is not immutable; over the centuries it was altered to reflect the beliefs prevalent in Christendom. Sometimes changes were made to address other issues, such as dealing with plague victims. More recently, it has been altered to accord with modern thought.
In many versions of the oath, concepts no longer reflective of the practice of modern medicine have been deleted, while other ideals important to contemporary society have been inserted. For example, the principle of patient autonomy may be central to the practice of medicine today, but it had no equivalent in ancient Greek medicine and was no part of the Hippocratic oath. The concept of patients’ rights forms an important part of many declarations currently in use.
In addition, the doctor-patient relationship has changed, with concepts such as informed consent becoming increasingly important. So it is understandable that only a small number of medical schools still administer the Hippocratic oath in its earlier form.
Other changes to the oath are perhaps more surprising. In 1993, only 43 percent of the oaths administered in the United States and Canada incorporated a vow that doctors be accountable for their actions, with most modern versions of the oath including no penalty for breach of its terms. Forswearing euthanasia and abortion and invoking a deity were even less common, and vowing to have no sexual contact with patients formed part of only 3 percent of the declarations used by the schools surveyed.
The Value of an Oath
Despite the many changes to the Hippocratic oath, the use of oaths is often seen as important to a profession committed to fundamentally noble and moral ideals. The 1993 survey referred to above found that most oaths in use focus on the commitment physicians make to their patients, requiring prospective doctors to promise to do their best in caring for their patients. Making such a declaration centers attention upon the worthy moral precepts underlying the medical profession.
In an editorial published in The Medical Journal of Australia, Professor Edmund Pellegrino wrote: “Perhaps for many the medical oath is today a shard of a fractured ancient image. But enough of that image remains in the consciousness of the profession to remind us that to forget it entirely would be to make medicine a commercial, industrial or proletarian enterprise.”
Whether the Hippocratic oath or the modern declarations that it has fathered are relevant today will probably continue to be a point of academic debate. But whatever the result, doctors’ commitment to caring for the sick remains worthy of appreciation.
[Box on page 21]
THE HIPPOCRATIC OATH
AS TRANSLATED BY LUDWIG EDELSTEIN
I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfil according to my ability and judgment this oath and this covenant:
To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art—if they desire to learn it—without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but to no one else.
I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.
I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.
I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.
Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.
What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself holding such things shameful to be spoken about.
If I fulfil this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.
[Picture on page 20]
A page from the Hippocratic collection
[Picture Credit Line on page 20]
Hippocrates and page: Courtesy of the National Library of Medicine