A friend recently asked me for my opinion on the Hippocratic Oath as she was preparing to teach a home school class on the subject. Most of us have heard of the Hippocratic Oath. It’s been taken by physicians since ~500 B.C. when it was written during the time of the Greek physician Hippocrates, the father of western medicine. Generations of physicians have sworn to uphold its principles, a tradition which continues to this day when most graduating medical school students take some form of the oath at their graduation ceremony. Recently the oath has come under criticism for some of its tenets such as the forbidding of euthanasia, abortion, and the use of surgical scalpels. Because those practices have become widespread in today’s medical world, some have called it the “Hypocritic Oath.” Where does the truth lie?
The classical version of the Oath reads as follows:
“I swear by Apollo the Physician and Asclepius and Hygieia and Panaceia and all the gods, and goddesses, making them my witnesses, that I will fulfill 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 the oath according to 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. 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 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 myself holding such things shameful to be spoken about.”
If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honoured 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.”
As I looked over the oath, I was struck by the agreement that I had with its principles, despite the fact that it was written 2500 years ago. I am comfortable with the spirit of its contents when you interpret its meaning in light of the times in which it was written. Here are the specifics:
• I am not a fan of the Greek gods or goddesses, but would change those words to reflect the one true God.
• It forbids the use of a surgical knife, something that was a good idea if you were a patient in 500 B.C.! I would revise it slightly to read that, “A doctor should avoid any procedure that harms a patient.” As a surgeon, my surgical knife is an instrument of good for my patients.
• As far as the doctor providing of a free education to the children of his/her teachers, medical education is no longer done this way. Even if I were to try to educate the children of my medical school professors, they would not be allowed to practice medicine, and probably for good reason! In the days of Hippocrates, teachers of medicine were not on a salary as they are today and because they had given out medical education for free, it made sense that they should receive back payment in the form of medical education for their children or even financial support if they needed it. Today students pay tuition and are effectively paying their professors in cash. The professors can use that cash to educate their children if those children wish to pursue a career in medicine as well as to save for their future financial needs.
The modern day counterpart of this section of the Hippocratic Oath might be, “To teach those fellow doctors who come to your office to learn and to do this free of charge, or at least free of exorbitant profit.” There is a very prominent Beverly Hills dermatologist, developer of a well-known line of skin care products, who teaches his techniques to visiting doctors for $35,000 per week. I can understand covering one’s costs, but this type of exorbitant fee is what the spirit of the Hippocratic Oath condemns.
• The Oath forbids active euthanasia done by giving a deadly drug. Most physicians of today as well as the law would agree with that dictum. After all, Dr. Jack Kevorkian spent 8 years in prison for his practice of active euthanasia. The Hippocratic Oath does not comment on passive euthanasia, that is the withholding of life-sustaining treatment in the case of a terminally ill patient, a practice that was presumably followed by the Greeks and that continues today.
• The performance of abortion is outlawed by the Oath. Many doctors today feel the same, believing that life begins at the moment of fertilization and not when the developing fetus implants into the uterine wall. For the Greeks, the performance of an abortion meant the termination of life, and they considered this to be wrong, whether in the case of an adult by means of a deadly drug or in the case of a fetus by abortion.
• It’s interesting that sexual relationships between doctor and patient was enough of a problem in 500 B.C. to merit its mention and condemnation in the Hippocratic Oath. Human nature hasn’t changed since we still have the same issue today! It was considered to be wrong then and is also considered as such today by physicians and courts of law. The Hippocratic Oath condemns all doctor-patient sexual relationships, whether the patient is unwilling or unwilling. Either type takes advantage of patients and introduces an additional element to the doctor-patient relationship that interferes with excellent patient care.
• The privacy of medical information was a practice upheld by the Greeks and is also practiced today. All of us are familiar with HIPAA forms that we sign when we 1st visit a doctor’s office. They explain which of your health care information is protected and how it is protected. The Greeks would have been very comfortable with HIPAA.
As I look back over the 2500 years since the Hippocratic Oath was written, I am amazed that its author(s) was able to deliver such a timeless document that we still find relevant today. It identifies many of the issues with which today’s doctors wrestle, and comes down on the correct side of those issues. I think I’ll take the oath again for good measure!
What do you think? Please feel free to leave a comment.
George Sanders, M.D.