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Do most med students realize just how far modern versions of the oath have strayed from the classical model?

The Hippocratic Oath Today: Meaningless Relic or Invaluable Moral Guide?

The Hippocratic Oath (see ancient and modern versions) is one of the oldest binding documents in history. Written in antiquity, its principles are held sacred by doctors to this day: treat the sick to the best of one's ability, preserve patient privacy, teach the secrets of medicine to the next generation, and so on. "The Oath of Hippocrates," holds the American Medical Association's Code of Medical Ethics (1996 edition), "has remained in Western civilization as an expression of ideal conduct for the physician." Today, most graduating medical-school students swear to some form of the oath, usually a modernized version. Indeed, oath-taking in recent decades has risen to near uniformity, with just 24 percent of U.S. medical schools administering the oath in 1928 to nearly 100 percent today.

Yet paradoxically, even as the modern oath's use has burgeoned, its content has tacked away from the classical oath's basic tenets. According to a 1993* survey of 150 U.S. and Canadian medical schools, for example, only 14 percent of modern oaths prohibit euthanasia, 11 percent hold convenant with a deity, 8 percent foreswear abortion, and a mere 3 percent forbid sexual contact with patients—all maxims held sacred in the classical version. The original calls for free tuition for medical students and for doctors never to "use the knife" (that is, conduct surgical procedures)—both obviously out of step with modern-day practice. Perhaps most telling, while the classical oath calls for "the opposite" of pleasure and fame for those who transgress the oath, fewer than half of oaths taken today insist the taker be held accountable for keeping the pledge.

Indeed, a growing number of physicians have come to feel that the Hippocratic Oath is inadequate to address the realities of a medical world that has witnessed huge scientific, economic, political, and social changes, a world of legalized abortion, physician-assisted suicide, and pestilences unheard of in Hippocrates' time. Some doctors have begun asking pointed questions regarding the oath's relevance: In an environment of increasing medical specialization, should physicians of such different stripes swear to a single oath? With governments and health-care organizations demanding patient information as never before, how can a doctor maintain a patient's privacy? Are physicians morally obligated to treat patients with such lethal new diseases as AIDS or the Ebola virus?

Some doctors who recited the Hippocratic Oath as a student now call it the "Hypocritic Oath."

Other physicians are taking broader aim. Some claim that the principles enshrined in the oath never constituted a shared core of moral values, that the oath's pagan origins and moral cast make it antithetical to beliefs held by Christians, Jews, and Muslims. Others note that the classical Oath makes no mention of such contemporary issues as the ethics of experimentation, team care, or a doctor's societal or legal responsibilities. (Most modern oaths, in fact, are penalty-free, with no threat to potential transgressors of loss of practice or even of face.)

With all this in mind, some doctors see oath-taking as little more than a pro-forma ritual with little value beyond that of upholding tradition. "The original oath is redolent of a convenant, a solemn and binding treaty," writes Dr. David Graham in JAMA, the Journal of the American Medical Association (12/13/00). "By contrast, many modern oaths have a bland, generalized air of 'best wishes' about them, being near-meaningless formalities devoid of any influence on how medicine is truly practiced." Some physicians claim what they call the "Hypocritic Oath" should be radically modified or abandoned altogether.

What is your opinion? What do you feel is the Hippocratic Oath's relevance in 2001? Is it a pointless anachronism or an invaluable moral guide? Should aspiring doctors still be made to take some version of the oath? If you're a doctor, would you take the oath again? Why?

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We will post responses on this Web site. In the subject field of your message, write either "Doctor Response" or "Non-Doctor Response," depending on which category you belong to. Please note your submission may be edited for clarity. Thank you in advance for your contribution.

*Orr, R. D., N. Pang, E. D. Pellegrino, and M. Siegler. 1997. Use of the Hippocratic Oath: A Review of Twentieth Century Practice and a Content Analysis of Oaths Administered in Medical Schools in the U.S. and Canada in 1993. The Journal of Clinical Ethics 8 (Winter): 377-388.

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