The Oath: Meaningless Relic or Invaluable Moral Guide?
The Hippocratic Oath 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?
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.
*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.
Hippocratic Oath: Classical Version
I swear by Apollo 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 an oath according to the medical law, but 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 who 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 fulfill 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.
—Translation from the Greek by Ludwig Edelstein. From The Hippocratic Oath: Text, Translation, and Interpretation, by Ludwig Edelstein. Baltimore: Johns Hopkins Press, 1943.
Hippocratic Oath: Modern Version
I swear to fulfill, to the best of my ability and judgment, this covenant:
I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.
I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.
I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.
I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.
I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.
I will prevent disease whenever I can, for prevention is preferable to cure.
I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.
If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.
—Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, and used in many medical schools today.