Doctor's Review: Medicine on the Move

January 24, 2022
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Is the Oath outdated?

Hippocrates’ legendary tract was first implemented in 1508. Are his guidelines still relevant today?

Enough has been written about Hippocrates to fill a library. Indeed, the Father of Medicine — as he is so rightly known — stands out among ancient minds in large part because of his modern ways of thinking. The Oath that bears his name is one example of his legacy, an amalgam of the standards to which all physicians should be held. But was it even Hippocrates who wrote the legendary tract? More importantly, is it still relevant or is the Oath simply an outdated historical cliché that holds no place in modern medicine?

Teaching truths

Hippocrates lived between 460 and 370 BCE — a golden age of science and art in Ancient Greece. At his medical school on the island of Kos, his tenure marked the beginnings of medicine as a discipline of scientific thought unto itself. Hippocrates summarized and synthesized the best of known medicine that came before him, and pushed forward a new era of clinical practice. Not much is known about his life, but his teachings are well documented in the Hippocratic Corpus... a body of work including more than 70 different texts in Ionic Greek.

The great teacher applied a common-sense approach to the treatment of disease and was a stickler for discipline and precision, veering away from superstition and towards empiricism for the first time in the Western tradition. No longer was illness seen as heavenly retribution for human wrongdoings, but rather the result of knowable pathological and environmental causes. He demanded that his students, as physicians, keep rigorous records of everything they did, for the sake of both personal responsibility and professional posterity. In short, Hippocrates is certainly deserving of his near-mythical status.

Apart from his scientific contributions — which run the gamut from the first takings of case histories, to the initial descriptions of a great many diseases, to the powerful humoral theory which held sway throughout the 19th century — the Oath holds a unique place in his work. It marked the first time ethical guidelines appeared in relation to a profession.

Whether it was Hippocrates himself who penned the guidelines or an equally ethically minded disciple, from that point on, those who practiced medicine would be held to a higher standard. Presumably, it was used as a teaching tool, a way to impart to those whom Hippocrates trained the seriousness of the responsibility they were taking on.

Though ancient, the Oath’s wording is concise, employing an economy of language so that it wouldn’t be misinterpreted. While the tenets put forth by the Oath have been the subject of much debate over the ages — especially in regards to abortion and euthanasia — its gist is indisputable: each physician must hold him or herself to the highest possible standard of conduct.

Rules of conduct

The Oath reminds the physician that all life is to be revered and preserved, whether it’s a king’s or a slave’s. Likewise, no practitioner can abuse his power to either harm or gain sexual favours. To respect those from whom he gained his knowledge and to pass that knowledge on to the next generation is crucial, as is maintaining confidentiality at all times. These are the principal directives of the Oath, and modern doctors are held to the same standards to this day.

The Hippocratic Oath was administered in its literal, original form for the first time to graduating physicians at the University of Wittenberg in Germany in 1508. In France in 1804, taking the Oath became part of the graduation ceremony at the medical school at Montpellier. Other western schools soon adopted the practice until it died out in the early 20th century.

Though lay people usually assume that the Oath is still taken, it’s rarely administered in its original from, if ever at all. Because some parts are outdated — physicians wouldn’t get very far if they were prohibited from cutting into their patients — modern versions have replaced the original wording. In addition, medical organizations evolved to include written codes of ethics instead of ones sworn aloud. The first modern code was written by Dr Thomas Percival in a 1794 pamphlet and was adopted by the American Medical Association in 1847. The guidelines of conduct he suggested for physicians and hospitals remain in use today.

New oaths, old ideas

Over the centuries, these other codes and oaths expanded or modernized the Hippocratic original. The Prayer of Maimonides, named for the great 12th -century Spanish physician and philosopher, was similar to the Hippocratic Oath, and had a religious spin, albeit a monotheistic one. After the atrocities committed by the Nazis during World War II, the Declaration of Geneva was put into effect by the World Medical Association as a way to remind the profession to treat all patients equally, regardless of race, colour or creed.

The oath most often employed by medical schools today is the Lasagna Oath. This tasty, but deity-free version was written in 1964 by Louis Lasagna, the academic dean of Tufts University’s Medical School, and tries to steer clear of controversial language. But is it enough? In 1993, a large-scale study of the oaths administered by almost 150 North American medical schools was undertaken to determine the popularity and content of modern oaths.

As it turns out, the oaths given in this day and age have changed substantially from the original. Fourteen percent ban euthanasia. Eleven percent invoke a higher power. Eight percent oppose abortion. And three percent prohibit sexual relationships between patients and physicians. Some might suggest that this is proof that medicine, like politics, has evolved much like the modern penchant for dividing church and state.

Hypocritical oath?

While the Hippocratic Oath may be somewhat of a relic of the past, oath-taking upon graduation is now at an all-time high with nearly all med schools offering some form of it. Eighty years ago, less than one quarter of doctors-to-be took an oath. While it’s not compulsory, the modern resurgence does speak to the chaos of our times, especially where medical ethics are concerned.

Ironically, some students argue that the very process of medical education itself — with its ruthless tradition of sleep deprivation and the damaging physical and psychological effects it can cause — is in itself in opposition to the spirit of the Oath. Similarly, the privatization of medicine and the problems surrounding medical malpractice, insurance issues and the commercialization of the entire profession is arguably at odds with the dictum of first doing no harm.

As for that famous, oft-quoted line, “First, do no harm,” the phrase was most likely taken from Epidemics, another of Hippocrates’ works: “As to diseases, make a habit of two things — to help, or at least, to do no harm.” Then, as now, the meaning of the word “harm” is open to debate. But no oath or pledge, no matter how perfectly worded, can ever resolve this issue.


The Hippocratic Oath

I swear by Apollo Physician and Asclepios and Hygeia and Panacea 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 favour 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 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.

Translation from the Greek by Ludwig Edelstein. From The Hippocratic Oath: Text, Translation, and Interpretation, by Ludwig Edelstein. Baltimore: Johns Hopkins Press, 1943.

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