The original Oath of Hippocrates was proposed by the 'Father of Medicine' around 400 BC. Hippocrates' intent was to set forth an informal code of behavior for physicians to follow as they entered into the profession of medicine.
For centuries, the Hippocratic Oath was a rite of passage into medicine. Nowadays, medical students are not required to take the original Oath. Furthermore, the Oath itself has sometimes been seen as “invalid in a society that has seen drastic . . . moral changes” over the last 25 centuries (Heart Views, 2005).
When is Revision Necessary?
Most ethical codes in medicine are a modern phenomena. Codes and regulations arose following the end of World War II and the Nuremberg Trials of 1946-1947.
In a bioethical context, there is nothing wrong with reviewing medical doctrines to see if the needs of physicians, patients, or society are being met. After all, the U.S. Constitution has been contorted by conservatives and liberals alike in an effort to seek approval from the 'Founding Fathers' for gun control, abortion, and income taxes — none of which are mentioned in the original document.
Modern medicine, however, has witnessed a slow erosion of ideals as technology has become more advanced. The Hippocratic Oath is a case in point.
The Hippocratic Oath and Modern Medicine
When the Hippocratic Oath was first proposed, its focus was simple. The Oath urged physicians to respect life, limit treatment only to those measures necessary to help the patient, prevent corruption of medical ideals (especially with regard to sexual relations), and protect patient confidentiality.
In modern medicine, physicians are confronted with some problems that were unknown to Hippocrates. For example, clinical trials were unknown in ancient times. As Shuster (1998) noted, the Hippocratic Method was “contemplative and non-interventionist” in nature. Ancient physicians were urged to administer sufficient remedies to cure patients, and then to go no further. Thus, the original Oath was not intended to “justify the unremitting urge of modem physicians to experiment on their patient-subjects.”
On the other hand, some modern problems were common to Hippocrates. For example, the original Oath forbid physicians from administering a “deadly drug” to anyone. In modern terms, this prohibits euthanasia, or physician-assisted suicide (PAS). Similarly, the original Oath was clear about not giving women “an abortive remedy.” Finally, physicians in the Hippocratic world faced sexual temptations also shared by modern physicians.
How, then, do modern medical schools use the Hippocratic Oath?
The Hippocratic Oath is Not Administered to Medical School Graduates
Over the last two decades, independent researchers have studied oaths administered to medical school graduates. According to Yolly Gamutan, a 1993 survey of U.S. and Canadian medical schools found that none of them used the original Oath. Instead, modern oaths were administered where only 14% prohibited euthanasia, 8% rejected abortion, and 3% forbid sexual misconduct, "which were all maxims held sacred” in the original Oath.
An updated analysis was conducted in 2000, and the results were comparable. Only one medical school out of 141 schools surveyed used the original Oath (Kao, 2004). Furthermore, 7% of modern oaths prohibited physicians from helping with euthanasia or PAS, 0% rejected abortion, and 5% forbid sexual misconduct.
Although these statistics provide a general idea of what ideals are not important to modern physicians, it is also worthwhile to examine one specific 'modern' version of the Hippocratic Oath.
The New Hippocratic Oath (1995)
In 1995, members of the Value of Life Committee, Inc., decided to update the Hippocratic Oath. The changes made are subtle, but reflect a conservative viewpoint that is as distant from Hippocrates' original intentions as may be imagined. Several notable differences are as follows:
- Rather than invoking “Apollo Physician and Asclepius and Hygieia and Panaceia” as witnesses, the revised Oath seeks the “presence of the Almighty . . . before my family, my teachers and my peers.”
- The original Oath required a commitment from physicians to give former teachers “in need of money . . . a share of mine.” The revised Oath removes all monetary compensation and merely suggests that teachers be regarded as “equally dear to me as my parents.”
- The original Oath admonished physicians from giving women “an abortive remedy.” The revised Oath goes beyond assisting with abortion to an outright ban on fetal stem cell research as well as PAS, with an aim of maintaining “the utmost respect for every human life from fertilization to natural death.”
- The original Oath did not mention the thorny problem of experimentation or human research. The revised Oath, however, prohibits physicians from research without “informed consent,” and cautions that research must benefit the individual involved.
- The original Oath prohibited physicians from engaging in sexual relations with any member of a patient's house. The revised Oath narrows the prohibition only to the “seduction of any patient.”
- The original Oath advised physicians to practice ethical principles so that they would receive the right to “enjoy life and art.” The revised Oath promised, as rewards, “the blessing of the Almighty” and the respect of “peers and society.”
Overall, the revised Oath promotes Christian principles and beliefs and thus excludes non-Christian physicians who worship Allah, subscribe to Buddhism, or choose not to believe at all.
As Graham (2000) observed, “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.” This is especially true of modern Hippocratic Oaths.
References
-------. 2005. The Hippocratic Oath (original version translated by J Chadwick & W.N. Mann, 1950). Heart Views. 6(2):86-89.
Graham D. 2000. Revisiting Hippocrates. Does an Oath Really Matter? JAMA. 284(22):2841-42.
Kao AC. 2004. Content analyses of oaths administered at U.S. Medical Schools in 2000. Academic Medicine. 79(9):882-7.
Shuster E. 1998. The Nuremberg Code: Hippocratic ethics and human rights. Lancet. 351:974-77.
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