Hippocratic Oath

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A 12th-century Byzantine manuscript of the Oath

The Hippocratic Oath (Greek ὅρκος horkos) is an oath historically taken by physicians. It is one of the most widely known of Greek medical texts. It requires a new physician to swear, upon a number of healing gods, to uphold specific ethical standards. Of historic and traditional value, the oath is considered a rite of passage for practitioners of medicine in many countries, although nowadays the modernized version of the text varies among them.

Scholars widely believe that Hippocrates, often called the father of medicine in Western culture, or one of his students wrote the oath.[1] The oath is written in Ionic Greek (late 5th century BC),[2] It is usually included in the Hippocratic Corpus.

Classical scholar Ludwig Edelstein proposed that the oath was written by Pythagoreans, an idea that others questioned for lack of evidence for a school of Pythagorean medicine.[3]

Original oath[edit]

This is the original version of the Hippocratic Oath:

I swear by Apollo the physician, and Aesculapius the surgeon, likewise Hygeia and Panacea, and call all the gods and goddesses to witness, that I will observe and keep this underwritten oath, to the utmost of my power and judgment.

I will reverence my master who taught me the art. Equally with my parents, will I allow him things necessary for his support, and will consider his sons as brothers. I will teach them my art without reward or agreement; and I will impart all my acquirement, instructions, and whatever I know, to my master's children, as to my own; and likewise to all my pupils, who shall bind and tie themselves by a professional oath, but to none else.

With regard to healing the sick, I will devise and order for them the best diet, according to my judgment and means; and I will take care that they suffer no hurt or damage.

Nor shall any man's entreaty prevail upon me to administer poison to anyone; neither will I counsel any man to do so. Moreover, I will get no sort of medicine to any pregnant woman, with a view to destroy the child.

Further, I will comport myself and use my knowledge in a godly manner.

I will not cut for the stone, but will commit that affair entirely to the surgeons.

Whatsoever house I may enter, my visit shall be for the convenience and advantage of the patient; and I will willingly refrain from doing any injury or wrong from falsehood, and (in an especial manner) from acts of an amorous nature, whatever may be the rank of those who it may be my duty to cure, whether mistress or servant, bond or free.

Whatever, in the course of my practice, I may see or hear (even when not invited), whatever I may happen to obtain knowledge of, if it be not proper to repeat it, I will keep sacred and secret within my own breast.

If I faithfully observe this oath, may I thrive and prosper in my fortune and profession, and live in the estimation of posterity; or on breach thereof, may the reverse be my fate![4]

"First do no harm"[edit]

It is a popular misconception that the phrase "First do no harm" (Latin: Primum non nocere) is a part of the Hippocratic oath. In fact the phrase is believed to have originated with the 19th-century surgeon Thomas Inman.[5]

Modern use and relevance[edit]

Engraving of Hippocrates by Peter Paul Rubens, 1638.[6]

The oath has been modified numerous times. One of the most significant revisions was first drafted in 1948 by the World Medical Association (WMA). Called the Declaration of Geneva. "During the post World War II and immediately after its foundation, the WMA showed concern over the state of medical ethics in general and over the world. The WMA took up the responsibility for setting ethical guidelines for the world physicians. It noted that in those years the custom of medical schools to administer an oath to its doctors upon graduation or receiving a license to practice medicine had fallen into disuse or become a mere formality".[7] In Germany during the Third Reich, medical students did not take the Hippocratic Oath, although they knew the ethic of "nil nocere" - do no harm.[8]

In the 1960s, the Hippocratic Oath was changed to "utmost respect for human life from its beginning", making it a more secular concept, not to be taken in the presence of God or any gods, but before only other people. When the Oath was rewritten in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, the prayer was omitted, and that version has been widely accepted and is still in use today by many medical schools.[9]

While there is currently no legal obligation for medical students to swear an oath upon graduating, 98% of American medical students swear some form of oath, while only 50% of British medical students do. [10]

In the United States, the majority of osteopathic medical schools use the Osteopathic Oath in place of or in addition to the Hippocratic Oath. The Osteopathic Oath was first used in 1938, and the current version has been in use since 1954. [11]

In a 1989 survey of 126 US medical schools, only three reported usage of the original oath, while thirty-three used the Declaration of Geneva, sixty-seven used a modified Hippocratic Oath, four used the Oath of Maimonides, one used a covenant, eight used another oath, one used an unknown oath, and two did not use any kind of oath. Seven medical schools did not reply to the survey. [12]

In a 2000 survey of US medical schools, all of the then extent medical schools administered some type of profession oath. Among allopathic schools, 62 of 122 used the Hippocratic Oath, or a modified version of it. The other 60 schools used the original or modified Declaration of Geneva, Oath of Maimonides, or an oath authored by students and or faculty. All 19 osteopathic schools used the Osteopathic Oath. [13]

In France, it is common for new medical graduates to sign a written oath.[14][15]

In 1995, Sir Joseph Rotblat, in his acceptance speech for the Nobel Peace Prize, suggested a Hippocratic Oath for Scientists. [16]

While the original Hippocratic Oath explicitly prohibits abortion, it is no longer considered a professional violation of ethics to perform one in countries in which it is legal.[citation needed]

Lethal injection and the Hippocratic Oath[edit]

There has been a large debate on whether a doctor administering or facilitating in a lethal injection to a prisoner is breaking the Hippocratic Oath they took.

In 1991, José High was set to be executed in Georgia, United States. The execution team could not gain access to Jose High's vein due to extreme drug use from his past. The execution team brought in a doctor who had critical care training and was an expert at finding deep veins in the human body. Once the doctor was hired for the sole reason of inserting an IV, the doctor at that point became part of the execution team.

Up until this point, doctors would not take part in placing an IV or administering the drugs, but were only there to pronounce the death of the inmate. The execution happened without incident; however, a group of doctors sued the Georgia State Medical Board for not disciplining the doctor, stating that he violated federal law and broke the Hippocratic Oath (although the Hippocratic oath is not legally binding). In response, the Georgia legislature passed laws protecting doctors who take part in lethal injections from civil and criminal prosecution. [17]

Breaking the Hippocratic Oath[edit]

There is no direct punishment for breaking the Hippocratic oath in modern days. It can be said that malpractice is the same thing and it carries a wide range of punishments from legal action to civil penalties.[18] In antiquity the punishment for breaking the Hippocratic oath could range from a penalty to losing the right to practice medicine.[19] While there are no direct laws, doctors can still be held accountable through malpractice and other civil and criminal charges.

See also[edit]

References[edit]

  1. ^ Farnell, Lewis R. (2004) [1920]. Greek Hero Cults and Ideas of Immortality : The Gifford Lectures : Delivered in the University of St. Andrews in the Year 1920. Whitefish, Montana: Kessinger Publishing. p. 269. ISBN 978-1-4179-2134-8. The famous Hippocratean oath may not be an authentic deliverance of the great master, but is an ancient formula current in his school. 
  2. ^ Edelstein, Ludwig (1943). The Hippocratic Oath: Text, Translation and Interpretation. p. 56. ISBN 978-0-8018-0184-6. 
  3. ^ Temkin, Owsei (2001). "On Second Thought". "On Second Thought" and Other Essays in the History of Medicine and Science. Johns Hopkins University. ISBN 978-0-8018-6774-3. 
  4. ^ "The Hippocratic Oath". The London Medical Repository 23 (135): 258. 1 March 1825. Retrieved 22 September 2014. . For the Greek text, see Jones, W. H. S., ed. (1868). Hippocrates Collected Works (in Greek) I. Cambridge Harvard University Press. pp. 130–131. Retrieved 22 September 2014. 
  5. ^ Sokol, Daniel K. (2013). "'First do no harm' revisited". BMJ 347 (f6426). Retrieved 20 September 2014. 
  6. ^ National Library of Medicine 2006
  7. ^ World Medical Association, Inc. "WMA History". www.wma.net. World Medical Association, Inc. Retrieved 1 November 2014. 
  8. ^ Baumslag, Naomi (2005). Murderous Medicine: Nazi Doctors, Human Experimentation, and Typhus. Praeger Publishers. pp. xxv. ISBN 9780275983123. 
  9. ^ "The Hippocratic Oath Modern Version". University of California San Diego. 
  10. ^ Dorman, J. (September 1995). "The Hippocratic Oath". Journal of American College Health 44 (2): 84–88. doi:10.1080/07448481.1995.9937519. ISSN 0744-8481. Retrieved 2013-09-20. [dead link]
  11. ^ "Osteopathic Oath". osteopathic.org. American Osteopathic Association. Retrieved 28 November 2014. 
  12. ^ Crawshaw, R (8 October 1994). "The Hippocratic oath. Is alive and well in North America.". BMJ (Clinical research ed.) 309 (6959): 952. PMID 7950672. 
  13. ^ Kao, AC; Parsi, KP (September 2004). "Content analyses of oaths administered at U.S. medical schools in 2000.". Academic medicine : journal of the Association of American Medical Colleges 79 (9): 882–7. PMID 15326016. 
  14. ^ Sritharan, Kaji; Georgina Russell; Zoe Fritz; Davina Wong; Matthew Rollin; Jake Dunning; Bruce Wayne; Philip Morgan; Catherine Sheehan (December 2000). "Medical oaths and declarations". BMJ 323 (7327): 1440–1. doi:10.1136/bmj.323.7327.1440. PMC 1121898. PMID 11751345. 
  15. ^ Crawshaw, R; Pennington, T H; Pennington, C I; Reiss, H; Loudon, I (October 1994). "Letters". BMJ 309 (6959): 952. doi:10.1136/bmj.309.6959.952. PMC 2541124. PMID 7950672. 
  16. ^ "Nobel Prize winner calls for ethics oath". Physics World. 19 December 1997. Retrieved 2008-07-19. 
  17. ^ Black, Lee. "Lethal Injection and Physicians: State Law vs Medical Ethics". Death Penalty Information Center. Retrieved 29 November 2014. 
  18. ^ Groner M.D., Johnathan (2008). "The Hippocratic Paradox: The Role of The Medical Profession In Capital Punishment In The United States". Fordham Urban Law Journal Library. 
  19. ^ Nutton, Vivian (2004). Ancient Medicine. New York, NY: Routledge. 

Further reading[edit]

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