Hippocratic Oath

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A 12th-century Byzantine manuscript of the Oath

The Hippocratic Oath is an oath historically taken by physicians and other healthcare professionals swearing to practice medicine honestly. It is widely believed to have been written by Hippocrates, often regarded as the father of western medicine, or by one of his students.[1] The oath is written in Ionic Greek (late 5th century BC),[2] and is usually included in the Hippocratic Corpus. Classical scholar Ludwig Edelstein proposed that the oath was written by Pythagoreans, a theory that has been questioned because of the lack of evidence for a school of Pythagorean medicine.[3] 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.

The Hippocratic Oath (horkos) is one of the most widely known of Greek medical texts. It requires a new physician to swear upon a number of healing gods that he will uphold a number of professional ethical standards.

Original[edit]

This is the original version of the Oath:[4]

Ὄμνυμι Ἀπόλλωνα ἰητρὸν καὶ Ἀσκληπιὸν καὶ Ὑγείαν καὶ Πανάκειαν καὶ θεοὺς πάντας τε καὶ πάσας, ἵστορας ποιεύμενος, ἐπιτελέα ποιήσειν κατὰ δύναμιν καὶ κρίσιν ἐμὴν ὅρκον τόνδε καὶ συγγραφὴν τήνδε‧

ἡγήσεσθαι μὲν τὸν διδάξαντά με τὴν τέχνην ταύτην ἴσα γενέτῃσιν ἐμοῖς, καὶ βίου κοινώσεσθαι, καὶ χρεῶν χρηί̈ζοντι μετάδοσιν ποιήσεσθαι, καὶ γένος τὸ ἐξ αὐτοῦ ἀδελφοῖς ἴσον ἐπικρινεῖν ἄρρεσι, καὶ διδάξειν τὴν τέχνην ταύτην, ἢν χρηί̈ζωσι μανθάνειν, ἄνευ μισθοῦ καὶ συγγραφῆς, παραγγελίης τε καὶ ἀκροήσιος καὶ τῆς λοίπης ἁπάσης μαθήσιος μετάδοσιν ποιήσεσθαι υἱοῖς τε ἐμοῖς καὶ τοῖς τοῦ ἐμὲ διδάξαντος, καὶ μαθητῇσι συγγεγραμμένοις τε καὶ ὡρκισμένοις νόμῳ ἰητρικῷ, ἄλλῳ δὲ οὐδενί.

διαιτήμασί τε χρήσομαι ἐπ' ὠφελείῃ καμνόντων κατὰ δύναμιν καὶ κρίσιν ἐμήν, ἐπὶ δηλήσει δὲ καὶ ἀδικίῃ εἴρξειν.

οὐ δώσω δὲ οὐδὲ φάρμακον οὐδενὶ αἰτηθεὶς θανάσιμον, οὐδὲ ὑφηγήσομαι συμβουλίην τοιήνδε‧ ὁμοίως δὲ οὐδὲ γυναικὶ πεσσὸν φθόριον δώσω. ἁγνῶς δὲ καὶ ὁσίως διατηρήσω βίον τὸν ἐμὸν καὶ τέχνην τὴν ἐμήν.

οὐ τεμέω δὲ οὐδὲ μὴν λιθιῶντας, ἐκχωρήσω δὲ ἐργάτῃσι ἀνδράσι πρήξιος τῆσδε.

ἐς οἰκίας δὲ ὁκόσας ἂν ἐσίω, ἐσελεύσομαι ἐπ' ὠφελείῃ καμνόντων, ἐκτὸς ἐὼν πάσης ἀδικίης ἑκουσίης καὶ φθορίης, τῆς τε ἄλλης καὶ ἀφροδισίων ἔργων ἐπί τε γυναικείων σωμάτων καὶ ἀνδρῴων, ἐλευθέρων τε καὶ δούλων.

ἃ δ' ἂν ἐν θεραπείῃ ἢ ἴδω ἢ ἀκούσω, ἢ καὶ ἄνευ θεραπείης κατὰ βίον ἀνθρώπων, ἃ μὴ χρή ποτε ἐκλαλεῖσθαι ἔξω, σιγήσομαι, ἄρρητα ἡγεύμενος εἶναι τὰ τοιαῦτα.

ὅρκον μὲν οὖν μοι τόνδε ἐπιτελέα ποιέοντι, καὶ μὴ συγχέοντι, εἴη ἐπαύρασθαι καὶ βίου καὶ τέχνης δοξαζομένῳ παρὰ πᾶσιν ἀνθρώποις ἐς τὸν αἰεὶ χρόνον‧ παραβαίνοντι δὲ καὶ ἐπιορκέοντι, τἀναντία τούτων.

English translation[edit]

I swear by Apollo, the healer, Asclepius, Hygieia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath and agreement:

To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art; and that by my teaching, I will impart a knowledge of this art to my own sons, and to my teacher's sons, and to disciples bound by an indenture and oath according to the medical laws, and no others.

I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.

I will give no deadly medicine to any one if asked, nor suggest any such counsel; and similarly I will not give a woman a pessary to cause an abortion.

But I will preserve the purity of my life and my arts.

I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.

In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or men, be they free or slaves.

All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.

If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all humanity and in all times; but if I swerve from it or violate it, may the reverse be my life.

The original oath broken down[edit]

The original Hippocratic Oath can be broken up to cover twelve different areas to which a physician is swearing to; the areas are as follows:[5]

  • The first is a covenant with the deity Apollo, who is the god of healing. Most modern oaths have removed this portion; however, the original translation reads "I swear by Apollo the physician…".
  • The second is the Covenant with Teachers, and this is done with the pledge of collegiality and financial support.
  • Next is the Commitment to Students by the promise to teach those who swear the oath.
  • After the Commitment to Students comes the Covenant with Patients, and this is the physicians pledge to use their best ability and judgment.
  • The fifth area is Appropriate Means with the use of standard "dietary" care; this is using the established and accepted practices to treat their patients.
  • Appropriate Ends is next and says that a doctor is to do what is best for the patient, rather than what is best for the physician.
  • The seventh area is the Limits on Ends, which was originally in the oath but has been omitted by many medical schools. The Limit on Ends in the oath said that a doctor would not help a women have an abortion and that the physician would not administer a lethal drug if asked. Both of these have caused many ethical dilemmas in modern times, with abortion being legal in the United States and with prisons using lethal drugs to execute prisoners.
  • The next area is Limits on Means; this refers to the leaving of surgeries and specialty care to those who have been trained in that particular specialty.
  • Next is Justice; upon taking the oath, the physician is swearing that they will avoid any voluntary act of impropriety or corruption.
  • After Justice comes Chastity, which states that a physician will not have any sexual contact with their patients.
  • The eleventh area covered is Confidentiality; this simply says that a doctor will not repeat anything that is seen or heard.
  • The final area of the oath is Accountability, which is a prayer that the physician be favored by the gods if the oath is kept and punished if it is broken.

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.[6]

Modern use and relevance[edit]

Engraving of Hippocrates by Peter Paul Rubens, 1638.[7]

The oath has been modified multiple times. One of the most significant revisions was first drafted in 1948 by the World Medical Association. Called the Declaration of Geneva, it was "intended to be a self-conscious rewriting of the Hippocratic Oath, reaffirming Hippocratism in the face of the shame and tragedy of the German medical experience". The Third Reich had, true to their genocidal ethic, of course deemed that there was such thing as a life not worth living, and this was seen in their medical experimentation on minorities throughout WWII.

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.

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. [8][dead link] 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. In France, it is common for new medical graduates to sign a written oath.[9][10] The modern Hippocratic oath being nonobligatory is in stark contrast to what a president, congressman, or other elected official takes when being sworn into office.[11]

In the United States, the majority of osteopathic medical schools use the Osteopathic Oath as well as the Hippocratic Oath. The Osteopathic Oath was first used in 1938, and the current version has been in use since 1954.

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

Abortion and the Hippocratic Oath[edit]

Despite the Hippocratic Oath prohibiting abortions, it is no longer considered a professional violation of ethics to perform one in the United States. This is very similar to what is happening currently with the lethal injection debate. As shown in the previous sections, the Hippocratic oath has been changed or modified to take out the section that forbids abortion. The important thing to remember here is that not every country has taken the same steps to modifying their Hippocratic Oath to remove abortion as the United States has. The major case that brought about this change was the Roe v. Wade case of 1973. As a result of the supreme court ruling that abortion was legal, change was brought about and the oath was modified.[12]

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, Jose High was set to be executed in Georgia. 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 become part of the execution team.

Up until this point, doctors would not take part in placing an IV or administering the drugs, they 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.

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.[13] In antiquity the punishment for breaking the Hippocratic oath could range from a penalty to losing the right to practice medicine.[14] While there may not be any outright punishment for a doctor breaking their Hippocratic oath one can see a large scale example of this with the holocaust. During the Holocaust in the early 1940s, Nazi Germany was executing people of the Jewish faith by the thousands. In an dastardly attempt to make the killing more effective they turned to doctors to help find a way to kill more people faster and cheaper. It was the ultimate violation of the Hippocratic oath on a mammoth scale. These doctors did not just go free; the United States and allies pursued these doctors and charged them with war crimes.[15] The thing to remember is that 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. (2004-06-30). "Chapter 10". Greek Hero Cults and Ideas of Immortality. Kessinger Publishing. pp. 234–279. ISBN 978-1-4179-2134-8.  p.269: "The famous Hippocratean oath may not be an authentic deliverance of the great master, but is an ancient formula current in his school."
  2. ^ The Hippocratic oath: text, translation and interpretation By Ludwig Edelstein Page 56 ISBN 978-0-8018-0184-6 (1943)
  3. ^ Temkin, Owsei (2001-12-06). "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. ^ Jones, W. H. S., ed. (1868). Hippocrates Collected Works (in Greek) I. Cambridge Harvard University Press. pp. 130–131. 
  5. ^ Hulkower, Raphael (2010). "The History of the Hippocratic Oath: Outdated, Inauthentic, and Yet Still Relevant". The Einstein Journal of Biology and Medicine. 
  6. ^ "The Hippocratic Oath Modern Version". University of California San Diego. 
  7. ^ National Library of Medicine 2006
  8. ^ Dorman, J. (September 1995). "The Hippocratic Oath". Journal of American College Health 44 (2): 84–88. ISSN 0744-8481. Retrieved 2013-09-20. 
  9. ^ 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. 
  10. ^ 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. 
  11. ^ Hulkower, Raphael. "The History of the Hippocratic Oath: Outdated,". Albert Einstein College of Medicine. 
  12. ^ Balch MD/Ph.D., Julie. "The Hippocratic Oath: An Ethic Surviving Historical,Social, and Religious Conflict". West Virginia University. Retrieved 1 April 2014. 
  13. ^ 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. 
  14. ^ Nutton, Vivian (2004). Ancient Medicine. New York, NY: Routledge. 
  15. ^ "Nazi Doctors & Other Perpetrators of Nazi Crimes". Webster University. Retrieved 18 April 2014. 
Notes

External links[edit]