Hippocratic Oath

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A 12th-century Greek manuscript of the Oath

The Hippocratic Oath is an oath historically taken by physicians. It is one of the most widely known of Greek medical texts. In its original form, it requires a new physician to swear, by 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 various modernized versions are often used; the message delivered is still the same, "Do no Harm."

Hippocrates is often called the father of medicine, in Western culture.[1] The original oath was written in Ionic Greek, in the late Fifth Century BCE.[2] It is usually included in the Hippocratic Corpus.

Scholars widely believe that Hippocrates or one of his students wrote the oath between the 5th and 3rd century BCE.[3] Alternatively, classical scholar Ludwig Edelstein proposed that the oath was written by the Pythagoreans, an idea that others questioned for lack of evidence for a school of Pythagorean medicine.[4]

Original oath[edit]

A fragment of the Oath on the 3rd-century Papyrus Oxyrhynchus 2547.

This is the original version of the Hippocratic Oath, in Greek and then followed by the English translation:

ὄμνυμι Ἀπόλλωνα ἰητρὸν καὶ Ἀσκληπιὸν καὶ Ὑγείαν καὶ Πανάκειαν καὶ θεοὺς πάντας τε καὶπάσας, ἵστορας ποιεύμενος, ἐπιτελέα ποιήσειν κατὰ δύναμιν καὶ κρίσιν ἐμὴν ὅρκον τόνδε καὶσυγγραφὴν τήνδε:

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

διαιτήμασί τε χρήσομαιἐπ᾽ ὠφελείῃ καμνόντων κατὰ δύναμιν καὶ κρίσιν ἐμήν, ἐπὶ δηλήσει δὲ καὶ ἀδικίῃ εἴρξειν.

οὐδώσω δὲ οὐδὲ φάρμακον οὐδενὶ αἰτηθεὶς θανάσιμον, οὐδὲ ὑφηγήσομαι συμβουλίην τοιήνδε: ὁμοίως δὲ οὐδὲ γυναικὶ πεσσὸν φθόριον δώσω.

ἁγνῶς δὲ καὶ ὁσίως διατηρήσω βίοντὸν ἐμὸν καὶ τέχνην τὴν ἐμήν.

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

ἐς οἰκίας δὲ ὁκόσας ἂν ἐσίω, ἐσελεύσομαι ἐπ᾽ ὠφελείῃκαμνόντων, ἐκτὸς ἐὼν πάσης ἀδικίης ἑκουσίης καὶ φθορίης, τῆς τε ἄλλης καὶ ἀφροδισίωνἔργων ἐπί τε γυναικείων σωμάτων καὶ ἀνδρῴων, ἐλευθέρων τε καὶ δούλων.

ἃ δ᾽ ἂν ἐνθεραπείῃ ἢ ἴδω ἢ ἀκούσω, ἢ καὶ ἄνευ θεραπείης κατὰ βίον ἀνθρώπων, ἃ μὴ χρή ποτεἐκλαλεῖσθαι ἔξω, σιγήσομαι, ἄρρητα ἡγεύμενος εἶναι τὰ τοιαῦτα.

ὅρκον μὲν οὖν μοι τόνδεἐπιτελέα ποιέοντι, καὶ μὴ συγχέοντι, εἴη ἐπαύρασθαι καὶ βίου καὶ τέχνης δοξαζομένῳ παρὰπᾶσιν ἀνθρώποις ἐς τὸν αἰεὶ χρόνον: παραβαίνοντι δὲ καὶ ἐπιορκέοντι, τἀναντία τούτων.[5]

I swear by Apollo The Healer, by Asclepius, by Hygieia, by Panacea, and by all the Gods and Goddesses, making them my witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture.

To hold my teacher in this art equal to my own parents; to make him partner in my livelihood; when he is in need of money to share mine with him; to consider his family as my own brothers, and to teach them this art, if they want to learn it, without fee or indenture; to impart precept, oral instruction, and all other instruction to my own sons, the sons of my teacher, and to indentured pupils who have taken the physician’s oath, but to nobody else.

I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly I will not give to a woman a pessary to cause abortion. But I will keep pure and holy both my life and my art. I will not use the knife, not even, verily, on sufferers from stone, but I will give place to such as are craftsmen therein.

Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bond or free. And whatsoever I shall see or hear in the course of my profession, as well as outside my profession in my intercourse with men, if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets.

Now if I carry out this oath, and break it not, may I gain for ever reputation among all men for my life and for my art; but if I transgress it and forswear myself, may the opposite befall me.[5]

Modern version[edit]

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 which 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. 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.

"First do no harm"[edit]

Main article: Primum non nocere

It is often said that the phrase "First do no harm" (Latin: Primum non nocere) is a part of the Hippocratic oath. The phrase as such does not appear in the oath, although the oath does contain Latin: ... noxamvero et maleficium propulsabo (Also ... I will utterly reject harm and mischief).[6] The phrase "primum non nocere" is believed to date from the 17th century (see detailed discussion in the article on the phrase).

Another equivalent phrase is found in Epidemics, Book I, of the Hippocratic school: "Practice two things in your dealings with disease: either help or do not harm the patient".[7] The exact phrase is believed to have originated with the 19th-century surgeon Thomas Inman.[8]

Modern use and relevance[edit]

Engraving of Hippocrates by Peter Paul Rubens, 1638.[9]

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's 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".[10] 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.[11]

In the 1960s, the Hippocratic Oath was changed to require "utmost respect for human life from its beginning", making it a more secular obligation, 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 US medical schools.[12]

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.[13]

In a 1989 survey of 126 US medical schools, only three reported use 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.[14]

In a 2000 survey of US medical schools, all of the then extant medical schools administered some type of profession oath. Among schools of modern medicine, sixty-two of 122 used the Hippocratic Oath, or a modified version of it. The other sixty schools used the original or modified Declaration of Geneva, Oath of Maimonides, or an oath authored by students and or faculty. All nineteen osteopathic schools used the Osteopathic Oath.[15]

In France, it is common for new medical graduates to sign a written oath.[16][17]

In 1995, Sir Joseph Rotblat, in his acceptance speech for the Nobel Peace Prize, suggested a Hippocratic Oath for Scientists.[18]

Abortion and the Hippocratic Oath[edit]

While many Christian versions of the Hippocratic Oath, particularly from the middle-ages, explicitly prohibited abortion, the prohibition is often omitted from many oaths taken in US medical schools today, though it remains controversial.[19] Scribonius Largus was adamant in 43 AD (the earliest surviving reference to the oath) that it preclude abortion.[20]

As with Scribonius Largus, there seemed to be no question to Soranus that the Hippocratic Oath prohibits abortion, although apparently not all doctors adhered to it strictly in his time. According to Soranus' 1st or 2nd century AD work Gynaecology, one party of medical practitioners banished all abortives as required by the Hippocratic Oath; the other party—to which he belonged—was willing to prescribe abortions, but only for the sake of the mother's health.[20][21]

Euthanasia and the Hippocratic Oath[edit]

The original oath forbids the physician from administering poison or suggesting its administration. This would forbid the physician from engaging in euthanasia and, all the more so, any role in physician-assisted suicide.[22]

Lethal injection and the Hippocratic Oath[edit]

There has been a large debate on whether doctors administering or facilitating lethal injections to prisoners are 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 José 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.[23]

Breaking the Hippocratic Oath[edit]

There is no direct punishment for breaking the Hippocratic oath in modern times. It can be said that malpractice is the same thing and it carries a wide range of punishments, from legal action to civil penalties.[24] In the US, several major judicial decisions have made reference to the classical Hippocratic Oath, either upholding or dismissing its bounds for medical ethics: Roe v. Wade, Washington v. Harper, Compassion in Dying v. State of Washington (1996), and Thorburn v. Department of Corrections (1998).[25] In antiquity, the punishment for breaking the Hippocratic oath could range from a penalty to losing the right to practice medicine.[26]

See also[edit]

Ethical codes of conduct for physicians
Ethical principles for human experimentation
Ethical practices for engineers

References[edit]

  1. ^ Kantarjian, Hagop (15 October 2014). "Relevant of the Hippocratic Oath in the 21st Century". 
  2. ^ Edelstein, Ludwig (1943). The Hippocratic Oath: Text, Translation and Interpretation. p. 56. ISBN 978-0-8018-0184-6. 
  3. ^ 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 Hippocrates oath may not be an authentic deliverance of the great master, but is an ancient formula current in his school. 
  4. ^ 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. 
  5. ^ a b Hippocrates of Cos (1923). "The Oath". Loeb Classical Library. 147: 298–299. doi:10.4159/DLCL.hippocrates_cos-oath.1923. Retrieved 6 October 2015. 
  6. ^ Pavur, Claude. "The Hippocratic Oath in Latin with English translation". academia.edu (in Latin and English). Retrieved 22 September 2015. 
  7. ^ Lloyd, Geoffrey, ed. (1983). Hippocratic Writings (2nd ed.). London: Penguin Books. p. 94. ISBN 0140444513. 
  8. ^ Sokol, Daniel K. (2013). "'First do no harm' revisited". BMJ. 347 (f6426). doi:10.1136/bmj.f6426. Retrieved 20 September 2014. 
  9. ^ National Library of Medicine 2006
  10. ^ World Medical Association, Inc. "WMA History". www.wma.net. World Medical Association, Inc. Retrieved 1 November 2014. 
  11. ^ Baumslag, Naomi (2005). Murderous Medicine: Nazi Doctors, Human Experimentation, and Typhus. Praeger Publishers. pp. xxv. ISBN 9780275983123. 
  12. ^ "The Hippocratic Oath Modern Version". University of California San Diego. 
  13. ^ "Osteopathic Oath". osteopathic.org. American Osteopathic Association. Retrieved 28 November 2014. 
  14. ^ Crawshaw, R (8 October 1994). "The Hippocratic oath. Is alive and well in North America". BMJ (Clinical research ed.). 309 (6959): 952–953. doi:10.1136/bmj.309.6959.952. PMC 2541124Freely accessible. PMID 7950672. 
  15. ^ Kao, AC; Parsi, KP (September 2004). "Content analyses of oaths administered at U.S. medical schools in 2000.". Academic Medicine. 79 (9): 882–7. doi:10.1097/00001888-200409000-00015. PMID 15326016. 
  16. ^ 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 1121898Freely accessible. PMID 11751345. 
  17. ^ Crawshaw, R; Pennington, T H; Pennington, C I; Reiss, H; Loudon, I (October 1994). "Letters". BMJ. 309 (6959): 952–953. doi:10.1136/bmj.309.6959.952. PMC 2541124Freely accessible. PMID 7950672. 
  18. ^ "Nobel Prize winner calls for ethics oath". Physics World. 19 December 1997. Retrieved 2008-07-19. 
  19. ^ Markel, Howard (13 May 2004). ""I Swear by Apollo" — On Taking the Hippocratic Oath". New England Journal of Medicine. 350 (20): 2026–2029. doi:10.1056/NEJMp048092. PMID 15141039. 
  20. ^ a b "Scribonius Largus"
  21. ^ Soranus, Owsei Temkin (1956). Soranus' Gynecology. I.19.60: JHU Press. Retrieved 6 October 2015. 
  22. ^ "Neither for love nor money: Why doctors must not kill"
  23. ^ Black, Lee. "Lethal Injection and Physicians: State Law vs Medical Ethics". Death Penalty Information Center. Retrieved 29 November 2014. 
  24. ^ 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. 
  25. ^ Hasday, Lisa (23 February 2013). "The Hippocratic Oath as Literary Text: A Dialogue". Yale Journal of Health Policy, Law, and Ethics. 2 (2): Article 4. Retrieved 6 October 2015. 
  26. ^ Nutton, Vivian (2004). Ancient Medicine. New York, NY: Routledge. 

Further reading[edit]

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