Definition of Hippocratic Medicine
Hippocratic Medicine has six primary requirements:
- Transcendence essential to medicine
- Physician & patient accountable to a higher authority
Medicine as a Moral Activity
- Medicine is a moral activity
- Physicians help patients decide what they ‘ought’ to do
Life Not Death
- Physicians promise not to intentionally kill or do harm
- Complete separation of killing and healing in society
- Covenantal relationship between physician and patient
- Professional relationship throughout illness until death
- Informed by medical judgment, conscience and faith
- Preserved by freedom to refuse harmful treatment
- Moral consensus amongst like-minded practitioners
History of the Oath of Hippocrates
The Hippocratic Oath was probably not penned by Hippocrates himself but, most likely, by a small collection of his students in the decades following his death. Nonetheless, the Oath named after him almost certainly represents the philosophy espoused by Hippocrates and by which he practiced medicine in his day. For the first time, this physicians’ Oath codified an ethical standard for the art, which, first of all, transcends the vicissitudes of societal law and, further, which specified a professional dedication to the sanctity of life and a trust-based relationship between doctors and their patients.
For 25 centuries, the Oath stood unamended and uncontested as the template for medical practice. Anthropologist Margaret Mead wrote:
For the first time in our tradition there was a complete separation between killing and curing. Throughout the primitive world, the doctor and the sorcerer tended to be the same person. He with power to kill had power to cure, including specially the undoing of his own killing activities. … With the Greeks, the distinction was made clear. One profession, the followers of Asclepius, were to be dedicated completely to life under all circumstances, regardless of rank, age, or intellect – the life of a slave, the life of the Emperor, the life of a foreign man, the life of a defective child. … [T]his is a priceless possession which we cannot afford to tarnish, but society always is attempting to make the physician into a killer – to kill the defective child at birth, to leave the sleeping pills beside the bed of the cancer patient. … [I]t is the duty of society to protect the physician from such requests. (Marker, 1991)
The importance of the immutability of this code of ethics cannot be overstated. The dangers of societal expectations, or even mandates, to violate that professional code are not merely hypothetical. After the second World War, it once again became necessary to codify professional conduct for physicians, but this time, in international law. Following the Nuremberg Trials and the “Subsequent Nuremburg Trials” of 1946-47 for Nazi doctors accused of crimes involving horrific examples of human experimentation, the Declaration of Geneva was adopted in 1948 by the General Assembly of the World Medical Association in Geneva. This declaration was a modern restatement of the tenets of the Hippocratic Oath which would forever prohibit the physician-perpetrated atrocities to humanity exposed among at least 20 Nazi doctors. These same atrocities were defended by the accused physicians based on their legality and by the mitigating circumstance that the doctors were operating under lawful orders of their superiors. The tribunal found the doctors guilty on the basis of violating a “higher law” than that of a nation. If such a professional code is not immutable, then these doctors were convicted unjustly. Clearly, by today’s standards, they would have been acquitted.
Sadly, this declaration has not been treated as immutable either, but has undergone a series of politically-correct amendments that considerably weaken it. For instance, the sanctity of human life has been obscured in the current form of the Declaration of Geneva. The following bracketed portion of the original provision was completely deleted in 2005:
I will maintain the utmost respect for human life, [from the time of its conception, even under threat, I will not use my medical knowledge contrary to the laws of humanity].
Despite clear examples of the wisdom of- and necessity for the Oath, some of its basic tenets have come under fire in recent decades.
Versions of the Hippocratic Oath
It should be instructive to compare this translation of the original Hippocratic Oath from the 4th Century BC, with the subsequent 1995 and 2009 revisions.
Original Oath of Hippocrates
I swear by Apollo, Physician and Aesclepius, Hygeia and Panacea and all the gods and goddesses, making them my witness, that I will fulfill according to my ability and judgement, this oath and this covenant:
To hold him who has taught me this art as equal to my parents and to live in partnership to 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 brother in male lineage and to teach them this art – if they deserve 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 taken an oath according to the medical law, but to no one else.
I will apply dietetic measures for the benefit of the sick according to my ability and judgement; I will keep them from harm and injustice.
I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect. Similarly, I will not give 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 from sufferers from stone, but will withdraw in favour of such men as are engaged in this work.
Whatever house I 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.
Whatever I may see or hear in the course of the treatment or even outside 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.
Translated by J. Chadwick and W.N. Mann 1950
Hippocratic Oath | 1995
I SWEAR in the presence of the Almighty and before my family, my teachers and my peers that according to my ability and judgment I will keep this Oath and Stipulation:
TO RECKON all who have taught me this art equally dear to me as my parents and in the same spirit and dedication to impart a knowledge of the art of medicine to others. I will continue with diligence to keep abreast of advances in medicine. I will treat without exception all who seek my ministrations, so long as the treatment of others is not compromised thereby, and I will seek the counsel of particularly skilled physicians where indicated for the benefit of my patient.
I WILL FOLLOW that method of treatment which according to my ability and judgment, I consider for the benefit of my patient and abstain from whatever is harmful or mischievous. I will neither prescribe nor administer a lethal dose of medicine to any patient even if asked nor counsel any such thing nor perform art or omission with direct intent deliberately to end a human life. I will maintain the utmost respect for every human life from fertilization to natural death and reject abortion that deliberately takes a unique human life.
WITH PURITY, HOLINESS AND BENEFICENCE I will pass my life and practice my art. Except for the prudent correction of an imminent danger, I will neither treat any patient nor carry out any research on any human being without the valid informed consent of the subject or the appropriate legal protector thereof, understanding that research must have as its purpose the furtherance of the health of that individual. Into whatever patient setting I enter, I will go for the benefit of the sick and will abstain from every voluntary act of mischief or corruption and further from the seduction of any patient.
WHATEVER IN CONNECTION with my professional practice or not in connection with it I may see or hear in the lives of my patients which ought not be spoken abroad I will not divulge, reckoning that all such should be kept secret.
WHILE I CONTINUE to keep this Oath unviolated may it be granted to me to enjoy life and the practice of the art and science of medicine with the blessing of the Almighty and respected by my peers and society, but should I trespass and violate this Oath, may the reverse be my lot.
Adapted and endorsed by 35 inter-faith ethicists and physicians.
Copyright, 1995, Value of Life Committee, Inc., P.O. Box 35279; Brighton, MA 02135.
Hippocratic Oath | 2009
In the presence of the Almighty, I promise to keep this Oath to the best of my ability and judgment. Those who have taught me the art of medicine I will respect, and will seek to faithfully impart my knowledge to those who also accept this covenant, and to whom I am a mentor.
I will always seek the healing and comfort of those who are sick according to my ability and medical judgment, protecting them from harm and injustice.
I will not help a patient commit suicide; neither will I help a woman obtain an abortion.
In purity and holiness, I will guard my professional moral integrity.
When indicated, I will seek the counsel of those with appropriate special skills for the benefit of my patient.
I will always act for the benefit of the sick, treating them with respect and dignity, and avoiding all sexual involvement with my patients.
Whatever I may see or hear about my patients, I will hold in strict confidence.
May I be found faithful to these promises and so enjoy life and the practice of the art of medicine at all times.