HIPPOCRATES REVISITED
Dr. ANTHONY LOLATGIS *
All of the writings of Hippocrates and his renowned pupils together with his famous Aphorisms were compiled under the title Corpus Hippocraticum in the 3rd Century BCE.
The Oath has come down to us from Greek antiquity and reminds us that medicine is not practiced in an ethical vacuum. Most of its content is relevant today, particularly its emphasis on privacy.
Hippocrates was born in the small Greek island of Kos (in the Aegean Sea) near the coast of Asia Minor in 460 BCE and died in Larissa, a town in mainland Greece in 377 BCE.
Before his era Medicine was practiced as an empirical Art and had strong religious and superstitious connotations.
Hippocratic Medicine represents the landmark for the evaluation of Western Medicine and was the beginning of Evidence Based Medicine.
Hippocrates rejected the notion that illness was caused by divine powers and believed that treatment should be based on observation reasoning and experience.
One of the intriguing aspects of the oath is that its meaning can always be a focus for reflection and discussion on contemporary modern day ethical issues.
It will inspire debate and promote reflection even in modern times some 2500 years from it genesis.
Below is the Declaration of Geneva a modern day version of the Oath, initially formulated after the second world war in 1948 and since 1948 revised on a number of occasions:
DECLARATION OF GENEVA
Adopted by the 2nd General Assembly of the World Medical Association, Geneva, Switzerland, September 1948 and amended by the 22nd World Medical Assembly, Sydney, Australia, August 1968 and the 35th World Medical Assembly Venice, Italy, October 1983 and the 46th WMA General Assembly Stockholm, Sweden, September 1994.
AT THE TIME OF BEING ADMITTED AS A MEMBER OF THE MEDICAL PROFESSION:
I SOLEMNLY PLEDGE myself to consecrate my life to the service of humanity;
I WILL GIVE to my teachers the respect and gratitude that is due;
I WLL PRACTICE my profession with conscience and dignity;
THE HEALTH OF MY PATIENT will be my first consideration;
I WILL RESPECT the secrets that are confided in me, even after the patient has died;
I WILL MAINTAIN by all the means in my power, the honor and the noble traditions of the medical profession;
MY COLLEAGUES will be my sisters and brothers;
I WILL NOT PERMIT consideration of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation or social standing to intervene between my duty and my patient;
I WILL MAINTAIN the utmost respect for human life from its beginning even under threat and I will not use my medical knowledge contrary to the laws of humanity;
I MAKE THESE PROMISES solemnly, freely and upon my honor.
Now, consider the Declaration of Geneva with the classical version(1) of the Hippocratic Oath:
- I swear by Apollo Physician and Asclepius and Hygeia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant.
- To hold him who has taught me this art as equal to my parents and to live my life in partnership with 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 brothers in male lineage and to teach them this art-if they desire to learn it - without fee and covenant; to give a share of precepts and oral instruction and all the other instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else
- I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.
- I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman abortive remedy. In purity and holiness I will guard my life and my art.
- I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.
- Whatever houses I may 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.
- What I may see or hear in the course of the treatment or even outside of 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 not violate it, may it be granted to me to enjoy life and art, being honored 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.
I am sure by reflecting on both of these versions it will inspire questions and curiosity in our readers. A number of questions immediately arise. Some of those questions may be:
- Should we swear on oath?
- Is it relevant today?
- What should be the content? Is content or tradition more important?
- Can a modern physician extrapolate modern meaning from the traditional oath? Does he need insightful guidance?
- Should we have an opportunity to choose yes or no and which version?
- Does an oath make a difference?
- Who decides? The profession? The faculty? The public? The government? The students?
- What is the view of the public our patients and the profession as a whole?
- Do these views differ and why?
- What do other countries do and what has been their experience?
In assessing the impact of Hippocratic values on modern American physicians one must note the extraordinary degree to which graduating medical students and their families and teachers support the public act of oath-taking.
In the United States perhaps three decades ago, students noted the discrepancies between what most of them believed and some of the proscriptions specified in the Hippocratic Oath; thus modern oaths were written, or alternatives such as the Oath of Maimonides, written in the Middle Ages, were utilized at graduation ceremonies for the public "professing" of newly minted physicians.
It has become the custom to allow students to choose their oath, and a remarkable trend has been the renewed prominence of the ancient Oath of Hippocrates in preference to the several others, which are as every bit as idealistic, often more complete and conceptual, and certainly express particulars more in keeping with the beliefs of most of the community(2).
If I were to express a personal view, it would be that I would like to see some form of oath taking performed at graduation as a choice or option for students. After all, our policemen and policewomen, our armed forces, our new citizens, and our officers of Government take some form of oath at the commencement of their positions. So too, do lawyers when admitted to practice. Perhaps it is time for reflection as to the position with medical practitioners.
NOTES
* Doctor of Medicine, Melbourne.
1. Translation from the Greek by Ludwig Edelstein. From the Hippo Transcratic Oath: Text, Translation and Interpretation by Ludwig Edelstein, Baltimore: John Press, 1943.
2. Roger J. Bulger and Anthony L. Barbato. "On the Hippocratic Sources of Western Medical Practice", Special Supplement, Hastings Center Report 30, NO. 4(200):S4-S7
Copyright 2004. Greek Legal and Medical Conference