Validity of the Hippocratic Oath 4
Here you have a clear message as to where he stands. When the ancient Greek civilization was at its peak during the 400’s BC, sick people sought magical cures in temples. It was Hippocrates belief that every disease had only natural causes and that a well-trained physician could cure illness with knowledge gained from medical writings or experience (Jason Frasco, Ancient Greek Medicine). This was, to say the least, a major leap forward. It is also fair to say Hippocrates created the field of medicine based on this approach and then went to lengths to institutionalize it. It can be disputed that he actually wrote the oath and it deserves a measure of scholarly attention to clear the air. We can do this by comparing what was practiced in the Hippocratic Corpus, to what was preached in the Hippocratic Oath.
If you look carefully at the original oath you can see is it bipartite. The first half talks about the duties of the student toward his teacher and the teacher’s obligations in transmitting medical knowledge to his students; the second half gives a summary of medical ethics. It is here that most scholars agree that the oath could not have been written by Hippocrates, but by some of his followers.
The first inconsistency appears when the oath prohibits abortion and yet, the Hippocratic Corpus contains a number of allusions to methods of abortion. One must remember in ancient times it was common practice and held justifiable to expose infants immediately after birth. It would seem even less objectionable to abort. The other discrepancy between the oath and general Hippocratic principles was the ban on suicide. Suicide, as a relief from illness, was regarded as justifiable and legalized in most Greek city-states. There is only one philosophical dogma that can account for these two
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inconstancies and that was Pythagoreanism (Arch/Surg/Vol. 135).
The Pythagorean School was the only school that strictly prohibited surgical procedures of all kinds involving the shedding of blood, hence the censure of suicide and abortion. They believed the soul was kept in the blood and to spill it, amounted to an egregious action. However, several treatises in the Hippocratic Corpus deal at length with surgical techniques and operating procedures. This is further supported by Hippocrates when he says:
What drugs will not cure, the knife will; what the knife will not cure, the cautery
will; what the cautery will not cure must be considered incurable” (Penguin, 1978).
There is no doubt many lives were saved over the course of many Greek wars and from just plain living day to day. This begs the question, of course, was the Hippocratic Oath an unfair representation of the founder’s medical ethics and practice? The simple answer is no, so long as you keep the intent of the oath in perspective. The rest of the oath falls in line with medical etiquette and although it has been modified several times it does address the overall concern about the duties of the physician, rather than the rights of the physician that you would normally associate with guildsmen or tradesmen. With this understanding let us move on to the rest of the oath to gather, as it were, the essentiality of the message it contained.
The two key ingredients of the oath, both modern and ancient, are the passing and sharing of knowledge to carry on the practice and then how one should conduct
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themselves in the practice. Comparing each of the first parts of the oaths the seriousness and earnestness of each is strikingly obvious. The tonality of each message couldn’t be more similar. This, of course, was by design in that the modern version attempts to copy the intent while maintaining some semblance of relevancy. Each of the parts reflects the customs of the day. The covenant is constant pertaining to formal instruction, whether it be the “hard won scientific gains” or “to give a share of precepts and oral instruction”. Each are key components to the art of medicine. The second halves of the oaths are more complicated, not only because of the bias mentioned earlier, in which the Pythagoreans put their spin on the oath, but that modern medicine has advanced so far, it is difficult to pick out the similarities.
The ancient version puts so many limitations on physicians that today it would be deemed ridiculous. The Greeks were believers in the idea of “Essentialism”, which was an evolutionary theory in that every living organism contained certain mixtures of the four elements (earth, air, fire, and water) called humours. The humours consisted of black bile, phlegm, yellow bile, and blood. If they weren’t in balance with each other sickness was the result (Jason Frasco, Greek Medicine). That’s why Hippocrates was one of the first to introduce diet as a means for healing. He used his knowledge of the humours in conjunction with diet to promote health. In fact, one could say he was one of the first to introduce preventative medicine. Hippocrates stipulates:
To know the cause of a disease and to understand the use of the various
methods by which disease may be prevented amounts to the same thing
in effect as being able to cure the malady. (Penguin, 1978)
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This is an example of ancient revolutionary thinking, encapsulating the modern oath’s verbiage “I will prevent disease whenever I can, for prevention is preferable to cure”. It gives ample reason why historians called Hippocrates the father of modern medicine. He was correct in his methods concerning the approach to the healing arts, and that is why it endures to this day. However, having said that, it still must be determined which part or parts of the oath are relevant.
When comparing the modern oath against the ancient one the dissimilarities are very apparent. However, there is one part of the oath, in both versions, which has perpetuated and become, as it were, the foundation to base its relevancy. It could not be any simpler. The ancient version declares “I will come for the benefit of the sick” and the modern version charges right back with “I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being”, forming an enduring and relevant expression that transcends time. Grant it, the ancient oath became buried and didn’t resurface in North American until 1804 (JAMA, December 2000), but by 1993 fully 98 percent of medical schools administered some form of the oath (Arch Surg/Vol 135). The modern version doesn’t swear to gods anymore, but it does convey a solemn and binding treaty. If anything, the oath gives the practitioner something of value to consider in relation to how the conduct of his or her practice is fulfilled.
There have been a number of debates in the medical community concerning the validity of the Hippocratic Oath. One doctor, in favor of the oath said “The oath binds us to commit ourselves to membership in a group that joins each of us to one another, and, more importantly, joins us to a body of moral precepts” (Gerald Healy, 1998). One
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would think, and be correct in their assumption, that Hippocrates wrote the oath for this very purpose. The commonalties that encompass the principles of beneficence and nonmaleficence have not changed in 2,400 years. The notion of “Primum non nocere” or “First, do no harm” is as apropos now as it was then. It is very possible, even probable, the legacy of the oath will outlast the pillars of the Parthenon, making it a true gift and enduring legacy from the ancient Greek world.
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Appendix
The Hippocratic Oath (Ancient 400 B.C.)
I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfil 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 learning to my sons and to the sons of him who has 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 an 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 fulfil this oath and do 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.
Translation from the Greek by Ludwig Edelstein. From The Hippocratic Oath: Text, Translation, and Interpretation, by Ludwig Edelstein. Baltimore: Johns Hopkins Press, 1943.
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The Hippocratic Oath (Modern, 1969)
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. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. 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 1969 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, and used in many medical schools today.
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G.E.R. Lloyd. Harmondsworth. (Penguin, 1978). (p 145, 236) Hippocrates,
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