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Hippocratic Oath

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The Hippocratic Oath is an oath traditionally taken by physicians pertaining to the ethical practice of medicine. It is widely believed that the oath was written by Hippocrates, the father of medicine, in the 4th Century B.C., or by one of his students (refactored from Farnell1). Classical scholar Ludwig Edelstein proposed that the oath was written by Pythagoreans, a theory that has been questioned due to the lack of evidence for a school of Pythagorean medicine. (refactored from Temkin) Although mostly of historical and traditional value, the oath is considered a rite of passage for practitioners of medicine.

The Hippocratic Oath

Original, translated from Greek.

I swear by Æsculapius, Hygeia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgement, the following Oath.

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 if they so desire without fee or written promise; to impart to my sons and the sons of the master who taught me and the disciples who have enrolled themselves and have agreed to the rules of the profession, but to these alone the precepts and the instruction.

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

To please no one will I prescribe a deadly drug nor give advice which may cause his death.

Nor will I give a woman a pessary to procure abortion.

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

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 with 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 men and in all times; but if I swerve from it or violate it, may the reverse be my lot.

Modern relevance

Several parts of the oath have been removed or re-shaped over the years in various countries, schools, and societies as the social, religious, and political importance of medicine has changed. Most schools administer some form of oath, but the great majority no longer use the ancient version, which praised non-Abrahamic deities, advocated teaching of men but not women, and forbade general practitioners from surgery, abortion, euthanasia, or abuse of the prescription pad. Also missing from the ancient Oath and from many modern versions are the complex ethical issues associated with HMOs, living wills, and whether morning-after pills are technically closer to prophylactics or an abortion.

Changed portions of the oath:

  1. To teach medicine to the sons of my teacher. In the past, medical schools would give preferential consideration to the children of physicians. This too has largely disappeared.
     
  2. Not to teach medicine to other people. If taken seriously, a physician who attempts to educate or make aware of treatment options, even online, to anyone not enrolled in medical school would lose his or her license.
     
  3. To practice and prescribe to the best of my ability for the good of my patients, and to try to avoid harming them. This beneficial intention is the purpose of the physician. However, this item is still invoked in discussions of euthanasia.
     
  4. Never to do deliberate harm to anyone for anyone else's interest. Physician organizations in the U.S. and most other countries have strongly denounced physician participation in legal executions.
     
  5. Never to attempt to induce an abortion. The wide availability of abortions in much of the world suggests that many physicians no longer feel bound by this.
     
  6. To avoid violating the morals of my community. Many licensing agencies will revoke a physician's license for offending the morals of the community ("moral turpitude").
     
  7. To avoid attempting to do things that other specialists can do better. The "stones" referred to are kidney stones or bladder stones, removal of which was judged too difficult for physicians, and therefore was left for surgeons (specialists). It is interesting how early the value of specialization was recognized. The range of knowledge and skills needed for the range of human problems has always made it impossible for any single physician to maintain expertise in all areas. This also highlights the different historical origins of the surgeon and the physician.
     
  8. To keep the good of the patient as the highest priority. There may be other conflicting "good purposes," such as community welfare, conserving economic resources, supporting the criminal justice system, or simply making money for the physician or his employer that provide recurring challenges to physicians.
     
  9. To avoid sexual relationships or other inappropriate entanglements with patients and families. The value of avoiding conflicts of interest has never been questioned.
     

Modern versions and alternatives

A widely used modern version of the traditional oath was penned by Louis Lasagna, former Dean of Tufts Medical School.

In the 1970s cultural and social forces induced many American medical schools to abandon the Hippocratic Oath as part of graduation ceremonies, usually substituting a version modified to something considered more politically up to date, or an alternate pledge like the Oath or Prayer of Maimonides.

The Hippocratic Oath has been updated by the Declaration of Geneva. In the United Kingdom, the General Medical Council provides clear modern guidance in the form of its 'Duties of a Doctor' and 'Good Medical Practice' statements.

Primum non nocere

It is a common misconception that the phrase primum non nocere, “first, do no harm” is included in the Hippocratic Oath. It is not, but seems to have been derived through Galen from Hippocrates’s Epidemics in which he wrote, “Declare the past, diagnose the present, foretell the future; practice these acts. As to diseases, make a habit of two things—to help, or at least to do no harm.”

See also

Footnotes

  • Template:Ent cf. L.R. Farnell, Greek Hero Cults and Ideas of Immortality, Chapter 10, "The Cult of Asklepios" (pp.234-279), 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."
  • Template:Ent, "On Second Thought," in "On Second Thought" and Other Essays in the History of Medicine, Baltimore: Johns Hopkins University Press, 2002.

References

External links

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