Definition of the Term and Background
What are the fundamental principles that govern doctors? The ethics of the medical profession are nuanced, and many have their origins in the Hippocratic Oath. The Encyclopedia Britannica defines the Oath as, “an ethical code attributed to the ancient Greek physician Hippocrates, adopted as a guide to conduct by the medical profession throughout the ages… [which] embodied a code of principles for the teachers of medicine and for their students” (“Hippocratic Oath”, 2017). The Oath itself is a derivation of an assembly of medical manuscripts known as the Hippocratic Collection, or the Hippocratic Corpus, that originated circa 400 BC and which has preserved to remain relevant in today’s discussions of medical ethics (“Hippocratic Oath”, 2017). It has been translated from the original Greek, leading to the creation of several different contemporary versions that are slight in their deviation.
The Oath is often used in during the graduation ceremonies of many medical schools, but more broadly it has been adopted as a guide of conduct (“Hippocratic Oath”, 2017). Despite many medical students reciting the Oath as part of their completion of medical school, the Oath is in fact not legally binding. It is instead an ethical framework within which doctors are widely expected to act. The Oath offers basic principles for how doctors should interact with their patients upon which medical practice can be built (Marketos, S. G., et al, 1996). While it remains mostly broad, which lends it flexibility throughout time, it is specific on certain issues, providing a voice to hotly debated medical and ethical issues in contemporary society.
While this encyclopedia entry will focus mainly on the way that the Hippocratic Oath impacts medical practice and societal questions in the United States, the Oath does extend to other nations. For more information on how the Oath effects medicine in developing countries, this article from The BMJ offers an interesting opinion from the point of view of a doctor who worked in rural Nepal: https://www.bmj.com/content/325/7367/783.1
A translation of the Oath has been reprinted below for reference:
I swear by Apollo the Physician and by Asclepius and by Health [the god Hygieia] and Panacea and by all the gods as well as goddesses, making them judges [witnesses], to bring the following oath and written covenant to fulfillment, in accordance with my power and my judgement; to regard him who has taught me this techné [art and science] as equal to my parents, and to share, in partnership, my livelihood with him and to give him a share when he is in need of necessitates, and to judge the offspring [coming] from him equal to [my] male siblings, and to teach them this techné, should they desire to learn [it], without fee and written covenant, and to give a share both of rules and of lectures, and of all the rest of learning, to my sons and to the [sons] of him who has taught me and to the pupils who have both made a written contract and sworn by a medical convention but by no other. And I will use regimens for the benefit of the ill in accordance with my ability and my judgement, but from [what is] to their harm or injustice I will keep [them]. And I will not give a drug that is deadly to anyone if asked [for it], nor will I suggest the way to such a counsel. And likewise I will not give a woman a destructive pessary. And in a pure and holy way I will guard my life and my techné. I will not cut, and certainly not those suffering from stone, but I will cede [this] to men [who are] practitioners of this activity. Into as many houses as I may enter, I will go for the benefit of the ill, while being far from all voluntary and destructive injustice, especially from sexual acts upon both women’s bodies and upon men’s, both of the free and of the slaves. And about whatever I may see or hear in treatment, or even without treatment, in the life of human beings—things that should not ever be blurted out outside—I will remain silent, holding such things to be unutterable [sacred, not to be divulged]. If I render this oath fulfilled, and if I do not blur and confound it [making it to no effect] may it be [granted] to me to enjoy the benefits both of life and of techné, being held in god repute among all human being for time eternal. If, however, I transgress and perjure myself, the opposite of these. (Miles, 2005, page xiii-xiv).
Context and Controversy
Antiquity and Hippocrates
The Hippocratic Oath was written and compiled during the 4th century BC, in Ancient Greece. It has been accredited to Hippocrates, an ancient Greek physician who is widely accepted to be the father of medicine, even though it is largely understood that he himself did not write the Oath. Hippocrates himself held wide influence as a doctor and took on almost legendary qualities, making it difficult to separate the reality from the myth when discussing his life and legacy (Smith, 2018).
Figure 1: In this comprehensive podcast from the BBC Radio, Melvyn Bragg invites several guests onto his show in order to discuss the Hippocratic Oath, from his origins in antiquity to the contemporary issues that it raises in today’s world (Bragg, BBC Radio, 2011).
In figure 1, the discussion of the Hippocratic Oath’s importance stretches from its conception in antiquity to modern-day questions. The host and his guests devote much of their dialogue to the ancient world and Hippocrates as a man and a myth. This historical context is helpful in understanding the mythical quality of the Hippocratic Oath and why its fundamental principles still have the ability to influence medicine today. The podcast offers various opinions on the Oath, through the voices of several guests, in order to better understand its lasting influence. For instance, they discuss several of the current questions regarding abortion and physician-assisted suicide, both areas of exploration forthcoming in this entry.
Contemporary Conversations
Because the Hippocratic Oath was originally written in antiquity, there are several debates surrounding its applicability in the context of today’s society, and particularly American culture. Increasingly, doctors are coming to regard the Oath is inadequate in the current medical world due to the changes in science, politics, and society that have taken place since its conception (Tyson, 2001). In an article criticizing the Oath in contemporary contexts, the idea of cultural lag is explored in relation to the specifics of the pledge. Cultural lag is defined as, “the failure of societal groups to keep pace with advances in science or changes in society” (Robin and McCauley, 1995). The authors go on to argue that the medical field is especially susceptible to this phenomenon, as exemplified by the continued use of the Hippocratic Oath. Although there are many questions that are raised by the Oath, such as the idea that doctors should not perform surgery or the fact that it seemingly had incredible forth sight into sexual abuse by physicians, this entry will explore the prohibition of lethal prescriptions and practices of abortion more deeply.
Physician-Assisted Suicide
“And I will not give a drug that is deadly to anyone if asked [for it], nor will I suggest the way to such a counsel” (Miles, 2005, page xiii-xiv).
There is an ongoing debate in American society concerning the right of individuals to end their own life if they face a terminal illness. As Robin and McCauley posit, the framers of the Hippocratic did not consider whether or not patients should be afforded the right to choose their own end of life procedures (Robin and McCauley, 1995). This line explicitly prohibits the distribution of deadly drugs or providing counsel, which provides an ethical dilemma to physicians who choose to assist their terminal patients. However, the underlying principle that doctors should not end the lives of their patients may be a positive core tenet of medical practice. As with most ethical dilemmas, the conversation regarding physician-assisted suicide has no clear-cut conclusion.
“And likewise I will not give a woman a destructive pessary” (Miles, 2005, page xiii-xiv).
Similar to the discussion of physician-assisted suicide, the explicit prohibition of abortion does not seem to fit into today’s world, especially in American society. Again, Robin and McCauley point out that the writers of the Oath did not consider that control over a woman’s body should be delegated to the individual but should instead be the sole responsibility of physicians to withhold that option (Robin and McCauley, 1995).
Perspectives
Clearly, there are a number of contemporary issues upon which the Hippocratic Oath falls short. This leaves many medical officials on one side or the other, either in support of swearing to the Oath or in favor of discarding it in today’s society. Robin and McCauley, doctors who have been cited in this entry in relation to both specific contexts of abortion and physician-assisted suicide, are in favor of getting rid of the current Hippocratic Oath and introducing a new creed. Their proposed version gives much more power to the individual patient, rather than the physician (Robin and McCauley, 1995). On the other hand, there are many doctors who value the Oath as it is. In a responding article to Robin and McCauley, Marketos et al. delineate the positive aspects of the Oath and attempt to discredit Robin and McCauley’s argument. These scholars instead boast the virtue and decency of the original Oath (Marketos, S. G., et al, 1996). The issue of medical ethics undoubtedly leaves lots of room for discussion and conflicting opinions. A distinct example of this ambiguity can be found in the Nuremberg Trials. Lawyers on both sides of the trial, the American prosecution and the Nazi defense, used the Hippocratic Oath as reasoning for and against the horrors committed by Nazi doctors throughout Adolf Hitler’s reign of Germany (Bragg, 2011).
For more information on the Nuremberg Trials and their connection to medical ethics, The New England Journal of Medicine offers a look into the significance of the Nuremberg Code 50 years later: http://www.nejm.org/doi/full/10.1056/NEJM199711133372006
Relation to Politics of Health
The conceptualization of America’s current medical system leads to many diverging and converging dialogues concerning the medicalization and pharmaceuticalization of American society. Both of these occurrences are important and shape the way that the American public interacts with the health care system. But rather than divulging into these entangled phenomena, this encyclopedia entry will instead examine how Michel Foucault’s theory of biopower applies to the medical institution, and thus how human bodies are regulated by the very doctors that take the Hippocratic Oath.
In the seminal book, The History of Sexuality, French philosopher Michel Foucault explores societal norms and prevailing medical theory. Specifically, in the chapter entitled, “Right of Death and Power over Life”, Foucault studies the development of biopower and how it manifests itself in society. Foucault reasons that the relationship that exists between the individual body and the forces that govern it, such as health care officials and the government, is one of a power dynamic (Foucault, 1985, page 137). Therefore, power is exerted over individual bodies through biological regulation, which brings up the issue of medicalization of the human body. It is consequently important to examine the very fundamental principles that direct the individuals who institute the health care institution, doctors. Within the medical institution, doctors regulate the treatment of their patients. Yet these doctors themselves are regulated by the Hippocratic Oath, giving it the power to impact all patients. Thus, the Hippocratic Oath and its implementation is tied to biopower in the regulation of human bodies through institutions.
Furthermore, as discussed earlier in this encyclopedia entry, this idea of biopower can be related to the debate surrounding physician-assisted suicide. The power to take life is a very primary form of biopower and the arguments for physician assisted suicide would afford this power to individual through health care officials. However, the Hippocratic Oath is explicit when it comes to the prescription of deadly drugs: “And I will not give a drug that is deadly to anyone if asked [for it], nor will I suggest the way to such a counsel” (Miles, 2005, page xiii-xiv). Some see the Death with Dignity movement as a move to empower the individual, yet it is prohibited in this fundamental creed. Does this point to the archaic nature of the Oath, or is it instead indicative of a fundamental ethical principle which ought to be maintained by physicians, even in today’s context? In figure 2, a Ted Talk by Grace Pastine, the Litigation Director at the British Columbia Civil Liberties Association, explores the right of individuals who are suffering from incurable illnesses to choose death over distress. Although the Death with Dignity movement directly conflicts with the text of the Hippocratic Oath, Pastine argues that the right to choose a dignified death in the face of terminal conditions should be fundamental.
Figure 2: In a TEDx Talk at Stanley Park, Grace Pastine speaks about the Canadian decision on a Death with Dignity Bill. Amidst controversy surrounding Physician Assisted Suicide, Pastine discusses the compassionate aspect of ending terminal suffering (Pastine, 2015).
Conclusion
The Hippocratic Oath has a long and nuanced history, and at times it can be controversial in today’s world. From a very brief, informal survey of several pre-med first year students at Vanderbilt, it seems that the general understanding of the Hippocratic Oath extends to it being an ethical guide centered on the idea of, “Do no harm”. But there is clearly much more to this creed than only that. With roots in antiquity, the Oath has, for the most part, withstood the test of time and is continuously used in contemporary contexts. However, there are certain pieces of the Oath which seem archaic, leading to the question of where does the Oath fit into today’s medical practices? Are the fundamental principles still valid for use in the twenty first century, or is it instead appropriate to conceive a new version of this ethical framework?
References
Bragg, Melvyn. “The Hippocratic Oath” Audio blog post. In Our Time. BBC Radio, September 15, 2011.
“Hippocratic Oath.” Edited by The Editors of Encyclopaedia Britannica, Encyclopædia Britannica, Encyclopædia Britannica, Inc., 15 Nov. 2017, www.britannica.com/topic/Hippocratic-oath.
Marketos, S. G., et al. “The Hippocratic Oath.” The Lancet, ScienceDirect, 13 Jan. 1996.
Miles, Steven H.. The Hippocratic Oath and the Ethics of Medicine, Oxford University Press, 2005. ProQuest Ebook Central, https://ebookcentral.proquest.com/lib/Vand/detail.action?docID=3053681.
Pastine, Grace. “Death with Dignity” Audio blog post. TEDxStanleyPark. TEDx Talks, June 19, 2015
“Right of Death and Power over Life.” The History of Sexuality, by Michel Foucault, Pantheon Book, 1985.
Robin, E. D., and R. F. McCauley. “Cultural Lag and the Hippocratic Oath.” The Lancet, Elsevier, 3 Jan. 1995.
Smith, Wesley D. “Hippocrates.” Encyclopædia Britannica, Encyclopædia Britannica, Inc., 9 Feb. 2018, www.britannica.com/biography/Hippocrates.
Tyson, Peter. “The Hippocratic Oath Today.” PBS, Public Broadcasting Service, 27 Mar. 2001, www.pbs.org/wgbh/nova/body/hippocratic-oath-today.html.
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