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    Dissecting the Hippocratic Oath

    The role of the Hippocratic Oath today has been challenged


    Peter J. McDonnell, MD
    When I was a boy, there were interesting movies (Westerns) in which white men and American Indians would come into conflict. In some movies, a combatant would come to learn that his counterpart was an honorable man, and they would become "blood brothers."

    With a knife, the white man and the Indian would each slice his palm, blood would flow from the wound, the former enemies would clasp hands and allow their blood to mix, and they would swear an inviolable oath of friendship. In this ceremony, two men would overcome the barriers of race and suspicion and swear to become brothers. Often, they worked together to defeat a common enemy (e.g., corrupt marshal, evil cattle baron).

    Today, in U.S. medical schools (and around the world, for all I know), medical students take the Hippocratic Oath. The oath that bears the Greek physician's name was meant to give moral and ethical guidance for physicians, who would swear to uphold it. Like the oath in Hollywood's blood brother ceremony, the Hippocratic Oath is a connection to ancient times and a call for humans to exhibit honorable behavior.

    Modifying the language?

    The role of the Hippocratic Oath today has been challenged. According to the public television series, NOVA, "A growing number of physicians have come to feel that the Hippocratic Oath is inadequate to address the realities of a medical world that has witnessed huge scientific, economic, political, and social changes, a world of legalized abortion, physician-assisted suicide, and pestilences unheard of in Hippocrates' time. Some doctors have begun asking pointed questions regarding the oath's relevance: In an environment of increasing medical specialization, should physicians of such different stripes swear to a single oath? With governments and health-care organizations demanding patient information as never before, how can a doctor maintain a patient's privacy? Are physicians morally obligated to treat patients with such lethal new diseases as AIDS or the Ebola virus?"1

    One approach has been to rewrite the oath, in order to update it and make it more relevant to today's doctors. The original oath addresses the issue of privacy: "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."

    In an updated version of the oath, the language at one medical school has been modified: "I will ensure confidentiality of medical records."

    Maybe it doesn't matter what oath we make our medical students swear to uphold. According to a survey of 2,000 U.S. physicians, only one in four believes the oath they took in medical school influenced them "a lot" and only 16% think the AMA Code of Ethics has influenced their practices.2

    My preference would be to use the same beautiful oath recited by physicians thousands of years ago. On the other hand, it may be that some of these ancient documents are not perfect. The code of Hammurabi3 says this about professional fee reimbursement for eye surgery: "If a physician make a large incision with an operating knife . . . and saves the eye, he shall receive ten shekels in money . . . If a physician make a large incision . . . and cut out the eye, his hands shall be cut off."

    Even if ophthalmologists are not pleased with looming cuts in Medicare, at least no one in Washington, DC, is threatening to cut our hands off when we have surgical complications.

    By Peter J. McDonnell, MD director of the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of Ophthalmology Times.

    He can be reached at 727 Maumenee Building 600 N. Wolfe St. Baltimore, MD 21287-9278 Phone: 443/287-1511 Fax: 443/287-1514 E-mail:

    References

    1. http://www.pbs.org/wgbh/nova/body/hippocratic-oath-today.html

    2. Antiel RM, et al. The impact of medical school oaths and other professional codes of ethics: Results of a national physician survey. Arch Intern Med. 2011;171:469-471.

    3. The code of Hammurabi. Translated by L.W. King. http://www.general-intelligence.com/library/hr.pdf

    Peter J. McDonnell, MD
    He is director of The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of ...

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