THE HIPPOCRATIC OATH
Over centuries the
Hippocratic Oath, sworn by doctors in ancient Greece, has acquired a patina of reverence
as a statement of the moral integrity expected of medical healers. It outlines
essential aspects of the doctor-patient relationship. Can physicians
today can recite the Oath, and how many wonder about its origins? (The full oath is reproduced below)
Hippocrates was born
on the island of Cos, in the Aegean Sea, about 469 BC, and died in 399 BC, the
same year that Socrates was condemned to drink hemlock poison. Plato, Pericles,
Sophocles, and Aristophanes were contemporaries and Greek culture flourished.
Various writings attest that Hippocrates was a well-known physician and that he
accepted payment for instruction. Nothing else is known for certain, except
that Aristotle indicated he was “of short stature”. All likenesses seen in art
and statuary appear to be artists’ imaginations.
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| Hippocrates, engraving by Peter Paul Rubens (Wikipedia) |
A collection of
writings on medicine, the Hippocratic Corpus, survives today. It was written by
an unknown number of unidentified physicians over an uncertain number of years,
and appears in the Ionian dialect, the dialect spoken on Cos. Presumably
Hippocrates was a contributor to the Corpus, but no one is sure. The writings eschew
mention of divine intervention, sin, or superstitious curses as causes of
illness. Sickness stems from natural causes, usually an imbalance of
various
“humors”. Eliciting a history of the illness and observation of the patient are
the techniques of diagnosis. These features mark the Corpus as an original document of
“modern” medicine.
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| Asklepion on Kos (Wikipedia) The cult of Asclepius grew as Hippocrates ended his career and invoked divine power for cures. |
The Hippocratic Oath,
one of the writings, was first mentioned by Scribonius Largus, a court
physician to the Emperor Claudius, in 47 AD. It is divided into two parts. The
first deals with the physician’s obligations to his profession and education
and is self-explanatory. The second part sets ethical standards for the
physician’s relation to patients, and begins with the requirement to not only
benefit patients but not to harm them. This recalls the oft-quoted line from
another part of the Corpus, “first do no harm”.
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| Byzantine version of Hippocratic Oath in form of a cross (Wikipedia) |
Next are the
admonitions to never give a patient a deadly medicine and not to practice
abortion. These are curious obligations. Giving a poisonous medicine could mean
participation in a murder, which was definitely illegal, or participating in a
suicide. Patient-requested suicide was not illegal, and was practiced to some
extent, except by Pythagoreans, who opposed all forms of suicide. Determining
the cause of death was not easy in those days, however, and the phrase may have
been a way of encouraging doctors to avoid trouble in doubtful cases.
Abortion was widely practiced in ancient Greece,
and in one of the Hippocratic writings there is even a technique described:
jump up and down, touching the buttocks with the heels at each leap. Infanticide
was also practiced and not illegal as long as the infant was killed before it
was first fed. It was recommended by Plato as part of his ideal state.
Pythagoreans, however, did oppose abortions. The prohibitions against abortion
and assisted suicide (if that was the intent) suggest to some that the Oath had
Pythagorean origins.
The oath not to use
the knife, not even on sufferers from stone, is also curious. Medicine was not
specialized in those days and Greek doctors practiced surgery as well as
prescribing potions and diets. Once again a Pythagorean influence is suspected,
as that sect considered it unethical to act in a way that would shed blood or
possibly kill. Leaving that activity to someone else was permitted, however, as
mentioned in the Oath.
The final duties involve
refraining from “wrong-doing” (corruption, theft, etc.), avoiding sexual
contact with patients and their families, and maintaining confidentiality in all
matters. They are easily understood and apply today. In ancient Greece, though,
medicine was just one craft among many. There was no licensing and there were
no guilds or laws regulating medical practice and no punishment for malpractice.
The Canon, one of the Hippocratic
writings, laments, “Although the art of healing is the most noble of all the
arts, yet because of the ignorance of both its professors and its rash critics,
it has at this time fallen into the least repute of them all.” The Oath, then,
may have been a way to enhance the reputation of traditionally educated
physicians and distinguish them from presumed quacks and charlatans.
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| Galen and Hippocrates in imaginary conversation 12th Century mural, Anagni, Italy (Wikipedia) Galen admired Hippocrates |
Other parts of the
Corpus deal with the appearance and decorum of physicians, important in inspiring
confidence and trust. He should be well-dressed and well educated, thoughtful
but not stern, he should avoid excessive laughter (considered vulgar), be of
high moral character, and be flexible in regard to fees. Manual dexterity in
surgical procedures was important, to minimize pain. Skill in prognosis
enhanced one’s reputation as much as a cure.
Parts of the Oath,
such as the prohibition on surgery, no longer mesh with today’s medicine. A
modern oath was composed in 1964 by Louis Lasagna, Dean of Tufts Medical
School, that is now used in many medical colleges. It, and the original, can be
seen at: http://www.pbs.org/wgbh/nova/body/hippocratic-oath-today.html
Other
versions exist.
The
original Oath, taken from Wikipedia, is:
I swear by Apollo the Healer, by Asclepius,
by Hygieia,
by Panacea,
and by all the gods and goddesses, making them my witnesses, that I will carry
out, according to my ability and judgment, this oath and this indenture.To hold my teacher in this art equal to my own parents; to make him partner in my livelihood; when he is in need of money to share mine with him; to consider his family as my own brothers, and to teach them this art, if they want to learn it, without fee or indenture; to impart precept, oral instruction, and all other instruction to my own sons, the sons of my teacher, and to indentured pupils who have taken the physician’s oath, but to nobody else.
I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly I will not give to a woman a pessary to cause abortion. But I will keep pure and holy both my life and my art.
I will not use the knife, not even, verily, on sufferers from stone, but I will give place to such as are craftsmen therein.
Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bond or free.
And whatsoever I shall see or hear in the course of my profession, as well as outside my profession in my intercourse with men, if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets.
Now if I carry out this oath, and break it not, may I gain for ever
reputation among all men for my life and for my art; but if I break it and
forswear myself, may the opposite befall me.[3] - Translation by James Loeb.
SOURCES:
Temkin,
Owsei. Hippocrates in a World of Pagans
and Christians. 1991.
Nutton,
Vivian. Ancient Medicine. 2013
Hippocratic Writings. Penguin Classics
Nuland,
Sherwin. Doctors: The Biography of
Medicine. 1988. Chapter
One.
The Hippocratic Oath Today. (Nova).
Carrick,
Paul. Medical Ethics in Antiquity:
Philosophical Perspectives on
Abortion and Euthanasia. 1985.
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