Pellegrino (1990) argues that the idea of medicine as a moral community can be linked back to Hippocrates. What intrigues me about this is that, given that the Hippocratic Oath was written c.a. 500 BCE, this document is clearly one of the most momentous and long-lasting codes of ethics. In this blog post, I will give some background information on the Hippocratic Oath and argue that the oath should presents a model code of professional ethics.
Hippocrates engraving by Peter Paul Rubens, 1638. (Wikimedia)
Hippocrates’ time (c.a. 460-370 BCE) was one when many untrained charlatans tried to present themselves off as physicians (Boylan “Hippocrates”). These charlatans swindled their patients, convincing them that health problems were the product of supernatural forces not understandable by the patient (Couch 1934). The term ‘fleecing’ shows up in descriptions of these quacks—etymologically, ‘fleecing’ is a metaphor for stripping a person “of money, property, etc., as a sheep is stripped of its fleece” (Oxford English Dictionary). They were self-serving individualists trying to make a quick buck. In this way, honest professional physicians were confronted with a dilemma, similar to what Pellegrino (1990) sees in contemporary professional medical ethics debates.
While it is uncertain if the oath itself was written by Hippocrates (Boylan “Hippocrates”), genuine physicians sought to protect patients from the dangers of these charlatans by setting up a code of ethics. The Oath was a way of “establishing medicine as a profession that ordinary people could trust” and a way to distinguish trained physicians from medical con men.
The contents of The Oath may strike the contemporary reader as outdated, or perhaps misguided. It contains specific bans of practices, such as “I will never induce an abortion” and “I will not engage in surgery”, which seem to run against contemporary medical ethics. But if we put these proscriptions in historical context, they make sense. In Hippocrates’ time, abortion and (most) surgeries would surely endanger the lives of the patient. The aim in forbidding these practices was to set up The Oath as a guide against physicians putting their patients through undue harm.
The Hippocratic Oath is a model code of professional ethics. Unlike many modern professional codes, its intent was to describe the “moral vision” for members of the medical community rather than to protect members of the community from incurring on the law (Boylan “Hippocrates”). In this way, it is a positive code of ethics—it describes what physicians ought to do, not only what they ought not do. On may object that the two bans mentioned above (i.e. ban on abortion, and ban on surgery) seem to work against this aim. But the reason for these bans is that physicians are supposed to help their patients, not harm them. As Pellegrino (1990) argues, it is not enough to provide “mere commitment to common beliefs” to provide the ethics of a professional moral community. Otherwise, morally repugnant groups like White supremacists and Nazi physicians would have claim to being members of a moral community (Pellegrino 1990).
Another important aspect of the Hippocratic Oath, which strengthens its position as a model code of professional ethics, is the inclusion of guidance for entering the profession. Medical practitioners have an obligation to “teach his/her family the art of medicine, if they want to learn it, without tuition or any other conditions of service” (Boylan “Hippocrates”). In this way, it shapes the medical community of inclusive. Those whom the guiding moral theory appeals to (heal, don’t harm) appeal to have a right to join the profession. At the same time, The Oath sets up medical knowledge not as a knowledge which is good in itself, but a knowledge that “generates obligations in those who possess it” (Pellegrino 1990).
Balance, Sir Charles. 1921. “The History of Brain Surgery”, The British Medical Journal 2.3181 (1041-1042).
Boylan. Michael. “Hippocrates”, The Stanford Encyclopedia of Philosophy (Winter 2012 Edition), Edward N. Zalta (ed.).
Courch, Herbert N. 1934. “The Hippocratic Patient and His Physician”, Transactions and Proceedings of the American Philological Association 65 (138-162).
Pellegrino, Edmund D. 1990. “The Medical Profession as a Moral Community”, Bulletin of the New York Academy of Medicine 66:2 (221-232).
 As an interesting aside, trepination, a surgical procedure of drilling a hole in the skull to relieve conditions such as brain swelling, has been practiced since pre-history (Balance 1921).