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The contents of The Oath may strike the contemporary reader as outdated, or perhaps misguided.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).
30 thoughts on “The Hippocratic Oath and Professional Ethics”
While you are definitely not alone in your call to change the Hippocratic Oath, I don’t know that it should be disregarded altogether. There are absolutely parts that are outdated (many that you mentioned), but that is naturally going to happen with a practice that is so old.
I still think it deserves just as much credit as it received the first time. While the oath should be updated, there are so many versions that it is hard to call out just one part of it. But it does still do a wonderful job of stating the moral promise that doctors are making by choosing such a profession. It is a tradition and for many medical students an experience they wait years for. It reflects that there is commitment to the ideal that there are morals and principals that come inherently with the medical profession.
Below is a copy of the Yale version of the Hippocratic Oath. I think it shows the potential of changing the Hippocratic oath to best fit modern needs, while still preserving that tradition and power of the Hippocratic oath.
I agree with Niyeti in that the Hippocratic Oath still serves an essential purpose in today’s society. The main point of the Oath, as stated in your argument, is that physicians should not harm people or con people into thinking that they are professionally trained doctors, when they are not. The Oath may be outdated, but that does not mean it cannot be edited in a manner that better suits modern society. In fact many old documents and codes of law are still around today because of their essential message, not their minute details because those are simply updated to fit modern society. One such example is the United States. Another example that isn’t as obvious is the Code of Hammurabi which has been adapted to many legal systems around the world (http://andrewham2000.wordpress.com/2010/05/11/how-does-the-code-of-hammurabi-affect-todays-laws/).
I find it interesting that the Hippocratic Oath has many parallels to the bioethical moral standards that are present today. For instance, you mention that physicians in Hippocrates’ time would not preform surgeries or abortions because they would severely endanger the lives of the patient. This mirrors the moral column of non-maleficence because physicians should not inflict unnecessary harm to patients. The example also ties into the moral column of beneficence in that physicians should promote the health and well-being of the patient. Clearly these concepts are crucial for The Oath of a moral community. As society evolves, I think it is important to include the latest ethical considerations, like personal autonomy, into The Oath to promote the moral stance of physicians everywhere.
The Hippocratic Oath is actually very different at every medical school and some medical schools do not even say an oath at graduation. I think that we can all agree that the intended principles of the Hippocratic Oath still apply today. Doctors practice the art of healing and thus seen to act in order to put their patient in the best physical health. However, sometimes it is necessary to “harm” a patient in order for them to get better. I think the oath is intended for doctor to understand the responsibility that they are taking on, for their decisions and actions can determine if a person lives or dies. Furthermore, consider a doctor has a patient who is dying and there is an experimental treatment available. However the effects of the treatment are not known and a physician must decide whether to give a patient the potentially harmful treatment while may cure them or not give the treatment and hope the disease doesn’t progress any further. I think the intention of the oath is in place in order to make doctor think thoroughly before they act.
I like that you display the oath for what it is- it is a positive code of ethics—”it describes what physicians ought to do, not only what they ought not do.” However, it can quickly become just another thing for medical school students to memorize. How do we keep the meaning of it alive if we believe in it so much? How about years into the career of the physicians? Perhaps there is some sort of system that can check in on a sort of moral-rating every year for doctors. With incentives to do the job fluctuating in our country, I think moving forward, instilling a system with this in mind is productive and progressive.
You made some very good points about the Hippocratic Oath, as being a positive code of ethics. Hippocratic Oath is not a specialized approach, but rather an existing notion from the time of Ancient Greek which, I believe, should still be regarded as the foundation and basis of the medical occupation. The Hippocratic Oath gives medical professionals a framework of the moral code of Ancient Greek medicine to maintain a harmony among the physician, the patient, and the illness. When talking about Hippocratic Oath, we have to keep in mind that medicine in early Greece was greatly influenced by the philosophical thoughts at the time. Philosophers such as Socrates encourage people to pursue knowledge by thinking deeply and raising questions. Hippocrates himself encouraged those in the field of medicine to “insert wisdom in medicine.” Today, medicine has evolved. Medicine is not only viewed as a means to help the sick, but it is a profitable business and has a purpose of scientific advancement as well. Medicine today is not just a triangle between a physician, patient, and an illness. Rather, medicine is a balance between patients’ expectations, financial and political realities, society’s demands, and also developing medical and scientific knowledge. Alone Hippocrates’s oath cannot be applied in today’s medicine. For instance, the original oath required patients to be cured regardless of circumstances. Today, patient’s autonomy has taken over the paternalistic medicine that Hippocrates refers to. Hence, I believe that Hippocrates Oath should still be the moral guidance for those in the medical field, but as a reference curriculum because it reminds those in the medical profession their ultimate reasons to get into this profession. As Pellegrino says, medicine is a profession that demands of physicians’ extraordinary moral sensitivity as they respond to patient susceptibility. However, the entire burden on physicians is not fair. The problems surrounding medical malpractice, high insurance, etc. in medical profession are, perhaps, the reasons why a need for a modern oath or an amendment to Hippocrates Oath is crucial.
I agree with Niyeti in that the Hippocratic Oath should not be disregarded. The Hippocratic oath carries iconic historical power and it results in an important association between medicine and ethics. While the punishments associated with breaking the oath have disappeared with time, the integrity and importance of the oath still remains. Beyond an oath at graduation, I think medical education should include ethic courses so that graduating physicians understand the moral burden they carry as their duty. These ethics courses should instill a moral responsibility to care for the patient and the Hippocratic oath could be a symbol of this realization.
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I will give some background information on the Hippocratic Oath and argue that the oath should presents a model code of professional ethics.
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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. Really?
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