A History of the Hippocratic Oath

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The Hippocratic Oath is arguably one of the most famous oaths of ethics in our history. Originating in Ancient Greece, it centers around medical practitioners swearing, “by all gods and goddesses,” physicians will uphold various ethical standards in their medical practice. Contrary to popular belief, the oath does not actually contain the renowned phrase, “First, do no harm,” an expression that has now become synonymous with the oath itself. Dated back to the fifth and third centuries B.C., the oath is often attributed to the Greek doctor, Hippocrates, though scholars have contended that it could, instead, be a work of the Pythagoreans. While its oldest remaining fragments date back to AD 275, the oath has been continually rewritten and adapted over the centuries to better suit the values and beliefs of evolving cultures and ethical standards.

Following the collapse of the Roman Empire and its religious ideals, today’s “multiethnic, multicultural, and pluralistic world” no longer worships ancient divinities such as Apollo or Asclepius (Indla, Radhika, 2019). As history progresses, the Hippocratic Oath has faced ideological challenges due to new and emerging technology, that did not exist in the era of Hippocrates. For instance, the Hippocratic Oath did not take into consideration a patient in a vegetative state, a patient suffering from pain, a patient requesting for an abortion, or addressing other autonomous rights of a patient. Considering that technology has and continues to advance the ancientHippocratic Oath has faced many modern-day dilemmas.

Consequently, the period following World War II, saw one of the Hippocratic Oath’s most significant revisions: the Declaration of Geneva. During this period, the tradition of medical graduates reciting the Hippocratic Oath became more than a mere formality. As such, the World Medical Association (WMA) altered the oath in the 1960s to state that providers would “maintain the utmost respect for human life from its beginning.” Making the custom a more secular obligation, that the oath is not to be taken in the presence of any divine figures, but before only other people. This served as a test of a practicing physician’s ethical, moral, and emotional standards, an especially remained an important notion after the atrocities of WWII.

As a result of this, in 1964 the Hippocratic Oath faced further revision. These alterations are most notably addressed by Dr. Louis Lasagna’s 1964 revision of the oath, which cites that “[doctors] do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability.” Such changes represent the increasing humanization of the relationship between a doctor and a patient. Despite the controversies that have come with these changes, such alterations begin to represent the influence that cultural identities and contextual values demand on the form of the oath. In fact, in 1973, the US Supreme Court rejected the Hippocratic Oath as a guide to medical ethics by determining that the oath is unable to maintain changing medical ethics and codes. The final, most modified document of the Hippocratic Oath, known as “Pellegrino’s Precepts,” which functions as a set of principles. These precepts directly speak to doctors and are a “universal set of precepts about the nature of medicine” in contrast to the Hippocratic Oath.

In modern times, the Hippocratic Oath has essentially been replaced by more extensive and pragmatic ethical codes issued by national medical associations, such as the AMA Code of Medical Ethics, or the British General Medical Council’s Good Medical Practice. These documents offer a more comprehensive overview of the responsibilities and professional behavior expected of a doctor to their patients and to society, rather than to healing gods and other divinities. As such, in the United States, many of the medical schools use the Osteopathic Oath in place of the Hippocratic Oath. For instance, schools such as, New York Medical College, University of California, or Tulane, have had medical students vow to not discriminate against patients based on “gender, race, religion, or sexual orientation.” Hence, as time passes, many of today’s doctors face various ethical issues that are not included in the Hippocratic Oath. Therein lies the question, “is our society in a post-Hippocratic era?” With a modern society, continuing to evolve, physicians have begun question whether the Hippocratic Oath holds outdated principles. If so, how can medical students incorporate an evolving society to protect patients. Despite this, many providers argue that the Hippocratic Oath epitomizes ideologies of gratitude, beneficence, and humility.

While there is no direct punishment for breaking the Hippocratic Oath, a notable, modern equivalent is ‘medical malpractice’ which carries a wide range of punishments from legal action to civil penalties. Doctors who violate these principles are at risk of being subjected to disciplinary proceedings, including the loss of their license to practice medicine.

Overall, what began as an ethical principle in Ancient Greece saw itself transformed frequently through time as a result of contemporary ideals and beliefs. From a prominent idea to a mere formality, the importance of the Hippocratic Oath has fluctuated almost as much as its content. While it may no longer be the central ideal of medical ethics, its ideas have ultimately pioneered modern practices and formed the crux of what we now call medicine. Today, 100% of medical school graduates in the United States swear to some variation of the Hippocratic Oath; therefore, the responsibility to continue to pursue beneficence, compassion, and humility within the field of medicine maintains its utmost significance.

See the Emory Class of 2020 Hippocratic Oath at Emory School of Medicine!
“The Oath of Hippocrates”
As the ancient Greeks swore by their pagan gods, so do I solemnly affirm that as a student in medicine at Emory University, according to my ability and judgment, I will keep this oath and stipulation. I will consider dear to me those who have taught me this art and will impart the precepts and instruction of the profession to all those who qualify as students of the art and agree to the standards of the profession. I will follow that system of regimen, which according to my ability and judgment I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. Into whatever house I enter I will go into it for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption. Whatever in connection with my professional practice or not in connection with it, I see or hear in the lives of men and women which ought not be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this oath inviolate, may it be granted to me to enjoy life and the practice of the art, respected by all people in all times, but should I trespass and violate this oath may the reverse be my lot.”
– Emory School of Medicine Class of 2020