Wednesday, January 25, 2006

Hippocratic Oath Changed - Again

See the article Cornell Medical School Turns Hippocratic Oath to (Mostly) Pabulum written by Wesley J. Smith The new version from Cornell drops the prohibition against sex between the doctor and patient. We are also told that this new version is 'inclusive'.

Oaths are usually used when power is given to someone and when we must trust them to do the right thing: doctors, lawyers, politicians, and soldiers all take oaths. Strictly speaking, a professional is someone who takes an oath—professes his trustworthiness.

We might as well compare the two versions here.

New: I do solemnly vow, to that which I value and hold most dear:
Old: I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant:

I'm not a pagan so I do appreciate the dropping of those deities. But "vow" replaces "oath", and is a weaker term. Oaths invoke divine witness and include curses for those who fail to uphold their duties. The new version vows "to that which I value and hold most dear", which can mean anything at all, relative to the physician. He may hold beer most dear. The old version of the oath is that he "will fulfill according to my ability and judgment this oath and this covenant" so the physician swears that he will uphold what is included in the oath itself. "Covenant" is a strong word, meaning an indissoluble family bond.

New: That I will honor the Profession of Medicine, be just and generous to its members, and help sustain them in their service to humanity;
That just as I have learned from those who preceded me, so will I instruct those who follow me in the science and the art of medicine;
Old: To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art - if they desire to learn it - without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else.

We have a welfare state nowadays, and nothing is done for free.

New: That I will recognize the limits of my knowledge and pursue lifelong learning to better care for the sick and to prevent illness;
That I will seek the counsel of others when they are more expert so as to fulfill my obligation to those who are entrusted to my care;
That I will not withdraw from my patients in their time of need;
That I will lead my life and practice my art with integrity and honor, using my power wisely;
Old: I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.
I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.
I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

The new version is clearer about expertise and the lack of it. The new version allows euthanasia and abortion. It substitutes " In purity and holiness I will guard my life and my art" with " I will lead my life and practice my art with integrity and honor, using my power wisely", which is weaker and secular, and drops the self-protection clause.

Completely new is "That I will not withdraw from my patients in their time of need"; this seems good at first. But some think that it can be construed to say that a physician cannot excuse himself morally, for example, if a patient requests abortion or euthanasia.

New: That whatsoever I shall see or hear of the lives of my patients that is not fitting to be spoken, I will keep in confidence;
That into whatever house I shall enter, it shall be for the good of the sick;
That I will maintain this sacred trust, holding myself far aloof from wrong, from corrupting, from the tempting of others to vice;
Old: Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.
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.

It used to be a physician was to remain "free of all intentional injustice, of all mischief" and now it is "far aloof from wrong". Most tellingly, the physician was to remain free "in particular of sexual relations" and this specific prohibition is now dropped. And just in case a person thinks that gay sex isn't really cheating, it adds "with both female and male persons". And we mustn't have a double standard based on rank: "be they free or slaves". The new version instead says that the physician must be free "from corrupting, from the tempting of others to vice".

"That into whatever house I shall enter". Do doctors still make house calls? Is it OK to do misdeeds in the clinic?

The new confidentiality clause seems weaker, too. So it is OK to disclose "fitting" information?

New: That above all else I will serve the highest interests of my patients through the practice of my science and my art;
That I will be an advocate for patients in need and strive for justice in the care of the sick.
I now turn to my calling, promising to preserve its finest traditions, with the reward of a long experience in the joy of healing.
I make this vow freely and upon my honor.
Old: If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.

The new version adds quite a bit including the promise to "strive for justice in the care of the sick", which I guess means that the physician vows to support socialized medicine.

The new version deletes the old curse clause " if I transgress it and swear falsely, may the opposite of all this be my lot."

The old version asks to be blessed with enjoyment of his art and his life and eternal universal fame. The new version only asks for " long experience in the joy of healing". The ancients were asking for sainthood, moderns are atheist.


Why was the ancient oath promulgated in the first place? Were there abuses that led to the need of an oath? Imagine these scenarios:

The patriarch of the family is elderly. Heirs want him dead so that they can inherit property. They pay the physician to kill him.

A doctor sells expensive quack remedies. He knows they are worthless.

A physician discloses that a patient has a deadly disease; the patient loses his job.

A physician discloses that someone has a sexually transmitted disease, ruining the patient's reputation.

A physician takes credit for the cure that his teacher developed.

The physician abuses his authority with his patients, convincing them to have sex with him. If he gets a female patient pregnant, he will abort the child.

Physicians release deadly pathogens into the environment to test effectiveness of vaccinations.

A physician practices dangerous treatments on his patients, or performs unnecessary surgeries.

Physicians conduct deadly medical experiments on prisoners.

A patient requests a treatment that is not helpful or even harmful. The physician complies.


In Plato's Republic, written sometime after the Hippocratic Oath, Socrates argues that the practice of politics should be like the practice of medicine: physicians were not out to defeat or dominate their patients, but had the best interests of the patient in mind. Nowadays physicians act like politicians, using their power to dominate patients and to extract their wealth.


It comes down to this. I place my life itself into the hands of a physician. Can I trust him?

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