The Hippocratic Oath

By Daniel Dylman
What is it?
The Hippocratic Oath is an oath of ethics historically taken by physicians.
It’s one of the most widely known of Greek medical texts. It requires a new physician to swear to the healing gods
to uphold specific ethical standards. The oath is the earliest expression of medical ethics in the Western world,
establishing several principles of medical ethics which remain of huge significance today. These include the
principles of medical confidentiality and non-maleficence.
Hippocrates
The oath is traditionally attributed to the Greek doctor Hippocrates and it is usually included in the Hippocratic Corpus. However, most
modern scholars do not regard it as having been written by Hippocrates himself.

Even if the oath is taken away from him, Hippocrates is still one of the most important figures in the history of medicine, and as such, he is
referred to as ‘’The Father of Medicine’’, in no small part due to his lasting contributions to the field as the founder of the Hippocratic School of
Medicine.

This intellectual school revolutionized Ancient Greek medicine, establishing it as a discipline distinct from other fields with which it had
traditionally been associated (theurgy and philosophy), thus establishing medicine as a profession.
History of the oath
Attributed to the Greek physician and teacher Hippocrates of Kos—who is often called the father of medicine—the
true author of the oath is unknown, and there may have been several authors. After Greek political power fell and
the influence of the Hippocratic school faded, the oath fell into obscurity for nearly 2000 years.
It was rediscovered by medieval Christian scholars and in 1508 was used in a ceremony at the University of
Wittenberg. By 1750 the Hippocratic oath had been translated into English and other European languages, and for
several centuries a version of the oath was recited by graduating doctors.
As the practice of medicine has changed so have the oaths taken. One of the most significant revisions was first
drafted in 1948 by the World Medical Association (WMA), called the Declaration of Geneva.
After the second world war the WMA took responsibility for setting ethical guidelines for the world’s doctors.
Crucially, the WMA oath contains the pledge: “I will not permit considerations of age, disease or disability, creed,
ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing, or any other factor to
intervene between my duty and my patient.”
In the 1960s, the original Hippocratic oath was again modified by Louis Lasagna, academic dean of the school of
medicine at Tufts University in the US. Lasagna’s oath was a secular version which was not to be taken in the
presence of God or any gods.
The Oath
I swear by Apollo the physician, and Asclepius, and Hygieia and Panacea and all the gods and goddesses as my witnesses, that,
according to my ability and judgement, I will keep this Oath and this contract:

To hold him who taught me this art equally dear to me as my parents, to be a partner in life with him, and to fulfill his needs when
required; to look upon his offspring as equals to my own siblings, and to teach them this art, if they shall wish to learn it, without fee or
contract; and that by the set rules, lectures, and every other mode of instruction, I will impart a knowledge of the art to my own sons,
and those of my teachers, and to students bound by this contract and having sworn this Oath to the law of medicine, but to no others.

I will use those dietary regimens which will benefit my patients according to my greatest ability and judgement, and I will do no harm or
injustice to them.

I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause
an abortion.

In purity and according to divine law will I carry out my life and my art.

I will not use the knife, even upon those suffering from stones, but I will leave this to those who are trained in this craft.
The Oath (cont)
Into whatever homes I go, I will enter them for the benefit of the sick, avoiding any voluntary act of impropriety or corruption, including
the seduction of women or men, whether they are free men or slaves.

Whatever I see or hear in the lives of my patients, whether in connection with my professional practice or not, which ought not to be
spoken of outside, I will keep secret, as considering all such things to be private.

So long as I maintain this Oath faithfully and without corruption, may it be granted to me to partake of life fully and the practice of my
art, gaining the respect of all men for all time. However, should I transgress this Oath and violate it, may the opposite be my fate.
The original Oath
Those taking the “original” Hippocratic Oath promise to:

● respect and support their teachers

● share medical knowledge with others who are interested
● use their knowledge of medicine and diet to help patients
● avoid harming patients, including providing no “deadly medicine” even if requested to do so
● not provide a “remedy” that causes an abortion
● seek help from other physicians (such as a surgeon) when necessary
● avoid “mischief,” “injustice,” and “sexual relations” during visits to patients’ homes
● keep patient information confidential.
What’s missing?
Today’s doctors face a number of important ethical issues that are not included in the Hippocratic Oath. For example, it
makes no mention of:

● honoring patients’ preferences

● sharing medical information with patients
● avoiding conflicts of interest, such as profiting by ordering unnecessary tests or treatments
● protecting patients who enroll in research studies
● treating all patients equally, regardless of ability to pay, social class, education, race, or suspicion of criminality
● avoiding the practice of medicine while impaired (due to physical or psychological disease).
Meaningful, memorable, irrelevant?
Some clinicians see the oath as a rite of passage, others can’t remember taking it, and some think it is irrelevant. Whether
doctors view it as meaningful or not, the oath still has the power to encourage debate, prompting them to consider what kind
of vow would uphold the standards of their profession, or even if they should take a vow at all.

Different variations of the Hippocratic oath are taken by doctors around the world. A version created in the 1960s is used in
the US, for example, while in Pakistan doctors adhere to the original oath. In Olsztyn, the oath includes a tribute to Nicolaus
Copernicus.

Medical students usually take an oath when they graduate but there is no standard approach across the UK. Some
universities, like Aberdeen and Dundee, use a modified version of the original, while Bristol uses the “Bristol Promise,”
which is said taken on the day of graduation
The Bristol Promise
Richard Huxtable, professor of medical ethics and law and director of the Centre for Ethics in Medicine from the
school of social and community medicine at Bristol University, describes why Bristol medical students have their
own oath: “The ethics centre was created in 1996 in Bristol, and its first director professor, Alastair Campbell, was
approached by medical students who wanted to create, in collaboration with his ethics colleagues, an oath that
they could take together on graduation. “It was very much a staff and student initiative.’’

The “promise” was driven by the need to collectively recognise the values that would guide graduates’ careers.
“Twenty years on, the promise remains one of the most powerful moments in the medical school year.
Students take the promise at the start of their studies and then again more formally on graduation day, along with
staff. “The values of the promise include: conscience, integrity, confidentiality, and to care for the public’s well
being. “I would invite colleagues to look to what their students want as future professionals when they take an
oath.
Some may feel their current oath is sufficient, but you should be mindful of changing values and open to the fact
that these might change as medical practices evolve. “At the same time you should acknowledge values that are
core to medical endeavour, such as maintaining confidences, avoiding harm, and respecting people’s rights. “It’s
about keeping the essence of the original oath, whilst keeping an eye on future horizons.
A moral compass
While it may not be an obligatory procedure in medical schools everywhere, the oath is still seen as a ‘’moral compass’’ of
sorts.

“It helps you with circumstances you face where you’re not sure what to do. It also gives you a sense of pride and purpose
in terms of the wider scope of medical practice and the importance of putting patients at the heart of decisions you make,
which we can forget sometimes.” - David Warriner

For Warriner, the original oath still resonates, particularly the phrase: “I will utterly reject harm and mischief,” which is
commonly misquoted as “First do no harm.” He says, “For me that fits perfectly with not over diagnosing, not over treating,
and sharing decision making.”

In the age of social media, the revised Hippocratic oath also seems valid when it asks doctors to pledge: “I will respect
secrets confided in me.”
A calling
Cosmo Hallstrom, a fellow of the Royal College of Psychiatrists, graduated in medicine in 1971. He remembers the
original Hippocratic oath being displayed in the common room at medical school. He didn’t attend his graduation
where classmates swore the oath together, but he does believe in it. “It reminds me of the longstanding tradition
of medicine—that it evolved from ancient times, of its ancient mysteries, and the importance of continuing that
noble tradition,” he says. He says that the problem with the original Hippocratic oath is that “much of it is quite
inappropriate these days.” He gives examples such as “I will not cut”—a vow then aimed at physicians, which
would be an impossible commitment in today’s medical profession. “I will not give to a woman a pessary to
produce abortion,” is also no longer a pledge many doctors feel comfortable adhering to. However, Hallstrom
endorses the revised 1964 oath, particularly its last line where doctors vow to “always act so as to preserve the
finest traditions of my calling and may I long experience the joy of healing those who seek my help.”
Sources
https://www.health.harvard.edu/blog/the-myth-of-the-hippocratic-oath-201511258447

https://www.bmj.com/content/355/bmj.i6629

https://en.wikipedia.org/wiki/Hippocratic_Oath

https://www.nlm.nih.gov/hmd/greek/greek_oath.html

https://en.wikipedia.org/wiki/Hippocrates

https://www.medicinenet.com/script/main/art.asp?articlekey=20909
Thank you