Is the Hippocratic Oath no longer relevant?

The Hippocratic Oath has endured for more than 2,400 years, penned 400 years before the birth of Christ.

G.E.R. Lloyd described the Hippocratic Oath as “an ideal gold ethics standard representing a clear dividing line separating healers and killers, a commitment that physicians make to protect life, and never to deliberately take life.”

Few documents have endured 2,400 years.  What is it about the Hippocratic Oath that has kept it alive for so long?  Anthropologist Margaret Mead wrote, “For the first time there was a complete separation between killing and curing. Throughout the primitive world, the doctor and the sorcerer tended to be the same person.  He with the power to kill had power to cure … With the Greeks the distinction was made clear.  One profession, the followers of Asclepius, were to be dedicated completely to life under all circumstances, regardless of rank, age or intellect — the life of a slave, the life of the Emperor, the life of a foreign man, the life of a defective child….”

The Hippocratic Oath

“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:

“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.  I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from injustice.

“I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect.  Similarly I 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.

“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 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.

“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 men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.” (Translation from Greek by Ludwig Edelstein).

Several decades ago well meaning physicians decided the Oath was no longer valid because of the staggering political and moral advancements that had occurred since the time of Hippocrates.  We needed an Oath better suited to our times.  One of the oldest binding documents in history was considered no longer relevant.  An oath held sacred by countless numbers of physicians was no longer accurate.  How did they change the Hippocratic Oath?  The strikethroughs (in the Hippocratic Oath above) are the major deletions in the updated Hippocratic Oath.  How are we doing with this revised Oath?  According to a 1993 survey of 150 U.S. and Canadian medical schools, only 14 percent of modern oaths prohibit euthanasia, only 11 percent hold covenant with a deity, only 8 percent reject abortion, and a mere 3 percent forbid sexual contact with patients — all tenants held sacred in the original Oath.

Is it still the Hippocratic Oath when its ideals and values are removed?  No, because “the original oath is … a covenant, a solemn and binding treaty.  Modern oaths are … near-meaningless formalities devoid of any influence on how medicine is truly practiced,” wrote Dr. David Graham in the Journal of the American Medical Association (12/13/00).  Did we intend to return to the mores of 400 B.C. advocating the doctor and the sorcerer to once again become one?  Did we want to reclaim the power to kill?  Is the Oath no longer relevant or did our values change making the oath a problem?  Was it the Oath that needed revising or is it we that need revising?  Which Oath, what values?

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