The Spirit of the Hippocratic Oath

   Doctors no longer take the Hippocratic Oath as regularly as they once did, for a number of reasons. The first was that the Christians do not swear oaths to Apollo, and the second was that the oath forbids abortion and assisted suicide. This is from the Greek tradition, independent of the Biblical tradition, which is the basis in America for the opposition to these things. This independent confirmation is stronger than the support from scripture for the conservative positions on assisted suicide and abortion. The purpose of medicine is to heal, and medicine is not to be used to kill. Hippocrates lived about 460-377 B. C, a contemporary of Socrates. He turned away from the superstitious attempts to ascribe the causes of disease to the divinities, and showed that diseases have natural causes. As such, he is the founder of modern or scientific medicine. He also taught “Our natures are the physicians of our diseases,” and treated many problems with proper diet and living. The World Book Encyclopedia (1972, vol. H, p. 227) includes: “His favorite medicine was honey.” The Hippocratic oath is still the basis of medical ethics. It binds physicians to practice no injustice and to keep secrets and to refrain from the seduction of patients and their relatives.

   As a doctor not of medicine to cure to body, but of politics, and a bachelor of psychology, we consider the principles of the Hippocratic oath to be minimal. But it is Socrates, in Plato’s Republic, who teaches the things most relevant to prescription drug abuse and the questions of contemporary medicine. In Book One, Socrates distinguishes the art of medicine, and all arts, from the art of money making, and states, “medicine doesn’t consider the advantage of medicine, but of the body” and “not the doctor’s advantage, but that of the sick man” (342 a-c). Later, while discussing gymnastics as the art that produces health, Socrates famously contrasts two kinds of medicine, ours with that of the ancient Aesclepiads, who would not flatter the valetudinarianism of the rich, treating many maladies, living to keep medical regimens, but rather, like carpenters, would do medicine to get back to work, but otherwise would be content to die rather than live to no purpose (404-408). He then contrasts a doctor, who treats a body with the soul, with a judge, who treats “a soul with a soul.” For the latter, it is not good to be too familiar with the diseases until they are older.

   As with my radiator leak on my car, the solution to some maladies is to simply “put up with it.” So far, it has proven to be not worthwhile to have spent 850$ to fix my radiator leak because I need only pay attention and add a bit of fluid once in a while. These principles by analogy are very important to our attempts at a national health care system. We have said repeatedly that this will be unworkable if we do not end insurance fraud and the lobbying of the prescription drug industry. We need not invent new names for maladies ad infinitum, like “restless leg syndrome,” which then need prescription drugs for their treatment and cure.

   The practice of the art of psychology and medicine depend upon the more fundamental practices of chastity and justice, and of what- in the matters of the soul- is like gymnastic in the health of the body. As there is medicine and gym for the body, so there is “therapy” and study for the soul, contemplation and inquiry, and certain other liberal practices like music that tend the health of the soul as gym does the body. The psychologist must study the nature of man and look upon the health of the soul. That these would prescribe drugs not as a last resort, but as a first and most profitable resort, would be unthinkable within a Socratic psychology. And for us it has become a hopeless corruption.

   I once thought it would be a good business to nicely print the oath and frame it for doctor’s offices. So here it is for free on “da plog.” Print it out if you like. The Hippocratic Oath, translated not by me but by an encyclopedia, reads as follows:

I swear by Apollo the physician and Aesculapius and health and all-heal (panacea) and all the gods and goddesses making them my witness that, according to my ability and judgement I will keep this oath and 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 stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the art to my own sons and to those of my teachers, and to disciples bound by a covenant and oath according to the law of medicine, but to none others.

I will follow that method of treatment which according to my ability and judgement I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to anyone if asked, nor suggest any such council; furthermore, I will not give to a woman an instrument to produce abortion.

With purity and with holiness I will pass my life and practice my art. I will not cut a person who is suffering with a stone, but will leave this to be done by practitioners of this work. Into whatever houses I enter I will go into them for the benefit of the sick, and will abstain from every voluntary art of mischief and corruption; and further from the seduction of females or males, bond or free.

Whatever, in connection with my professional practice, or not in connection with it, I may see or hear in the lives of men which ought not to be spoken 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 men at all times but should I trespass and violate this oath, may the reverse be my lot.

 The supremacy of the oath above political law one interesting point. The “Doctors Without Borders” view of the supremacy of medical practice to political law has been with us for some time. Another interesting point is the dependence of medical ethics upon common sense and philosophic principles of justice that cannot possibly come from the science of medicine. For example, is it unhealthy to seduce one’s patients, or would one not thereby obey Darwinian principles of survival and reproduction that are the supposed goals of the body? How could medicine determine that it is unhealthy to attribute the purposes of the body to the soul? Or that it is unjust to subject the art of medicine to the art of money-making? The health of the soul is the higher study, and even Hippocrates knew regarding the body that nature is, and our natures are, the physician or the guide regarding health and disease, and the knowledge that guides practice is a knowledge of this and these: the intelligible health of the body and soul on one hand, and the diseased particulars on the other. Even if one has never seen the healthy body empirically, or the virtuous soul, it is still the principle that guides both medicine and psychology or education. It is truly amazing just how the body knows by genetically coded knowledge how to heal a cut, and some animals can grow whole new appendages. Socrates taught that the soul contains knowledge of the soul, and that is the basis of politics and psychology. And don’t forget that spoonful of honey!

Appendix: The modern replacement

Declaration of Geneva

From Wikipedia, the free encyclopedia

The Declaration of Geneva was adopted by the General Assembly of the World Medical Association at Geneva in 1948, amended in 1968, 1983, 1994, editorially revised in 2005 and 2006 and amended in 2017.

It is a declaration of a physician‘s dedication to the humanitarian goals of medicine, a declaration that was especially important in view of the medical crimes which had just been committed in German-occupied Europe. The Declaration of Geneva was intended as a revision[1] of the Hippocratic Oath to a formulation of that oath’s moral truths that could be comprehended and acknowledged in a modern way.[2] Unlike the case of the Oath of Hippocrates, the World Medical Association calls the statement a “pledge”.

Creation

During the post World War II era and immediately after its foundation, the World Medical Association (WMA) showed concern over the state of medical ethics in general and all over the world, taking the responsibility for setting ethical guidelines for the world physicians. The details of the Nazi Doctors’ Trial at Nuremberg which ended August 1947 and the revelations about what the Imperial Japanese Army had done at Unit 731 in China during the war clearly demonstrated the need for reform, and for a re-affirmed set of guidelines regarding both human rights and the rights of patients.[citation needed]

A study committee was appointed to prepare a “Charter of Medicine” which could be adopted as an oath or promise that every doctor in the world would make upon receiving their medical degree or diploma.[3] It took two years of intensive study of the oaths and promises submitted by member associations to draft a modernized wording of the ancient oath of Hippocrates which was sent for consideration at the WMA’s second general assembly in Geneva in 1948. The medical vow was adopted and the assembly agreed to name it the “Declaration of Geneva.”[4] This document was adopted by the World Medical Association only three months before the United Nations General Assembly adopted the Universal Declaration of Human Rights (1948) which provides for the security of the person.[5]

Declaration

The Declaration of Geneva, as currently published by the World Medical Association[6] reads:

AS A MEMBER OF THE MEDICAL PROFESSION:

  • I SOLEMNLY PLEDGE to dedicate my life to the service of humanity;
  • THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration;
  • I WILL RESPECT the autonomy and dignity of my patient;
  • I WILL MAINTAIN the utmost respect for human life;
  • 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;
  • I WILL RESPECT the secrets that are confided in me, even after the patient has died;
  • I WILL PRACTICE my profession with conscience and dignity and in accordance with good medical practice;
  • I WILL FOSTER the honour and noble traditions of the medical profession;
  • I WILL GIVE to my teachers, colleagues, and students the respect and gratitude that is their due;
  • I WILL SHARE my medical knowledge for the benefit of the patient and the advancement of healthcare;
  • I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard;
  • I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat;
  • I MAKE THESE PROMISES solemnly, freely and upon my honour.

Changes from original

The original oath read “My colleagues will be my brothers,” later changed to “sisters and brothers.” Until 1994 it also read “I will maintain the utmost respect for human life, from the time of its conception (…)”.[7] Age, disability, gender, and sexual orientation have been added as factors that must not interfere with a doctor’s duty to a patient; some rephrasing of existing elements has occurred. Secrets are to remain confidential “even after the patient has died.” The violation of “human rights and civil liberties” replaces “the laws of humanity” as a forbidden use of medical knowledge. “The health” in general of a patient is now the doctor’s first consideration compared to the “health and life” as stated in the original declaration. This was apparently changed to free the medical profession from extending life at all cost. The 68th WMA General Assembly in October 2017 approved revisions including: respecting the autonomy of the patient; mutual respect for teachers, colleagues and students physicians to share medical knowledge for the benefit of their patients and the advancement of healthcare; a requirement for physicians to attend to their own health as well as their patients.[8] Furthermore, the revised text is meant to be used by all active physicians (“as member of the medical profession”) while before the text was used by beginners only (“At the time of being admitted as a member of the medical profession”).

Discussion about the declaration changes

The Declaration of Geneva was originally adopted by the WMA General Assembly in 1948[9] right after one year of the formation of World Medical Association,[10] and has undergone a series of amendments throughout the years, until 2006 and the latest amendments, made at the 68th WMA General Assembly in Chicago in October 2017, make several significant additions. The most notably addition was a result of ongoing lobbying by doctor well-being advocate Dr Sam Hazledine, of MedWorld; in order to provide a high standard of care to patients, doctors must look after their own health.

The newly revised Declaration of Geneva, released in October, contains some modifications in terms of words throughout but also four entirely new points.:[11]

  • I WILL RESPECT the autonomy and dignity of my patient.
  • I WILL SHARE my medical knowledge for the benefit of the patient and the advancement of healthcare.
  • I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard.

The new Geneva Declaration version acknowledges respect for human rights of patients, the value of sharing knowledge with the community and profession, and the right and obligation of physicians to care for themselves, and to maintain their abilities for the benefit of society. [12][13]

Timeline (WMA meetings)

  • 1948: Adopted. 2nd General Assembly, Geneva
  • 1968: First amendment. 22nd General Assembly, Sydney
  • 1983: Second amendment. 35th General Assembly, Venice
  • 1994: Third amendment. 46th General Assembly, Stockholm
  • 2005: Editorial Revision. 170th Council Session, Divonne-les-Bains
  • 2006: Editorial Revision. 173rd Council Session, Divonne-les-Bains
  • 2017: amended. 68th WMA General Assembly, Chicago, United States

See also

References

  1. ^ “World Medical Association (2017) press release 12 May”. Wma.net. 2017-05-08. Retrieved 2018-03-14.
  2. ^ “International Code of Medical Ethics”. World Medical Association. Archived from the original on 2008-09-20.
  3. ^ “The Story of WMA/ who we are/History”. Cirp.org. 2002-06-06. Retrieved 2018-03-14.
  4. ^ “WMA History”. WMA. Archived from the original on 2015-02-06. Retrieved 2013-06-04.
  5. ^ “The Oath”. Cirp.org. 2002-06-06. Retrieved 2013-06-04.
  6. ^ World Medical Association. “WMA Declaration of Geneva”. WMA. Retrieved 14 October2017.
  7. ^ Merino, Aruanno, Gelpi, Rancich (2017). “THE PROHIBITION OF EUTHANASIA” AND MEDICAL OATHS OF HIPPOCRATIC STEMMA” (PDF)Acta Bioethica23: 171-178 (176).
  8. ^ World Medical Association. “MODERN PHYSICIANS’ PLEDGE APPROVED BY WORLD MEDICAL ASSOCIATION”. WMA. Retrieved 14 October 2017.
  9. ^ WMA , The modern Hippocritic Oath, April 1956
  10. ^ World Medical Association, The story of WMA
  11. ^ World Medical Association WMA Geneva Declaration, 06 November, 2017
  12. ^ LoebClassical library, 6 october 2015
  13. ^ ‘Claude Pavur , 22 September 2015

Further reading

External links

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