Do most med students realize just how far modern
versions of the oath have strayed from the classical model?
The Hippocratic Oath Today:
Meaningless Relic or Invaluable Moral Guide?
The Hippocratic Oath (see ancient and
modern versions) is one of the oldest
binding documents in history. Written in antiquity, its principles are held
sacred by doctors to this day: treat the sick to the best of one's ability,
preserve patient privacy, teach the secrets of medicine to the next generation,
and so on. "The Oath of Hippocrates," holds the American Medical Association's
Code of Medical Ethics (1996 edition), "has remained in Western
civilization as an expression of ideal conduct for the physician." Today, most
graduating medical-school students swear to some form of the oath, usually a
modernized version. Indeed, oath-taking in recent decades has risen to near
uniformity, with just 24 percent of U.S. medical schools administering the oath
in 1928 to nearly 100 percent today.
Yet paradoxically, even as the modern oath's use has burgeoned, its content has
tacked away from the classical oath's basic tenets. According to a 1993* survey
of 150 U.S. and Canadian medical schools, for example, only 14 percent of
modern oaths prohibit euthanasia, 11 percent hold convenant with a deity, 8
percent foreswear abortion, and a mere 3 percent forbid sexual contact with
patients—all maxims held sacred in the classical version. The original calls
for free tuition for medical students and for doctors never to "use the knife"
(that is, conduct surgical procedures)—both obviously out of step with
modern-day practice. Perhaps most telling, while the classical oath calls for
"the opposite" of pleasure and fame for those who transgress the oath, fewer
than half of oaths taken today insist the taker be held accountable for keeping
the pledge.
Indeed, a growing number of physicians have come to feel that the Hippocratic
Oath is inadequate to address the realities of a medical world that has
witnessed huge scientific, economic, political, and social changes, a world of
legalized abortion, physician-assisted suicide, and pestilences unheard of in
Hippocrates' time. Some doctors have begun asking pointed questions regarding
the oath's relevance: In an environment of increasing medical specialization,
should physicians of such different stripes swear to a single oath? With
governments and health-care organizations demanding patient information as
never before, how can a doctor maintain a patient's privacy? Are physicians
morally obligated to treat patients with such lethal new diseases as AIDS or
the Ebola virus?
Some doctors who recited the
Hippocratic Oath as a student now call it the "Hypocritic Oath."
Other physicians are taking broader aim. Some claim that the principles
enshrined in the oath never constituted a shared core of moral values, that the
oath's pagan origins and moral cast make it antithetical to beliefs held by
Christians, Jews, and Muslims. Others note that the classical Oath makes no
mention of such contemporary issues as the ethics of experimentation, team
care, or a doctor's societal or legal responsibilities. (Most modern oaths, in
fact, are penalty-free, with no threat to potential transgressors of loss of
practice or even of face.)
With all this in mind, some doctors see oath-taking as little more than a
pro-forma ritual with little value beyond that of upholding tradition. "The
original oath is redolent of a convenant, a solemn and binding treaty," writes
Dr. David Graham in JAMA, the Journal of the American Medical
Association (12/13/00). "By contrast, many modern oaths have a bland,
generalized air of 'best wishes' about them, being near-meaningless formalities
devoid of any influence on how medicine is truly practiced." Some physicians
claim what they call the "Hypocritic Oath" should be radically modified or
abandoned altogether.
What is your opinion? What do you feel is the Hippocratic Oath's relevance in
2001? Is it a pointless anachronism or an invaluable moral guide? Should
aspiring doctors still be made to take some version of the oath? If you're a doctor, would you take
the oath again? Why?
Send your thoughts, of whatever length, to us at:
We will
post responses on this Web site. In the subject field of your message,
write either "Doctor Response" or "Non-Doctor Response," depending on which
category you belong to. Please note your submission may be edited for clarity.
Thank you in advance for your contribution.
*Orr, R. D., N. Pang, E. D. Pellegrino, and M. Siegler. 1997. Use of the Hippocratic Oath: A Review of Twentieth Century Practice and a Content Analysis of Oaths Administered in Medical Schools in the U.S. and Canada in 1993. The Journal of Clinical Ethics 8 (Winter): 377-388.
Do most med students realize just how far modern
versions of the oath have strayed from the classical model?
Some doctors who recited the
Hippocratic Oath as a student now call it the "Hypocritic Oath."
