Doctors Aren’t Bound by the Hippocratic Oath

Myth: Doctors are bound by the Hippocratic Oath.

stethescopeA binding agreement, as much a social contract as Social Security or Medicare, the traditional Hippocratic Oath holds those who swear to it to a strict code of professional and personal conduct. Contrary to popular belief, though, most doctors never take this oath, and, actually, most of us are probably glad they never do.

Original Hippocratic Oath

Although scholars disagree about when it was written, or even who wrote it, the general consensus is that the Hippocratic Oath was penned about 2500 years ago. Most commonly attributed to Hippocrates, the father of modern medicine, the ancient vow demands a lot from doctors, including a certain level of chastity, charity and swearing to pagan gods. It provides in pertinent part:

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 judgment, I will keep this Oath and this covenant . . . to teach them this art . . . without fee or covenant.

I will use those dietary regimens which will benefit my patients . . . and I will do no harm or injustice to them.

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 a woman an abortive remedy.

I will not use the knife. . .

Whatever houses I may visit, I will . . . remain[] free of sexual relations with both female and male persons . . .

What I may see or hear in the course of treatment . . . I will keep to myself.

If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, begin honored . . . . if I transgress is and swear falsely, may the opposite of all this be my lot.

Although ancient, swearing the oath was not used as a rite of passage at medical schools until 1508, when the University of Wittenberg first administered it. By 1804, it had been incorporated into the graduation ceremony of the medical school in Montpellier, France. However, it was still not commonly administered, and by the early 20th century, not even 20% of U.S. medical schools included the oath as part of their commencement ceremonies.

Outmoded Requirements and Prohibitions

The restrictive, ancient vow poses several problems for the modern practitioner. First, the oath forbids physician use of a knife, a key instrument involved in nearly every medical practice. Second, its prohibition against abortion violates U.S. law, and would alienate over 40% of the population. Third, its restraint on euthanasia runs counter to the modern trend toward physician-assisted suicide.

Fourth, who swears to Apollo anymore, let alone the much lesser known Asclepius, Hygieia and Panacea?

Fifth, many doctors treat, or at least give medical advice to, those close to them, including spouses and sexual partners, which is prohibited by the oath.

Sixth, the oath is potentially a binding contract, which, in our litigation-heavy society, could provide a dissatisfied patient with yet another avenue to sue her doctor.  [Typically, when a patient sues a doctor, it is for malpractice – a claim that often must be brought within 1-3 years. Contrarily, when someone sues for a breach of contract, they often have a longer time period in which to sue.]

Modern Oaths

Although most do not swear to the original Hippocratic Oath, the majority of doctors do take an oath – often when they graduate from medical school. Despite early disinterest, physician oaths began to come into vogue after World War II.

During the Holocaust, doctors in Nazi concentration camps committed previously inconceivable atrocities against prisoners. Experimenting with extreme temperatures, radiation, untested drugs and vaccines, unnecessary and sometimes bizarre surgeries and infecting captives with deadly diseases, the exploits of concentration camp physicians shocked and horrified the world. Sane doctors realized stricter rules, and a code of ethics, were needed.

In 1948, the 2nd General Assembly of the World Medical Association adopted the Declaration of Geneva, appearing below as amended:

AT THE TIME OF BEING ADMITTED AS A MEMBER OF THE MEDICAL PROFESSION:

I solemnly pledge to consecrate my life to the service of humanity . . . 

I will practice my profession with conscience and dignity;

The health of my patient will be my first consideration;

I will respect the secrets that are confided in me . . .

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 maintain the utmost respect for human life;

I will not use my medical knowledge to violate human rights and civil liberties, even under threat . . . .

Similarly, in 1964 a modern version of the Hippocratic Oath was penned by Professor Lasagna of the School of Medicine at Tufts University. Although the modern oath retains many of the themes of the original, it omits the troublesome parts about surgery, euthanasia, abortion and sexual relations.

A number of other, similar oaths have also been written, and today, nearly every medical school requires some sort of oath of its graduates, although most are seen as “ceremonial and nonobligatory . . . compared to that taken by a judge, president, or other politician when he or she is sworn into office.”

Future of Medical Oaths

Seen as essentially providing only general moral and ethical guidance, many physicians today find physicians’ oaths lacking. Some point to the number and diversity of specialties in modern medicine and note that one, generalized oath is inadequate. Others identify that the oaths often conflict with necessary medical experiments, or simply do not address them.

Still others find the oaths lacking when it comes to managing infectious, fatal diseases. Strict adherence to an oath would demand that physicians treat patients infected with lethal, highly contagious diseases, like the Ebola virus, regardless of circumstance or preparedness. Likewise, an oath may prohibit a doctor from sharing patient information that would help epidemiologists and others during an epidemic.

Despite their shortcomings, doctors’ oaths are likely here to stay. As Dr. Howard Markel recently noted:

It is unlikely to become superannuated. It serves as a powerful reminder and declaration that we are all a part of something infinitely larger, older, and more important than a particular specialty or institution . . . . The need for physicians to make a formal warrant of diligent, moral, and ethical conduct in the service of their patients may be stronger than ever.

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  • mmi

    It is good that about 1/5 of medical school graduates still take the Hippocratic Oath, and we hope that the number will rise as the years go by and people come to their senses. A lot of damage has been done to society by the discarding of the H. Oath (by turning to other versions or none at all). Naturally, the modern version of the H. Oath has been improved by the dropping of the mention of pagan deities. Considering the fact that he WMA Oath, quoted above, has been altered about six times in just 65 years (and will probably be altered again), the ancient Hippocratic Oath does not deserve to be criticized by anyone today. The truth is that the H. Oath is solid and demanding, but the recent alternatives (WMA and Lasagna) are comparatively wimpy and watered down. Too bad … but society will learn (or collapse totally).

  • MarkS

    You haven’t mentioned the recent reports about how US doctors systematically violated their oaths to torture suspects at Guantanamo.

    Doctors aided US torture at military prisons, report says
    http://www.bbc.co.uk/news/world-us-canada-24801084

    The study says that medical professionals helped design, enable and participated in “torture and cruel, inhumane and degrading treatment” of detainees.

    Such violations of medical oaths and the Geneva Convention still continue to this day, with the explicit approval of the Obama administration.

    • gizz

      We don’t have REAL torture in our prisons. Go to China and find out what REAL torture is.

      • On you

        Yes we do, “We tortured some folks” Obama 2014

  • Bella

    You obviously have a poor grasp of medical history. The prohibition of the use of knives by physicians (to represent the practice of surgery) is because in the old times, surgeries were performed not by physicians, but by barbers.

    • Daven Hiskey

      @Bella: Check out Melissa’s article on The Barber Pole linked in the related links above and I think you’ll be satisfied that she’s well aware of the barber/physician connection. 🙂

    • gizz

      100% True

  • wben483

    It is not a bad thing, but a good one, that about 1/5 of medical school graduates still take the Hippocratic Oath, and the number will rise as the years go by and people come to their senses. A lot of damage
    has been done to society by the discarding of the H. Oath (by turning to other versions or
    none at all). Naturally, the modern version of the H. Oath has been improved by the
    dropping of the mention of pagan deities. Considering the fact that he WMA Oath, quoted
    above, has been altered about six times in just 65 years (and will probably be altered
    again), the ancient Hippocratic Oath does not deserve to be criticized by anyone today.
    The truth is that the original H. Oath is basically solid and demanding, but the recent alternatives (WMA and Lasagna) are comparatively wimpy and watered down. Too bad … but society will learn (or collapse totally).

  • gizz

    Do we want to follow the Nazi doctors with abortion and euthanasia? Dr. Mengela anyone?

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  • Remi

    I heard that the modern day oath doesn’t include anything about abortion. All doctors should be legally bound not to harm any patients (including unborn babies). That the oath isn’t legally binding is stupid, doctors should be held to protecting all patients.

  • James

    “Remi January 28, 2014 at 2:08 pm – Reply
    I heard that the modern day oath doesn’t include anything about abortion. All doctors should be legally bound not to harm any patients (including unborn babies). That the oath isn’t legally binding is stupid, doctors should be held to protecting all patients.”

    So what you are saying is that even if the parent would die the doctor cannot perform a life saving abortion on a diseased but living fetus. Hmmm sounds kinda dangerous to me. As far as the Oath goes I do think we need one that is binding in a court of law but one that is non-denominational and keeps to the premiss that a doctor should harm none in there practice. I also believe that they should include a bit about having an obligation to there community and a reasonable practice of compensation for there services…

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  • Gordon Bailey

    My wife has a heart condition, and we have found out recently that her consultants have, placed a do not resuscitate not on her medical records. We had not been given the opportunity to discuss this it was all taken out of our hands. So where is the part of the oath that makes doctors accountable to try save lives in all cases. Todays doctors have now the right to decide who lives or who dies and not the right that we should all have the right to live. My wife has also been told she can’t have a transplant because she is slightly overweight. Even though she has lost 5 stone they have made the decision not to allow her to even be assessed for a transplant. This was how we found out about the do not resuscitate, They have told her own heart consultant to stop all her medication, turn off her pacemaker and ICD implant, and do not resuscitate. In other words, we are sending you home to die, however they do put a fancy name on this and they call it palliative care. But however you dress it up its wrong, you should be given every chance to have the right to live, also I forgot to mention that my wife is only 45 years old. What are your thoughts.

    • Diane

      My thoughts are that all of that is shocking and sad! Sounds like you are in the UK, right? I think not all of that could happen in the US, where the default action is to resuscitate and make every effort to sustain life. Not saying our system is any better, ultimately…it’s just a different set of problems.

      I’m sorry you’re facing all this, and I pray you and your wife will find better solutions soon.

    • Dave

      Welcome to socialized medicine, and the leftist agenda in general. If you really want to know how the leftist elites feel about us great, unwashed masses. Read Bill Ayers Prarie Fire.

  • There needs to be a binding oath for doctors. And one more thing, the doctors should notr be allowed to buy into hospitals in which they control the health care of us. The CEO’s at Lutheren hospital in Ft. Wayne Indiana should not be allowed to tell doctors or set rules relating to health care or pain management. These doctors will not prescribe any type of pain meds; you have to go to a pain management, which are being busted as they should be for over prescribing. But the state attorny general droped 1700 pateints on the street with no where to go as the system here can’t handle the overflow and the pain centers are afraid that if they pick up the slack they are next on the state attornys hit list. This hospital and doctor Hendrix, who was the 1st to be busted has set up this money making situation. And we who suffer 24 hour pain from injuries have to suffer. This whole ceo/doctor controll sucks and has to be outlawed to save us who suffer months without our meds for no reason. And family doctors wont even take in these people. Fuck this system and all the doctors who have made landslide money killing within it. Give us a doctors binding oath and a system out of the CEO’s ability to take controll and make more money for themselves!!!