Hippocrates Oath

Several parts of the Oath have been removed or re-worded over the years invarious countries, schools, and societies but the Oath still remains one ofthe few elements of medicine that have remained unchanged. Most schoolsadminister some form of oath, but the great majority no longer use thisancient version, which praises pagan gods, advocates teaching of men but notwomen, and forbids cutting, abortion, and euthanasia.1 Also missing from theancient Oath and many modern versions are complex, new ethical landmines suchas dealing with HMO's, living wills, whether morning-after pills aretechnically closer to prophylactics or an abortion (they are different fromRU-486), experiments on humans who give informed consent, or geneticresearch. Some doctors prefer to drop all pretenses of swearing an oath orforcing others to do so, since medical boards and courtrooms are the realforces where unethical conduct is judged today. Following is a listing of thespecific promises and a modern perspective:

To support my teacher if necessary. Professional courtesy (not chargingfamilies of physicians for one's services) is perhaps the last trace of thisitem and has largely been abandoned.

To teach medicine to the sons of my teacher. In the past, medical schoolswould give preferential consideration to the children of physicians. This toohas largely disappeared.

To practice and prescribe to the best of my ability for the good of mypatients, and to try to avoid harming them. This beneficial intention is thepurpose of the physician. However, this item is still invoked in discussionsof euthanasia.

To never deliberately do harm to anyone for anyone else's interest. Physicianorganizations in the U.S. and most other countries have strongly denouncedphysician participation in legal executions.

To never attempt to induce an abortion. The wide availability of abortions inmuch of the world suggests that many physicians no longer feel bound by this.

To avoid violating the morals of my community. Many licensing agencies willrevoke a physician's license for offending the morals of the community("moral turpitude").

To avoid attempting to do things that other specialists can do better. The"stones" referred to are kidney stones or bladder stones, removal of whichwas judged too difficult for general practitioners, and therefore was leftfor specialists. It is interesting how early the value of specialization wasrecognized. The range of knowledge and skills needed for the range of humanproblems has always made it impossible for any single physician to maintainexpertise in all areas.

To keep the good of the patient as the highest priority. There may be otherconflicting "good purposes," such as community welfare, conserving economicresources, supporting the criminal justice system, or simply making money forthe physician or his employer that provide recurring challenges to physicians.

To avoid sexual relationships or other inappropriate entanglements withpatients and families. The value of avoiding conflicts of interest has neverbeen questioned.

To keep confidential what I learn about my patients. Confidentialitycontinues to be valued and protected, but governments and third-party payorshave occasionally encroached upon it.