New variations on Hippocrates


Oath: Words that for centuries have defined the role of the physician can still set off questions and debate.

May 20, 2001|By Diana K. Sugg | Diana K. Sugg,SUN STAFF

The keynote speaker has finished. The medical students have received their degrees. Then, at most medical schools in the United States, comes the climactic act of the graduation ceremony. In a moment many aspiring physicians have imagined for years, the class rises together to recite an oath.

The newly minted physicians, reciting one of the many versions of the Hippocratic Oath, pledge to do their best to take care of their patients and are reminded that they are embarking upon an enterprise unlike any other.

"I swear by Apollo Physician," the original oath begins, " ... whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice. ... If I fulfill this path and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot."

"I was thrilled by it," says Dr. Louis Lasagna, a Tufts University dean who remembers his moment 54 years ago. "It made me feel like I was part of a noble tradition."

Hippocrates himself is mostly a mystery. A physician and teacher in Greece in the fifth century B.C., he was a contemporary of Plato and Socrates and lived on the Greek island of Cos. Despite the busts that bear his name, experts say no one knows what he looked like. And historians doubt he even wrote the oath.

The Hippocratic Oath was saved, historians say, because a group of physicians apparently copied down Hippocrates' teachings and did their own work, producing about 70 treatises on medicine, including some, like the oath, as short as a page.

Underlying these works was a new philosophy that illnesses were natural processes that could be studied; illnesses, these early physicians reasoned, stemmed from causes such as the environment or food rather than the supernatural.

But the oath did not enter widespread use until the Middle Ages, when Europeans deleted its references to Greek gods and emphasized values such as charity. As science overtook some of Hippocrates' theories, its use waned.

But as people have learned that science doesn't have all the answers for patient care, the oath has regained popularity. In the early 1900s, only a quarter of U.S. medical schools included an oath at graduation; today, virtually all schools do. Some use it in the ceremonies in which medical students receive their first white coat.

But there is no longer a single oath on which all physicians agree.

For physicians, the wording is often an emotional, personal issue. They look to the Hippocratic Oath to capture their enduring values, to be mission statement, ethics guidelines and inspiration all at once. Doctors want it to be universal enough that most can agree on it, yet specific enough to mean something.

It's a tall order for a few dozen lines.

"It's not just empty words. We have to represent what we believe in. Medicine is a profession, it's a wholesome one, an altruistic one, but there are temptations," says Dr. Jack Gladstein, associate dean for student affairs at University of Maryland School of Medicine, which uses a modified version of the Hippocratic Oath. "It's the last thing we want to say to our students. It says it all."

Physicians have debated for years in medical journals what exactly should be said. Some see the Hippocratic Oath as an anachronism whose specifics, such as swearing to Greek gods, referring only to men and prohibiting abortion, are offensive or irrelevant. Some argue that the oath is a sacred script that binds physicians to generations of their predecessors.

"It's the spirit of what's being said. This is a contract between you and society, and one that you share with all your colleagues and that guides your professional behavior," says Dr. Helen Loeser, associate dean for curriculum at the University of California, San Francisco School of Medicine, the site of fierce debates every year as students decide which oath to use. "I find it quite powerful."

"The reason the Hippocratic Oath has endured is in part because every group needs its heroes, figures of long tradition whom we can look up to," says Dr. Gert H. Brieger, professor of the history of medicine at the Johns Hopkins University School of Medicine.

Others say the universal human principles outlined in the oath still hold true, just as much as in Hippocrates' time, when doctors had few medications or cures. Although the original oath does not specifically state "do no harm," the idea is there. So are promises to keep patient information private and to abstain from sexual relationships with patients.

The oath also says that physicians will not perform abortions or assist in suicide. These last two points, as well as the all-male nature of the original oath, have been points of contention.

Baltimore Sun Articles
Please note the green-lined linked article text has been applied commercially without any involvement from our newsroom editors, reporters or any other editorial staff.