Tuesday, October 02, 2012

400 B.C.: The Hippocratic Oath

Wall plaque of Hippocratic Oath
What good is a physician who cannot be trusted.  If you were wounded in battle and had access to a physician, then you could get a soothing salve to allay your pain and speed your recovery.  Yet amid rumors your doctor took a bribe to poison a friend of yours, you wonder if you should avoid your doctor at all costs.

It was such poor ethics among the medical community around 400 B.C. that enticed the writers of the Corpus Hippocraticum to write an oath.  The goal was to improve ethics among physicians, and increase respect for the profession among the peoples.  The original oath was as follows:
I swear by Apollo the Physician and Asclepius and Hygieia and Panaceia and all the gods, and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this 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 covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken the oath according to medical law, but to no one else.

I will apply dietic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect. In purity and holiness I will guard my life and my art.

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.

What I may see or hear in the course of treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep myself holding such things shameful to be spoken about.
If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honoured 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.
Like many ancient oaths it begins with an acknowledgement of the gods. Apollo, Asclepius, Hygieia and Panaceia are the gods of health, and every person seeking good health will worship and make sacrifices to one of these gods.
This oath appears in the Corpus Hippocraticum, and is generally attributed to Hippocrates or one of his students.  Although some historians place it's origin after the death of Hippocrates, and it's these historians who think it was written by some other physician and later added to the Corpus. Although the true origin may never be known.

The Ancient Greeks and Romans, unlike other ancient civilizations, liked to give credit for ancient texts to the original author.  Yet when the original author is unknown, the texts is attributed to the next best thing:  a hero.  In this way, Hippocrates is often given credit for all the Hippocratic writings.  Yet we know there were many writers.

The oath became so famous that one version of it or another has been said by physicians even to this day.  The modern version is as follows:
I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of over treatment and therapeutic nihilism.
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.
I will not be ashamed to say "I know not", nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.
I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given to me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.
I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.
I will prevent disease whenever I can, for prevention is preferable to cure.
I will remember that I remain a member of society with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.
If I do not violate this oath, may I enjoy life and art, be respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.
The integrity of the medical profession has grown exponentially since the time of the Hippocratic writings, in part due to the ethical standards set forth by this oath. Some of the most respected people in any community are your doctors.

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