Ever since the time of the honorable Hippocrates, newly minted physicians swear the traditional Hippocratic Oath that mandates that they “first do no harm” to their patients. There is no such mandate. The original oath requires that they “swear by Apollo Healer, by Asclepius, by Hygieia, by Panacea, and by all the gods and goddesses…”
But times change, which means what was usual previously may need to be updated to meet the spirit and needs of the times and, incidentally, not to swear by Roman or Greek gods/goddesses. The burning question facing medical education today is how best to revise the oath that some find anathema. If medicine is anything, it is based on philosophy and science when it comes to making potentially life-changing decisions for patients.
How does the oath meet the needs of women’s healthcare when a life is in danger if a therapeutic abortion is not performed? The whole concept of “harm” comes into direct conflict with the oath. Where is the harm and which is the greater harm?
Does the oath, as it stands, still have relevance in a world decidedly different from the one in which it was written, or are we still being held to standards set at that time?
The question is roiling medical school administrators and students alike who must take the oath. And this is not an insignificant instance of a simple ceremonial change; it involves careers and issues of life and death. It should be noted that neither the American Medical Association nor the American Association of Medical Colleges requires an oath.
In 2015, a survey of 111 medical schools in the United States and Canada took part in a survey of commencements and the oaths that were taken then and at white coat ceremonies. The results show that more than half of these ceremonies did not use the original Hippocratic text but some variant of it, which was unique to the school and to those students. Three elements were found to be present in all the oaths: respecting confidentialities, avoiding harm, and upholding the profession’s integrity.
In 1964 Dr. Louis Lasagna prepared “A Modern Oath” which addressed many of the same issues found in the Declaration of Geneva first published in 1948 and then revised in 2017.
Some schools have used the updated version of The Declaration of Geneva that addresses a number of key ethical parameters relating to the patient-physician relationship, medical confidentiality, respect for teachers and colleagues, and other issues.
The revised declaration of Geneva carries pledges to:
1) consecrate their life to the service of humanity,
2) respect for teachers and showing gratitude,
3) practicing medicine with conscience and dignity,
4) the health of the patient is to be their first consideration,
5) secrets confided to them are respected even after a patient’s death,
6) maintaining the honor and noble traditions of medicine,
7) not permitting considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or other factors to intervene in the provision of medical services,
8) respect for human life
9) not using their medical knowledge in violation of human rights or civil liberties
Social norms and concerns are now a part of these oaths and cover serious issues facing anyone in medicine today. The past is revered, but the present and future are also given their due in oaths being written by students today. There is no longer the mention of religious obedience in the oath and bias and discrimination have been addressed as well.
Ethical issues remain the province of the medical practitioner and are in flux with changes that will be encountered. Dramatic advances in technology will bring new, unexpected demands of physicians and other in healthcare. Flexibility of the oath would appear to be its abiding factor with regard to this future shift.
