Should doctors change the Hippocratic Oath?

The Hippocratic Oath is a document that has survived -- and remained relevant -- for more than 2,500 years. Conceived by the ancient Greek physician Hippocrates, commonly referred to as the father of medicine, the oath is a cornerstone of medical ethics [source: PBS]. Hippocrates had a rational perspective of medicine and sought out common sense explanations for diseases rather than ascribing supernatural causes to them. By his death in 377 B.C., Hippocrates had become the most well-known physician in Greece.

Today, there are classical and modern versions of the Hippocratic Oath. The commonly used maxim "do no harm" comes from the classical version, although the oath itself does not contain this exact phrase. (The oath does require doctors to "keep [patients] from harm" [source: PBS].) The classical oath is dedicated to the ancient Greek gods, including Apollo, and explicitly bars euthanasia and abortion. It calls on doctors to maintain confidentiality and to refrain from having "sexual relations" with people in the houses they visit [source: PBS]. Additionally, the classical Hippocratic Oath prohibits doctors from performing surgery: "I will not use the knife."

Dr. Louis Lasagna, dean of the School of Medicine at Tufts University, wrote the modern version of the oath in 1964. His interpretation emphasizes caring, sound treatment, humility, compassion and acknowledgment of a patient's humanity. It also mentions the importance of prevention by maintaining good health.

Most Western medical students say an oath, whether it's the Hippocratic Oath or a modern interpretation of it. Lasagna's modern version is considered more appropriate for the realities of today's world. Common criticisms of the classical oath include its invocation of the ancient Greek gods and its prohibitions against abortion, euthanasia and any form of surgery. The classical version also instructs that doctors should teach aspiring physicians "without fee and covenant" -- essentially, for free, which is generally impractical in an era when medical facilities, supplies and faculties require significant financial investments [source: PBS].

Like any old document, the Hippocratic Oath can be seen as dated and in need of adaptation to reflect changes in societal standards, technology, medical science and health care practices -- like abortion and euthanasia, or assisted suicide. On the next page, we'll take a look at a document that may eventually supplant the Hippocratic Oath.

Replacing the Hippocratic Oath

In 2002, the Medical Professionalism Project, a coalition of international medical foundations, introduced a document called "Medical Professionalism in the New Millennium: A Physician Charter." Also known as the Charter on Medical Professionalism, the document calls for doctors to uphold three main principles:

Patient welfare -- A patient's health is paramount.
Patient autonomy -- A doctor serves to advise a patient only on health care decisions, and a patient's own choices are essential in determining personal health.
Social justice -- The medical community works to eliminate disparities in resources and health care across regions, cultures and communities as well as to abolish discrimination in health care.

[source: Annals of Internal Medicine]

The charter includes a "set of professional responsibilities" that are expected of doctors. Responsibilities are outlined with an overarching phrase, such as "commitment to honesty with patients," followed by several sentences of explanation [source: Annals of Internal Medicine]. Besides defining these principles, the charter also serves to facilitate discussion about medical practices across societies and cultures and to consider issues particular to the modern era. For example, many of today's doctors face conflicts of interest either by advising, working for or otherwise interacting with drug companies.

The Charter on Medical Professionalism won't necessarily replace the Hippocratic Oath, though it does cover many of the same issues. Both documents share some core principles, including the overriding importance of patient health, patient confidentiality and nonsexual relationships with patients. But there are some problems with the charter as a potential replacement, including its length: 1,445 words compared to the 341 words of the modern version of the Hippocratic Oath.

The charter is more of a statement of general principles than an oath to be invoked. Some of these points are open to interpretation, which could be positive, given that medical techniques, relevant laws and cultural practices vary around the world. But this vagueness may hinder the charter's adoption. Consider this excerpt from the paragraph about the "principle of patient autonomy":

Patients' decisions about their care must be paramount, as long as those decisions are in keeping with ethical practice and do not lead to demands for inappropriate care [source: Annals of Internal Medicine]

What are these ethical practices? What is "inappropriate care," and how can it be defined? These are the sorts of questions raised by critics of the charter.

There are other influential medical documents besides the Hippocratic Oath and the Charter on Medical Professionalism. The Declaration of Geneva, also called the World Medical Association International Code of Medical Ethics, contains many of the same principles found in the charter but is often more explicit: "A physician shall respect a competent patient's right to accept or refuse treatment" [source: World Medical Association]. It includes three sections -- Duties of Physicians in General, Duties of Physicians to Patients and Duties of Physicians to Colleagues -- as well as a short oath to be taken when a doctor is admitted to practice medicine.

The Declaration of Helsinki, first adopted in 1964 and amended five times since, prohibits experimentation on humans. The declaration draws clear lines for acceptable medical research involving human subjects, such as vaccines. The document was created in order to outlaw the kind of brutal, inhumane experimentation performed on human subjects by Nazi doctors.

If a successor to the Lasagna version of the Hippocratic Oath eventually emerges, it will likely draw inspiration from the Charter on Medical Professionalism and these other documents that have widespread support. For more information about the Hippocratic Oath and other related topics, please refer to the links on the next page.

Should doctors change the Hippocratic Oath?

Replacing the Hippocratic Oath

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