The Hippocratic Oath

The Hippocratic oath was an oath generally thought to be written in the 4th century BCE by Hippocrates, who is considered by many to be the founder of modern medicine. Some now question Hippocrates' authorship of the Hippocratic oath, and certain scholars believe that instead, Pythagoras may have authored the oath. Most assume that the Hippocratic oath is still taken by all doctors and that the most important part of the oath is a promise to “ first, do no harm.” Actually this phrase derives from another part of Hippocrates writing and is not in the oath. Additionally, incoming physicians do not recite the Hippocratic oath in its original form, though many physicians recite a modernized version of the oath. The classic Hippocratic oath swears first to honor one’s teachers, take care of their family or children if need be, and offer free medical training to a teacher’s children. The oath does describe a promise to try not to harm anyone and to prescribe medicines to the best of one’s abilities, and to never give medications that could be used to poison someone or to cause a woman to abort a child. The Hippocratic oath further promises never to cut anyone (perform surgery), which clearly is not valuable in modern applications. It enjoins that physicians keep their patients' conditions private, that they not have sexual relationships with patients or a patient’s family, and that they work always for the good of the patients. Certain modern versions of the Hippocratic oath are similar in construction. Some physicians upon taking the oath still swear not to perform abortions. Most tenants of the oath are promises, and do not carry the strength of the initial Hippocratic oath. Instead, any practices of physicians in most countries are legislated by governing medical boards. Breaking the laws can mean losing one’s license to practice. The original Hippocratic oath contains too many promises that have become increasingly morally challenging. For example, does a doctor perform abortions and does this constitute harm? Further, is physician-assisted suicide a violation of a modern oath? Thus the oath, like the marriage vows are promises that may not be kept, even if the oath is taken with due solemnity. Interns and fellows have often stated that 120 hour work weeks are in direct violation of any oath a physician might take. If a physician is supposed to try not to harm people, then how can they order schedules for residents that might possibly harm their students? Research suggests that those without adequate sleep have a car greater risk of being in a car accident. Does requiring a 24 or 48-hour schedule thus mean physicians violate their oath? Such a question remains problematic for the medical field. Most would be surprised to learn that about 100 years ago, only 20% of American physicians took the Hippocratic oath. The number has actually increased steadily, with virtually all medical school graduates in the US now taking some form of the oath. The modern oath seems more of a rite of passage than an actual swearing of actions. The only promises a physician must keep are those that are made laws by governments, Medical Review Boards, or by hospitals in which a physician works.