Oaths for Physicians -- Necessary Protection or Elaborate Hoax?

Erich H. Loewy, MD

Disclosures
In This Article

On Oaths in General and Medical Oaths and Codes, in Particular

An oath is a public statement or promise to behave or not to behave in certain ways. It is sworn by some thing or things that are precious to the taker of the oath. A promise, one would think, would be something that honorable men and women would keep as a matter of course. Unfortunately (and I am afraid increasingly), this world is hardly made up of honorable men and women of whom a handshake suffices to seal a bargain or who, when such a bargain is complicated, are satisfied with an initialed note spelling out the particulars. That this is not the case in today's culture is obvious.

Oaths, as Sulmasy so well puts it, are like promises: They are "performative utterances" that in general have "more moral weight" because they (1) are "public utterances," (2) appeal to something held sacred, and (3) appeal to "consequences should they fail to be kept.[5,6]" To swear before a court "to tell the truth, the whole truth and nothing but the truth" implies that, in our culture, without such an oath a person might well feel at liberty to lie: yet the prima facie duty not to lie is, and should be (for otherwise discourse would be pointless), an obvious obligation no matter what ethical theory one might subscribe to or in what culture one finds oneself. Swearing in court, however, carries the additional weight of consequences for such a lie -- a charge of perjury.

Perhaps an oath is useful in impressing the gravity of the situation, and perhaps the fact of swearing to such an oath and knowing that not keeping it may have consequences (in self-esteem if not also in the eyes of colleagues) is at least as important as its contents. The medical oath, adapted as it is to modern situations, may well serve this purpose. An oath is a public declaration by which someone promises to adhere to certain ways of behaving as well as to ethical standards and/or activities. Oaths are generally not legally binding, but exist alongside legislative restrictions. In essence, they are a declaration of intention, a public promise of fidelity sworn no longer in the name of the "Gods" in which many of us no longer believe but on our honor (which, one would hope, is precious to us). Persons taking this oath bind themselves to being sanctioned should they fail to keep to the oath (the stick) and in return (in most oaths), to have the reward of a long experience in the joy of healing (the carrot). I have picked out two of several oaths not because I think them superior but because they seem to encapsulate briefly what almost all modern oaths are about, and what, in my view, being a physician -- no matter in what field -- is all about.

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