Is It Time to Retire the Hippocratic Oath?

Neil Chesanow

Disclosures

January 25, 2017

In This Article

A Range of Opinions

In Medscape's poll, most doctors (81%) found the traditional Hippocratic Oath "very" or "somewhat meaningful" to how they practice medicine.

"It would spell the end of decent practice if the oath were abandoned," an internist commented. "The oath is the constitution of the medical profession." But 7% of poll participants found the oath only "slightly meaningful"; 11% deemed it "not at all meaningful."

"Even back in the 1980s, we had the option to take it or not," a surgeon recalled. "Many in my class opted out. Until the patient-provider relationship is left to itself, there is no chance that an oath can be upheld, so all we are doing is swearing to something we know we can never accomplish."

A majority (62%) of participating doctors felt that the traditional oath should be preserved as is. But over one quarter (28%) maintained that the oath should be revised or replaced, and 9% believed it should be abandoned altogether.

"The oath is hardly relevant when medical care is being dictated by insurers, who are leasing our licenses," a doctor felt. "It's they who need to take an oath."

But this was a minority view.

"It is politically correct to doubt the relevance of the Hippocratic Oath nowadays," a cardiologist wrote, a sentiment echoed by many doctors who offered comments. "I believe that its value should be forever."

"The original Hippocratic Oath is still relevant," an orthopedic surgeon insisted. "All doctors must constantly think about what role we play in the society. Most of us just think about the money and forget the true essence of being a medical doctor. That is what the oath reminds us of--that this is a sacred profession, one that I'm proud to belong to."

"The Hippocratic Oath is quite relevant today, as it gives our newly trained colleagues an idea of the principles our once noble profession espoused, when we served patients for their good, not bureaucrats for theirs," a pain management specialist observed.

"There are no better substitutes of which I am aware," a family doctor responded. "Better this than no oath of honor at all."

The Importance of Oath-Taking

Ironically, even though most of our respondents maintained that the words of the Hippocratic Oath are timeless, "most practicing physicians probably don't remember what the actual content of the oath is," notes B. Alex Foster, MD, assistant professor of pediatrics at the University of Texas Health Science Center in San Antonio. Dr Foster and colleagues conducted the aforementioned survey of medical school deans. "But at the same time," he adds, "it's also very important to many physicians that they took an oath."

The language of the oath isn't conducive to easy recall. A key passage reads[3]:

I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly I will not give to a woman a pessary to cause abortion. But I will keep pure and holy both my life and my art. I will not use the knife, not even, verily, on sufferers from stone [kidney stone], but I will give place to such as are craftsmen therein.

The words spoken may be less significant to many physicians than the act of oath-taking. Oath-taking is a public declaration. It honors the social contract between the medical profession, its members, and society. It symbolizes the ethical bond not only between doctors and their patients, but also between new doctors and their physician forebears, who took the same pledge down through the centuries.

"I think the oath is more a symbolic connection with medical tradition than a ledger of particular rules to follow to the letter," a hematologist wrote. "In that regard, I prefer to preserve it in its original form, while bearing in mind its limitations."

Although a growing number of doctors-to-be are pledging to replacements of the original oath, the value of preserving tradition is not lost on others.

"The oath is a reminder of our professional values and expectations, but also a powerful coming-of-age ritual for all clinicians," maintains Shiv M. Gaglani, a student at Johns Hopkins School of Medicine in Baltimore, Maryland.

For Vincent Migliaccio Michaelson, who attends O&M Medical School in Santo Domingo, Dominican Republic, the oath continues to be "an ethical standard everyone should live by to care for and protect our patients."

"The oath to me is symbolic," says family physician Alexa Mieses, MD, MPH, a first-year resident at Duke University School of Medicine in Durham, North Carolina. "It does not influence how I operate with regard to ethics and responsibility. I developed my code of ethics throughout medical training. However, reciting the oath at graduation was a momentous occasion, because it marked the moment in which I joined a profession."

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