Is It Time to Retire the Hippocratic Oath?

Neil Chesanow

Disclosures

January 25, 2017

In This Article

Objections to the Traditional Oath

For other doctors, while oath-taking is still "a momentous occasion," the words spoken matter a great deal, and content of the traditional oath is problematic.

Criticisms include Hippocrates' invocation of "all the Gods and Goddesses," which, their pagan character aside, injects a religious element into medical ethics that many doctors object to.[4]

Women weren't physicians in ancient Greece, so the oath is written for and addresses only men, which makes some female physicians bridle, an unwelcome reminder that medicine was and continues to be a male-dominated profession.[4]

There is an allusion to slaves.[4] Physicians are proscribed against administering "poisons" to patients—evidence that the oath is outdated to some doctors. If that admonition were taken literally today, much pharmacotherapy would be forbidden, as would chemotherapy and radiation therapy.

Physicians are admonished not to "cut" their patients, so no surgery.[4] Abortion is forbidden, as is assisted suicide. Any concept of death with dignity is absent.

Moreover, Hippocrates did not distinguish between patients. Doctors healed the sick—without qualification. They did not refuse patients without insurance, or who had Medicaid or Medicare, or who did not have the right commercial insurance.

Some doctors find it hypocritical to vow to uphold ethical standards written for a bygone time—a futile enterprise. On the other hand, a plastic surgeon pointed out: "Schemes for reimbursing doctors for services rendered need not negatively impact on the oath's underlying principles. Rather than feeling helpless against the various payment schemes, doctors should be energized by the oath to constantly advocate for a better deal for the patients we have sworn to serve."

"In my book," he added, "the Hippocratic Oath remains very relevant. Its strength lies not only in its longevity but, more importantly, in the spirit it engenders."

Other Problems With the Oath

"Although the 20th century saw a dramatic increase in medical oaths administered at graduation, the traditional Hippocratic Oath has been subjected to serious criticism and revision," noted Erich H. Loewy, MD, the first chair of bioethics at the University of California, Davis, and a pioneer in the field.[5] "Some argue that its content is outdated, indicated by the many modifications schools have made. Others believe that the oath fails to incorporate many new ideals that are held dear to medical practice, such as societal and legal responsibilities, research ethics, and accountability in collaborative patient-care models."

Dr Loewy was skeptical that incorporating "many new ideals" into the oath would give it greater ethical authority.[5] For doctors-to-be who arrived at medical school with a strong sense of ethical values, he reasoned, the act of oath-taking was redundant. For those who lacked those values, it was an exercise in hypocrisy.

"I personally do not remember what the oath says, which means that on an average day, I don't recall what I swore an oath to," admits Simeon Koh, a student at Chicago Medical School at Rosalind Franklin University, no doubt speaking for many colleagues. "However, I think the reason the Hippocratic Oath doesn't have a strong impact on my life is because I already agree with it."

The question of relevance was raised by poll respondents in several contexts.

"Why," an oncologic surgeon wondered, "is a VIP patient always operated on by the senior surgeon and a laborer by a resident, if any oath that says 'Put the patient first' is relevant?"

"As long as physicians continue to kill unborn babies and help post-born patients kill themselves, as allowed by contemporary law and by the profession itself, then the ancient oath of Hippocrates is irrelevant," a pediatrician declared.

"Still relevant? Are you kidding?" a rheumatologist asked. "Absolutely not—not in a medical world controlled by clueless administrators and CEOs, none of whom see patients or realize what it takes to care for patients on a daily basis. Hippocrates would be turning in his grave."

"Sadly, irrelevant," an ob/gyn concluded. "Medicine has evolved from a profession into a huge service industry that involves many other players. These players—like the health insurance industry, hospital employers, and the pharmaceutical industry—do not pray to the same god as physicians do."

In addition, a growing number of physicians contend that the traditional oath, by ethically binding doctors to make patient care their sole priority—without addressing the human needs of the doctors themselves—encourages those who take this responsibility seriously to burn themselves out by futilely trying to live up to an impossible ideal.

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