Is It Time to Retire the Hippocratic Oath?

Neil Chesanow

Disclosures

January 25, 2017

In This Article

Oaths for a New Generation of Doctors

For many doctors, the act of oath-taking is all-important. The words spoken are secondary, for each doctor invests the words with his or her own meaning.

For other doctors, the words pledged to matter a great deal. The many oath replacements attempt to get the words just right. But in the process, many doctors of a certain age believe, what makes a tradition a tradition—the transmission of customs and beliefs from generation to generation—is being lost.

"Unfortunately, the meaning of the oath is relevant mostly to the majority of us in an older generation, who recited it in its original form, as suggested by Medscape's poll," an orthopedic surgeon lamented, noting that he graduated medical school in 1985. "Our society has 'evolved' away from so many other noble values. I wonder if the traditional oath is even spoken about in our modern-day medical schools and residency programs."

It is, but their numbers are shrinking. Nearly 50% of the medical school deans surveyed in 2009 reported that their institutions used either the Lasagna Oath, which attempted to modernize the Hippocratic Oath with updated language, or the Declaration of Geneva, perhaps the first oath replacement to use an entirely different text.[2] The survey also found that as many medical schools and students were writing their own oaths as were still pledging to the Hippocratic Oath.

In 2005, to take one example, when Weill Cornell Medical College in New York set out to revise the traditional oath, the school delegated the task to a 20-member committee that included four deans, two student leaders, and three department chairs.[6] Some of the language in the traditional oath was so archaic that students, who had little prior exposure to the oath, "would laugh at certain parts," recalled cardiologist Antonio M. Gotto, Jr, MD, the college dean.[6,7]

The Weill Cornell oath reads, in part[2]:

I do solemnly vow, to that which I value and hold most dear... That I will seek the counsel of others when they are more expert so as to fulfill my obligation to those who are entrusted to my care; That I will not withdraw from my patients in their time of need; That I will lead my life and practice my art with integrity and honor, using my power wisely; That whatsoever I shall see or hear of the lives of my patients that is not fitting to be spoken, I will keep in confidence; That into whatever house I shall enter, it shall be for the good of the sick; That I will maintain this sacred trust, holding myself far aloof from wrong, from corrupting, from the tempting of others to vice...

But even this language, while easier reading than the translated Hippocratic Oath, is a bit stilted. More smooth-flowing and modern is the language in the oath used by the Yale School of Medicine, which takes pains to specify that physicians will treat patients without bias.[2] Yale's oath advances the perspective that doctors act not just as caregivers in the clinic or hospital, but also social actors who should use their standing in society to work for the common good. A portion of it reads[2]:

I will practice medicine with integrity, humility, honesty, and compassion, working with my fellow doctors and other colleagues to meet the needs of my patients. I shall never intentionally do or administer anything to the overall harm of my patients. I will not permit considerations of gender, race, religion, political affiliation, sexual orientation, nationality, or social standing to influence my duty of care. I will oppose policies in breach of human rights and will not participate in them. I will strive to change laws that are contrary to my profession's ethics and will work towards a fairer distribution of health resources.

The 2016 graduating class at the newly opened Dell Medical School at the University of Texas at Austin collectively crafted their own oath.[8] "I will remember that I do not treat a fever chart, or a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability," according to one passage.[8] "My responsibility includes these related problems, if I am to care adequately for the sick."

At Harvard Medical School, each class of students now writes its own oath.[9] These vows can be impassioned calls to action, in contradistinction to the comparatively solemn language that modern oath writers often strive for. The current version, for example, exhorts doctors-to-be to "wake up to the realities of the world." It goes on to say that "we promise to bear witness to historical injustices that continue to unfold for marginalized communities." At another point, it urges that "we must have the courage to act when we witness injustice."

At the Keck School of Medicine at the University of Southern California, students are asked to write their own versions of the Hippocratic Oath.[10] These vows may take the form of multimedia projects—a far cry not only from the traditional Hippocratic Oath, but also from modern text-only replacements. In this new reconceptualization of the medical oath, an oath may take almost any creative form—photo collages, musical scores, poems, or personal essays. Seventy-six of these highly personalized vows have been anthologized in a book: Hippocrates Revisited: A Collection of Personal Student Oaths.

"This anthology reflects the art of medicine," explains Jo Marie Reilly, MD, associate professor of clinical family medicine.[10] "The oaths represent creatively the themes that students are struggling with and celebrating as they begin their journey in the medical profession."

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