Is It Time to Retire the Hippocratic Oath?

Neil Chesanow

Disclosures

January 25, 2017

In This Article

What Makes an Oath Valid?

Physicians with a traditional bent may view such newfangled attempts to keep the oath relevant with a certain dismay.

"Knowledge comes easily to the young," a poll participant, an ob/gyn reflected. "Wisdom is achieved only with age and experience. Is there room for wisdom in this age of evidence-based medicine?"

There is, but there are now many roads to wisdom. Family physician Bradley P. Fox, MD, a member of the clinical faculty at Gannon University and a practicing physician in the Saint Vincent Health System in Erie, Pennsylvania, is surely not the only doctor who keeps a copy of the traditional oath on his office wall, like a sacred text. He looks at it from time to time. He draws inspiration from it. "There is a lot of relevance," he says."

For many doctors, who have long since forgotten what the Hippocratic Oath actually says, that relevance is epitomized by a single phrase: "First do no harm." There is a certain irony in this. "What most physicians consider to be the main precept of the oath—Primum non nocere—is not part of the oath," notes William Sonneberg, MD, a family physician in Titusville, Pennsylvania. That memorable phrase is actually derived from another work by Hippocrates, Epidemics.[3]

It is common for doctors to draw their own meaning from the oath—and that is what they remember, not necessarily what is literally there. What matters to them is what the oath represents, and those interpretations are highly personal.

But if you accept that, it is easier to understand why younger generations of doctors seek meaning from their own symbols and traditions. When some of these younger doctors read the Hippocratic Oath, what impresses them are not its noble ideals but its archaic concepts. Molded by different cultural influences than their older colleagues, they may find the traditional oath difficult to relate to.

In the traditional oath, for instance, Hippocrates advises young physicians to hold their teachers "in this art" equal to their own parents, to make their teachers partners in their livelihood, and to share their money with their teachers if the teachers are in need.[3]For many doctors-to-be, who are often carrying tens of thousands of dollars in medical school debt, this advice seems comical.

Which is not to suggest that medical students and young doctors don't benefit from having an oath to pledge to. More students are taking an oath today in medical school than they were a half-century ago. As Dr Foster and his colleagues note, "The practice of oath-taking has steadily increased over the past fifty years, from 72% in 1969, to 100% in both 1999 and 2009"—years when medical schools were surveyed on whether their students took oaths.[2]

The forms that oaths take have also multiplied. Not every doctor of a certain age views this development with chagrin.

"In its original form, the Hippocratic Oath lacks relevance due to archaic language," a pediatrician wrote. "Its intent is probably more relevant today than ever before. Many of the recent iterations are perfect. In several US schools, the oaths created by the students have been outstanding."

"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," Dr Loewy, the bioethicist, concludes.[5] "The medical oath, adapted as it is to modern situations, may well serve this purpose."

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