Since time immemorial, upon finishing their training, physicians have taken some sort of oath. Around 400 B.C. Hippocrates came out with what became known as the Hippocratic oath. By 1993 in the U.S., 98% of medical school graduates took an oath based on the Hippocratic prototype. Today, the physician’s oath has morphed into something that Hippocrates would never recognize. Woke culture and social justice have found their way into the oath. Hippocrates’s influential treatise begins, “I swear by Apollo the Healer, by Asclepius, by Hygieia, by Panacea, and all the gods and goddesses, making them my witness, that I will carry out, according to my abilities and judgement, this oath and indenture”. In polytheistic societies, the physician swore this oath before the gods, which meant by violating the oath the physician would, as it were, defile himself in front of the gods. The same is true for monotheistic societies, where the oath is sworn before God. In either case, violating the oath meant eternal damnation for the physician. Not something to trifle with. Today, any mention or trace of God is gone, much as it is in our society as a whole.
What was the physician swearing to do and not do? For starters, of course, do no harm. The Hippocratic oath states, “I will not give a woman a pessary to cause abortion.” This is because human life was considered sacred from conception to death. A woman seeking an abortion in ancient Rome or 10th century France would be out of luck, as would someone seeking euthanasia. Physicians swore to prolong life as long as possible and ease suffering. There was no wiggle room, nor room for interpretation or debate. A sworn oath to a higher power was a sacred duty. It wasn’t until the mid-20th century that the physician’s oath began to change. The biggest break with the original oath came in 1964 with a new, more humanistic version authored by Dr. Louis Lasagna, a dean at Tufts University. Gone were several key components of the original oath, including any invocation or mention of a deity. Also missing was the prohibition against abortion. In their place were exhortations to exercise “warmth, sympathy, and understanding” and to be willing to say “I know not” when stumped.
With this new version the oath was radically, and irrevocably, changed. It now became a secular thing, beholden only to the physician’s conscience and powers of moral self-restraint. No God was to be overlooking the physician’s clinical doings. The divine covenant was gone. Within three plus decades of Lasagna’s 1964 rewrite only one medical school in the U.S. was still using the original Hippocratic oath. At Harvard Medical School, each graduating class is invited to write their own oath. Graduates are called upon to “bear witness to historical injustices.” Hippocrates would not be pleased.
If you would like to read various versions of the physician’s oath, including Hippocrates version, go to: www.aapsonline.org/ethics/oaths.htm
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By Peter Galvin, MD