Saturday, 12 February 2011

Hippocratic oath

Due to more or less popular demand I have decided to write something about the Hippocratic Oath.

As you may know or may not realise, I live and studied in the Netherlands. Compared to about any country I've ever been to, this is a fairly atheist country. If mention 'church', you almost say it softly because you don't know how people would react. (If you say 'mosque', run. Yet, a teacher at one of our colleges, refuses to shake hands with female students based on his new-found faith after a trip to Mecca. In Holland, you shake hands till you have no right hand left. If he tried that with me, I'd demand a different teacher and make a complaint against him for discrimination based on gender. If I'm too filthy for him to shake my hand, I can't trust that I'll get assessed for my work and not the fact that I happen to be born with a vagina.)

The Hippocratic Oath is a tradition. Technically, it's no longer a Hippocratic oath, but a Doctor's oath, since we don't really pray to Apollo any more, and it has been revised many many times. It holds, at least in this country, no legal value: my registration as a doctor is the legal bit. It is a sort of rite of passage into doctor-hood, if you want. It's a moral oath, and it is not the same as the various guidelines on ethics, good clinical practice and such.


The original Hippocratic oath may or may not have been written by Hippocrates of Kos (450-370 BC), but it's one of the most well known documents from that time. For the first time, it required physicians to submit to a moral code of conduct. Also, for the first time, the curer and the killer were not the same person. For those interested in the original version: http://en.wikipedia.org/wiki/Hippocratic_Oath; Actually, go see, it's pretty interesting. Even back then there was a problem with doctors sleeping with patients and others, apparently! Also weird: the oath is Greek. Yet, we all know the related 'primum non nocere'. Latin.

(^Aesculapius. I wonder what ancient physicians would say about modern medicine. At least we have one other thing in common: I like to wear dresses too.)

In the Middle Ages, the learnings of the pragmatic Galenus of Pergamum became crucial. He was less interested in the moral grounds of the Hippocratic teachings. However, during the middle ages, it was common for physician's oaths to be sworn. It wasn't until the 1500's that the Hippocratic Oath made it's way to European universities. It has been translated into Arabic in the 900's, and has played a role in the Islamic world since. During the Renaissance Galenus' popularity decreased, whilst that of Hippocrates increased. It was another way for the Renaissance man to attempt to become perfect. (Or wait, was the Homo Universalis after that?) Of course, the stance taken on euthanasia and abortion in the Oath matched that of the time, based on Christian, Jewish or Islamic religion. (You'd say that discussions on these topics would get old after 2500 years!) Ironically, the text on no killing may not even have had anything to do with euthanasia, but with a frequent request to ancient physicians to kill somebody. Swearing the oath was introduced in Europe in the 1500's, of course, adjusted to the Christian faith. The oath has remained fairly unchanged here since 1878, until 2003.

Nowadays, the main concept of the oath is still intact. Some aspects have changed: abortion, for example, and the fact that sometimes 'Do No Harm' and 'I will not take the life of another man' contradict each other. The Hippocratic ethic has reached it's limits in the late 1700's already. In 1948, after nazi abuse of medicine, the Declaration of Geneva was written:


D EC L A R AT I O N O F G ENE VA
(Wo r l d M e d i c a l A s s o c i at i o n , 1 9 4 8 ; l a at s t e h e r z i e n i n g 2 0 0 6 ) 4
At the time of being admitted as a member of the medical profession:
I solemnly pledge to consecrate my life to the service of humanity;
I will give to my teachers the respect and gratitude that is their due;
I will practise my profession with conscience and dignity;
The health of my patient will be my fi rst consideration;
I will respect the secrets that are confi ded in me, even after the patient has died;
I will maintain by all the means in my power, the honour and the noble traditions of the medical profession;
My colleagues will be my sisters and brothers;
I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affi liation, race, sexual
orientation, social standing or any other factor to intervene between my duty and my patient;
I will maintain the utmost respect for human life;
I will not use my medical knowledge to violate human rights and civil liberties, even under threat;
I make these promises solemnly, freely and upon my honour.

The oath is by no means a religious oath. It is a pledge to yourself, and to society. (Or, like the British like to say: The Public). It never was a religious oath; despite all the Greek deities. It was meant to make better physicians. You know, who have moral standards and don't sleep with patients. I think many patients think it means we become superhuman.

In 2003 a revised Dutch physician's oath was written, based on a conference in Kos, Greece. In this, you have the option to mention the Almighty, or not. and that is what I meant with the traditional, religious oath, or the atheist one.



Ne d e r l a n d s e a r t s en e e d ( 2 0 0 3 )
Ik zweer/beloof dat ik de geneeskunst zo goed als ik kan zal
uitoefenen ten dienste van mijn medemens. Ik zal zorgen voor
zieken, gezondheid bevorderen en lijden verlichten.
Ik stel het belang van de patiënt voorop en eerbiedig zijn
opvattingen. Ik zal aan de patiënt geen schade doen. Ik luister
en zal hem goed inlichten. Ik zal geheim houden wat mij is
toevertrouwd.
Ik zal de geneeskundige kennis van mijzelf en anderen bevorderen.
Ik erken de grenzen van mijn mogelijkheden. Ik zal mij open en
toetsbaar opstellen.
Ik ken mijn verantwoordelijkheid voor de samenleving en zal de
beschikbaarheid en toegankelijkheid van de gezondheidszorg
bevorderen. Ik maak geen misbruik van mijn medische kennis,
ook niet onder druk.
Ik zal zo het beroep van arts in ere houden.
Dat beloof ik.
of
Zo waarlijk helpe mij God* almachtig.


The above, translated by yours truly as that seemed easier than finding the actual (non existent?) translation:
Dutch Physican's Oath (2003)

I swear/promise that I will, to the best of my abilities, perform the art of medicine to the benefit of my fellow human beings.
I shall take care of  the ill, promote health and alleviate suffering.
I shall put the interest of the patient first and shall respect their views.
I shall do no harm to the patient. I will listen and properly inform them. I shall keep secret that what has been confided to me.

I shall promote the medical knowledge of myself and others.
I admit the limits of my abilities. I shall be open and transparent, and I know my responsibilities towards society.
I shall promote the availability and accessibility of health care.
I shall not abuse my medical knowledge, not even under pressure.
I shall keep the profession in honour, 

This I promise
or
So help me God Almighty.





And, for completion's sake: the UK version:
T HE D U T I E S O F A D O C TOR
R EGI S T ER ED W I TH T HE
G ENER A L M E D I C A L COU N C I L 1 4
( 2 0 0 6 )
Patients must be able to trust doctors with their lives and health.
To justify that trust you must show respect for human life and you
must:
• Make the care of your patient your fi rst concern
• Protect and promote the health of patients and the public
• Provide a good standard of practice and care
- Keep your professional knowledge and skills up to date
- Recognise and work within the limits of your competence
- Work with colleagues in the ways that best serve patients’
interests
• Treat patients as individuals and respect their dignity
- Treat patients politely and considerately
- Respect patients’ right to confi dentiality
• Work in partnership with patients
- Listen to patients and respond to their concerns and
preferences
- Give patients the information they want or need in a way they
can understand
- Respect patients’ right to reach decisions with you about
their treatment and care
- Support patients in caring for themselves to improve and
maintain their health

• Be honest and open and act with integrity
- Act without delay if you have good reason to believe that
you or a colleague may be putting patients at risk
- Never discriminate unfairly against patients or colleagues
- Never abuse your patients’ trust in you or the public’s
trust in the profession.
You are personally accountable for your professional practice
and must always be prepared to justify your decisions and
actions.

Resources:
* Nederlandse Artseneed, de Commissie Herziening Artseneed, 2009.
* Wikipedia, partly
*Ned Tijdschr Geneeskd 2005;149:1062-7

2 comments:

  1. Although it is easy to see the similarities in all of them, I like the Dutch Oath.
    To me it seemed crisp, clean and to the point.

    Also where it says "I shall promote the availability and accessibility of health care", in America they would have to add "without regard for profit"

    ReplyDelete
  2. While we're casting votes, I like the Declaration of Geneva. The medical school I attend actually has excerpts of it everywhere, I just didn't realize that that's where they were coming from. The translation is slightly different, but I always sort of (humbly) look up at the one outside of the library that reads, "I will practice my art with uprightness and honor."

    Let us know what you end up choosing (it's kind of cool that you get a choice)!

    ReplyDelete