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The Hippocratic Oath

Dr. William Palmer's cigar case with cigar, France, 1840-1855

Dr. William Palmer's cigar case with cigar, France, 1840-1855

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The Hippocratic oath was introduced in ancient Greece as a guide to behaviour for new physicians. It was incorporated into medical practice in the Islamic Empire. Since then it has been forgotten, rediscovered, rewritten and reused.The Hippocratic oath was probably compiled by several authors following Hippocrates’ philosophical principles.

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Its most basic principle was that a doctor must always cure patients, but never harm them. It also discussed respecting teachers, passing medical knowledge to new generations and keeping patients’ secrets. Many of these principles are still part of medical culture.

The return of the Hippocratic oath

The modern Hippocratic oath was used again in the 1940s, as a symbol of medical ethics. At the end of the Second World War, the world learned about Nazi atrocities committed on prisoners. Nazi scientists such as Josef Mengele used people in experiments to test the effects of radiation or high altitude and cold. Others gave untested vaccines to prisoners, then infected them with a deadly disease and counted how many survived. They claimed they were advancing medical knowledge.

The link between doctors and the Holocaust shocked the medical profession. Strict rules were written to avoid future abuses. The Hippocratic oath, underlining the sanctity of human life, was rediscovered by medical schools worldwide. It became an ethics guideline for new practitioners.

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Contemporary dilemmas

The reintroduction of the oath has been problematic. Medical ethics are complex. They must balance patient expectations, social demands and taboos, economic and political realities, and evolving medical and scientific knowledge.For instance, the original oath required patients to be cured regardless of circumstances. However, using placebos in double-blind trials, considered essential for drug development, means doctors do not attempt a cure. The original oath would also forbid triage. This is used during war or disasters when treatment is prioritised based on patients’ survival chances. Different medical care for patients with or without health insurance would be impossible. Some dangerous types of chemotherapy using toxic drugs in high doses would be disallowed. Finally, the original oath prohibits assisted euthanasia to relieve the suffering of patients with incurable conditions.

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The Hippocratic oath today bears little resemblance to the original. Some medical schools, particularly in the United States, combine other oaths with modern rules to create a workable ethical model. Unlike the original, the new oath does not require that doctors swear it before they can practise. Instead, it is a code of practice, and a symbol for young doctors entering the profession and their commitment to healing.

Bibliography

D Steinberg (ed.), Biomedical Ethics: A multidisciplinary approach to moral issues in medicine and biology (Hanover: University Press of New England, 2007)

 A G Christen and J A Christen, ‘Alfred P. Southwick, MDS, DDS: Dental Practitioner, Educator and Originator of Electrical Executions’, Journal of the History of Dentistry, 48/3 (2000), pp 117-22

 J S Hawkins and E J Emanuel (eds.), Exploitation and Developing Countries: The Ethics of Clinical Research (Princeton: Princeton University Press, 2008)

 R Huxtable, Euthanasia, ethics and the law: from conflict to compromise (London: Routledge, 2007)

 P Nitschke and F Stewart, Killing Me Softly: Voluntary Euthanasia and the Road to the Peaceful Pill (Penguin Books, 2005)

Glossary:

Radiation

Transmission of any type of energy by means of rays, waves or as mobile sub-atomic particles (electrons, neutrons and protons).

Vaccine

A substance given to humans or animals to improve immunity from disease. A vaccine can sometimes contain a small amount of bacteria that is designed to stimulate the body's reaction to that particular disease. The first vaccine was developed in 1796 by Edward Jenner to prevent smallpox.