The Modern Oath of Hippocrates

We owe the American Medical Association our profound and sincere apology. The so-called Modern Oath of Hippocrates which had previously been on this site is incorrect. Although we received the "Modern Oath" from a reliable medical doctor, unfortunately that oath did not originate from the AMA.

The AMA has been kind enough to do some in-house research to determine if the Modern Oath on this site had somehow originated from the AMA. It had not. The AMA has a code of ethics, but there is, in fact, no version of the Hippocratic Oath that the AMA espouses or promotes. This is the information we have received from the AMA's Ethics Division.

Our own research on the Hippocratic Oath, inspired by the discovery that our posting of the Modern Oath did not originate from the AMA, has been most interesting. While it is common knowledge among both doctors and the lay public that doctors take an oath that says, "Never do harm," the fact is that not all medical schools require their graduating doctors take the Hippocratic Oath. In addition, Medicine's use of the Oath changes over time. Here are some items for your consideration, the results of a study by Robert Orr, M.D. and Norman Pang, M.D., in which 157 deans of allopathic and osteopathic schools of medicine in Canada and the United States were surveyed regarding the use of the Hippocratic Oath:

1. In 1993, 98% of schools administered some form of the Oath.

2. In 1928, only 26% of schools administered some form of the Oath.

3. Only 1 school used the original Hippocratic Oath.

4. 68 schools used versions of the original Hippocratic Oath.

5. 100% of current Oaths pledge a commitment to patients.

6. Only 43% vow to be accountable for their actions.

7. 14% include a prohibition against euthanasia.

8. Only 11% invoke a diety.

9. 8% prohibit abortion.

10. Only 3% prohibit sexual contact with patients.

From - "The Use of the Hippocratic Oath: A Review of 20th Century Practice and a Content Analysis of Oaths Administered in Medical Schools in the U.S. and Canada in 1993." by Robert D. Orr, M.D. and Norman Pang, M.D.

UPDATE

The British Medical Association, in March 1997, published their first draft of a revised Hippocratic Oath to be considered by the World Medical Association.

If you would like to hear the critique of this proposed revised Oath by The Gersten Institute, click here.

"The Oath, a set of ethical principles derived from the writings of the ancient Greek physician Hippocrates, has been updated to put patients first. It aims to be a unifying force, superseding national, ethnic, religious and cultural boundaries by focusing on widely shared values.

The new wording can be adapted by nurses, paramedics and other health professionals."

Commenting on the revised wording, Dr Sandy Macara, chairman of the BMA Council, said:

"It is as important now as ever it was for doctors to have an agreed statement of ethical principles. On qualifying, doctors need such a statement to make a public commitment to the professional responsibilities they are assuming. Thereafter these principles should provide guidance in the increasingly difficult ethical decisions they will make throughout their professional lives.

"The value of this update will be all the greater if it comes into use by every doctor qualifying from every medical school in the world."

The BMA has been campaigning for the past five years for a revitalisation of the Hippocratic values. It has gathered examples of ethical codes from all over the world and common points from these have been integrated into the new wording.

The BMA has undertaken this work on behalf of the World Medical Association as the first stage of a revision of the current international code of medical ethics, the Geneva Declaration, which celebrates its 50th anniversary next year.

Appendix I

DRAFT REVISION OF THE HIPPOCRATIC OATH

The practice of medicine is a privilege which carries important responsibilities. All doctors should observe the core values of the profession which centre on the duty to help sick people and to avoid harm. I promise that my medical knowledge will be used to benefit people's health. They are my first concern. I will listen to them and provide the best care I can. I will be honest, respectful and compassionate towards patients. In emergencies, I will do my best to help anyone in medical need.

I will make every effort to ensure that the rights of all patients are respected, including vulnerable groups who lack means of making their needs known, be it through immaturity, mental incapacity, imprisonment or detention or other circumstance.

My professional judgement will be exercised as independently as possible and not be influenced by political pressures nor by factors such as the social standing of the patient. I will not put personal profit or advancement above my duty to patients.

I recognise the special value of human life but I also know that the prolongation of human life is not the only aim of healthcare. Where abortion is permitted, I agree that it should take place only within an ethical and legal framework. I will not provide treatments which are pointless or harmful or which an informed and competent patient refuses.

I will ensure patients receive the information and support they want to make decisions about disease prevention and improvement of their health. I will answer as truthfully as I can and respect patients' decisions unless that puts others at risk of harm. If I cannot agree with their requests, I will explain why.

If my patients have limited mental awareness, I will still encourage them to participate in decisions as much as they feel able and willing to do so.

I will do my best to maintain confidentiality about all patients. If there are overriding reasons which prevent my keeping a patient's confidentiality I will explain them.

I will recognise the limits of my knowledge and seek advice from colleagues when necessary. I will acknowledge my mistakes. I will do my best to keep myself and colleagues informed of new developments and ensure that poor standards or bad practices are exposed to those who can improve them.

I will show respect for all those with whom I work and be ready to share my knowledge by teaching others what I know.

I will use my training and professional standing to improve the community in which I work. I will treat patients equitably and support a fair and humane distribution of health resources. I will try to influence positively authorities whose policies harm public health. I will oppose policies which breach internationally accepted standards of human rights. I will strive to change laws which are contrary to patients' interests or to my professional ethics.

APPENDIX 2

Translation of the Original Hippocratic Oath by authors of this BMA draft.

"I swear by Apollo the physician, and Aesculapius and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgement, I will keep this Oath . . . "

Commentary from The Gersten Institute

1. Be it declareth this date, October 4, 1998, that the above Revised Hippocratic Oath, herein and hereafter referred to as RHO is a wee bit dry. Okay, let's get to the point. There is not enough heart in the RHO. It does not move or inspire. As a physician who has no recall at all if my medical school administered any version of the Hippocratic Oath in 1975, the year I graduated, I strongly believe that if doctors are to take an Oath ONCE in their lifetime, it should be a powerful, impassioned Oath that carries, at the very least, the spirit of the original Hippocratic Oath.

2. RHO is couched in a good deal of legal terminology. Perhaps that is necessary in this era of medicine, but it only adds to the growing distance between doctors and patients and does not, in my opinion, advance the real issue, namely quality of care.

3. The philosophy and principles contained in the RHO are good and sound.

4. The BMA translation of the original Oath is interesting. Instead of the correct translation in the first line, which refers to the Greek Gods Apollo, Aesculapius, Hygeia, and Panacea, this translation mis-tranlates "Hygeia" as "Health" and "Panacea" as "All-Heal." We should have a genuinely honest translation before we can consider revisions.

5. Gallup polls in the 1990's show that 95% of Americans believe in God and that 50% of atheists and agnostics PRAY! 50% of patients would like their doctors to pray with them. While it is correct to "drop the Greek Gods," is it a disservice to both doctors and patients to totally leave out the spiritual dimension in the RHO? I think so. It is an impossible task to try to capture the spirit of the original Hippocratic Oath while throwing out all mention of God, holiness, sacredness, and spirituality. It is necessary and sufficient as physicians to swear to practice according to the highest dictates of our conscience, with God (as we know and call Him or Her) as our witness.

6. With these items considered, perhaps the world should consider this Revised Hippocratic Oath. On the other hand, perhaps Hippocrates knew what he was doing. Perhaps we should keep the original Oath and simply make note that Apollo, Aesculapius, Hygeia, and Panacea are not universally accepted. Nor is Jesus, Buddha, Allah, Krishna or Ahura Mazda.

Dennis Gersten, M.D.


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