Written by: Angie Kim

“I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses…” The Hippocratic Oath: one of the most widely known Greek texts in history that still makes the same significant impact on modern-day physicians as it did 2,500 years ago. It falls into two parts: the duties of the student towards one’s teacher (and the teacher’s family) along with the student’s transmission of medical knowledge, and the second being the rules of treatments with certain medical ethics. After four years of assiduous work, medical students are expected to recite the oath that will guide them in the field of ethics and values in years coming forth as practicing doctors. According to Dr. Christine Thang, a graduate of the David Geffen School of Medicine at UCLA, “the oath is a reminder that a physician’s job is to treat not just the diseases we encounter but to think of each individual patient as a whole person.” However, today’s medical students are reciting a modernized Hippocratic Oath, rather than the original pledge, to accommodate the changing atmosphere of medicine in response to the increasing usage of the digital world and avant-garde medical practices. For example, an ethical code mentioned in the original Hippocratic Oath is the disallowance of giving poison to a patient. As modern society becomes more open to euthanasia options for terminally ill patients, many physicians are now slowly viewing the Oath as irrelevant in the 21st century. As more modern regulations impede and collide with the ancient conditions the physicians encountered when the Oath was created, the question of whether or not the Hippocratic Oath should be abolished or not stands. The Hippocratic Oath, modern or not, should continue to be implemented as an obligatory step in becoming a physician as it serves as an affirmation of tradition and of professional responsibility. To further understand the heated debate, one must examine and analyze the time period in which the Hippocratic Oath was created and why Hippocrates had it created.

​Nearly half of U.S. medical schools today include at least some version or part of the Oath into their graduation ceremonies as a rite of passage. What are the origins of the original Hippocratic Oath? The Hippocratic Oath is an ancient Greek Document that is divided by items such as justice, chastity, confidentiality, etc. Although Historians do not know for sure the creator of the Oath, it is widely accepted that it was written by a Greek physician by the name of Hippocrates. Before the Oath was created, philosophers in Greece had shown great interest in medicine yet approached it with either “strong shamanistic, religious, or philosophical aspects” as a way of treating patients. Their code was based on theories of philosophies such as those of Pythagoras of Samos; he believed that diseases were caused by an imbalance of opposites (hot and cold, bitter and sweet, e.g.). As a result, it was common for Greek citizens to rely on their religious beliefs or personal philosophies on whether they would recover or not. Ancient Greek medicine was therefore defined as illness being a punishment from the gods and healing as a gift.The “Father of Western Medicine”, or Hippocrates of Kos, refused to rely on such beliefs. Instead of a traditional philosophical approach, he believed that the human body was controlled by natural forces and that medicine should be based on studies.  For example, he knew that diseases were a morbid phenomena; that they would run their course; that their origin was influenced by atmospheric environments. From this, he would tell his patients to modify their way of living through exercise, diet, etc. The same belief that Hippocrates had that guided his refusal of supernatural powers of healing is now what advances medicine today: healing and practicing based on detailed observations and past studies.

There were no qualifications to become a practicing physician in Ancient Greece; anyone could treat a patient. The lack of supervised treatments and qualifications are important to consider as the issue would soon start the flame of making a moral and ethical code of conduct. The Spartans, as an exception, did have specifically designated doctors for their military. This being said, with no guidelines of practicing medicine, the Hippocratic Oath was created. The birth of the Hippocratic Oath was, according to Cartwright, a “religious document ensuring a doctor operated within and for community values.” With that Oath, along with swearing by Apollo, codes such as abusing patients, using a knife, etc. were implemented. This would be a significant moment in the history of medicine. The Hippocratic Oath was not always appreciated, even in the ancient times. According to Hulkower, the “pagan religious content at the opening of the Oath” was a cause of discontent amongst Western monotheists even though they had in agreement with what the rest of what the Oath says. The Hippocratic Oath was created to address the challenges of the absence of qualifications for ancient Greek Physicians and out of their current religious and philosophical beliefs.

The question still remains: why is the Hippocratic Oath relevant in modern world medicine? One can understand why the debate continues to exist when looking and analyzing at certain lines. For example, the line “I will not use the knife” cleanly contradicts with the amount of surgical procedures physicians are practicing every day. This line may have been written as it was accepted in the ancient Greek time period when medical practitioners (such as Diocles of Carystus) generally avoided surgery and instead focused on natural healing methods. However, this purely cannot be used as an argument against the irrelevance of the Oath. Surgeons in modern day healthcare do not use the knife (or scalpel) to do harm on the patients, which would strictly go against the famous “do no harm” line, but rather for the benefit of the patient’s health – something the Hippocratic Oath emphasizes on. Even in ancient Greece, after practicing doctors were sworn in, minor surgeries were carried out especially with wounded soldiers to achieve the ultimate goal of restoring a patient’s well-being. Other practices such as abortion and euthanasia are also prohibited in the Oath. But like the scalpel, certain exceptions are open to be made when the decision is ultimately made for the patient mentally and physically; euthanasia tends to suffering and an abortion can be used to avoid serious health risks. Therefore, it can be concluded that certain lines that one may deem inappropriate or irrelevant in modern day healthcare cannot be used as an argument to obliterate the Oath from medicine because such rules have exceptions when the patient’s health is held in the highest regards.

The use of the Hippocratic Oath, despite its wide range of variations and edits in response to the fluidity of medicine, serves as an important function in the modern era of healthcare. According to Smith, it firstly sets the “right of conduct” and serves as a professional statement, especially for the public, of the ethics in regards to the profession as a whole. It provides, if one will, as a personal moral code and gives physicians a strong starting point on where to draw their lines or address the “grey areas” of medicine. Additionally, reciting the Hippocratic Oath most importantly presents itself as an affirmation of heritage in which both the audiences in graduation who are witnessing and the physician is reminded to be aware of the tradition that had passed down for centuries – similarly to the flame in the cauldron standing as a symbol during the Olympics. Both have the potential of abuse such as the flame symbol being used as a political influence rather than a celebration. However in the end, practicing physicians and athletes are reminded of the historical tradition that has been passed down for centuries and the responsibilities that will come forth in their activities.

The Hippocratic Oath, whether modern or not, should still continue to be implemented as an important step in becoming a physician because it serves as an affirmation of tradition and of professional responsibility. Just like all things that were held sacred by tradition and passed down for centuries, it is significant to acknowledge and be reminded of where it started and why. The Oath does exactly that as during the graduation ceremony, future practitioners are obligated to recite the Oath out loud and the audiences who are witnessing the act also are taking part in recognizing the tradition. The mistake of selecting certain lines of the original Hippocratic Oath as a reason for the Oath to be discarded should be avoided at all means as doing so will disregard the highest duty of the physician. This is important to consider because Hippocrates had intended the Oath to be guidance on how to achieve the highest quality of care for the health of one’s patient. With history in mind, it becomes easier to understand the reason in which the Oath had endured for centuries: the Hippocratic Oath had not merely been kept in Medical Schools for its authoritarian codes, but rather to affirm a physician’s commitment in medicine and as a reminder to uphold the patient’s well being at the highest responsibility.

Bibliography

Cahill, Janet. “Political Influence and the Olympic Flame.” Journal of Olympic History, 1999, 29–32.

Cartwright, Mark. “Ancient Greek Medicine.” Ancient History Encyclopedia. 2018. Accessed April 9, 2020. https://www.ancient.eu/Greek_Medicine/.

Chaney, Patricia. “Modern Hippocratic Oath Holds the Underlying Values of Medicine in a Digital World.” Prospective Students. UCLA. 2018. Accessed April 9, 2020. https://medschool.ucla.edu/body.cfm?id=1158&action=detail&ref=1056.

Hippocrates, and Edward Theodore. Withington. Hippocrates. Cambridge (Mass.): Harvard Univ. Press, 1928.

Hulkower, Raphael. “The History of the Hippocratic Oath: Outdated, Inauthentic, and Yet Still Relevant.” Einstein Journal of Biology and Medicine 25, no. 1 (February 2016): 41. https://doi.org/10.23861/ejbm20102542.

Veatch, Robert M. Cross-Cultural Perspectives in Medical Ethics. Boston: Jones and Bartlett, 2000.

Smith, D. C. “The Hippocratic Oath and Modern Medicine.” Journal of the History of Medicine and Allied Sciences 51, no. 4 (January 1996): 484–500. https://doi.org/10.1093/jhmas/51.4.484.