The Hippocratic Oath Today

A 12th-century Byzantine manuscript of the Oat...

A 12th-century Byzantine manuscript of the Oath, rendered in the form of a cross. (Photo credit: Wikipedia)

The Hippocratic Oath Today

The Hippocratic Oath is one of the oldest binding documents in history. Here you’ll find classical and modern versions of the oath as well as a brief article that offers a sense of the controversial nature of the oath today. Follow links at the bottom of the page to post your own comment or read those of others.

An etching of a bust of Hippocrates, the so-called father of medicine.While Hippocrates, the so-called father of medicine, lived in the early 5th century B.C., the famous oath that bears his name emerged a century later. No one knows who first penned it. EnlargePhoto credit: Peter Paul Rubens/public domain

THE OATH: MEANINGLESS RELIC OR INVALUABLE MORAL GUIDE?

The Hippocratic Oath is one of the oldest binding documents in history. Written in antiquity, its principles are held sacred by doctors to this day: treat the sick to the best of one’s ability, preserve patient privacy, teach the secrets of medicine to the next generation, and so on. “The Oath of Hippocrates,” holds the American Medical Association’s Code of Medical Ethics (1996 edition), “has remained in Western civilization as an expression of ideal conduct for the physician.” Today, most graduating medical-school students swear to some form of the oath, usually a modernized version. Indeed, oath-taking in recent decades has risen to near uniformity, with just 24 percent of U.S. medical schools administering the oath in 1928 to nearly 100 percent today.

Yet paradoxically, even as the modern oath’s use has burgeoned, its content has tacked away from the classical oath’s basic tenets. According to a 1993* survey of 150 U.S. and Canadian medical schools, for example, only 14 percent of modern oaths prohibit euthanasia, 11 percent hold convenant with a deity, 8 percent foreswear abortion, and a mere 3 percent forbid sexual contact with patients—all maxims held sacred in the classical version. The original calls for free tuition for medical students and for doctors never to “use the knife” (that is, conduct surgical procedures)—both obviously out of step with modern-day practice. Perhaps most telling, while the classical oath calls for “the opposite” of pleasure and fame for those who transgress the oath, fewer than half of oaths taken today insist the taker be held accountable for keeping the pledge.

Indeed, a growing number of physicians have come to feel that the Hippocratic Oath is inadequate to address the realities of a medical world that has witnessed huge scientific, economic, political, and social changes, a world of legalized abortion, physician-assisted suicide, and pestilences unheard of in Hippocrates’ time. Some doctors have begun asking pointed questions regarding the oath’s relevance: In an environment of increasing medical specialization, should physicians of such different stripes swear to a single oath? With governments and health-care organizations demanding patient information as never before, how can a doctor maintain a patient’s privacy? Are physicians morally obligated to treat patients with such lethal new diseases as AIDS or the Ebola virus?

Other physicians are taking broader aim. Some claim that the principles enshrined in the oath never constituted a shared core of moral values, that the oath’s pagan origins and moral cast make it antithetical to beliefs held by Christians, Jews, and Muslims. Others note that the classical Oath makes no mention of such contemporary issues as the ethics of experimentation, team care, or a doctor’s societal or legal responsibilities. (Most modern oaths, in fact, are penalty-free, with no threat to potential transgressors of loss of practice or even of face.)

With all this in mind, some doctors see oath-taking as little more than a pro-forma ritual with little value beyond that of upholding tradition. “The original oath is redolent of a convenant, a solemn and binding treaty,” writes Dr. David Graham in JAMA, the Journal of the American Medical Association (12/13/00). “By contrast, many modern oaths have a bland, generalized air of ‘best wishes’ about them, being near-meaningless formalities devoid of any influence on how medicine is truly practiced.” Some physicians claim what they call the “Hypocritic Oath” should be radically modified or abandoned altogether.

Below, see classical and modern versions of the oath. At the bottom of the page, you’ll find links to pages where you can read comments by [doctors] and [non-doctors] and add your own.

*Orr, R. D., N. Pang, E. D. Pellegrino, and M. Siegler. 1997. “Use of the Hippocratic Oath: A Review of Twentieth-Century Practice and a Content Analysis of Oaths Administered in Medical Schools in the U.S. and Canada in 1993.” The Journal of Clinical Ethics 8 (Winter): 377-388.

 

A parchment page of script bearing the name Few medical schools today require students to recite the classical version of the oath.EnlargePhoto credit: public domain

HIPPOCRATIC OATH: CLASSICAL VERSION

I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant:

To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art—if they desire to learn it—without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else.

I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.

What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.

If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.

—Translation from the Greek by Ludwig Edelstein. From The Hippocratic Oath: Text, Translation, and Interpretation, by Ludwig Edelstein. Baltimore: Johns Hopkins Press, 1943.

 

A piece of parchment paper as a title page of Hippocratic OathJust as medical textbooks have come a long way from Hippocrates’ archaic writings, the modern versions of the oath veer far from the classical. EnlargePhoto credit: Aldus Manutius/public domain

HIPPOCRATIC OATH: MODERN VERSION

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.

I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

—Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, and used in many medical schools today.

Editor’s note: To add your own comment as a doctor or a non-doctor, and to read the comments of other doctors and non-doctors, go to the following pages, which appear on the original website for NOVA’s program “Doctors’ Diaries”:

THE HIPPOCRATIC OATH TODAY:
DOCTORS’ RESPONSES

 

I prefer to think in terms of “a” Hippocratic Oath as opposed to “the” Hippocratic Oath, and in these terms I believe it is as relevant today as when the concept was initially introduced in classical times. The taking of a Hippocratic Oath occurs at a critical time in the development of physicians, setting the moment separate from the previous process and laying the groundwork for their future careers and their future care of patients.

I do not see it as a legally binding oath, but as a sign of personal importance, commitment, and solemnity, just as when we mark the birth of our young, choose life’s partners, and bury our dead. The exact wording we use to mark these events changes through time and through cultures, but the basic human emotions that these words wish to convey are universal: celebration, commitment, and mourning.

Similarly, a Hippocratic Oath intends to convey our inner emotions and thoughts as we pass from one stage of our journey (medical school) to the next stages of training and providing care. Whether we do this through the words of other times (the Hippocratic Oath) or through the words of our present times (modern iterations of a Hippocratic Oath), we are bonding with our fellow students in the moment, joining our mentors in the present, and recognizing our predecessors.

Yes, I believe “a” Hippocratic Oath is relevant—for me in June of 1990 (when I took it), in March of 2001, and every day of my life in this profession in which I am honored to be a member.

What is the essence of a Hippocratic Oath? Simple and echoed throughout time, whatever the words: “May I care for others as I would have them care for me.”
Daniel G. Deschler, M.D., FACS

The classical Hippocratic oath is at once largely irrelevant to medical practice while also grossly inadequate to express the duties that we owe to our patients. Think of the key points from each of its eight paragraphs:

Three paragraphs (1, 2, and 8) occupy themselves with the oath or the medical guild, including swearing to gods who are either not relevant or perhaps offensive to one’s religion, proposing fee-splitting with your teacher as well as financial support to him or her or their progeny while passing on knowledge only to others in the guild, and again asking for reward or punishment for upholding or disregarding this oath. Little here relates the new physician to his or her patients.

Another two paragraphs (5 and 6) are curios, promising to leave surgery to others (it used to be the barbers) and forswearing sex with your patients or their families. The first is wrong and outmoded, given that surgery has been a core skill in medicine for hundreds of years now, while the second hardly sets a sufficiently high moral standard for our profession.

Only three paragraphs (3, 4, and 7) apply in any serious fashion to what most physicians and laypeople would expect to be the content of a solemn oath at medical school graduation. The first of these suggests giving good advice on diet and keeping patients from harm. The second prohibits both euthanasia and abortion. The third promises patient confidentiality.

Now, giving good dietary advice is certainly laudable, but it hardly expresses a comprehensive commitment to provide knowledgeable treatment of all sorts, without performing a sort of biblical exegesis. Keeping patients from harm, by contrast, is a critical concept to any relevant medical oath, as is the confidentiality of patient information. However, many physicians are fully supportive of abortions, and some physicians are sympathetic to aiding in euthanasia for terminally ill patients precisely to “keep them from harm.”

To summarize the operational part of the Hippocratic Oath, then, all physicians would swear to (1) give good dietary advice, (2) keep the patient from harm, and (3) maintain confidentiality; would probably swear (4) to abjure euthanasia; and might swear (5) to abjure abortion.

The revised oath by Dr. Louis Lasagna, which I am reasonably sure we used at my Harvard Medical School graduation in 1969, contrasts sharply with the uninspiring curios of the [classical] Hippocratic Oath. Lasagna picked up on many of the major themes of our profession: Do positive good, not just keep from harm. Promote our knowledge and skills for the benefit of the patient. Provide sound advice and guidance to the person and family, not just manipulate the diseased organ systems. Focus on prevention. His oath also specifically includes the important Hippocratic concepts of avoiding harm and keeping confidentiality.

Lasagna’s message comes dramatically closer to expressing the mission and complexity of our profession and offers the appropriate breadth and inspiration for the graduation of new physicians as well as for all of our personal renewal from time to time. His oath, or a version of it, is something I did and could swear to. As for the classical Hippocratic Oath, I’ll think of it every time I am tempted to split fees with my teachers or sleep with my patients.
Steven R. Kanner, M.D., MSM
Massachusetts General Hospital Weston
Weston, Massachusetts

I do not have strong feelings about the oath. I think it is an outstanding, profound declaration, especially considering when it was written. There are a few items that are not pertinent anymore, but I still like to see it included in med school graduation ceremonies, at least in the printed program.

I graduated from med school (University of Minn.) in 1958. We had a small ceremony prior to the main graduation. There was a printed version somewhat similar to Louis Lasagna’s PC version. I don’t remember if we recited it or not. I really doubt it, but I can’t recall for certain.

At any rate, it is nice as a tradition but probably more of a big deal to the lay public than to physicians.
Anonymous

The longstanding guiding principle of health care is primum non nocere, first do no harm. While this was a logical guidepost for medicine in the ancient Greece of Hippocrates, it is clearly dated in a world where people recognize and accept risk driving automobiles, smoking cigarettes, skiing, bungee jumping, having cosmetic facelifts, and donating kidneys and portions of their liver and lungs to friends and relatives in need of organ transplants.

Health-care providers are called upon to improve and maintain the health of our patients, a mission that has become increasingly complex as our knowledge of disease and our therapeutic armamentarium have grown. Given that surgeons’ ministrations routinely include wounds we intentionally create, taken literally, my colleagues and I violate the Hippocratic concept of primum non nocere daily.

Our society, founded on the Jeffersonian concept of “life, liberty, and the pursuit of happiness,” has consonantly invested heavily in research and development of new knowledge and methods to prolong and enhance human life. Our modern first principle of health policy and medical decision-making should be that patients should decide autonomously how they will be treated, provided their decisions do not potentially injure others. For the 15 percent of GDP that our healthcare system costs, providers should be able to deliver: 1) frank and meaningful advice with regard to risks and benefits of all reasonable treatment strategies, including no treatment at all; 2) effective treatments free of all needless risks; and 3) a continuing stream of innovative solutions to healthcare problems for which our present standard therapies are inadequate.

I propose the creation within the U.S. Department of Health and Human Services of a Center for Healthcare System Performance. The goals of this center would be to ensure continuous improvement in the quality of healthcare delivery. Quality would be measured based on the expected deliverables of our healthcare system, assuring: 1) patient autonomy, access, dignity, and convenience; 2) measurable, maximally beneficial treatment outcomes with minimal risk; and 3) a rational and efficient process of introducing new treatments.

Intrinsic to the development of new therapies is the recognition that higher levels of risk and uncertainty are acceptable for treatments for problems for which present solutions are poor. Conversely, new treatments for which standard therapies are highly effective should require rigorous documentation of safety.

The Center would coordinate activities of the National Institutes of Health, the Food and Drug Administration, and Healthcare Finance Administration to ensure their synergistic approach to maximizing the quality of American healthcare delivery. We should set the expectation to continue to lead the world with measurable achievement of goals analogous to our efforts in spaceflight and environmental preservation.

Products and services that prolong and enhance life have obvious fundamental appeal. Instead of a timid, primum non nocere approach to our imperfect healthcare system, let us systematically improve its performance.Carpe diem.
Dr. Eric Rose
Columbia Presbyterian Medical Center
New York, New York

As a senior medical student about to move on to residency, the overwhelming emotion I have at this time is one of disillusionment. At the heart of the Hippocratic Oath, both classical and modern, is the vow to avoid doing harm and to help when appropriate and necessary. Yet medical education, both undergraduate and graduate, brutalizes its students.

Sleep deprivation is the norm—I have seen residents working up to 120 hours a week. With such inhuman work hours for so many years, alienation from one’s family, health, and peace of mind is often the result. Falling asleep at the wheel is common, and deaths of both residents and medical students have been noted in the press. Medical mistakes are inevitable when people are so exhausted. The medical literature clearly and unequivocally states the risk to health and even life when people are sleep deprived, but medical educators seem to believe that somehow, magically, doctors can rise above their own physiology. Physical and psychological abuse from attending physicians are common complaints of both residents and students.

To quote from the Annals of Internal Medicine, “For many residents, fatigue cultivates anger, resentment, and bitterness rather than kindness, compassion, or empathy” (Annals of Internal Medicine 123(1995):512-517). How are we to provide compassionate care to others when our own educational system is the model of abuse? Primum non nocere indeed—the hypocrisy of this oath is that we can’t even manage to muster nonmaleficence to practitioners of our own profession, let alone our patients.
Anonymous

I took the original Hippocratic Oath in 1982 upon my graduation from medical school and returned to this institution upon completion of my training. I have done my best working as an overworked, underpayed academic physician in high-risk obstetrics in a metropolitan city teaching university since then. I look back to the wisdom and guidance of Hippocrates everyday as I struggle to balance my duties, patient rights and allocation of hospital/societal resources for the sake of underprivileged and acutely ill mothers and their unborn children.

Several years ago, a junior medical class within our Catholic medical school demanded removal of any version of the Hippocratic Oath at graduation. Their argument was this oath was outdated, degrading, and inappropriate for the “modern reality” of medicine. The majority of our faculty were initially stunned and confused by these arguments at the time. Our academic community eventually compromised with a modern version of the Hippocratic Oath and the option for objecting students to step off the graduation stage during that portion of the ceremony. Some students remain belligerent to this day in this gesture, though most still choose to take a version of the Hippocratic Oath at graduation.

I now understand why this new generation of physicians might feel this way about the original Hippocratic Oath. It is particularly evident in this modern era when more students are choosing residencies in radiology, anesthesiology, and pathology for the sake of their lifestyle. Our outstanding residency program in OB/Gyne has difficulty in filling our slots because of significant workload and lifestyle issues. These Hippocratic Oath dissenters tend to openly complain about excessive clinical workload despite obvious patient needs. Many of these individuals rationalize a “shift-mentality” as their future practice of medicine that justifies going home when they are “off-duty” despite any other professional obligations. It appears that “job quality” is a priority when compared to “professional duty” in the medical practice of these particular future physicians.

Some of this new breed of colleagues also have a public display of disrespect for the indigent, confused, and simplistic patient. Instead of becoming an advocate and/or protector of society’s weakest element, they would discard this needy population in preference for the medical procedure, economizing their clinical practice or optimizing their time at home with family and friends.

The most disconcerting attitude within this subset of these “New Age” practitioners is the blatant contempt and disrespect for their elder colleagues in our medical profession. Stated reasons are outdated practitioners and oblivious perspectives to the “modern face” of medicine. While I am still at an intermediate stage in my professional career, I continue to learn more about the practice and ethics of my specific profession from my soon-retiring colleagues than from any journal, Web site, or national meeting.

While I am liberal and approachable on most professional matters, I am utterly dismayed by these radical attitudes of my junior colleagues who lambaste the Hippocratic Oath. Perhaps this conflict between the generations in our medical profession is why I have given up the important academic positions of Clerkship and Residency Director of our Ob/Gyne program over the past decade.

While I truly love being a mentor, I see little opportunity to guide these young professionals into a lifelong career in service to humanity, when it is obvious their major interests lie in lifestyle and livelihood. This personal attitude may be further reinforced by the radical change in healthcare delivery that promotes the role of physician as clinical and economic manager rather than professional decision-maker and patient advocate in this era of managed medical care.

I therefore contend that any attempt to eliminate an appropriate version of the Hippocratic Oath upon graduation from medical school by our younger colleagues reflects a self-centered, misguided, and ill-advised attempt to test their reality of current medical practice. This personal attitude is in defiance of the time-tested, patient-oriented, and physician-managed practice of medicine. While this original philosophy dates back to the Greeks, it continues to provide a roadmap that maximizes patient/societal outcomes within our profession while limiting the individual benefit of payment, stature, and control of physicians upon healthcare delivery. The original Hippocratic Oath should become standard learning for patients and physicians alike.

Generation X has recently matriculated into the field of clinical medicine, and our national healthcare system will only suffer further when we tolerate physicians who do not care, apply inappropriate medical techniques, and have little professional respect for the patient-physician relationship as outlined in this product of early medical philosophy.

P.S. I continue to identify a small group of non-generation-X students and residents each year who defy this societal transformation and who strive to follow in the footsteps of myself and my elders. My solution for this “Gen X syndrome in medicine” is a realistic Third World medical experience for junior trainees (which I have done on several occasions) to give them a perspective that healthcare is a right for all human beings, not a scheduled or convenient privilege!!!

I like the thought already expressed by one doctor “Do unto others as you would have them do unto you.” That really gets to the heart of the matter and addresses the fact that there will always be a difference of opinion as to the “sanctity” of human life. As a society we should accommodate both points of view, acknowledging that individuals have a right to determine whether they wish to live or die, and that doctors who share that belief be allowed to meet their needs without social or legal penalty.

Much of the dialogue on abortion, euthanasia and patient/doctor rights seems driven by quasi-religious considerations and a mindset that places humankind at the pinnacle of evolution. However, I believe we are gradually moving towards a more balanced perspective and reluctantly waking up to the need to conserve resources and make radical adjustments if we are to avoid gross overpopulation and global suffering.

Throw out the cant and hypocrisy of the old oath and even the erudite “modern version.” I vote for “Do unto others as you would have them do unto you!”
Michael Jones

From my perspective as a student of history, some elements of the medical profession appear to be evolving in directions that compromise the original spirit and intent of the Hippocratic Oath. Rather than see that happen, and see doctors increasingly under pressure to compromise one set of values for another, I would make this proposition:

We need a separate career field whose emphasis is not on the preservation of life but rather the humane assistance of its closure, whether that be naturally occurring or artificially induced. These would be individuals not under the Hippocratic Oath but under a totally different oath, equally committed to the sanctity of humanity and the diversity of religious belief.

Just as there is a fine separation between doctors who prescribe medication and those pharmacists who dispense it, there needs to be separate practice in which the professional would not be under pressure to compromise his or her commitment to the preservation of health and well-being. Individuals involved with hospice already do this to some degree; they just need to be given more professional jurisdiction. All doctors know when they have reached the limit of their specialty, and when the time comes to make a referral to another specialty. Let’s stop forcing our doctors to do something they were never intended to do.
Robert Williams
Southern Oregon University

I saw your Web site feature in regards to the Hippocratic Oath. However, you failed to mention the Osteopathic Oath. Do you not know that we are full physicians who do surgery, prescribe drugs, and exist in all specialties? M.D.’s are not the only physicians in America. Enclosed I have copied the Oath. Perhaps you will see fit to incorporate us into your feature. Please do not neglect us. We have a long and proud history.

The Osteopathic Physician’s Oath
I do hereby affirm my loyalty to the profession I am about to enter. I will be mindful always of my great responsibility to preserve the health and the life of my patients, to retain their confidence and respect both as a physician and a friend who will guard their secrets with scrupulous honor and fidelity, to perform faithfully my professional duties, to employ only those recognized methods of treatment consistent with good judgment and with my skill and ability, keeping in mind always nature’s laws and the body’s inherent capacity for recovery.

I will be ever vigilant in aiding the general welfare of the community, sustaining its laws and institutions, not engaging in those practices that will in any way bring shame or discredit upon myself or my profession. I will give no drugs for deadly purposes to any person, though it be asked of me.

I will endeavor to work in accord with my colleagues in a spirit of progressive cooperation, and never by word or by act cast imputations upon them or their rightful practices.

I will look with respect and esteem upon all those who have taught me my art. To my college I will be loyal and strive always for its best interests and for the interests of the students who will come after me. I will be ever alert to further the application of basic biologic truths to the healing arts and to develop the principles of osteopathy that were first enunciated by Andrew Taylor Still.

Thank you for your time.
Anonymous

I highly recommend leaving the modern oath exactly as it is. The modern Hippocratic Oath should be a powerful Mission Statement. It should not be a platform of ancient and modern medical and social issues. Leaving the modern Hippocratic Oath as a Mission Statement reminds the doctor exactly why s/he became a doctor, and the good doctor affirms this why verbally and in writing, and more importantly, this why becomes a Form, an Idea in his/her mind while living. Commenting further on medical and social issues, both ancient and modern, such can be addressed in Purpose and Action documents, which “reside” under the Mission Statement, and such P&A documents can be changed to suit the reality of the times.
Roland J. Stoller

I am a retired Aerospace Science Education Specialist. While in college I majored in biology and toyed with the idea if attending medical school.

The classical oath makes reference to pagan gods. Since paganism was popular at this time, it was acceptable then but unacceptable now. Most doctors today may have some religious persuasion, and it is likely that they will recognize and may even worship the God of most of the God-worshipping population of the world. This is the God to be mentioned in the oath, if God is to be mentioned at all. After all, an oath is calling God to witness someone accepting the conditions of the oath.

The classical oath burdens, unnecessarily, the new physician to be responsible to his or her teacher to train certain relatives of the teacher, and his or her own relatives, to teach the healing art. Today there is so much illicit sex (homosexual and heterosexual) prevailing that it would be worth adding this as a restriction in the modern oath.

As far as I can understand in reading both oaths, there does not seem to be any contradiction in what the oaths propose. The problem arises when we realize what doctors can do to, and for, patients that are beyond the parameters of either oath. Though abortion is still an undesirable availability in the sight of many, it is legal and desirable by perhaps just as many. Unless Roe v. Wade is repealed in the U.S., a universal oath should bypass this issue and leave it out since it is likely to prevail in other parts of the world. If it is defeated in the U.S., then the American Hippocratic Oath should specifically recommend against abortion.

Otherwise, I see the modern oath as adequate. It is the responsibility of the individual doctors to have the moral and ethical values to decide if and how far they are willing to go beyond the guides of the Hippocratic Oath.
Ransom Ritter

I have been following a friend through her medical treatment for several years now. I have seen doctors who seem to be more interested in making money than following the Hippocratic Oath, either the original or modern one. They claim they will treat the poor but withhold medicine that may cure the patient in order to get more money out of the patient’s insurance, Medicare or Medicaid. The specialist refuses to see patients without the right insurance, although patients may really be benefited by the doctor’s knowledge of their condition.

These doctors are more interested in giving less care, less expensive treatment, or not admitting a person to the hospital, though that person clearly would not have stayed in the emergency room for hours if they did not need care.

On the other hand, some doctors do medical tests that seem excessive on people with high-paying insurance. People who live in affluent areas are sent to specialists to rule out illnesses that there is only a small chance they have. Some medical facilities pad the bills to the insurance companies by charging extra for a treatment that may not have been done.

I know in every field there are people who abuse their positions. However, in medicine, these doctors were supposed to have taken an oath. Does the oath mean something to these doctors after they have been practicing awhile?
Francis O’Reilly

Having worked in the lower levels of health care, I’ve worked under numerous doctors and nurses. The implication of the Hippocratic Oath is that there is little variation among health-care professionals. I think it would be more useful if consumers were informed of the capabilities of the doctors and others, including chiropractors and hospitals, that they have to rely on. Of these others no oath is required, and yet they are often as much or more involved in a patient’s care and treatment. Without the oath, there would be little difference in the responsibility that would fall on each of these caregivers.

Another point is the worsening of health care availability, especially for those of us who can no longer afford it. A few decades ago it cost only a few dollars a month and included anything from a doctor’s visit to an involved surgery. Now it is a hundred times more expensive just to get in the door. This makes a joke of the Oath’s ideal of treatment without regard for the bill at the end.
David Hulme

I must admit I had never read either the classical or the modern version of the Hippocratic Oath. I had always assumed there was only one, and I falsely thought all doctors had to take it. I think it’s clear that the classical version is completely out of touch with reality, and I wonder if it was ever taken seriously even back in Hippocrates’ era. The modern version tries to help put a little more reality into the oath and adds a moral element and a more humanistic approach to the document. It tries to deliver a physician we all can respect. I think it comes down to respect—on both sides of the table.

Far too many of today’s doctors have little or no respect for the importance of the patient-to-physician relationship. Instead of promoting this most critical part of health care, doctors are taught by their lawyers’ insurance companies, and their own peers to turn a deaf ear to their patients and believe only test results. Relationships take time, and time is the enemy. In this environment, listening and observing become counterproductive.

We as patients tolerate physicians who do not care, prescribe inappropriate tests and medicines, and act in a condescending manner. We have little respect for them but we feel powerless.

I think if all doctors had to recite this (modern version) Oath, display it on the office wall and retake it every few years, it would go a long way toward rebuilding some of the lost respect.
R.J. Francis

I believe the original, ancient oath contained valuable moral and ethical constraints and imperatives that are essential for those serving fellow men (and women). A covenant philosophy is still needed to ensure unbiased and ethical behavior in those who command the great respect and responsibility that physicians have in our society. Furthermore, accountability and consequences for breaking the societal covenant should be reinstituted and monitored by physicians and nonphysicians alike. Perhaps this is idealistic; however, patients need this assurance for their confidence and reliance on physicians to be sustained untainted by fear and distrust. If these are lost, individual and public health will suffer—perhaps with catastrophic results.
Anonymous

Today’s modern medical technology produces smarter, knowledgeable doctors—and that’s it. I don’t think it transformed them into healers; they’re just there to introduce at bedside the cure. Most of today’s doctors are there just for the big bucks. I think the true healers are the caregivers with true and compassionate tasks as health-care workers.
Anonymous

With regard to “doing no harm,” perhaps the profession should take a look at its own practice of harming graduating students by imposing working hours of internship and residencies that severely damage the new doctor’s physical, mental, social, spiritual, and in some cases marital health. Shame!
Anonymous

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