Anatomy of the Hippocratic Oath

Saturday, May 6, 2006 | 0

By Jomar Almeda "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."

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While opinion on the relevance and applicability of the Hippocratic Oath varied with the changing times, the very core of medical ethics and patient well-being inscribed in its body remained the same.

Every physician at one point in their lives, have publicly recited the Oath upon entry into the institution as an enthralled young practitioner of the art and science of healing. Except for the not to be missed addition of the letters M and D next to each one's names however, the very essence of the Oath's recitation had been left in oblivion by some. The Oath, believed to have been written by Hippocrates in the 4th century B.C. is considered a rite of passage for all practitioners of medicine. His perceived need for standard professional conduct must have ignited Hippocrates' desire to create such guidelines. This had delineated the practice of civilized versus unrefined medicine, whose principles were the guiding light for the next generations. Over the years, this had been revised, modified, and restated to conform with the existing situation and society. Numerous versions of the modernized oath were written, among them was the Declaration of Geneva which was first adopted in 1948.

"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 practice my profession with conscience and dignity;
The health of my patient will be my first consideration;
I will respect the secrets that are confided 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 affiliation, 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 contrary to the laws of humanity, even under threat;
I make these promises solemnly, freely and upon my honour."

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Noticeably, both the classical and modern versions have highlighted two things in common. Duty towards one's patients, and duty towards one's colleagues. These duties are embodied in the practitioner's sworn dedication of compassion, competent medical care, and respect. Rolled into one, it is about medical ethics.

Since 400 B.C., the standard of care had been to do what is best for the patient, and to put his interest above all. Those were the days when healthcare delivery was just between the physician and his patient alone. Today, it cannot be denied, that this time-honored arrangement had become a luxury not readily available to everyone. The workers' compensation arena is a multifaceted world, complicated by conflicting views and numerous factors that has changed the manner of healthcare delivery. The once short link between patient and physician has now become stretched out with the addition of more characters within the link. In the present set-up, physicians in the employ of insurance companies are viewed as their agents, and are deplored by the opposite group for depriving patients of necessary care. On the other hand, a treating physician may also be actually blameworthy for over or unnecessary treatment. On the other extreme however, there are good insurance doctors who's genuine intention is no more than the delivery of the best and cost-effective treatment. And in the same manner, there are competent and honest treating physicians dedicated to providing the best treatment that his patient truly deserves.

Overtreatment is unethical, and so is undertreatment. To discriminate and object to treatment provided by the physician in charge is not at all times fair. This is particularly true if the patient's condition reasonably warrants it based on the physician's actual examination and honest clinical judgment. Often, the comment or decision is made by someone who has never in fact seen nor examined the patient. To put it in the correct perspective, it is the person who is being treated, and not his medical records nor imaging films. Patients' symptoms are not all the time explained by his test results, and his test results do not necessarily portray his symptoms. On the other end, there have been allegations of unnecessary and overtreatment, either deliberate or from mere lack of competence. In this situation indeed, credible peer reviewers must be considered essential to provide safeguards and uphold the appropriateness and high standard of medical care. Physicians can never be experts in all fields and will at times need to rely on other specialists or colleagues too. In short, a physician's competence is not solely gauged by his ability to provide medical care, but also by his ability to come to a decision to put an end to treatment when enough had been given. In either case, as physicians are to regard their colleagues as brothers, none of them deserve adverse remarks and unjust criticisms, as this clearly falls outside of the oath's ideology. It is only by examining their deeds, within themselves, that physicians can rightfully discern if their recitation of the oath was Hippocratic or hypocritic.

In this arena, it is demoralizing that patients will have to grapple for every consult, and the doctors for every report. The present structure in healthcare delivery had allowed these things to happen. None of us can serve two masters at the same time, or fall in the pit of conflicting interests. This is a real test of a physician's integrity and loyalty to one of his two masters - the Company or the patient. In this ever changing world and varied circumstances, it is certainly not a question of which side one is with. The question is whether medical care goes along the basic ethical principles of beneficence and nonmaleficence. Having said this, it now becomes even more disturbing that some physicians turn into entrepreneurs, prescribing and dispensing medicines, gadgets, and treatments of no proven value for their own financial interest. No matter what one does, the real challenge other than one's achievements and social standing is being able to maintain an ethical professional behavior. Only in so doing can one declare that he is true to the sacred intentions of his profession.

The future of medical care relies to a great part on the physician's re-recognition of the forgotten oath, and putting them back into practice. To many, the Hippocratic Oath remains to be an essential guide in the practice of the noble profession of medicine. Sadly to some, it has become nothing more than a meaningless remnant of the past.

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