The recitation of the oath attributed to Hippocrates is an integral part of medical school graduation in the Western world. Referred to as either the Hippocratic oath or the oath of Hippocrates, the oath exists in a variety of forms and has been translated and revised over the centuries. Early versions advised physicians to practice the art of medicine solely for the benefit of their patients. Twentieth-century versions emphasized that doctors abstain from practices that would harm their patients, and stress the ethical basis of medical practice.
The Hippocratic oath requires that medical graduates solemnly promise to adhere to a course of professional conduct that has guided physicians in ages past. It also requires that they promise to revere their instructors and to care for them should they ever require assistance; transmit (teach) the art of medicine to deserving persons; utilize good judgment to provide beneficial treatment for patients; abstain from providing any harmful or dangerous treatments; refrain from intervening in cases that require greater skill and training; remain pure and holy in the practice of the profession; limit involvement with patients solely to the benefit of the patient's health; give no cause for disrespect of the profession through word or deed; and keep confidential all that is learned through practice of the profession. The oath concludes with a statement that if the physician adheres to these precepts, he or she will enjoy happiness, success, and respect.
The Hippocratic oath is an anachronism. It is outdated and holds no power. There are no sanctions for those who violate its precepts, nor does it have status in a court of law. It is a historical document with unconscious, symbolic dimensions stemming from its 2,500-year-old historical tradition. Its persistent use during medical school graduation ceremonies does provide symbolic significance beyond words. In essence, it emphasizes the unique role and responsibilities of the physician in activities of a high nature and establishes a basis for the guiding principles of medical care, which include autonomy, beneficence, justice, and nonmaleficence.
The most recent version of the oath is the product of collaboration between doctors from both the United States and Europe. It contains three guiding principles—primacy of patient welfare, patient autonomy, and social justice—and lists ten professional responsibilities. It stresses the centrality of altruism in the physician-patient relationship. It states that the quality of medical care must not be compromised by market forces, societal pressures, or administrative exigencies. It emphasizes that doctors must be honest with their patients and empower them to make informed decisions about their treatment. Patient decisions about their care must be recognized as paramount, as long as those decisions are consistent with ethical practice and do not contribute to demands for inappropriate care. It urges physicians to work actively to eliminate discrimination in health care, whether based on race, gender, socioeconomic status, ethnicity, religion, or any other social category.
WILLIAM M. LAMERS JR.