Monday, November 2, 2009

Literal Interpretation of Which Hippocratic Oath?

I've heard more and more silly blog chatter from the right recently about the Hippocratic oath and the current health care bill's rejection of the oath, as if the oath is a binding, legal document, like the Bill of Rights or the Constitution.

While the original Hippocratic Oath, written in 4 BC, includes something similar to the famous “First, do no harm,” the modern version, used prominently since the late 1960s, does not. It states, in full:

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.

Yet various forms of the oath exist and are used. Recently, the oath is approached with some sort of reverence and quotes are extracted for political or ideological purposes. Sometimes, those quotes don't even come from the modern oath! Note Mary Selby's misguided use of selected/fabricated extractions to argue that the current Democratic administration is "in violation" of the oath:

“I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect.”

Both Obama and Hilary Clinton supported in separate interviews Oregon’s "Death with Dignity Law. Hilary Clinton stated that Oregon was "breaking new ground and providing valuable information as to what does and doesn’t work when it comes to end-of-life questions, I think, is very beneficial."


“Similarly I will not give to a woman an abortive remedy.”

(Modern: I WILL FOLLOW that method of treatment which according to my ability and judgment, I consider for the benefit of my patient and abstain from whatever is harmful or mischievous. I will neither prescribe nor administer a lethal dose of medicine to any patient even if asked nor counsel any such thing nor perform the utmost respect for every human life from fertilization to natural death and reject abortion that deliberately takes a unique human life.)

The Democratic Party Platform violates this part of the oath:

“The Democratic Party strongly and unequivocally supports Roe v. Wade and a woman’s right to choose a safe and legal abortion, regardless of ability to pay, and we oppose any and all efforts to weaken or undermine that right. The Democratic Party also strongly supports access to comprehensive affordable family planning services and age-appropriate sex education which empower people to make informed choices and live healthy lives. We also recognize that such health care and education help reduce the number of unintended pregnancies and thereby also reduce the need for abortions. The Democratic Party also strongly supports a woman’s decision to have a child by ensuring access to and availability of programs for pre- and post-natal health care, parenting skills, income support, and caring adoption programs”

I have no idea what Selby is quoting here but nowhere does the modern oath define life as beginning with fertilization and ending with natural death.

Public adherence to the original, or a mythical version thereof, is fascinating considering the original oath’s other directives: to not sleep with patients, male or female; to give freely to your teacher and his sons your earnings; and to pledge loyalty to Apollo, Hygieia, and other gods and goddesses.

Like most literal interpretation, using the oath to contest modern medical ethics is akin to selecting verses from the bible (which also exists in many forms and languages) or the US Constitution that support one's political or ideological views and rejecting those that don't.


For a little lesson in literal interpretation of documents for application to our modern world: During the election, John McCain was on The View. Woopi Goldberg asked him about strict interpretation of the original Constitution. Yes, he said, he agreed with strict interpretation. Woopi asked if she was then going to have to be a slave again. (Don't miss the opening parts about separation of church and state!)

UPDATE: From imagerynet, some statistics on oath usage from:


he 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

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