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8/10/2019 Reflections on the Hippocratic Oaths
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Reflections on the Hippocratic Oaths
Author(s): June GoodfieldReviewed work(s):Source: The Hastings Center Studies, Vol. 1, No. 2, Values, Expertise, and Responsibility in theLife Sciences (1973), pp. 79-92Published by: The Hastings CenterStable URL: http://www.jstor.org/stable/3527515.
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2/15
CODES,
MORALITY,
LAW,
&
PROFESSIONALIZATION
Reflections
o
t h e
ippocratic
a t h s
JUNE
GOODFIELD
OMETIME
uring
the
early
Twenties,
Chauncey
Leake,
according
o his own
accounts,
was
col-
lecting
material
for a
study
on
the
his-
torical
development
of
medical ethics.
He asked
Dr. Maurice
Fishbein,
Editor
of
the
Journal
of
the American
Medical
Association,
or an
opinion
of the
merits
of such a
project.
Dr. Fishbein's
reply,
as
reported
n the Prefaceto
Chauncey
Leake's edition
of
Percival's Medical
Ethics,
is classic:
"Unnecessary
and
of
no
significance
or an
understanding
f
the
matter
.
."1
If
this anecdote s
true,
it
tells
us that
the
medical
profession
shared with
the
scientific
profession
a
typical
attitude
toward
historical
studies,
namely,
that
in
no
way
have
they utility
or relevance o the
practice
of the
craft,
and
are
best left to
members
of
the
pro-
fession,
when
retired.
It
is
only
recently
that more and
more
people
have
begun
to
appreciate
the force
of
Santayana's
dictum:
"Those
who
ignore
the
lessons
of
history
are doomed
to
repeat
t."
It is
quite
clearthat
the issueof
medi-
cal ethics,medicaletiquette,and the re-
lationship
of
the
profession
o
society
at
large
presently
raises
questions
of
such
depth
and
importance
hat it
would be
a
foolish
doctor
who
would
try
to
sweep
them
aside.
Nevertheless,
even if
he
agreed
about
the
importance
of
medical
ethics,he
might
still
agree
with
Fishbein's
comments,
eeling
that
a
historical
urvey
is of no value in the consideration f his
own
situation
and
dilemmas.
am
not so
certain.
We
tend
to
think
of
our
own
social
situation
as
simple,
unique,
and
static.
Such
an
attitude
comes
naturally
because
it
provides
such an
easy
way
to
deal
with
difficulties.
f
the
problem
of
contemporary
medical
ethics
is
both
sim-
ple
and
acultural
hen
we
can
get
away
witha facileanduniversal olution.Since
most
of us are
lazy-minded
nd
just
want
to
go
on
doing
that
which
we
enjoy
doing
most,
i.e.,
practicing
medicine
and
earn-
ing
money,
it
is
tempting
to
ignore
the
problem.
But
history
eachesus
important
hings,
such
as how
rarely
situations
are
simple;
1Thomas Percival,
Medical
Ethics,
ed. and
introd.
by
Chauncey
Leake
(Baltimore:
Wil-
liams and
Williams,
1927
[originally
published
Manchester:
1803]).
8/10/2019 Reflections on the Hippocratic Oaths
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80
HASTINGS
ENTER
STUDIES
how most
problems
of
professional
ctivi-
ties,
with their
concomitant
questions
of
ethics and
accountability,
rise not
in
a
vacuum,
but in
response
to
the
demands
of
a
social
situation.
This,
in
its
turn,
tells
us that
our
response
o
contemporary
ethical
problems
must be
made in
the
light of
our
existing
situation,
and
this
we must
understand,
analyze,
and
ap-
preciate,
before
we can
hope
to
deal with
such
problems
effectively.
In
addition,
f
there
s
a
degree
of
relativism
n
our his-
torical
situation,
there
is
also
a similar
degree
of
relativism
across
our
cultures.
Recognition
of
relativism n
history
and
through
ulture
does
not,
of
course,
mply
that
there can
be
no
answers o
contem-
porary
problems.
Rather
it
implies
that
there
can
be no
universal
answers
which
would
be
equally
applicable
throughout-
time
and
across
the
space
of
different
societies.
This
again
is
no
comfort
for
the lazy-minded,or it meansthat if we
wish
to
consider
the
problems
of
say,
birth
control,
euthanasia,
and
artificial
transplants,
we
shall
have to
consider
them
anew
for
such
disparate
ocieties as
those of
North
America,
India
and South
Vietnam.
My
intention
here,
in
this
rather
ight-
hearted
essay,
is
to
look
at
some of
the
variant
forms of
the Doctor's
Oath,
and
see what
questions
hey
raise
about
med-
ical ethics.
These are not
new
issues,
but
in
reexamination
we
might
note the
par-
ticular
orce or
validitythey
have in our
twentieth-century
ituation,
and
perhaps
incidentally
demonstrate
the
teaching
value of
history.
For
it is
quite
clear
that
problems
of
medical ethics
and medical
etiquette
are
closely
bound
up
with
prob-
lems of the
professionalization
f medi-
cine.
As
Chauncey
Leake
pointed
out in
1927,
when we
study
the
evolutionof
the
present
situation with
regard
to
medical
ethics,
then
it
may
become
clearer
why
it is
that
the
profession
resists
efforts to
change
its
present
relation
to
society.2
But where
did
all this start?
I want to
look
initially
at the variations
n the
Oath
that
was taken
by
doctors
during
the
years
when the
profession
was
emerging
and see where
this
varietyoriginated
and
what effects
it
might
have had.
The
classic work
was done
by
W. H.
S.
Jones.
He
wrote
the definitive
tudies
on
the various
forms
of the Oath
and
was,
in
the
1920's,
the
recognized
authority
on
Hippocrates.3
As Jones
points
out,
there
was no verbal
idelity
n the
preser-
vation of the
Hippocratic
ext. Provided
the
general
sense came
across,
no
one
worried
about
iteral aithfulness.
By
con-
trastwith
the
reverent
attitude
which
kept
the texts
of
many
classical
authors
com-
paratively
pure,
the
Hippocratic
material
was
treated
in
a
cavalier
manner,
prob-
ably
because
theseworks
were
textbooks,
with no
pretention
o be
literary
master-
pieces. Wordsget
transposed,
nterpola-
tions are
very
common,
and
there
are
losses of
phrase
and
meaning.
The
rea-
son for this
may
lie in
the
changing
cul-
tural
context of
medical
problems.
Un-
21
shall
be
arguing
in
a
later
series of
papers,
that
there
are,
indeed,
common
elements
in
all
professions
whose
tendencies
increase the
mem-
bers'
reluctance
to alter
the
"social
contract"
with
society.
This
has
a
great
deal
to do
with
the
process
by which
the
social
contract
evolved;
until
very
recently,
I
believe,
society
has
been the weaker
partner
and
many profes-
sions
dislike
and
mistrust
what
they
see
as
a
new
interference
in
tradition
hallowed
by
time.
This
point,
incidentally,
also
demonstrates the
value
of
a
historical
perspective
on
these
prob-
lems.
Without
it,
we
would
be
tempted
to
regard
doctors
and
scientists
as
merely
reac-
tionary.
3W.
H. S.
Jones,
The Doctor's
Oath:
An
Essay
in
the
History
of
Medicine
(Cambridge,
Eng.:
Cambridge
University
Press,
1924).
Un-
less
stated
otherwise,
this book is the
source
for
my
various
versions of
the
Oath.
I
make
no claim
for
any
originality
in the bulk
of
this
paper;
it rests
heavily
on
the historical
work
of
others
and
the
stringent
and valuable
criticism
offered
by
participants
n the humanities
project
of the Institute
of
Society,
Ethics
and
the
Life
Sciences.
8/10/2019 Reflections on the Hippocratic Oaths
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THE
HIPPOCRATIC
OATHS
81
like,
for
example,
a
commentary
on
Aristotle,
the
Hippocratic
Oath
had
a
very
clear-cut function for
doctors-
though
not for
society-in defining
heir
relationship
o
society.
The
interpolations
and
modifications
n the
text
can,
without
too
much
distortion,
be seen as
responses
to the different
social matrices
n
which
the Doctor's
Oath
played
a
part, showing
us
a
process whereby
an
institution
is
modified
to meet a
changing
social
or
ideological
demand. In
this
sense,
the
Oath was
a
tool,
not a
scholarly
work,
and
as such had
and has no more
claims
for
immutability
han
a
legal judgment
presently
has
in
English
or
American
society.
The
earliestrecorded
copy
of
the
Oath
is in
the
Vatican
Library,
and comes
from
the
tenth
or
eleventh
century.
t
is not
the
earliest
form
for it
is the
Oath
modified
so that "a Christian
may
take
it."
The
earliest
form,
the
Pagan
Oath,
comes
from
a
fourteenth-centurymanuscript
and
reads
as
follows:
I
swear
by
Apollo
Physician,
by
Asclepius,by
Health,
by
Heal-all,
and
by
all
the
gods
and
goddesses,
making
them
witnesses,
that
I will
carry
out,
according
o
my ability
and
judgment,
this
oathand this
indenture:
To
regardmy
teacher
n
this
art
as
equal
to
my parents;
o make him
part-
ner in
my
livelihood,
and when he
is
in
need of
money
to
share
mine with
him;
to
consider
his
offspring
o
equal
my
brothers;
o
teach
them
this
art,
if
they
require
o
learn
it,
without
fee
or
indenture;
and
to
impart
precept,
oral
instruction,
and all
the
other
learning,
to my sons, to the sons of my teacher,
and
to
pupils
who
have
signed
the in-
denture
and
sworn
obedience
to
the
physician's
Law,
but to
none
other.
I
will
not
give
poison
to
anyone
though
asked to
do
so,
nor
will I
sug-
gest
such
a
plan.
Similarly
I
will not
give
a
pessary
to
a
woman
to
cause
abortion.
But in
purity
and
in
holiness
I
will
guard
my
life
and
my
art.
I
will
not use
the
knife
either on
sufferers
from
stone,
but
I will
give
place
to such
as are craftsmen
herein.
Into whatsoever
houses
I
enter,
I
will do so to help the sick, keeping
myself
free
from
all
intentional
wrong-
doing
and
harm,
especially
rom
forni-
cation
with woman
or
man,
bond
or
free.
Whatsoever
n the course
of
practice
I see or hear
(or
even outside
my
practice
in social
intercourse)
that
ought
never
to be
published
abroad,
I
will not divulge, but consider such
things
to be
holy
secrets.
Now
if
I
keep
this
oath and
break
it
not,
may
I
enjoy
honor
in
my
life
and
art,
among
all men
for
all
time;
but if
I
transgress
nd forswear
myself,
may
the
opposite
befall
me.
Notice
how
already
there
is a
distinc-
tion between
the doctor
and the
surgeon.
Probably he sentence"I will not use the
knife
either
on
sufferers
from
stone,"
should,
Jones
suggests,
read,
"I
will
not
use
the knife even
on
sufferers
from
stone."
The
injunction s,
"leave
this to
the
operative
craftsman."
Now
let us look
at the
Oath,
modified
"insofaras a
Christian
could
swear it."
Blessed
by
God the
Father
of
our
Lord Jesus
Christ,
who
is
blessed
for
ever
and
ever;
I lie
not.
I
will
bring
no stain
upon
the
learn-
ing
of the
medical
art.
Neither
will I
give
poison
to
anybody
though
asked
to
do
so,
nor
will
I
suggest
uch
a
plan.
Similarly
I
will
not
give
treatment
o
women
to cause
abortion,
treatment
neither
from
above
nor
from
below.
But
I
will
teach
this
art,
to
those who
require
to
learn
it,
without
grudging
and
without
ndenture.
will
use
treat-
ment
to
help
the
sick
according
o
my
ability
and
judgment.
And in
purity
and in
holiness
I
will
guard
my
art.
Into
whatsoever
houses
I
enter,
I
will
do so
to
help
the
sick,
keeping
myself
free
from
all
wrongdoing,
ntentional
or
unintentional,
ending
to
death or
to
injury,
and
from
fornicationwith
8/10/2019 Reflections on the Hippocratic Oaths
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82 HASTINGS
ENTER
STUDIES
bond
or
free,
man or
woman. What-
soever
in
the
course
of
practice
I
see
or
hear
(or
outside
my practice
in
social
intercourse)
that
ought
not to
be published abroad, I will not divulge,
but
consider
such
things
to be
holy
secrets.
Now if
I
keep
this
oath
and
break it
not,
may
God
be
my
helper
in
my
life
and
art,
and
may
I
be
honored
among
all
men for
all
time. If I
keep
faith,
well,
but if
I
forswear
myself
may
the
opposite
befall
me.
The
three
main
modifications,
besides.
of
course,
the
disappearance
of the
pagan
deities,
are
interesting
and
instructive.
The
first
one
relates
to
the
question
of
abortion.
Where
doctors
undertake
not
to
give
treatment
to
women
to
cause
abortion,
the
clause
"Treatment
neither
from
above nor
from
below,"
is
added to
the
sentence.
This
clause
was,
perhaps,
inserted
as
an
effective
counter-measure
against those who
thought
they
could still
hold
to
the
Oath if
they
used
means
other
than
a
pessary
to
cause
abortion.-'
Written
injunctions
are
fine
but
there
are
always
loopholes
Secondly,
notice
that
unintentional
harm
is
just
as
forbidden as
intentional
harm.
The
notion
of
criminal
negligence
has
entered in for
the
first
time.
Thirdly,
there is
no
lengthy
de-
scription of those to whom medical
knowledge
should
be
imparted-to
this
point
I
will
return.
The
Arabic
Oath
The
Oath
passed
into
the Arabic
through
Syriac,
and is
found in this
form
in the
Lives
of
Physicians,
written
by
Ibn
abi
Usaybia.
This dates from
the
middle
part
of the thirteenth
century,
and
it
was
Ibn abi
Usaybia
who was
possibly
the
first
to
suggest
that
the Oath
originated
not
so much to
protect
society
or
even
the
reputation
of the individual
physician,
but to
protect
the
reputation
of
the
school.
The Schools of
Greek
Medicine
were
hereditary
schools
and it could
well
be that when it
was found
necessary
to
admit
outsiders,
then
Hippocrates
ad-
ministered
an oath-before
admission
rather than after
qualifying-in
order
to
secure candidates of a suitable
character.
The
Arabic version of the
Oath is as
follows:
Hippocrates
said:
I swear in
the
name of
God,
the Master
of life
and
death,
the
Giver
of health and
Creator
of
healing
and of
every
treatment,
and
I
swear
in the name
of
Aesculapius,
and of all the holy ones of God, male
and
female,
and
I call them to
witness,
that I
will fulfill this
oath and
these
conditions.
I
will
regard
my
teacher
in this art as
my
father,
I will
share
with
him
my
means
of
livelihood
and
I will make
him
my partner
in
my
wealth,
and
I will
give
him
my
wealth
whenever
he
may
be in need of
it.
As for
his
descendents,
I
regard
them as
my
brothers, and I will teach
them this
art without
any
remuneration
or
condition,
should
they
desire
to
learn
it. And
I
associate
together
(i.e.
regard
as
equal),
in
the
injunctions
and
in the sciences and
in all else
contained
in
the
art,
my
own
children,
the children
of
my
teacher,
and
the
disciples
on whom the
oath
(or
cove-
nant)
has been
imposed,
and
who
have sworn to observe the medical
code
of honor.
And I will not do
so for
any
other than
these.
In all
my
treatment
I will strive
so
far
as lies in
my power
for the
benefit
of the
patients.
And
I will restrain
my-
self from
things
which
are
injurious
to
them,
or
are
likely
in
my
opinion
to do them harm. And
I will
not
give
them
any poisonous
drug
if
they
ask
4Has something-an extra clause or phrase,
perhaps-been
transposed
or
dropped
in
this
translation?
For
the
phrase,
"But
I
will
teach
the art.. ."
placed
now
next
to
the
abortion
clause
reads
as
though
it
referred to
the
teach-
ing
of
abortion.
In
all
other
versions
it is
placed
in a
less
ambiguous
position.
This trans-
position
was
surely
not
intentional.
The
hy-
pothesis
that it
is due
to
careless
copying
on
the
part
of
a
sleepy
monk
is,
for
my money,
the
most
likely
explanation.
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THE
HIPPOCRATIC
OATHS
83
for
it,
nor will I
advise
them
thus.
Nor will I
contemplate
administering
any pessary
which
may
cause
abortion.
And
in
my
treatment
and
in the
prac-
tice of my art I will keep myself pure
and
holy.
And I will
not
operate
on
those who have stone
in
the
bladder;
rather I will leave
it for
those whose
profession
it is.
And
I will
enter
every
abode
into
which
I
may
go
only
for
the
benefit of
the
sick,
being
in
a
state
devoid
of
(all
deliberate
intention
of)
wrong-doing, injustice,
mischief-mak-
ing,
such as
might
be
intended
in
other
transactions, or in respect of sexual
relations with
woman or
man,
whether
free
or
slaves.
And as
for the
things
which I
may
see
or
hear
during
the time
of
treating
the
sick,
or
at times other than
those
in which I
am so
engaged,
about
such
behaviour
of men
as
should
not
be
talked of
outside,
I will
keep
silence,
considering
that such
things
should
not
be discussed.
He
who fulfills
this
oath
and does
not
violate
any part
of
it,
to
him
will
it
be
granted
to
carry
out
his treatment
and
his art under
the most
excellent
and favorable
conditions,
and to
be
praised
by
all
men in
future
for
ever;
while
the
contrary
will
be the
portion
of
him who
transgresses
it.
To
complete
this
potted
tour
around
doctors' oaths
we
can
take in a
couple
of
variations,
this
time
based
upon
an
Indian
theme.
The first
form
is
found
in
the
old
medical
books
of
India,
as
ad-
dresses to
students;
while
calling
for a
high
degree
of
moral
rectitude
on
the
part
of
the doctor with
regard
to his
own
behaviour,
the
injunctions
demand,
too,
a
high degree
of
moral
judgment
with
regard
to
the behaviour
of
others
To
insist
that
a
doctor
must refuse to
treat
a "hunter" or a "fowler"
surely
must
be
seen in
the
light
of the
Buddist belief
in
the
sanctity
of
all life-not
only
human.
Thou
shalt
renounce
lust,
anger,
greed,
ignorance,
vanity, egotistic
feel-
ings,
envy,
harshness,
niggardliness,
falsehood, idleness,
nay
all acts
that
soil the
good
name of man.
In
proper
season thou
shalt
pare
thy
nails
and
clip
thy
hair and
put
on the
sacred
cloth,
dyed
brownish
yellow,
live
the
life of a truthful self-controlled an-
chorite,
and be obedient
and
respectful
towards
thy
preceptor.
In
sleep,
in
rest,
or while
moving
about-while
at
meals
or in
study,
and in
all acts
thou
shalt
be
guided
by
my
directions...
Thou
shalt
help
with
thy professional
skill
and
knowledge,
the
Brahmanas,
thy
elders,
preceptors
and
friends,
the
in-
digent,
the
honest,
the
anchorites,
the
helpless and those who shall come to
thee
from a
distance,
or those
who
shall live close
by,
as well as
thy
rela-
tions
and
kinsmen,
to
the
best of
thy
knowledge
and
ability,
and
thou
shalt
give
them
medicine
without
charging
for it
any
remunerations
whatever,
and
God
will bless
thee for
that. Thou
shalt
not treat
medicinally
a
professional
hunter,
a
fowler,
a
habitual
sinner,
or
him who has been
degraded
in
life;
and
even
by
doing
so
thou
shalt
acquire
friends,
fame,
piety,
wealth
and
all
wished-for
objects
in
life,
and
thy
knowledge
shall
gain
publicity.
The
second,
the
Oath
of Charaka,
ac-
cording
to Mohan
Lal
Sharma,
has
re-
cently
received
much
prominence
in
the
Indian
Press,
and
is
administered
by
the
guru to a disciple.
Thou
shalt
speak
only
the
truth,
eat
no
meat,
eat
only
pure
articles
of
food,
be
free
from
envy
and
carry
no
arms.
There shall
be
nothing
that
thou shalt
not do
at
my
behest,
except
hating
the
king
or
causing
another's
death or
committing
an
act
of
unrighteousness.
Day
and
night,
however
thou
may-
est be
engaged,
thou
shalt
endeavour
for
the
relief of
patients
with
all
thy
heart
and
soul.
Thou
shalt
not
desert
or
injure
thy
patient
ever for
the
sake
of
thy
life or
thy
living.
Thou
shalt not
commit
adultery
even in
thought.
Thou
shalt
not
covet
others'
possessions.
Thou shalt
be
modest in
thy
attire
and
appearance.
Thou
shouldst
not be
a
drunkard or
a sinful
man nor
shouldst
thou
associate with
the
abettors of
8/10/2019 Reflections on the Hippocratic Oaths
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84 HASTINGS CENTER STUDIES
crime.
Thou
shouldst
speak
words
that
are
gentle,
pure
and
righteous,
pleas-
ing,
worthy,
true,
wholesome
and mod-
crate.
Thy
behavior must be in
keeping
with the time and
place
and heedful
of
past
experience.
Thou shalt
act al-
ways
with a
view to
acquiring
knowl-
edge
and
fullness of
equipment.
No
offering
of
presents
by
a woman
without the behest
of
her husband
or
guardian
shall be
accepted by
thee.
While
entering
the
patient's
house
thou
shall
be
accompanied
by
a
man who
is
known to the
patient
and
who has
his
permission
to enter and thou shalt
be well clad and
bent
of
head,
self-
possessed
and conduct
thyself thought-
fully.
Thou
shalt
make
thy
entry
in
the
proper
way.
Having
entered,
thy
speech,
mind,
intellect and senses
shall
be
entirely
devoted to
no
other
thought
than to that of
being
helpful
to
the
patient
and
of
things
concerning
him
only.
The
peculiar
customs of
the
patient's
household shall not be made
public.
Though
possessed
of knowl-
edge,
thou
shalt
not boast
very
much
of
thy knowledge.
Most
people
are
offended
by
the boastfulness of
even
those
who
are
otherwise
good
and
authoritative.-)
Finally,
let
us
compare
these
earlier
forms
with the
Oath as
presently
sworn
at
Montpellier
and
Glasgow
Universities,
both
of
which have
old
and
renowned
schools
of
medicine.
The
Montpellier
Oath.
In
the
pres-
ence
of
the
masters of
this
school,
of
my
dear
fellow-students
and
before
the
image
of
Hippocrates,
I
promise
and
I
swear,
in
the name of
the
Supreme
Being,
to be
faithful
to
the
laws of
man
and of honor
in
the
exercise
of medi-
cine.
I
will
give
my
services
without
fee to
the
needy,
and I
will
never
exact a
higher
fee than
my
work de-
serves. When I
am admitted inside
houses,
my eyes
shall not
see what
goes
on
there,
and
my
tongue
shall be
silent
about the
secrets
which shall be en-
trusted
to
me,
and
I will
not abuse
my
position
to
corrupt
morals or to en-
courage crime. Respectful and grateful
towards
my
masters,
I
will
give
back
to
their children
the
instruction that
I
have received
from their fathers.
May
men
grant
me
their
esteem
if I am
faithful
to
my
promises.
May
I be
covered
with shame and
despised
by
my
fellows
if I fall short.
The
Glasgow
Oath.
I do
solemnly
and sincerely declare that, as a Grad-
uate
in Medicine
of
the
University
of
Glasgow,
I
will exercise
the several
parts
of
my
profession,
to the best of
my
knowledge
and
abilities,
for the
good,
safety,
and
welfare of all
persons
committing
themselves,
or committed
to
my
care and
direction;
and that
I
will
not
knowingly
or
intentionally
do
anything
or
administer
anything
to
them to their hurt or prejudice, for any
consideration,
or
from
any
motive
whatever.
And I further declare that
I
will
keep
silence as to
anything
I
have seen
or
heard while
visiting
the
sick which it would
be
improper
to
divulge.
And
I
make this
solemn declaration
in virtue
of
the
Provisions of
the
Promissory
Oaths
Act,
1868,
substitut-
ing a Declaration for Oaths in certain
cases.
II
The
Oath in
all its
forms
represents
"those
noble
rules
of
conduct,
loyal
obedience
to which
has
raised
the
art
of
medicine
to
the
high position
it
now
holds." This
statement,
the
opinion
of W.
H.
S.
Jones,
carries
overtones of
nobility,
sublimity,
and
aspiration
worthy
of Prince
Albert.
I,
however,
take
a somewhat
cyn-
ical view of
the matter.
What
we
don't
know,
for
instance,
is
what,
if
any,
were
the
sanctions
to
be
imposed against
someone
who
broke the
Oath. Were there
any penalties
at all?
Did
all students swear
or
only
those
that
5Mohan Lal
Sharma,
"Oath
of
Charaka,"
New York State
Journal
of
Medicine,
71
(Oc-
tober
15,
1971),
p.
2457.
8/10/2019 Reflections on the Hippocratic Oaths
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THE
HIPPOCRATIC
ATHS
85
belonged
to a
definite
guild
or school?
Was it
ever
actually
administered, r,
like
the Sermon
of
the
Mount,
merely
held
up
as a counsel of
perfection?
There
was
no General
Medical
Council,
and it
has
often
been
suggested
that a doctor
who
transgressed
he
Oath
was not
punished
unless,
in
fact,
he
actually
sinned
against
the civil or
criminal aws of
the
state.
One
enchantingpiece
in
the
Hippocratic
col-
lection,
called
Law,
actually
complains
about
this state of affairs."The
only
pen-
alty
to
which
an
erring
doctor
was sub-
ject
was
dishonor,
and as the author
of
Law
rightly
points
out,
this
was no
pun-
ishment
to
those who
were
"compacted
of it."
On
the otherhand
the
state seldom
brought
any
severe
sanctions
to
bear
either. W.
H.
S.
Jones
argues
that be-
cause
of
the
general
slackness
of
state
supervision
or
discipline,
t
was
therefore
necessary
to
make
every possible
appeal
to a doctor's
religious
cruples
and to his
moral
sense.7
The
first
traits which
enable us to
identify
he
properties
f
a
guild,
or
trade
union,
are also
apparent
from
the
first
form of
Oath;
they
are
jealouslyguarded
professional
privileges.
The new
doctor
must
give special
favors to
his
teacher
and
family.
He
can
reveal the
secrets
of
his craft
only
to his
sons,
and the
sons
of
his teacher
and
to
those
outsiderswho
have sworn
allegience
to
the
physician's
law. It
may
well
be
that
the
apprentice
took
the Oath before he
actually joined
the
guild,
rather
than
after he
became
a l e n
tells
us,
there
was
never
any
rule
whichsaid
that
as a matterof
medical
etiquette
new
knowledge
and
discoveries
must
be
made
public.
He
tells
how
surgeons
concealed
themselves
and
their
patients
during
the
course
of
operations,
not for
reasons
of
modesty
but
in
order
to
keep
some
of
their methods
secret.
This
highlights
one
im-
portant
distinction
be-
tweenthe practiceof
medicineand that
of
science.
qualified,
as is
now the case.
And
this
brings
up
another
question, namely
whether
he medical
society
was
a
totally
secret
one--secret
that
is
in
the
sense
that
all
outsiders
were
rigidly
excluded from
their
meetings
and
their
lectures.
Two
treatises in
the
Hippocratic
collection,
Precepts
and
Decorum,
carry quaint
and
obscure
overtoneswhich
are
very
familiar
to
those
who
have
troubled to
read the
libretto of
The
Magic
Flute
from
begin-
ning
to
end.
Freemasons
would
find
a
strange
familiarity
and,
as
Jones
points
U'Works
f
Hippocrates,
Trans.
by
Francis
Adams
(New
York:
Wm.
Wood,
1886).
7Ludwig Edelstein makes the same point.
"The
Oath
as a
whole
is
hardly
an
obligation
enforced
upon
the
physician
by
any
authority,
but
rather
one
which
he
accepts
of
his own
free
will. It
is not
a
legal
engagement;
as
the
wording
indicates,
it is a
solemn
promise
given
and
vouchsafed
only by
the
conscience
of him
who
swears."
(Emphasis
added.)
Ludwig
Edel-
stein,
"The
Hippocratic
Oath,"
Supplement
to
the
Bulletin
of
the
History
of Medicine,
No.
1
(Baltimore:
Johns
Hopkins'
Press,
1943).
8/10/2019 Reflections on the Hippocratic Oaths
9/15
86
HASTINGS
CENTER
STUDIES
out,
it is as
though
the
writer
purposely
did not wish to be
understood
by
those
who
were
unfamiliar
with
liturgy
or
ritual. Decorum
closes with
an
injunction
to
acquire
certain
knowledge
to
"keep
it
safe and to
pass
it
on."
Law,
an
address
to
young
students
given
at the
beginning
of
their
medical
course,
ends: "But
holy
things
are shewn to
holy
men. The
pro-
fane
may
not
be
shewn
them until
they
have
been
initiated
into the
rights
of
science."s
This
injunction
is
very
similar to
those
at the
end of
many
Arabic
alchemical
texts which
generally
finish
with,
"The
Godly
may
not
show this to
the un-
Godly:
outsiders
may
not have
it
ex-
plained."
This
does
suggest
that
secrecy
in
the
medical
profession may
have
its
origins
not in
an omniscient
attitude that
comes with
knowledge
nor
in
an
altruistic
concern
for
what
knowledge
the
laity
and
patient
can
"bear,"
but rather
by
virtue of
a
professional
injunction
meant
to
preserve
the
unity
and
status of
the
guild.9
As
Galen
tells
us,
there
was
never
any
rule
which
said
that
as a
matter of
med-
ical
etiquette
new
knowledge
and
dis-
coveries
must
be
made
public.
He
tells
how
surgeons
concealed
themselves
and
their
patients
during
the
course
of
op-
erations,
not
for
reasons of
modesty
but
in
order
to
keep
some of
their
methods
secret.
This
highlights
one
important
dis-
tinction
between
the
practice
of
medicine
and
that
of
science.
The
similar
ban
on
dissemination of
knowledge
in
alchemical
texts noted
above is without
doubt one
of the most
important
factors
that led
to
the intellectual fossilization
of
alchemy
as a
system
of
knowledge.
Scientific
un-
derstanding
grows by
a
dynamic
balance
between
imaginative
speculation
and
the
critical
judgment by
others.
It is
inter-
esting
to
speculate
whether
or not
med-
ical
knowledge
might
have
advanced
faster
had this
open
kind of attitude
been
encouraged,
for one has
only
to
recall
Harvey's
complaint.
He was
very
scorn-
ful of the
uncritical manner
in which doc-
tors assumed
that
what
they
were
told
about
the ancients'
knowledge
of the
cir-
culation
must
be true. And
they
were
so
passive
that
they
did not even
trouble
to observe
for
themselves.
Some
clauses
in the
Oath are
quite
incongruous,
for
example
those
which
refer
to
operations
in
general,
particularly
for
cutting
of the stone.
This clause
is
generally
sandwiched between clauses
containing
moral
injunctions.
Of
course,
the distinction was
constantly
emphasized
between
the doctor
and
the
"butcher,"
but
this
particular
clause
may
also
deal
with
yet
another
problem
of
medical
eth-
ics.
Some
people
have
suggested
that
it
contains
a hidden reference
to
castration,
which
was
abominated
by
the
Greeks.1o
But since this
operation
clause is not
present
in
the
Christian
form of
the
Oath,
it is
possible
that it
actually
does
illus-
trate a
response
to a
changing
social
situation,
a
response
to fashion
and
prej-
udices
of
certain
physicians
at
a
certain
period
of
time. It
is
very
likely
that it
was the
ban
on
operations
in
Rome,
no-
ticed and
recorded
by
Galen,
which
caused the insertion to be made at this
point
in
time,
some
centuries
after
the
-For
an
examination
of
the
Oath's
relation-
ship to secret cults see LudwigEdelstein's"The
Hippocratic
Oath,"
in
Ancient
Medicine,
ed.
by
Owsei
Temkin
and
C.
Lilian
Temkin,
trans.
by
C.
Lilian
Temkin
(Baltimore:
Johns
Hopkins Press,
1967),
pp.
3-64.
Also "The
Hippocratic Oath,"
Supplement
to
the
Bulletin
of
The
History
of
Medicine.
9TFhis
spect
of
secrecy
is
quite
distinct,
of
course,
from the
more familiar
one of
confi-
dentiality
with
regard
to
patient's
disclosures,
which
1
deal
with
later.
1"One
scholar,
Reinhold,
has even
gone
so
far
as to amend
the text
so as to read:
"I
will
not castrate
even
persons
who
are
not
grown-
up."
Jones' comment
is
right
on
target;
this
is
a
truly
unhappy
illustration
of the
art
of
correcting
corrupt
texts:
surely
the
phrase,
"I
will not
castrate,"
would have been
quite
adequate.
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rHE
HIPPOCRATIC ATHS
87
initialChristianOath.
The distinction
be-
tween the
physician
and
the "butcher"
r
"barber"
surgeon,
though
present
in
pagan
times and
in
the
Pagan
Oath,
was
much
intensified
by
this
Roman
injunc-
tion
and reached ts
epitome
in
medieval
times. The
medical
profession
and the
public
have suffered
rom this
legacy
of
history.
Fortunately
here
is much
more
cooperation
now,
but
powerful
relics of
this
division
exist
even
today,
in
the
dif-
ferent
attitudes
of
the
public,
and also
of
physicians
and
surgeons
towards the
introduction
of
new
therapeutic
tech-
niques
in
medicine
and
surgery;
e.g.,
the
differing
concerns
for
regulation
n the
case
of
drugs, ranging
from
thalidomide
to
The
Pill,
and in
the
case
of
surgical
procedures
ike heart
transplants,
y-pass
operations,
or
psycho-surgery.
Even
thoughearly
Christians
ad
great
reluctanceto
take oaths
of
any
kind-
a reluctancewhich
is
shared
by present-
day
Quakers'"-nevertheless,
t is
certain
that
many
Christian
doctors
subscribed
to it.
But in
relationto this
question
an-
other
striking
difference-almost
an
ideo-
logical
one-between
the
Christian orm
of
oath
and the
Pagan,
is
that in
the
Christian form
all
those
clauses
which
would tend to encourage the formation
of
a trade union
are
omitted.
Secret
so-
cieties
were
considered
contrary
to
the
teachings
of
the
Christian
religion,
and
even
today,
the
Roman
Catholic church
bans
secret
brotherhoods.A
clause which
encouraged
the
formation of
an inner
ring
of
physicians,
rom
which
outsiders
were
excluded,
demonstratedan aristo-
cratic exclusivenesswhich was in great
contrast to the universal
brotherhood
of
early Christianity.
And if
the
beginning,
and the
end,
of all medical
art
was
the
relief
of
pain
and
suffering,
then
it
should
be
tied and hindered
by
nothing-
whether
guild
rules,
or
secrecy,
or
pre-
occupation
with
status. "I
will teach
this
art
to those who
require
to learn
it,
without
grudging
and without
ndenture,"
says
the
ChristianOath
simply-without
reference
to
the
physician's
sons,
or
his
teacher's
sons,
or those who have
been
enrolled n the
guild.
If the Christian
opposition
to
secret
groups
finds its
rationale
n the
concept
of
universal
brotherhood,
hen we
are
brought
directly
to such
large
issues
as
the
relationship
etween
professional
and
universal
responsibilities.
t is
impossible
to know to what extent
such
issueswere
discussed
by
doctors in
ancient
times. I
suspect
not
at
all;
certainly
it is most
unlikely
rom
what
we
know of
this craft
guild.
Even
though
Socrates
and his
dis-
ciples
in the market
place might
examine
the nature
of
personal
and
universalre-
sponsibility,
I
would,
in
the absence of
direct
contrary
evidence,
be inclined to
think that the doctors
rarely
troubled
their
minds
with such
deep
issues,
seeing
such
debates as the
function of
philoso-
phers
not
physicians.
Moreover,
he
effec-
tive
philosophical
problem
posed
above
is a
sophisticated
one and we should
never
forget
that
problems
and
theories,
just
as
much
as
people
and
institutions,
have their
histories,
too.
If
now
we see
the
relationship
etween
professional
and
universal
responsibility
as an
issue
to
which
all
of
us,
doctors
and
lay
people,
too,
have
something
o
contribute,
hat is
no reason to
suppose
that the
early
Greeks
saw it this
way.
Such
a
new
awareness ould
reflectan
amalgam
of
several
things:
the
complex-
ity
of
the
present relationship
between
the
profession
and
society;
the
new
fuller
sociological
mplications
of
a
tough
pro-
fessionalization;
the
extent to which our
ideas about the
nature of
responsibility
have evolved
and
changed through
times
and cultures. We can
no
more take an
ahistorical view
of
this matter than we
can
of scientific theories.
They
were never
immutable then and
they
are not now.
11This belief
of
the
Quakers
is based
on the
phrase
"Swear
not
at
all"
in
Matthew
v.
34.
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88
HASTINGS
CENTER
STUDIES
It
would,
therefore,
be as
unreasonable
of us
to
expect
strong
similarities
etween
the Greek
view
and our
contemporary
view on the
nature
of
responsibility,
as
it
would be
to
expect
similarities
etween
their
knowledge
on
atoms
and our
more
detailed,
sophisticated
heories.
The continuities
n the forms
of
the
Oath
are clear
enough,
but there
are
great
contrastsbetween
our
contemporary
situation
and
those
of
earlier times.
The
Oath as it evolved
had one
aim and
one
aim
only; namely
the
moral
regulation
of
the
physician
by
other
physicians.12
It
may
well
be,
as
Chauncey
Leake
sug-
gested,
that
during
the
height
of
Greek
civilization
the
generally accepted
view
he final
transition,
from
the broad
moral
precepts
of
Greek
medical
practice
to
the
un-
codified
but
accepted
system
of
medical
ethics of the
present day,
occurred
around
the
seventeenth
century
....
the
era
of
the search for
immutable
laws.....
of
morality
rendered
any
written
admoni-
tion
on
medical
ethics
unnecessary.
(It
must
be rememberedhat
the
Hippocratic
collection
emerged
only
in
the
Alexan-
drian
period,
several
centuries
after
this
height
of Greek
civilization.)
But
I
feel
that
Chauncey
Leake
may
have
suc-
cumbed
to
that well
known
seduction
of
history-seeing
Greek
life
through
rose-
colored
spectacles.
From
the
evidence,
I am not certain
that we are
entitledto
assume
that there
was
a
"generally
ac-
cepted
view
of
morality,"
r if there
were,
that
it was
necessarily
one conducive
to
good
medical
practice.
I would
prefer
to
emphasize
a
different
cultural
character-
istic
of the Greeks
as the crucial
factor,
and one which we do know survives
today.
For
in
ancient
Greece,
the
rivers
of
"philotimno"
un
deep.13
A
doctor
was
under
no
compulsion
to
act
"properly,"
but was
trained o consider
good
behavior
as the
right
thing.
Greeks
considered
themselves
artistsand men.
It was
per-
haps
love of the
art,
combined with
"philotimo"which purifiedthe doctors'
calling,
and
kept
it
pure,
just
as
much
as
any
general
standards
of
morality.
Nevertheless,
the
admonition
of
the
Hippocratic
collection
which
emerged
n
the
Alexandrian
epoch,
could
well
have
been
formulated
n
an
attempt
to
main-
tain
older,
unwritten
tandards,
however
these
originated.
I
emphasize
again:
the
compulsion
o ethical
practice
n
ancient
Greece
might
well
be
found
only
in
the
physician's
genuine
ove
both
of
his
craft
and
of
men,
and if
the
law
was
ineffec-
tive,
medical
etiquette
protected
the
pa-
tient
by
appealing
o
artistic
nstinct
with-
out
the
imposition
of
civil
penalties.
12See
the
essays
by
Ludwig
Edelstein
already
cited.
13I
refer
to
that
identifying
Greek
national
characteristic
"philotimo".
."personal
code of
honor."
If
any
one
is
tempted
to
regard
this
cultural
evidence as
anecdotal,
incongruous
or
slight,
they
should
refer to
many
of
the nu-
merous
discussions of
"philotimo."
The
most
recent,
and
among
the
very
best,
can
be
found
in
David
Holden's
brilliant
and
astringent,
Greece
Without
Columns
(London:
Faber,
1972),
especially
pp.
30,
92-4, 97,
283.
He
demonstrates
the
negative
aspects
of
"philo-
timo"
too--hubris
and
blamelessness.
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THE
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OATHS
89
Things began
to
change
in
the
Middle
Ages.14
Internal
sanctions
and
penalties
against
transgressors
f the
craft
tradi-
tion were backedby demands or action
on
the
part
of the
civil
authorities
as
well,
and
these
demands
came
from
the
doctors. But
the final
transition,
from
the
broad moral
precepts
of
Greek
med-
ical
practice
to
the
uncodified but
ac-
cepted system
of
medical
ethics
of
the
present
day,
occurred
around
the
seven-
teenth
century;
and the
truly
tough
pro-
fessionalismof modern medicine is an
even
later
development.
This
was
the
era of
the
search
or
immutable
aws,
not
only
in
science,
but
within
conduct,
and
law
and
morality
in
general.
Thomas
Percival
(1740-1804)
who
formulated
the
well-known,
and
much
used,
code
of
medical
ethics
could
not
have
envisaged,
thatby trying o covereverypossiblecon-
tingency,
two
unfortunate
consequences
followed.
There
was
conflict
which
came
from
sheer
multiplicity
f
the
rules
them-
selves
and
a
growing
emphasis
on
the
letter
of
the
law,
rather
han
on its
spirit.
For
external
sanctions,
with
pains
and
penalties,
can
enforce
only
those rules
which
are
specific,narrow,
and
concise.
On
the
other
hand,
as
we
learn
to
our
cost,
width
and
vagueness
ead
to
unfair-
ness
and
injustice,
both
to
the
doctor
and
to
the
patient.15
It
is
worth
glancing
briefly
at
the
ways
in
which
the
civil
authorities
have
either
intervened
or
been
called
in,
to
regulate
the
practical
physicians.
The
first
inter-
ventioncamewithregard o fees. Chaun-
cey
Leake
emphasizes
an old
point;
one
basic
ethical
question
arises
simply by
virtue
of the
fact
that,
if
physicians
have
a pecuniaryinterestin their work, can
they
in
all
honesty
really
desire
to
see
men
in
perfect
health?
(This
problem
can
be
avoided
f one
adopts
the
ancient
Chinese
practice;
namely,
of
only
paying
the
physicians
so
long
as one
is
in
health )
Though
in
an
ideal
world
the
answer
to the
question
would
be,
yes;
hedonistically
t
is,
of
course,
no.
Society
protects-or
has
protected-interests
of
the
patient
both
by
enacting
fee
codes
and
by
requiring
a certain standard
of
training
andskill
before
a mancan
prac-
tice medicine.
In
a
free market
economy
the
fee codes
certainly
do
no more
than
lay
down
the
minimum
which
shall
be
charged
and,
as
we know
only
too
well,
the doctorusuallychargeswhatthe mar-
ket will
stand.
But when
first
introduced,
the
fee code
provided
a
system
of
bal-
ance
and
checks-no
pun
intended.
The
code
of the laws
of
Hammurabi
f
Baby-
lon,
dating
from about
2200
B.C.,
lays
down
both
the
fees
to
be
given
for
a
physician's
ervices,
graded
according
o
the social
status
of the
patient,
and
also
the
punishments
to
be
inflicted
if
the
treatment
resulted
in
injury
or
death.
Neither
the Greeks
nor the Romans
pro-
vided
legal
regulations
controlling
the
practice
of medicine
until
forced
to
do
so
by
a
combination
of
quackery
and
drug-selling,
which
apparently
ed
to
a
situation
in which
it was
necessary
to
clean
up
both
the
profession
and
the
towns.
By
one
and the
same
stroke,
An-
tonius
Pius,
both
restricted
the
number
of
physicians
hat
could
practice
n
a
city
-thus
making
the doctors
happy-and
also
provided
hem
withan
annual
alary,
thus
making
them
happier.
This
was
all
done,
"in
order
that
they
may
honorably
serve the
poor
rather
than
basely grovel
before
the
rich."One
would
like
to
know
14A
brief
history
of
the
medical
profession
in
the
Middle
Ages
and
the
seventeenth
cen-
tury
is
impossible
here.
See,
however,
David
Riesman,
The
Story
of
Medicine
in the
Middle
Ages
(New
York:
1935).
15Percival,
Medical
Ethics.
Much of
Perci-
val's
medical
ethics has
been
adopted
and
adapted
by
the
British
and
American
medical
professions.
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90
HASTINGS
ENTER
STUDIES
he
rela-
tionships
between
codi-
fied
ethics,
general
morality,
enforced
law,
and
professionalization
remain, indeed,
fascinat-
ing
and
perplexing.
Does the
appearance
of a
codified
ethic,
indicating
greater professionaliza-
tion,
also
indicate that
ethical
sensibility
is
on
the
rise?
Or
does
such
a
code
emerge precisely
because
moral
responsi-
bility
is on
the
decline?
When
ethical
considera-
tions have arisen...
does
professionalization
help
or hinder
an
appro-
priate
response?
just
how
successful this
was.'6
Perhaps
turning
doctors into civil
servants in this
way may have benefitted the poorer sec-
tions
of
society,
and
the
pill
was
surely
sweetened
by
the
exemption
that
these
doctors
enjoyed
from taxation
and
vari-
ous
public
duties.
Gradually
over
the
years,
the
profession
developed
not
only
prestige
but also
a
vested
interest
in
maintaining
its own
standards,
so
that
civil authorities
gradually
relinquished
their
control both over
the
moral
atti-
tudes
and
qualifications
of
the
physicians
and
also over their
finances.
Many
states in
the
U.S.A. still
reserve
the
right, technically
at
least,
to
require
good
moral character
from
all
those
who
would
practice
medicine
and
all
those
who are
practicing
medicine.
While it
may
be
possible
to
study
the
moral
char-
acter
of
a
student
while
at
school,
it
is
almost
impossible
to
do
so
when
he
gets
into
practice,
let
alone
continue to
moni-
tor him.
And,
therefore,
this
aspect
of
the
law
is
another
dead-letter
requirement.
The
only
recourse
that
a
patient
has
is to
bring
a civil
suit
against
the
doctor in
cases
of
immoral
practice,
and
the
likeli-
hood
of
success
will
vary
very
much.
However,
the
term
"medical
ethics,"
as introduced
by
Percival,
was,
as
Chaun-
cey
Leake reminds
us,
actually
a
mis-
nomer.
Professional
courtesy
is
not
the
same
thing
as
professional morality,
and
medical
ethics
is
by
no means
the
same
thing
as
medical
etiquette,
though
these
are
usually
confused
or taken
to be
the
same in
the
mind
of
the
profession.
If
we
consider
the
"ethics"
to
be
based
on
Greek
notions
of
good
taste,
rather
than
absolute
standards
of
morality,
then
what
we
are now
really
referring
to in
the
twentieth
century
is the
rules of
etiquette
which
regulate
the
conduct of
members
of
the
profession
with
regard
to
each
other.
But,
using
Chauncey
Leake's
defi-
nition
of ethics
as,
"concerned with
the
ultimate
consequences
of the
conduct
of
physicians
towards
their
individual
pa-
tients
and
towards
society
as
a
whole,
and
which
should include
a
consideration
of
the
motive and will
behind the
con-
I'(In
theory
this
should
work.
Certainly
it
has often
been
tried. But
a recent
and
very
amusing paper by
Tabin of
Hungary
examining
the
spread
of
parasolventia
in
his
country
shows the
difficulties.
Parasolventia
is not a
new viral
disease
but
the
tendency
of
patients
to
give
and
doctors
to
accept gifts
(wine,
geese,
etc.)
in
the
expectation
of better medi-
cal treatment.
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THE
HIPPOCRATIC
OATHS
91
duct,"
I
am led
to
a drastic
conclusion.
It
may
well
be
that,
on
examination,
we
have
no
medical
ethics,
and
that
through-
out
medical
history
we
never
have
had
them,
either.
Fifty years
ago,
Chauncey
Leake
could
write
with
this
kind
of
optimism:
New
conditions
are now
arising
in
medical
practice.
No
matter
how
greatly
we
may
lament
the
fact,
the
old
family
doctor,
beloved
of
us
all,
is
rapidly
passing away
in
the
growth
of
specialism,
group
clinics,
and
gen-
eral hospitalizationof the sick. The
close
personal
relations
between
the
physician
and
his
individual
patient
are
disappearing
n
the
routine
of
tech-
nical
diagnoses,
mass
treatment,
and
nation-wide
prophylaxis.
Medicine
is
being recognized
more
and
more
as
a
matter for
national
and
international
public
health
efforts,
rather
than
as
a
professioncatering
to
individual
am-
bition. Its aim is its own
end-the
prevention
of
disease.
With
the
eco-
nomic
pressure
f
insurance
ompanies,
with
general
public
health
education,
and
with
frequent
periodic
health
ex-
aminations,
t
will
become
financially
more
interesting
or
the
general
prac-
titioner o
keep
his
clients
well
than
to
treat
them
when
they
become
sick.
[Italicsadded.]
This
is
bound to
alter
the
status
of medical
ethics.
Since
1927,
much of
what
Chauncey
Leake
predicted
in
that
quotation
has
come to
pass.
But
he
missed
out on
one
point
and
this
proves
to
be
fundamental.
He
clearly
believed
that
the
medical
pro-
fession
would,
could,
metamorphose
nto
guardian
and
protector
of
national
and
international ublichealthefforts,rather
than
being
solely
a
profession
which
satisfied
ndividual
mbitions,
whether
n-
tellectual
or
financial.
It
may
well
be
true
that
should
it
become
financially
more
rewarding
or
a
doctor
to
keep
his
patients well,
rather
than
to
treat
them,
then,
indeed,
the
whole
statusof
medical
ethics,
such
as it
is,
would
alter.
But
would
it take
only
financial
incentives?
Chauncey
Leake
was realistic
enough,
in
1927,
in
recognizing
he
strong
pull
of
the
financial
carrot,
but
in
the
context
of
contemporary
American
society
it
is
difficult
o see
how,
short
of
reverting
o
the ancient
Chinese
practice,
even
this
could
be
manipulated.
The
problem
that
I see
is that
this
is
a
question
of
general
and
total
morality,
both
of
the
attitudes
of the
profession
and
of
individual
doctors.
It
may
well
be that until
we
manage
to recover love
of
the art
and love
of
people, as
opposed
to love
of the
tech-
nique,
or
love
of the
affluence,
or
love
of
the
status,
as
the real
motivation
or
entering
medicine, we
may
not
get
a
satisfactoryethical
relationship
between
doctors
and
society.
But
if this
did
hap-
pen
it
is clear
to
me
that
our
ethical
aphorisms
would
then
not
even
have
to
be stated, let alone codified. And
any
Oath
would
become
redundant.
III
Looking
back
over
what
I
have
writ-
ten,
I
hear
a
voice
accusing
me
of
issuing
a
whole
series
of blank
checks
which
have
not
yet
been
cashed.
How
much
more
basic
research n the history and
sociology
of
the medical
profession
must
be done
before
these
promissory
notes
can
be
redeemed
In
relative
terms
the
much
younger
profession
of
science
has
received
infinitely
more
attention,
and
theearlier
years
of
the
emerging
cientific
profession
carry
much
more
documenta-
tion
of
problems
both
internal
and
ex-
ternal.
The
relationships
between
codified
ethics,
general
morality,
enforced
law,
and
professionalization
emain,
indeed,
fascinating
and
perplexing.
Does
the
ap-
pearance
of
a
codified
ethic,
indicating
greater
professionalization,
lso
indicate
that ethical
sensibility
s
on
the
rise?
Or
does
such
a code
emerge
precisely
be-
cause
moral
responsibility
s
on
the
de-
8/10/2019 Reflections on the Hippocratic Oaths
15/15
92
HASTINGS
CENTER
STUDIES
cline?
When ethical
considerations
have
arisen,
or
in the case
of
science
been
forcibly imprinted
on the
profession's
consciousness,
does
professionalization
help
or
hinder
an
appropriate
response?
Our
answers,
when
we have
any,
can
only
be
tentative.
I
believe that the
Hippo-
cratic
Oath
was
related to the
general
morality only
marginally,
and
that
ini-
tially
it
served
the needs
of an
emerging
profession
or
guild,
rather
than those of
society.
Ultimately,
nothing
can
serve us
-society
or
professions-better
than
a
wide
general
morality.
And where this
does not
exist,
nothing,
it
appears,
can
properly
function in
its
place. Certainly
not a codified
ethics,
which
is too
often
full of
loopholes
or so
vague
and
plati-
tudinous
as to
be
without
meaning.
Cer-
tainly
not
an enforced
law,
which is
too
often
unenforceable,
or so
precise
as
to
be
inhumanely
restrictive.
On
the
other
hand,
where
the
general
standards
of
professional
and social
morality
are
high,
then
both codified
ethics
and
enforced
law become
irrelevant,
redundant,
and
unnecessary.
The
problem
is,
what is
it
that
promotes,
or can be made
to
pro-
mote,
a
high
moral
purpose
in a
society
or a
profession?
About
the
answer
to
that
question,
all we
know is that
it
will
not
be
simple.