(LifeSiteNews) — I am a physician who took the Hippocratic Oath upon graduating from UCLA School of Medicine in 1984. The Oath we were given states: “I will give no deadly medicine to anyone if asked, nor suggest any such counsel; furthermore, I will not give to a woman an instrument to produce abortion. With purity and holiness, I will pass my life and practice my art.” As a physician, I believe in the tenets of the Hippocratic Oath, and I believe that we ignore Hippocrates at our own peril.
Hippocrates did, in fact, predict in his own oath the benefits and tragedies that could befall the professional depending on faithfulness to the oath: “While I continue to keep this oath inviolate, may it be granted to me to enjoy life and the practice of the art…but should I trespass and violate this oath, may the reverse be my lot.”
Who was Hippocrates, and why is he so important? The Hippocratic Oath has been an enduring standard of medical ethics for the 2,400 years since Hippocrates and his school penned it. It has, with good reason, achieved its rightful place in guiding physicians towards the ethical practice of their trade. Abortion and euthanasia were clearly issues of medical ethics which Hippocrates felt so strongly about that he addressed them centrally within his oath. Respect for preborn human life and respect for the elderly and disabled were crucial moral bookends which, for Hippocrates, encompassed the entire breadth of earthly human existence. And abortion and euthanasia, which violated these bookends, were expressly forbidden of the ethical physician.
Even the Supreme Court justices who wrote the majority opinion of 1973’s Roe v. Wade had to acknowledge Hippocrates’ explicit prohibition of abortion by physicians. In fact, they had trouble rationalizing their departure from the revered 2,400-year-old oath of physicians. The justices ultimately stated that the authority of Hippocrates did not prevent abortions in Greece and Rome. They said that most Greek thinkers and physicians commended abortion and that only the Pythagorean school of philosophers frowned upon abortion and suicide. Only Hippocrates and the minority Pythagorean thinkers opposed abortion, and the future teachings of Christianity fit well with Pythagorean ethic. Thus, the justices concluded that the Hippocratic Oath is “a Pythagorean manifesto and not the expression of an absolute standard of medical conduct.”
There is no argument that the oath was a minority opinion among Greek physicians. But that’s the point. It was certainly Hippocrates’ moral opinion and intention to distinguish his school of doctors who practiced in an ethical framework set apart from Greek mainstream medicine. If the status quo medicine of the day had satisfied Hippocrates, he would not have deemed it necessary to establish his new guidelines for medical ethics.
Hippocrates, in a real sense, was counteracting the erroneous and relativistic values of his own time and culture. A beacon of light illuminating the darkness of his culture, he prefigured what Christianity would do 400 years later, and what true Christianity continues to be called to do. The core and spirit of the Hippocratic Oath is indeed the expression of an absolute standard of medical conduct. It does not alter with the passing societal customs and fads of nearly two and half millennia. Is this an oath that we can dismiss as casually as the majority seven US Supreme Court justices did in 1973?
The Nuremberg Trials of 1945-49 judged atrocities committed by the Nazi regime. The chief prosecutor at the medical doctors’ hearings pointed out that these were “no mere murder trial,” for the physician defendants had sworn by their Hippocratic Oath. Indeed, repeated mention was made at the trials regarding the preeminence of the Hippocratic Oath.
A.C. Ivy, MD, the primary expert medical advisor at the Nuremberg Medical Trials, wrote in 1949:
I realized for the first time at the Nuremberg trials, the full meaning and importance of the contributions of Hippocrates and his school to medicine and human welfare … He apparently realized that a scientific and technical philosophy of medicine could not survive through the ages unless it was associated with a sound moral philosophy. One cannot conceive of a sound society with medicine that does not have a sound moral philosophy.
Ivy added that the “precept, introduced by Hippocrates, is ingrained in the mind of the profession, and only a misguided public would want its physicians taught any other therapeutic principle.” He warned that the profession would be derelict in its duty to abrogate the moral responsibility of its profession to business or political ethicists, which could easily spoil the intrinsic moral purity of authentic medicine for surrogate purposes.
Another medical expert at the trials, Leo Alexander, wrote that “temporal laws, in comparison to our Hippocratic obligation, enduring throughout the entire history of medicine are merely words written into sand.” Certainly, this metaphor can be applied to 1973’s Roe v. Wade – a direct violation of the Hippocratic Oath – as a mere writing in sand which, with its recent overturning, has now been washed away.
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Does Western culture have a sound moral philosophy today? If not, did society corrupt medicine, or did medicine’s violation of Hippocratic principles corrupt society? Or did they happen simultaneously? That is the value of Hippocrates and his school: they set a pure standard of medicine apart from the culture and the commonality of irreverent medical practice. The school of Hippocrates is meant to serve at a “higher level” and advance a “right society” in addition to a “right medicine.”
The original Hippocratic Oath has endured for millennia as an enduring ethical standard. How did Nazi medicine and its physicians view the Hippocratic Oath? Strangely and paradoxically, Nazi medicine didacknowledge the value of the Hippocratic oath, but in only in an obliquely emotional way, not in a tangible and acutely practical manner. The Nazi physicians were thus able to flagrantly violate the Hippocratic oath while invoking it, unable to see the egregiously overt contradiction.
In his 1986 classic The Nazi Doctors: Medical Killing and the Psychology of Genocide, Robert Jay Lifton writes that the “oath was perceived as little more than a distant and muted ritual one had performed at medical school graduation and was readily reversed…by the direct pressures and rewards in the direction of a Hippocrates-free Auschwitz.” Even Heinrich Himmler spoke of “the great Greek doctor Hippocrates” proclaiming “a morality, the strengths of which are still undiminished today and shall continue to determine medical action and thought in the future.” Lifton notes that there was a sort of internal logic for the Nazi physicians as a “sense of recasting the medical profession…in the service of larger healing,” but that this ideology, in its Nazi form, required a rejection of the “Christian compassion for the weak.”
So, the Nazi ideology was to propagate the “superhuman” without concern for the weak, and Christian principles stood in the way. Never mind that the Hippocratic principle contradicted them as well, but the Nazi mindset upheld its image of Hippocrates, independent of what his Oath actually said. Double-speak and propagandized mind control was part of Nazi ideology.
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Is modern Western medicine exempt from such double-speak, where something can be simultaneously “true” and “not-true”? Do our modern medical students view the recitation of the Hippocratic Oath at their graduation or “white coat” ceremonies as a “distant and muted ritual” that has little practical meaning?
When I graduated from UCLA in 1984, we were provided with the original Hippocratic Oath. Since then, fewer and fewer medical schools use the Hippocratic Oath in its original form. A 1989 study showed that only 2% of medical schools administered the original Hippocratic Oath. By 2006 the AMA wrote that State University of New York Upstate Medical School in Syracuse was the only U.S. medical school that still administered the original Hippocratic Oath. The vast majority of graduating medical students were not swearing to avoid performing abortions or assisting suicides.
Modernized or self-written oaths are now the norm. In fact, the reality of doctor-induced death is written into at least one version of the oath (L. Lasagna, 1964): “…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.” It is not clear in this version of the oath if the life-taking refers to the legitimate withdrawal of futile care, or to the illicit performance of abortion and euthanasia. It could certainly be interpreted by some to justify the latter. Changing the words of the Hippocratic Oath can make it mean anything one desires. Interestingly, the Hippocratic Oath was invoked by the Nuremberg Trial’s Nazi physician defendants. They claimed they had obeyed the basic precepts of the oath. The German medical expert at the trials, Werner Leibbrandt, testified:
The Hippocratic Oath had been the universal legal and moral code of physicians for 22 centuries and had explicitly forbidden causing harm to patients, injustice and immorality. Nazi doctors and SS members who had said they relied on the Hippocratic Oath in their practices were simply grotesque.
Should the original Hippocratic oath inform the ethics of modern medicine, or should modern, possibly relativistic, medicine rewrite the oath for us? Certainly, Nazi doctors thought they could make the rules for ethical medicine. The Nuremberg Medical Trials, however, clearly judged that ethical medicine already has its rules, and these rules are embodied in the Hippocratic Oath.
To gain some insight into the relevance of the Hippocratic Oath for modern medical students, we performed a study several years ago with the UCLA medical school graduating class (“Contemporary medical students’ perceptions of the Hippocratic Oath,” Linacre Quarterly, 2018). We investigated what knowledge the students had of the contents of the original oath and how it affected their opinion of it.
Our hypothesis when we embarked on the study was that the more the students knew about the actual historic contents of the oath, the more they would want to use the original oath, or at least to allow students to choose which oath to take – original or revised. To my surprise, this hypothesis, proved completely false. We found that 79% of students considered the original oath relevant, but 53% disagreed that the original oath be used. Euthanasia and abortion prohibitions were recognized overall by 68% and 62%, respectively. Increased knowledge of these prohibitions was significantly better for those students who disagreed that the original oath be used. Those who disagreed that a choice of oaths be provided had significantly better knowledge of the original’s euthanasia/abortion prohibitions than those who agreed. Thus, the study found that the more students knew about the original wording of the Hippocratic Oath, the less the students wanted to use the Hippocratic Oath, or even to give students the choice of using the original Hippocratic Oath. Indeed, this completely defied our original hypothesis.
Overall, 40% felt that graduating students should be able to choose the original Hippocratic Oath or a modified oath, but many disagreed. Those who thought a choice should be withheld knew the original’s prohibitions against euthanasia and abortion significantly better than those who thought a choice should be given. Those students who felt strongly that a choice of Hippocratic Oath versions be provided (6%) or not be provided (13%) each had a 100% accuracy of identifying the euthanasia/abortion prohibitions of the original Hippocratic Oath. In other words, those who felt strongly one way or another about giving a choice to students recognized without exception the prohibitions of euthanasia and abortion.
The ray of hope in the study was that there was a definite subset of students, albeit in the minority, who felt that the original oath is extremely relevant in modern medicine, strongly felt that it should be used at graduation, and felt that the modified version eliminated important components of the original.
Unfortunately, the fact remains that few if any US medical schools now use the original Hippocratic Oath. The Hippocratic prohibition of abortion and euthanasia is a taboo subject not readily discussed in polite medical school spheres, is perhaps only peripherally recognized, and is uncomfortably swept under a dusty rug. But as the adage goes, all that is necessary for evil to triumph is for good people to do nothing. And, indeed, medical students’ and health care providers’ impressions of the Hippocratic Oath do have practical importance, not only in specific cases, but in general health-care policy.
A 2016 “Consensus Statement on Conscientious Objection in Healthcare” by a group of prominent bioethicists argued that legal protection of physicians who conscientiously object to euthanasia and abortion is “indefensible,” and that physicians who refuse to perform such procedures should be brought before “tribunals” and forced to “compensate society and the health care system for their failure to fulfill their professional obligations.” Imagine – to be brought before a tribunal for being true to the moral stipulations enshrined in the Hippocratic Oath! But the consensus statement says also that medical students too “should not be exempted from learning how to perform basic medical procedures they consider to be morally wrong.” Would the Nuremberg Medical Trials and the weight of history have concurred with this proclamation?
As has been succinctly observed, “unprecedented technologic advances have been accompanied by the same moral laxity that plagued Nazi Germany. Once again, as in the days of Hippocrates, there is an entire subset of medical professionals who have blurred the line between killing and curing.” When the moral reservoir is depleted and the spark of goodness upon which we have based our entire civilization is extinguished, what authority shall we invoke to conduct our lives in an orderly, ethical manner?
Extreme ideologies can easily hijack a medicine separated from its moral roots, particularly in a relativistic society forgetful of its moral foundations. An altered and truncated paradigm of medicine devoid of Hippocratic principles is not in the best interests of patients or society. If, indeed, many in the medical profession do not consider the Hippocratic Oath relevant in our technological medical age, then the fundamental question remains: If not the Hippocratic Oath, what moral framework is invoked in the ethical practice of medicine, and what by what authority does this moral framework make its claims? The World Health Organization? The political party in power at any given time? And if the voids in medicine are not refilled by Hippocrates’ principles very soon, they may indeed be filled by something far less benevolent.
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Sources:
- Roe v. Wade, 1973. https://supreme.justia.com/cases/federal/us/410/113/.
- Ivy, A.C. “Nazi war crimes of a medical nature.” JAMA 1949; 139: 131-135.
- Alexander, L. “Medical science under dictatorship.” NEJM 1949;241:39-47.
- Lifton, R.J. The Nazi Doctors: Medical Killing and the Psychology of Genocide. 1986; New York, NY: Basic Books
- Lasagna, L. “A Modern Hippocratic Oath.” https://www.aapsonline.org/ethics/oaths.htm#lasagna
- Baumgartner, F.; Flores, G. “Contemporary medical students’ perceptions of the Hippocratic Oath.” Linacre Quarterly 2018;85:63-73.
- Ballantyne, A.R.; Card, R. et al. “Consensus statement on conscientious objection in healthcare.” Practical Ethics, 2016.