A Question of Relevance
Should the Hippocratic Oath continue to set the ethical standard of patient care for today's physicians, or is the oath an anachronism that ought to be retired?
Many doctors disagree on the answer.
"When you are a young doctor, usually you laugh about taking an oath in the name of long forgotten Greek gods," a vascular surgeon wrote to Medscape. "As years go by and you face complicated ethical cases, the oath begins to make more and more sense. Sometimes it can be a burden, but staying true to your pledge makes you finally realize that the Hippocratic Oath is a true jewel of humanity, as true and modern now as when it was first written."
An orthopedic surgeon offered a countervailing view.
"Ethics and morality are taught long before graduating from medical school," he observed. "Any oath is symbolic, and agreeing to it does not change a person's underlying honesty or compassion. Technology has advanced far beyond our ethics, and an oath centuries old cannot encompass all of modern medical science or practice. An oath of some form will remain, but it is window dressing, much like our academic robes."
One of the oldest professional oaths, the Hippocratic Oath is 2400 years old. However, medical students pledging their allegiance to the oath as a group is of relatively recent vintage. The practice began at the University of Wittenberg in Germany in 1508, and it has waxed and waned in popularity until the second half the 20th century, when it became entrenched as a medical school tradition.
Nearly all medical students take an oath of some sort today—either the Hippocratic Oath or one of a growing number of replacements.
Since the 1950s, there have been repeated efforts to modernize the oath to keep it relevant. It has been tweaked, revised, and replaced, and the replacements have been revised, and revised again, in an attempt to accurately reflect the changing expectations of ethical behavior by doctors toward their patients in a world in which the doctors often do not have the last word over care decisions.
Which oaths have doctors taken over the past few decades? Do those who took the Hippocratic Oath still view it as being relevant to the practice of medicine? Should the traditional oath be revised to reflect contemporary ethical concerns?
To find out, we queried medical school students and practicing physicians. We also posted an online poll that drew over 2600 responses from doctors, and over 200 comments, many of them extensive. Here's what we learned.
Modernized Oath Replacements
Over one half (56%) of our physician respondents had recited the traditional Hippocratic Oath in medical school, translated from the ancient Greek.
Three percent had pledged to the oath of Maimonides, a traditional oath for physicians attributed to Maimonides, a medieval philosopher and physician, used as an alternative to the Hippocratic Oath.
Six percent had taken the 1948 Declaration of Geneva, which established ethical guidelines for physicians after World War II in the wake of the atrocities committed by the Nazi doctors, which were revealed at the Nuremberg trials.
Five percent had recited a modified version of the Hippocratic Oath written in 1964 by Louis Lasagna, MD, academic dean at Tufts University School of Medicine.
Nine percent had pledged to an alternative oath written by their medical school faculty; 1% had recited an oath written by their medical school class; and 14% did not pledge to any physician oath.
Three quarters of respondents (75%) were 45 years of age or older. Twelve percent were 35-44 years of age; 9% were under 34 years of age.
An indication of how oath-taking has changed in recent years was provided by a survey conducted in 2009, in which 98 medical school deans in the United States and Canada reported the form of the oaths used at their institutions. It found that use of the traditional Hippocratic Oath was on the wane. In 33.3% of the schools, students took the Lasagna Oath. The next most commonly used oath was the Declaration of Geneva (15.6%). Tied for third, at 11.1%, were the traditional Hippocratic Oath and "other," which included oaths written by a medical school faculty, its students, or the two in collaboration.
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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Neil Chesanow. Is It Time to Retire the Hippocratic Oath? - Medscape - Jan 25, 2017.