Hippocratic Oath

Hippocrates (bust, Pushkin Museum)

The Hippocratic Oath, dating from the 4th century BC, is the first known set of written rules governing medical ethics. Some of its principles are still valid today.

Most sources relating to the life of Hippocrates are indirect, and the authenticity of many of the writings attributed to him is open to question. This makes it difficult to distinguish reality from legend. In any case, he is considered the first to have separated medicine from other fields of knowledge, to have formalized ethical rules for its practice and to have emphasized clinical observation. The therapeutic principles of Hippocratic medicine, however, have little in common with modern medicine.

The original Hippocratic oath

The Hippocratic principles are as follows:

• Medicine is an art to be handed down from doctor to doctor
• The disciple owes respect and assistance to his master and his descendants
• Monopoly of knowledge
• Principle of beneficence (doing good)
• Principle of refusal to harm (including refusal of abortion, assisted suicide and euthanasia)
• Dedication
• Notion of excluding surgery from the field of medicine
• Prohibition of seduction and sexual relations with patients or their relatives
• Medical confidentiality
• Honorability of the profession
• Religious references and authority

The Hippocratic Oath today

Contrary to popular belief, doctors are not obliged to take the Hippocratic Oath. Depending on the country, various Hippocratic principles are not respected today:

• In all societies, surgery is now part of medicine.
• According to the evolution of moral standards and individual "consciences" specific to each society (e.g.: respect for "masters" and their descendants, euthanasia, abortion, breach of medical confidentiality in certain circumstances, relativity of notions of "good" and "evil", etc.).
• According to the evolution of lifestyles specific to each society (e.g.: the relativity of the notion of "devotion" in the face of the notion of personal fulfillment).
• Infringements imposed by public authorities in various contexts are commonplace to varying degrees:
  • Tending to force the breaking of professional secrecy by judicial decision or arbitrary executive decision
  • Involvement of doctors in police, military or national security operations
  • Involvement of doctors in judicial executions (e.g. China, United States), institutionalized torture (e.g. United States, Israel), the development of chemical or biological weapons (e.g. United States, Syria), institutionalized discrimination (e.g. segregationist United States, South African apartheid, Israel), examinations carried out without their consent (e.g. in the United States)....), examinations carried out without any interest for the patient as part of legal proceedings (all countries), forced sterilizations (e.g. Nazi regime, post-war Australia, Finland, Norway,...) or for payment (e.g. India in the '80s,...),...
• Religious or sacred references are now generally absent from medical practice.

Ethical rules are now governed by law and by the codes of national medical associations. These rules, which vary from country to country, are also sometimes subject to specific situations (e.g.: military doctors, medical officers, etc.). However :

• In some countries, it is customary for doctors to take an "updated" version of the oath when they graduate. When this is the case, however, the authority of the oath is frequently undermined by the fact that :
  • For practical reasons, the oath is often taken by a single representative on behalf of all graduates, without their opinion being sought (e.g.: Université Libre de Bruxelles, where the "representative" is the student in his or her graduating class with the highest marks in examinations).
  • On the ordinal and legal levels, only the codes of ethics and the body of legislation must be respected.
• Generally speaking, there are common principles, proclaimed if not always respected, in the codes of ethics and/or legislative corpus of all countries, as well as certain Hippocratic principles:
  • Duty of beneficence
  • Refusal to harm (the inclusion of abortion, assisted suicide and/or euthanasia in this framework varies from country to country)
  • Devotion
  • Prohibition on using one's influence to obtain undue sexual or pecuniary favors
  • Medical confidentiality
  • Honorability of the profession

Author(s)

Dr Shanan Khairi, MD

Bibliography

Jouanna J, Hippocrate, Paris, Librairie Arthème Fayard, 1992, annexe I

Littré E, Oeuvres complètes d'Hippocrate, vol. 4 (Baillière, Paris 1844), pp. 628-632