The pledge traditionally affirmed by physicians upon entering their profession. It embodies the general ethical principles governing relations of a physician to his profession and to his patients. Variant readings of its text frequently represent Christian or non-Christian modifications.
The earliest form of the oath is found among a corpus of some 70 ancient Greek medical writings that have been associated with the name of hippocrates of Cos (460–377 or 359 b.c.) and have been referred to as the Hippocratic Collection. This short work shares in historical, textual, and hermeneutical difficulties besetting the general Hippocratic literary question.
Hippocrates was held in such regard, even by plato, his junior contemporary, that the ethos inspired by his idealized image—namely, deep medical insight and high performance of duty—accounts for the association made by history between his name and the writings included today in the Hippocratic corpus. The texts reflect a Grecian setting. The importance of these writings, however, described by some as the library of the School of Cos, composed and collected over a span of five centuries, is measured by the value consistently placed on them in succeeding ages. The present text of the oath is thought to be probably post-Hippocratic. One opinion finds a pre-Hippocratic source in Pythagorean tradition. Erotian, living in Nero's time, considered the oath to be genuine. Thus, whether from his hand or spirit, the oath is worthily deemed Hippocratic.
In addition to the usual division of the text's teaching into duties to the healing art and to the patient, there is a statement of the goal of medicine. The physician practices his art for the benefit of the patient in the form of health, a human good. Thus is it linked with the science of human good, or ethics. Hence, the second half of the oath is suitably directed to ethical matters in medicine. A further unfolding of the temperate virtues, becoming to a physician, is found in other works of the collection, for example, in "On the Physician" and "On Decorum."
Some things in the oath are difficult to interpret. The precise meaning of "oath" and "indenture" in the text, the professional import of "the craft of the knife," and the ethical connotation in ancient Greece of forswearing abortive procedures and of the giving of harmful drugs present goading questions. Despite such obscurities the physician who would use this pre-Christian document as a venerable source will find it consistent with later professional ethical principles.
The oath's hardy medical affinity has made it a symbolic vehicle for medical ideals. A professional pledge is not only written; it is also lived. The literal meaning therefore is secondary to the moral signification as this has come to be understood through doctor-patient experience acquired over centuries. With appropriate modification the ethical burden of the Hippocratic Oath has been found compatible with both Christian and non-Christian thought. Its binding force has been variously estimated from that of an obligatory promise to that of exemplary counsel. In general it has been the traditional formula pledged during graduation exercises at medical schools.
A nostalgic simplicity characterizes its presence among the modern national and international codes of medical ethics. In the face of problems arising from technical medical advance and mankind's stockpiling of scientific means that function both for human destruction and for the deterrence of aggression, ethical principles with a greater degree of explication have had to be formulated. Modern medical codes proclaim the humanistic goal of medicine and protect physicians from untoward pressures to have them participate in genocide or in the aggressive activities of ABC warfare or in certain inhumane uses of psychological skills. Although the medical practice of Hippocrates is long outmoded, his ideals are enduring.
Bibliography: hippocrates, "The Oath," ed. and tr. w. h.s. jones, Hippocrates v.1 (Loeb Classical Library; London-New York-Cambridge, Mass. 1948) 291–301. l. edelstein, The Hippocratic Oath: Text, Translation, and Interpretation (Baltimore 1943). c. j. singer and e. a. underwood, A Short History of Medicine (2d ed. New York 1962).
[a. w. murphy]
The recitation of the oath attributed to Hippocrates is an integral part of medical school graduation in the Western world. Referred to as either the Hippocratic oath or the oath of Hippocrates, the oath exists in a variety of forms and has been translated and revised over the centuries. Early versions advised physicians to practice the art of medicine solely for the benefit of their patients. Twentieth-century versions emphasized that doctors abstain from practices that would harm their patients, and stress the ethical basis of medical practice.
The Hippocratic oath requires that medical graduates solemnly promise to adhere to a course of professional conduct that has guided physicians in ages past. It also requires that they promise to revere their instructors and to care for them should they ever require assistance; transmit (teach) the art of medicine to deserving persons; utilize good judgment to provide beneficial treatment for patients; abstain from providing any harmful or dangerous treatments; refrain from intervening in cases that require greater skill and training; remain pure and holy in the practice of the profession; limit involvement with patients solely to the benefit of the patient's health; give no cause for disrespect of the profession through word or deed; and keep confidential all that is learned through practice of the profession. The oath concludes with a statement that if the physician adheres to these precepts, he or she will enjoy happiness, success, and respect.
The Hippocratic oath is an anachronism. It is outdated and holds no power. There are no sanctions for those who violate its precepts, nor does it have status in a court of law. It is a historical document with unconscious, symbolic dimensions stemming from its 2,500-year-old historical tradition. Its persistent use during medical school graduation ceremonies does provide symbolic significance beyond words. In essence, it emphasizes the unique role and responsibilities of the physician in activities of a high nature and establishes a basis for the guiding principles of medical care, which include autonomy, beneficence, justice, and nonmaleficence.
The most recent version of the oath is the product of collaboration between doctors from both the United States and Europe. It contains three guiding principles—primacy of patient welfare, patient autonomy, and social justice—and lists ten professional responsibilities. It stresses the centrality of altruism in the physician-patient relationship. It states that the quality of medical care must not be compromised by market forces, societal pressures, or administrative exigencies. It emphasizes that doctors must be honest with their patients and empower them to make informed decisions about their treatment. Patient decisions about their care must be recognized as paramount, as long as those decisions are consistent with ethical practice and do not contribute to demands for inappropriate care. It urges physicians to work actively to eliminate discrimination in health care, whether based on race, gender, socioeconomic status, ethnicity, religion, or any other social category.
See also: Advance Directives; Euthanasia; Informed Consent; Suicide Types: Physician-Assisted Suicide
WILLIAM M. LAMERS JR.
Hip·po·crat·ic oath / ˈhipəˈkratik/ • n. an oath stating the obligations and proper conduct of doctors, formerly taken by those beginning medical practice. Parts of the oath are still used in most medical schools.