Hippocratic Oath Gives Way to `Ethics a la Mode'

Article excerpt

The Hippocratic oath has been revised extensively for political correctness and other purposes in recent years, and some doctors charge this has weakened and stripped the oath of the "father of medicine" of its focus.

Dr. Paul R. McHugh, Henry Phipps professor and director of the department of psychiatry and behavioral sciences at Johns Hopkins, expressed his concerns about oaths being recited in medical school commencements in a commentary published this month in the journal Nature Medicine.

He argued that some of the revised versions of the 2,500-year-old oath, including those now in use at the Johns Hopkins School of Medicine and Harvard, tend to be more "self-centered" than patient-centered and are ridden with a lot of "vague precept."

"Such articulations of ethics a la mode are all about benefits to the physician and only remotely about `benefits to the sick,' " he said.

"That the best and brightest young doctors recite such self-serving and jejune oaths is more than an embarrassment. It's a false step at a time of great vulnerability for medicine - a time when others such as `health' managers and government legislators are ready to define - with clarity - just what doctors will do."

Dr. McHugh's commentary examines deletions his institution made in the Hippocratic oath, beginning in the '60s, and scrutinizes substitute versions drafted at Johns Hopkins in 1985 and 1994.

His analysis also looked at revised versions of the Hippocratic oath that were recited by Harvard University medical school students beginning in 1989 and 1994.

Because more women are becoming doctors today, the updated oaths removed all the references to men contained in the original.

"But something is lost - a certain tough-mindedness" in the revised Johns Hopkins oaths, Dr. McHugh said. "Although the Hippocratic goal - to benefit the sick - remains, it is not the first assertion about behavior. Rather, the expression `I will lead my life and practice my art in uprightness and honor' leads off" in today's oath.

He said that and other language in the revised Johns Hopkins oaths smacks of "self-absorption."

The original oath of Hippocrates is the earliest medical oath still influencing current Western medical practices. According to a report in the journal Academic Medicine, it was written "in the Hellenic period by an unknown sect and later became attributed to the Hippocratic medical tradition," based on the premise that a well-trained doctor can treat - and even cure - disease by reading medical writings and through experience. The Hippocratic tradition challenged doctors whose remedies were magic and witchcraft.

The famed Turkish-born physician Galen, who lived in the first centuries after Christ, was largely responsible for making Hippocrates famous. Hippocrates practiced medicine on the Greek island of Cos several hundred years before Galen was born. Galen held that the Hippocratic oath was a model for the ethical practice of medicine. …