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The Hippocratic Oath: Revised but still relevant

The 2,500-year-old Hippocratic Oath, one of the most enduring documents in the history of medicine, has recently been revised to more appropriately reflect contemporary thinking. Since its inception, multiple generations of graduating medical students have vowed to uphold the principles of ethical conduct defined in this pledge.

It remains the ultimate moral benchmark that affirms the sanctity of the medical profession’s doctor-patient relationship. Lately, some nonphysicians, in the interest of reforming health care, have challenged that moral bond. Adherence to and recognition of the oath’s principles, which are firmly rooted in the mores established on the streets of ancient Athens, must continue as it has for centuries for the benefit of the patient who the doctor serves.

Physicians from the early Greek era to modern times have always had a special closeness to the oath beyond its ethical value. The very word “profession” comes from “profess”, which in its original meaning was “to swear an oath.”

Long ago in Greece, the oath’s earliest form was constructed to fill a void that had been created by the absence of any legal or ethical restraints on the practice of medicine. In that environment, those practitioners who took the vow and voluntarily adopted its axioms could claim authority over less-qualified health providers and therefore justify charging higher fees.

But with the passage of time, the archetype oath became more than a way for physicians to enrich themselves. It was transformed into the moral bedrock for the practice of medicine.

The oath consisted of two main parts: The first section addressed the obligation of the doctor to transmit medical knowledge to others. The second part was a summary of medical ethics as a self-regulated profession.

The most recently revised rendition embraced on Oct. 14 in Chicago by the World Medical Association is called the Declaration of Geneva or Physician’s Pledge. It is a direct, albeit distant, relative of the original Hippocratic Oath. It more realistically considers today’s medical profession and the contemporary influences on the doctor’s practice.

The modern version espouses the original oath’s doctrine for the physician’s dedication to a life service, respect for the well being of the patient, confidentiality, not permitting outside factors to intervene with duty to patients and it honors the sharing of medical knowledge. While the present-day pledge is not in the poetic language of the past, it is easier to understand and eliminates some of the inappropriate, nonpolitically correct sections in the original document.

Like the ancient oath, the current Physician’s Pledge is a reminder of the special, inviolate relationship between a doctor and his/her patient. One can hope that physicians will be able to continue to cleave to this fundamental principle of medicine and not have those in authority eliminate this historic tradition.

Stolz is a retired physician with a longtime interest in the history of medicine.

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