Do No Harm

The following is the oath that all doctors would swear when they entered the medical profession, from the time of Hippocrates around  400 BC (emphasis mine).

• I swear by Apollo the Physician and Asclepius and Hygieia and Panaceia and all the gods, and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant:
• To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art–if they desire to learn it–without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken the oath according to medical law, but to no one else.
• I will apply dietic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.
• I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.
• I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.
• Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.
• What I may see or hear in the course of treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep myself holding such things shameful to be spoken about.
• If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.

It was changed over the years to be more in line with the culture (for instance, the Greek gods had to go), but was generally the same. The parts I have emphasized are things that were removed in the next version. The Declaration of Geneva in 1948 amended the oath as follows:

• I solemnly pledge to consecrate my life to the service of humanity
• I will give to my teachers the respect and gratitude which is their due;
• I will practise my profession with conscience and dignity;
• The health and life of my patient will be my first consideration;
• I will respect the secrets which are confided in me;
• I will maintain by all means in my power, the honour and the noble traditions of the medical profession;
• My colleagues will be my brothers
• I will not permit considerations of religion, nationality, race, party politics or social standing to intervene between my duty and my patient;
• I will maintain the utmost respect for human life, from the time of its conception, even under threat, I will not use my medical knowledge contrary to the laws of humanity;
• I make these promises solemnly, freely and upon my honour.

Note that the injunction against euthanasia is gone as is that against injustice, mischief and sexual relations with patients or their families. In 2005 it was changed again. Once again I have highlighted sections that changed or were removed.

• I solemnly pledge to consecrate my life to the service of humanity;
• I will give to my teachers the respect and gratitude that is their due;
• I will practise my profession with conscience and dignity;
• The health of my patient will be my first consideration;
• I will respect the secrets that are confided in me, even after the patient has died;
• I will maintain by all the means in my power, the honour and the noble traditions of the medical profession;
• My colleagues will be my sisters and brothers;
• I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;
• I will maintain the utmost respect for human life;
• I will not use my medical knowledge to violate human rights and civil liberties, even under threat;
• I make these promises solemnly, freely and upon my honour.

Aside from a multitude of considerations that are not to intervene, we have some interesting changes. Confidentiality now extends beyond the patients life, women are now explicitly included in the text, and religion is no longer mentioned. It has morphed into "creed". I can't find a good reason for the change. "Creed" is a more vague term, but certainly not broader or narrower. Perhaps someone was upset by the mention of the word "religion."

The main point is that the 2200 year old, prohibitions against euthanasia and abortion have both been removed, as well as the prohibition against injustice and sexual misconduct, all in the matter of a few years.

It's all a moot point, since no oath is required of doctors today. How far we have come.

Posted in: Ethics,Medicine,Thought