The Hippocratic oath adapts over time, Oct. 1 2007

New doctors still take a pledge, but the trend has been to modernize Hippocrates' version.

Many of today's doctors, upon receiving their degrees, swore by the Hippocratic oath — one of the oldest and most familiar texts in the field of medicine. But as times have changed, so has the pledge. Today, more and more medical schools are forgoing the ancient text in favor of something more modern.

The Hippocratic oath was penned 2,400 years ago by the ancient Greek physician Hippocrates who, sensibly, instructed doctors to treat patients to the best of their ability and respect each patient's privacy.

But his professional guidelines also included lesser-known details: The oath advises doctors to avoid sexual relations with patients, treat their teachers as they would members of their own family and teach the art of medicine to the next generation "without fee."

It also obliges doctors not to perform surgery, abortions or euthanasia.

Abortion and euthanasia (along with infanticide) were common in Hippocrates' day — which meant that in its time, the oath wasn't a reflection of popular opinion and didn't quite take off.

Despite that, it stuck around. Ancient Greek physicians who succeeded Hippocrates found much to admire in his body of work and took up his oath in earnest. By the Middle Ages, medical professionals began tinkering with the wording, notably adding references to God. The oath eventually made its way to the U.S., where, by the early 20th century, about one-third of medical schools administered it to graduating students.

Professional oaths ultimately became the norm in U.S. medical schools during the last century. But although all schools now use some form of an oath, just half of those are the Hippocratic.

Which isn't surprising — the original text is out of date and controversial. A minority of today's medical school oaths prohibit euthanasia, and even fewer proscribe abortion. And one would be hard-pressed to find an oath that requires doctors to swear off surgery and teach without pay.

Some medical schools now offer students a variety of oaths they can recite at graduation. The Oath of Maimonides, a vaguely religious recitation written by a Jewish physician in the 12th century, is on the list (it was originally intended to be recited daily), as is the Declaration of Geneva, a pithy pledge adopted by the World Medical Assn. in 1949. And so is the Oath of Lasagna, which is more serious than its name implies. The oath was written in 1964 by former Tufts University medical school dean Dr. Louis Lasagna; it calls on doctors to remember the importance of "warmth, sympathy and understanding" in their practice.

Lasagna's oath is popular, but about one-fourth of all schools now opt to write their own. The custom oaths do away with much of Hippocrates' more controversial material, but most retain his pledge of confidentiality. They also add provisions that Hippocrates left out: Many prohibit racism, for one, and other kinds of discrimination. Few, curiously, prohibit sexual relations with patients.

The act of pledge-taking in medicine seems poised to last, though the original content of Hippocrates' oath appears unlikely to endure.

Which may be for the best. To date, scholars can't uniformly agree that Hippocrates even wrote the oath attributed to him. Some suspect it was written by one of the Pythagoreans, the ancient Greek philosophers whose lasting legacy — geometry — is the target of complaints issued by high school students, not doctors.

Elena Conis
Esoterica Medica
LA Times

Hippocratic Oath — Classical Version

DWDV Comment: Astute readers will notice (a) references to ancient Gods, (b) parternalism and
misogyny, (c) free tuition for followers, (d) refusal of abortion, euthanasia and surgery and
(e) no reference to preventive medicine.

Hippocratic Oath — Modern Version

DWDV Comment: Astute readers will notice that the modern version
is consistent with Physician Assisted Dying (PAD).

"First, do no harm"

The astute reader will also notice that the commonly used expression "First, do no harm" appears in neither the classical nor modern Hippocratic oath. It is, rather, a helpful summary for a doctor to do his or her best, recognising that many treatments have side effects and that the net benefit of treatment should outweigh the net downsides of that treatment.

For a very long time it has been assumed that the doctor decides exclusively in his or her "expert" capacity whether the benefits are greater than the downsides. However, in modern western society, as evidenced in the modern Hippocratic oath's reference to "warmth, sympathy and understanding", recognition of what the patient believes, with full information, to be the greater good or harm, is now accepted practise.