The Hypocritic Oath

I was listening to Jerry Cronin, the Right-to-Life Party gubernatorial candidate in New York, on the radio this morning, and he claimed that the Hippocratic Oath proscribes abortion. This sounded wrong to me, so I looked it up. Turns out he’s right. The injunctions of the original oath are remarkable. They are:

• To tithe one’s income to one’s teacher and his offspring;
• To teach, for free, anyone who swears the same oath;
• To help the sick and not to harm them (the oft-cited “first, do no harm” clause, although it isn’t put exactly that way);
• No euthanasia;
• No abortion;
• No surgery;
• No sex with patients;
• To protect the privacy of patients and their families.

Leaving aside the question of whether this medical advice is actually Hippocratic, it is certainly, for the most part, medical advice. (Unsound and out-of-date medical advice in my view, but that’s another matter.) The modern version, to which the overwhelming majority of medical students are still required to swear, is rather different. There are many but this is among the most popular.

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.

I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

The tithing and teaching provisions have been reduced to an anodyne exhortation to “respect” and “gladly share” one’s scientific knowledge. The medical advice has disappeared altogether, replaced by vague social duties. What are the “special obligations” that doctors owe to the “sound of mind and body”? To what extent, exactly, is a doctor obliged to account for his patient’s “family and economic stability,” and how is this a medical matter?

Respecting patients’ privacy survives more or less intact; the rest is cuddle clauses. If you want a warm, sympathetic, understanding, humble doctor with awareness of his own frailty, be my guest. I’d prefer a cold, nasty, arrogant doctor whose knowledge if his field is current and who will back, when necessary, his best medical judgment to the hilt. You can have Charles Bovary; I’ll take Monsieur Larivire. Doctors of my acquaintance tell me that no one takes the modern oath very seriously, which is fortunate. But if it isn’t taken seriously why should it be taken at all?