Hippocratic and other traditions in health care
quote2
"A more practical and useful objective would be to look for ways to leverage the cultural significance of oath-taking as the first step toward establishing forms of practice and cultural dispositions that promote curiosity about, and continued collective engagement with, what it means to be a physician."
"I Swear by Apollo..."
"Given the myriad challenges facing almost every aspect of medicine in the 21st century, the need for physicians to make a formal warrant of diligent, moral, and ethical conduct in the service of their patients may be stronger than ever." -- Howard Markel, M.D.
QUOTE
"In the context of the urgent need to mobilize consciences in favour of life, people in the field of healthcare need to be reminded that "their responsibility today is greatly increased. Its deepest inspiration and strongest support lie in the intrinsic and undeniable ethical dimension of the health-care profession, something already recognized by the ancient and still relevant Hippocratic Oath, which requires every doctor to commit himself to absolute respect for human life and its sacredness." [#35]
The Holy Father expanded on the evil of abortion:
"It's against the Hippocratic oaths most doctors take. It is an evil in and of itself, but it is not a religious evil in the beginning, no, it's a human evil. Then obviously, as with every human evil, each killing is condemned," he said.
prayer of maimonides
"Let me be contented in everything except in the great science of my profession." Almighty God! Thou hast chosen me in Thy mercy to watch over the life and death of Thy creatures. I now apply myself to my profession. Support me in this great task so that it may benefit mankind, for without Thy help not even the least thing will succeed."
Pseudo-Galen:
"The perfect physician is one who has completed the whole cycle of theoretical and practical studies." [both theory and practice] Maimonides: shalem/shelemut: the four human accomplishments: [from Guide of the Perplexed] Resources or wealth Physical perfection Ethical perfection Intellectual excellence Perfection in medical knowledge is the aptitude of making a decision with the least possible percentage of error.
quote
"This conservative minimalism is also the source of an inability to speak in as meaningful a way to many students' and physicians' most central concerns and passions."
"Daily Prayer of a Physician" Formerly attributed to Maimonides
"Thou sendest to man diseases as beneficent messengers to foretell approaching danger and to urge him to avert it." "Do not allow thirst for profit, ambition for renown and admiration, to interfere with my profession."
Edmund Pellegrino, M.D.
"Virtuous persons will always be the beacons that light the way back to moral sensitivity."
The Hippocratic Oath Invoked...
- "Can Physicians Work in US Immigration Detention While Upholding Their Hippocratic Oath?"—JAMA August 2019 -"Recommending Marijuana Use: Violation of the Hippocratic aphorism of "do good or do no harm"—European Journal of Internal Medicine January 2019
From the Oath According to Hippocrates in so far as a Christian May Swear It (Urbinus 64 mss) cont.
- Into whatsoever houses I enter, I will do so to help the sick, keeping myself free from all wrong-doing, intentional or unintentional, tending to death or to injury, and from fornication with bond or free, man or woman. - Whatsoever in the course of practice I see or hear (or outside my practice in social intercourse) that ought not to be published abroad, I will not divulge, but consider such things to be holy secrets. -Now if I keep this oath and break it not, may God be my helper in my life and art, and may I be honoured among all men for all time. If I keep faith, well; but if I forswear myself may the opposite befall me. Source: W.H.S. Jones, The Doctor's Oath. (Cambridge: Cambridge UP, 1924), 23, 25.
veatch cont 3
- prohibition on surgery suggests that such work was beneath Hippocratic physicians. could also refer to a proper division of labor among specialists -normative ethical principles the main Hippocratic principle "to benefit the patient according to the physician's ability and judgment" versus Natural law perspective: "do good and avoid evil," and Kantian perspective: to follow overriding duties and respect patient autonomy or dignity Classic example: duty to tell the truth versus the therapeutic privilege -Biblical traditions focus on care for the needy and justice.
"Hippocrates Has Vital Meaning for Physicians." by Herbert Ratner, M.D.
-"A patient cannot be known adequately apart from his environment." -"We treat an individual, not a universal." -"Doing no harm" may mean taking patients off all their meds if they are on more than 5!
"Given the myriad challenges facing almost every aspect of medicine in the 21st century, the need for physicians to make a formal warrant of diligent, moral, and ethical conduct in the service of their patients may be stronger than ever."
-- Howard Markel, M.D.
From the Oath According to Hippocrates in so far as a Christian May Swear It (Urbinus 64 mss)
-Blessed be God the Father of our Lord Jesus Christ, who is blessed for ever and ever; I lie not. -I will bring no stain upon the learning of the medical art. Neither will I give poison to anybody though asked to do so, nor will I suggest such a plan. Similarly I will not give treatment to women to cause abortion, treatment neither from above nor from below. but I will teach this art, to those who require to learn it, without grudging and without an indenture. - I will use treatment to help the sick according to my ability and judgment. And in purity and in holiness I will guard my art.
Rabbi Moses ben Maimon Abu Imran Musa Ibn Maimun "Maimonides" (1135-1204)
-Born in Córdoba -Became physician to Sultan Saladin the Great in Cairo -Author of "Guide for the Perplexed," much influenced by Hippocrates, Galen and Aristotle
"The Indispensability of Hippocrates" John F. Brehany's List of Values Expressed in the Hippocratic Oath
-First, that the physician's office is to be exercised in submission to God and the fundamental goodness of human life, -Second, the value of belonging to a disciplined professional community that can authentically pass on its values to future generations, and -Third, the warning to respect nature and to care for patients and their wellbeing.
The Uses of Medical Oaths in the Twenty-First Century (Crawshaw et al)
-Plausible functions of oath-taking in medical education include: ~A symbol and public declaration of a social contract between the profession and its individual members, and society as a whole; ~A symbol of the profession's struggle to maintain its autonomy; ~A way to highlight the profession's values; A foundation for ethical practice within the profession.
Maimonides continued
-The perfect physician is a physician to which the patient "is ready to entrust in his hands both his soul and body, and follow all his directions." -The physician does not cure a disease, he cures a diseased person. Each person is a unique combination of body and emotions. -The perfect physician is always learning, testing, and humble, happy to be working towards perfection with others.
"A Philosophical Basis for the Patient-Physician Interaction" Edmund Pellegrino, M.D.
-The physician must get to know the patient and his or her values, so together they can "consent" (see-together) to a course of action. -A sick patient is particularly vulnerable, more vulnerable than they would be in any (other professional-client relationship.) -Patients must be truthful to the physician & not ask them to violate their conscience.
Pellegrino's defense of the Hippocratic oath
-almost all medical schools have students take some oath mainly with a Hippocratic framework -invocation of god reflects fact that 95% of Americans say they believe in god -strong requirements for confidentiality and non exposition of the weak -demands accountability to peers as well as patients -can be seen in context of virtue ethics, discretion, prudence, generosity and reverence
Veatch cont 2
-duty to the dying in Hippocrates oath suggests not poisoning them versus a Christian expectations to care for the ill and dying. neither tradition insists on doing everything to avoid death. - catholic tradition also insists upon avoiding any direct killing (also not found in the oath) - on abortion Christina tradition has a broader range of prohibition measures
Veatch cont.
-early greek Christians destroyed Hippocrates temple -the Hippocratic oath was mentioned very infrequently by western (Christian) writers during the first 100 years of Christianity. A 10th century version. "oath according to the Hippocrates in so far as a Christian may swear it" it addresses the oath to "god the father of our lord jesus chirst" and omits oath of secrecy - any Christians of Jewish oath would express responsibility to god and the community not to the medical profession
veatchs criticism of the Hippocratic oath
-ignores patient autonomy and informed consent. Paternalistic -encourages secrecy. cultic ritual -ignores community aspects of health and responsibility to the community at large -outdated elements: invocation of Greek or other deities prohibitions of surgery, abortion, and euthanasia.
quote3
3. The Magisterium also seeks to offer a word of support and encouragement for the perspective on culture which considers science an invaluable service to the integral good of the life and dignity of every human being.
Oath of Commitment
AS I EMBARK UPON THE STUDY OF MEDICINE AT THE UNIVERSITY OF CINCINNATI COLLEGE OF MEDICINE, I WILL: -Enter into a relationship of mutual respect with my teachers and my colleagues to enhance the learning environment and gain the knowledge, skills and attitudes of a good physician; -Uphold the highest standards of academic honesty, scientific integrity, and ethical practice throughout my training and the remainder of my professional life; -Accept responsibility only for those matters for which I am competent, maintain the trust expected of a physician, and never take advantage of the patient-doctor relationship; -Respect the patient's right to privacy; -Value the knowledge and wisdom of the physicians who have preceded me and endeavor to contribute to this tradition; -Recognize my weaknesses and strengths and strive to develop those qualities that will earn the respect of my patients, my colleagues, my family and myself; -And continue this learning throughout all the days of my life.
Concerning Physicians and Health Sirach 38
Honor physicians for their services, for the Lord created them; for their gift of healing comes from the Most High, and they are rewarded by the king. The skill of physicians makes them distinguished,and in the presence of the great they are admired. The Lord created medicines out of the earth, and the sensible will not despise them.
the Hippocratic oath classical version
I swear by Apollo physician and Asclepius and hygiene and Panaceia and all the gods and goodnesses making them my witnesses that I will fulfill according to mu ability and judgement this oath and this covenant to hold him who has taught me this art as equal to my parents and to live life in partnership with him and if he is in need of money to give him a share of mine and to regard his offering as equal to my brothers in male linage and to teach them this are if they desire to learn it without fee and covenant to give a share of precepts and oral instruction and all 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 an oath according to the medical law, but no one else
Islamic ethics
I swear by God ...The Great To regard God in carrying out my profession To protect human life in all stages and under all circumstances, doing my utmost to rescue it from death, malady, pain and anxiety. . To keep peoples' dignity, cover their privacies and lock up their secrets ... To be, all the way, an instrument of God's mercy, extending my medical care to near and far, virtuous and sinner and friend and enemy.
Oath of Dr. Louis Lasagna--1964
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.
oath cont.
I will apply dietetic measures for the benefit of the sick according to my ability and judgement I will keep them harm and injustice I will neither give a deadly drug to anyone who asked for it. nor will I make a suggestion to this effect. similarly I will not give to a women 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
Oath of Dr. Louis Lasagna cont.
I will apply, for the benefit of the sick, all measures [that] 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.
Oath of Dr. Louis Lasagna cont. 3
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. Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, and used in many medical schools today.
Oath of Dr. Louis Lasagna cont. 2
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.
sacrifice of Elijah?
My child, when you are ill, do not delay, but pray to the Lord, and he will heal you. Give up your faults and direct your hands rightly, and cleanse your heart from all sin. a sweet-smelling sacrifice, and a memorial portion of choice flour, and pour oil on your offering, as much as you can afford.
VATICAN CITY
On his return flight from Mexico, Pope Francis strongly rejected abortion as a response to the fears surrounding the Zika virus outbreak.
Maimonides on the Perfect Physician Samuel S. Kottek, M.D.
Pseudo-Galen: "The perfect physician is one who has completed the whole cycle of theoretical and practical studies." [both theory and practice] Maimonides: shalem/shelemut: the four human accomplishments: [from Guide of the Perplexed] Resources or wealth Physical perfection Ethical perfection Intellectual excellence Perfection in medical knowledge is the aptitude of making a decision with the least possible percentage of error.
Dignitas Personae Instruction on Certain Bioethical Questions
September 8, 2009: "In the current multifaceted philosophical and scientific context, a considerable number of scientists and philosophers, in the spirit of the Hippocratic Oath, see in medical science a service to human fragility aimed at the cure of disease, the relief of suffering, and the equitable extension of necessary care to all people. At the same time, however, there are also persons in the world of philosophy and science who view advances in biomedical technology from an essentially eugenic perspective." [#2]
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Then give the physician his place, for the Lord created him; do not let him leave you, for you need him. There may come a time when recovery lies in the hands of physicians for they too pray to the Lord that he grant them success in diagnosis and in healing, for the sake of preserving life. He who sins against his Maker, will be defiant toward the physician.
muslim spiritual care services
To strive in the pursuit of knowledge and. harnessing it for the benefit but not the harm of Mankind. To revere my teacher, teach my junior, and be brother to members of the Medical Profession joined in piety and charity. To live my Faith in private and in public, avoiding whatever blemishes me in the eyes of God, His apostle and my fellow Faithful. And may God be witness to this Oath. And when I am ill it is He Who cures me.
Pope Francis on Abortion and the Hippocratic Oath
VATICAN CITY — On his return flight from Mexico, Pope Francis strongly rejected abortion as a response to the fears surrounding the Zika virus outbreak. "Abortion is not the lesser of two evils. It is a crime. It is to throw someone out in order to save another. That's what the Mafia does. It is a crime, an absolute evil," the Pope said on Feb. 18, 2016.
the healing of tree of life
Was not water made sweet with a tree in order that its power might be known? And he gave skill to human beings that he might be glorified in his marvelous works. By them the physician heals and takes away pain; the pharmacist makes a mixture from them. God's works will never be finished; and from him health spreads over all the earth.
A person is merely a "tenant in this temple i.e., the human body] for Him, Who made him to dwell therein and stipulated that in lieu of the payment of rent for his dwelling he take care of its upkeep and preservation, its cleaning, repair and use, and in a manner which would help him in his search for happiness in both this world and in the next world."
[Dar Su'ad al-Sabbah]
oath cont.
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
The great variety of oaths and lack of coherence of ethical frameworks
plays an important role in undermining the authority of oaths and oath-taking for a new generation of medical practitioners."
Maimonides:
shalem/shelemut: the four human accomplishments: [from Guide of the Perplexed] -Resources or wealth -Physical perfection -Ethical perfection Intellectual excellence Perfection in medical knowledge is the aptitude of making a decision with the least possible percentage of error.
"Abortion is not the lesser of two evils. It is a crime. It is to throw someone out in order to save another. That's what the Mafia does. It is a crime, an absolute evil,"
the Pope said on Feb. 18, 2016.
oath cont. 2
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 the treatment or even outside o the treatment in regard to the life of men which on no account one must spread abroad I will keep to myself holding such things shameful to be spoken about
