A Modern Scrutinization of the Hippocratic Oath
Luke Krier / Spring Semester 2022
How our medical professionals respond to crises is of the utmost importance — it is literally a problem of life and death. Questions like “is it okay to do a procedure without the consent of the patient if it may give them a better outcome?” or “in cases of high need and little capability, who do we attend to first?” are not mere hypotheticals: these are questions doctors and physicians in the field must answer every day. One highly influential answer to these questions is the Hippocratic Oath, a code of ethics and commands for doctors to regulate their conduct. Prior to the introduction of the Hippocratic Oath, medicine was highly speculative and relied heavily on superstition for its answers. Moreover, in ancient Greece, there was no requirement for becoming a physician or a doctor, and thus many charlatans ‘practiced’ medicine (“Part I” 1482-1483). The Hippocratic Oath was then employed to fix these issues and standardize medicine on “accurate observation, accumulated experience and logical reasoning” (“Part I” 1482). The principles it established have historically played key roles in landmark legal and ethical decisions. For example, they laid the groundwork for the basic ethical code used in the Doctor’s Trial that prosecuted the Nazi Party’s physicians. However, just because its principles have been foundational to western medical ethics does not justify leaving them unscrutinized — tradition is no good justification. In what follows, this paper will scrutinize the Hippocratic Oath to argue thatthat although it set many of the ethical underpinnings of western medicine, the text of the Hippocratic Oath should not be used in medical or legal decision making because legal guidelines fill its place and the harm it can cause via its abortion injunction.
It ought to be noted that the Oath’s principles generally should not be abandoned, but rather that the Oath itself should not be adhered to. This is because the code of ethics it does establish are widely influential and, in general, good upstanding directives. For example, the most famous principle of the Oath, “First, do no harm,” (which, while this exact phrasing does not appear in the Oath the sentiment is maintained by “I will keep them [the patients] from harm and injustice”) dictates that doctors cannot intentionally do harm to the patient (Asclepiades). This principle is so fundamental, intuitively obvious, and integral to many other ethical structures arguing against it would be ludicrous; attempting to minimize the harm done to a patient is the primary goal of medicine. In another case, the Oath instructs Doctors to keep the patient’s information private — the doctor cannot disclose information from a meeting, procedure, or test to anyone without the patient’s permission. This command creates strong trust between the patient and the doctor and is overall beneficial for medicine. Most of the principles set by the Oath are good. These good principles will and ought to remain integral to medical decision making, but that does not mean the Oath is overall a force for good.
Importantly, the Oath is not necessary to modern medicine as legal structures fill its role. The Oath is no longer needed to fill the role of ethical standard because of the creation of strong legal structures and higher barriers to entry. For example, within the U.S. there are robust systems to make judgements on medical ethical questions such as abortion. The legal guidelines created by the democratic system are then adjudicated on by judges — this is what happened with the landmark Supreme Court case Roe v. Wade (and what will happen in the recent overturning case of Dobbs v. Jackson). Even apart from these legal systems, there are many independent organizations that regulate and certify medical practitioners, such as the American Medical Association, Center for Disease Control and Prevention that can similarly create patient-doctor trust. Internationally, there exists the World Health Organization and International Association of Medical Regulatory Authorities. These organizations set standards and requirements for their doctors thus regulating them without needing the Oath. Finally, even disregarding these international and extralegal organizations, codes of ethics have been established in the aforementioned Doctor’s Trial via the Doctor’s Code and in Tom Beauchamp and James Childress’ book Principles of Biomedical Ethics which “is now considered the standard theoretical framework for decision-making in medicine.” (Part I 1481). Therefore, because of the strength and number of governing organizations, it is clear that medical ethics and healthy doctor-patient relationships will not decay without the direct presence of the Oath — the Oath is superfluous.
While it is true that the mere existence of governing bodies does not warrant the end of the Oath’s usage, the Oath also presents legitimate problems that do. Particularly its infamous abortion injunction. The injunction reads: “I will not give to a woman an abortive remedy” (Asclepiades). The text appears unambiguous: doctors are forbidden under any circumstance to give a woman an abortion. The injunction understood in this manner is dangerous. Restrictions on abortion directly coorelate with an direct increase in mortality rates (Haddad et al. 124). In fact, the death of the child-bearer happens at a rate of “34 deaths per 100,000 childbirths” in countries with strict abortion regulation compared to “1 or fewer per 100,000 childbirths” in countries without (Haddad et al. 124). Adherence to the Oath, therefore, opens the door to an increase in mortality rates of pregnant people. Abortion has become an accepted part of modern medicine and continuing to use the Oath because it is historically important is needlessly endangering real people for tradition.
There is, however, debate on the meaning of the injunction. Askitopoulou and Vgontzas, emiritus professor at the University of Crete and Supreme Court justice of Greece, respectively, argue that “Although this injunction is widely misinterpreted as a prohibition of abortions, it is clearly not against all abortive methods, but only against the use of a destructive vaginal (1496 European Spine Journal (2018) 27:1491–1500) drug-soaked suppository” therefore the actual text of the Oath is not problematic (Part II 1495-1496). Supposing that this opinion is factually correct, it still does not justify using the Oath. Because the injunction is still widely understood by most to prohibit abortion, regardless of its ‘true’ interpretation, the Oath still should not be used; for instance, the Roe v. Wade majority opinion asks “Why did not the authority of Hippocrates dissuade abortion practice in his time and that of Rome?” as abortion in Rome was relatively common during Hippocrates’ day. This question has no wisp of the nuance Askitopoulou and Vgontzas read in the Oath — this question only makes sense under the framework where abortion generally is prohibited — betraying the understanding that the Oath does prohibit abortion generally. Additionally, in its answer to the question, adopting Dr Edelstien’s explanation, it points to the fact that most people interpret it this way too: “with the end of antiquity, a decided change took place. Resistance against suicide and against abortion became common. The Oath came to be popular.” The stated resistance against abortion caused the Oath to become popular implying that the reason for widespread support of the Oath was its unuanced view on abortion. Thus, it is shown that generally, both in legal precedent and through history that the Oath generally prohibited abortion. Consequently, the continued usage of the Oath, regardless of the correct interpretation, will continue to endanger lives — all while there are sufficient legal structures to take its place. Therefore, even if Askitopoulou and Vgontzas’s interpretation is correct, due to the prevalence of the interpretation that it strictly prohibits abortion, continued usage of the Oath in decision making in general unecessarily endangers real people.
The historical legacy of the Hippocratic Oath is undoubted. It has been an important and integral part of medical ethics for millenia, but historical importance isn’t reason enough to keep using a code of ethics. Medical ethics bears on the most important and literally life altering decisions people can face — so those decisions must be made correctly. After scrutinization, it is clear that, one, the Oath’s legitimately good principles will remain in usage and its legacy will not be forgotten, two, the Oath is no longer necessary to the continued good practice of medicine, three, the most common interpretation directly endangers women’s lives, and four, despite any other possible correct interpretation, the Oath would still endanger people’s lives, and therefore, it is not worth the risk of continuing to adhere to the Oath in real decision making.
Works Cited
Asclepiades, Hippocrates. “The Hippocratic Oath: Classical Version.” Translated by Ludwig Edelstein, 1943, https://www.pbs.org/wgbh/nova/doctors/oath_classical.html
Askitopoulou, Helen, and Vgontzas, Antonios. “The relevance of the Hippocratic Oath to the ethical and moral values of contemporary medicine. Part I: The Hippocratic Oath from antiquity to modern times.” Eur Spine J 27, 1481–1490, 2018, https://doi.org/10.1007/s00586-017-5348-4.
Askitopoulou, Helen, and Vgontzas, Antonios. “The relevance of the Hippocratic Oath to the ethical and moral values of contemporary medicine. Part II: interpretation of the Hippocratic Oath—today’s perspective.” Eur Spine J 27, 1491–1500, 2018, https://doi.org/10.1007/s00586-018-5615-z.
Blackmun, Harry. “Roe v. Wade, 410 U.S. 113.” 1973, https://supreme.justia.com/cases/federal/us/410/113/#tab-opinion-1950137.
Haddad et al. “Unsafe Abortion: Unnecessary Maternal Mortality.” Women’s Health in the Developing World, vol.2, no.2, 2009, pp.122-126. “National Library of Medicine,” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2709326/.