The New Hippocratic Oath

Series: Window on the World

by Phil Ryken May 4, 2003

It is widely believed that most doctors still take an oath when they begin to practice medicine. The most famous oath is the one written nearly 2,500 years ago by Hippocrates the Greek. What is less widely known is the oath’s strongly pro-life orientation. In the original version of the Hippocratic oath, a physician swore, “I will neither give a deadly drug to anybody who 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” [from The Hippocratic Oath: Text, Translation, and Interpretation, Ludwig Edelstein (Baltimore: Johns Hopkins, 1943)].

Given the many changes taking place in medical ethics—few of them positive—it is not surprising that a group of European and American doctors has seen fit to update the Hippocratic oath by writing a new “Charter on Medical Professionalism” [For the full text see The Lancet, Vol. 359, February 9, 2002]. The Hippocratic oath was last updated in 1964, when Louis Lasagna from the School of Medicine at Tufts University wrote a version he considered more in keeping with modern times. Today some medical students take Lasagna’s revision rather the oath written by Hippocrates. And when it comes to matters of life and death, they make the following promise: “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.” Yet by claiming the power to take a life at all, this is precisely what doctors and other health professionals are doing: playing at God.

The new international charter introduces even more changes. Some of the same issues addressed in the old Hippocratic oath are still covered: collegiality, propriety, and confidentiality. Many new areas are also addressed, including malpractice, patients’ rights, conflicts of interest, the fair distribution of medical resources, and cost-effective health care management. Over the last 2500 years, the field of medicine has become more complex. But what doctors no longer promise is that they will refuse to take an innocent life. The new charter is pro-professionalism, and in some ways pro-patient, but it is not pro-life.

Hippocrates and his colleagues believed that a physician’s duty was to comfort and to cure, but not to kill. They rightly feared what would happen if doctors claimed the power to end life as well as to help it flourish. Thus they insisted that a physician should “do no harm.” For centuries this principle was foundational to the whole Western practice of medicine. Although not exclusively biblical, it agrees with what the Bible teaches about life as a gift from God (Ps. 139:13-16), who has made people in his image (Gen. 1:27), who forbids the taking of innocent life (Gen. 9:6), and who claims the ultimate authority to heal our diseases (Ps. 103:3).

One of the most glaring omissions from the new charter is any mention of God. Compared to the original oath, God is conspicuous by his absence. Admittedly, Hippocrates did not swear to the Christian God. He appealed to “Apollo, Asclepius, Hygeia, Panacea, and all the gods and goddesses” as witnesses to what he called “this oath and this covenant.” But at least Hippocrates recognized a transcendent dimension to medicine. He made his oath before God. The new oath is no longer a covenant; it is only a charter. In other words, it is a merely human agreement. Thus it begins by claiming, “Professionalism is the basis of medicine’s contract with society.” What is lost is any sense of the doctor’s obligation to God, and hence any truly moral basis for the practice of medicine.

The Hippocratic oath has never been more urgently needed than it is today. Embracing its pro-life principles would help to resolve many of the troubling ethical dilemmas we face in the 21st century. It would bring an end to abortion. It would rule out the wanton destruction of human embryos, and thus strike a blow against the horrific prospect of human cloning. And it would resolve the debate over euthanasia by eliminating so-called “mercy killings” and promoting instead the kind of palliative care that relieves the suffering of those who are about to die, while still leaving room for God’s sovereignty.

Christians in the health professions should be careful what they swear to uphold, because unlike their patients, not all oaths are created equal. The recent revisions remove safeguards essential to the ethical practice of medicine. Do not be afraid to uphold ancient principles for the preservation of life—principles that have both God and history on their side. The only doctor people can trust is one who understands the difference between curing and killing, and who therefore is committed to protecting the absolute sanctity of human life from conception to death.

One of the best statements of the doctor’s true calling comes from the seventeenth century physician Thomas Sydenham (1642-1689), who wrote:

It becomes every man who purposes to give himself to the care of others, seriously to consider the four following things: First, that he must one day give an account to the Supreme Judge of all the lives entrusted to his care. Secondly, that all his skill, and knowledge, and energy as they have been given him by God, so they should be exercised for His glory, and the good of mankind, and not for mere gain or ambition. Thirdly,… let him reflect that he has undertaken the care of no mean creature, for in order that he may estimate the value, the greatness of the human race, the only begotten Son of God became himself a man, and thus ennobled it with His divine dignity, and far more than this, died to redeem it. And fourthly, that the doctor being himself a mortal man, should be diligent and tender in relieving his suffering patients, inasmuch as he himself must one day be a like sufferer [quoted by John Patrick in “Hippocrates and Medicine in the Third Millennium,” Christian Medical and Dental Society].

If Sydenham had put his idea in the form of covenant, we’d have something even better than the oath handed down by Hippocrates.

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