William M. Briggs

Statistician to the Stars!

Physician Oaths, Then & Now

Hippocrates_rubens

It is well worth examining the changes over time in the oaths physicians swear to, especially as we have entered an era when the term “doctor” is being applied to people whose goal is not to preserve life and to heal, but to kill and inflict injury. The World Medical Association is also decided to revamp to Declaration of Geneva, which is the modern-day Hippocratic Oath.

Nobody knows what the new Declaration will be, but we have clues in the changes to the Hippocratic oath, and in considering the politicization of medicine. I do not mean this review to be exhaustive.

The original Hippocratic oath opened thusly:

I swear by Apollo the physician, and Aesculapius the surgeon, likewise Hygeia and Panacea, and call all the gods and goddesses to witness, that I will observe and keep this underwritten oath, to the utmost of my power and judgment.

This had, in places, morphed to “I swear by God” or some variant. In the original oath is also the clause “I will comport myself and use my knowledge in a godly manner.” A modern version of that oath, written in 1964, began “I swear to fulfill, to the best of my ability and judgment, this covenant”; buried in another clause are the words “Above all, I must not play at God.” The Declaration of Geneva, written in 1948, and currently perhaps the most used document, begins, “I SOLEMNLY PLEDGE to consecrate my life to the service of humanity”.

Swearing an oath to be under the watchful eye and (ultimate) judgement of God or even of the gods is a terrible and awesome burden. Promising to be godly recognizes and puts supreme authority above the physician; it is humbling. Tepid admonitions not to “play God” imply a man could be God but shouldn’t, or at least not too often.

The modern documents are not quite oaths, merely promises a man makes to himself. How so? By 1948 the words covenant consecrate, which are in the modern documents, had become what David Stove called a “smile words”. They used to mean “a solemn (or sacred) compact” and “to set apart as a sacred office”, but now they only mean “believed by somebody to be a solemn compact” and “believed by somebody to be a sacred office.” Believed by somebody, not me, that is. The words have been drained of force; thus, those that use the words know they aren’t sacrificing much freedom. Certainly the modern “oaths” are more like guidelines than pledging one’s soul.

The second clause of the original:

I will reverence my master who taught me the art. Equally with my parents, will I allow him things necessary for his support, and will consider his sons as brothers. I will teach them my art without reward or agreement; and I will impart all my acquirement, instructions, and whatever I know, to my master’s children, as to my own; and likewise to all my pupils, who shall bind and tie themselves by a professional oath, but to none else.

In Geneva this changes to the brief “I WILL GIVE to my teachers the respect and gratitude that is their due”, an amusing difference. We have moved from “I will teach them my art without reward or agreement” to “The median education debt for medical school shall be $170,000, and that is before residency.”

The most consequential discords are in the value of life. Relevant clauses from the original oath:

With regard to healing the sick…I will take care that they suffer no hurt or damage.

Nor shall any man’s entreaty prevail upon me to administer poison to anyone; neither will I counsel any man to do so. Moreover, I will give no sort of medicine to any pregnant woman, with a view to destroy the child.

“Doctors” now routinely kill the lives inside would-be mothers, and, in some countries legally and elsewhere illegally, even kill their patients. Not accidentally; on purpose and by design. “Doctors” also now—for a fee—mutilate patients or cause them other harm, usually at the patients’ request but not always (parents might request mutilation for a child, or relatives for an unconscious patient).

The 1964 contract excised the original hard proscriptions, and in their place, or anyway added,

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

These are an enormous changes! Before, patients sought out physicians when they were ill. Now, physicians must seek out patients even when they are in health. Physicians have become authorities over patients, instead of the opposite. Consider that the actions to prevent lack of health are limitless, thus theoretically the power physicians gave to themselves is also without limit.

In Geneva, the cautions against causing death and injury are these:

THE HEALTH OF MY PATIENT will be my first consideration;

I WILL MAINTAIN the utmost respect for human life;

These are banalities, as is obvious in cultures which preach that abortion, euthanasia, and mutilation are “rights”. Since it is impossible to have a right without a responsibility, a “right” to a killing requires the responsibility on someone to do the killing. This is why governments are requiring doctors to perform “services” such as killing and maiming. Apropos is this article (with implied affirmative answer: “Could it soon be illegal for doctors to believe in male and female?

Significantly absent in Geneva are any proscriptions or cautions against directly harming any person. Yet in the modified Hippocrates is found this bizarre passage: “But it may also be within my power to take a life; this awesome responsibility must be faced with great humility and awareness of my own frailty.” The “doctors” who perform abortions do not think of those that they are killing as “patients”; instead the would-be mothers are “clients” who receive a “service”, much like a man at a garage has a scratch buffed out on his car. Doctors who kill patients at the patients’ request do, of course, consider those they kill as patients, but only in a brutal, utilitarian, which is to say pagan, sense. It’s not patient lives which are to be cherished, but (states of) “health.”

Absent from the original Hippocrates are specific political statements. Not so in the 1964 version, which contains this: “I will remember that I remain a member of society, with special obligations to all my fellow human beings”. Now this doesn’t seem much, until these passages from Geneva (which were inserted well after 1964) are considered:

I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;

I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat;

Both statements reek with politics. The first clause is entirely superfluous, medically speaking. And it’s nonsensical practically. Does blindness to “sexual orientation” include ignoring rapists, pedophiles, those attracted to goats, cadavers, fairground rides or God knows what all else? What could “or any other factor” possibly mean? “Rights” is so abused that we needn’t discuss it. “Civil liberties” is the Orwellian phrase that means “uncivil restrictions”, things like mandated commerce and forced assembly. A male patient pretending to be a woman (and possibly maimed by another “doctor” in an attempt to resemble one) and insist it is his “civil right” to be treated as a woman, which is to make medicine a farce.

We can reliably forecast more inversions in the changes to the Declaration of Geneva. According to Urban Wiesing and Ramin Parsa-Pars, in a Bioethics article discussing the World Medical Association’s proposed modifications, “respect for patient self-determination has been established as one of the most important principles of medical ethics. However, it is not mentioned in the Declaration of Geneva.” Meaning it will be.

Not only will health be a “right”, but so will whatever body state a patient wishes. And, as above, since rights implies responsibilities, patient “self-determination” will be forced upon doctors—and upon you, too.

16 Comments

  1. Not surprising the change to “prevent” disease, which goes along with “health insurance”, which is not about maintaining health but rather treating illness as cheaply as possible with the company making large incomes as the main goal (who mixed business with health? Business is to make money. Health is not about making money—oh, but wait, it is, all the way from vaccines to “natural” cures to the nonsense Dr. Oz spews forth. Maybe that part about “I will teach them my art without reward or agreement” should have stayed in.)

    Anything can be legal or illegal if enough people say so. Look how Hitler changed medicine in Nazi Germany. Jews were exterminated like bugs. How easy much easier is it to eliminate male and female (it’s going to be problem in research, though, because no male/female is directly in contradiction to testing drugs on both male and female. Seems fitting women will suffer the most from this—they caused it.)

    If there is no admonition against killing, there should be no problem with the death penalty. Yet, there seems to be. So it’s only killing those the Doctor wants dead, not people the state sentenced to death, that is acceptable. Non-verbal patients have no rights, of course, so killing the non-verbal is not covered by this.

    Of course, now if the patient wants to use a witch doctor to cure heart disease, rather than the statins prescribed, his doctor must dutifully agree with this choice. Later, the family of the dead patient will sue the medical doctor while still sending family members to the witch doctor. It’s all about income, you know. Doctors, lawyers and politicians. If only medicine was about caring for the sick……

  2. Doctor, my eyes have seen the years
    And the slow parade of fears without crying
    Now I want to understand

    I have done all that I could
    To see the evil and the good without hiding
    You must help me if you can

    Doctor, my eyes
    Tell me what is wrong
    Was I unwise to leave them open for so long

    ‘Cause I have wandered through this world
    And as each moment has unfurled
    I’ve been waiting to awaken from these dreams

    People go just where they will
    I never noticed them until I got this feeling
    That it’s later than it seems

    Doctor, my eyes
    Tell me what you see
    I hear their cries
    Just say if it’s too late for me

    Doctor, my eyes
    Cannot see the sky
    Is this the prize
    For having learned how not to cry

    – Jackson Browne

  3. Sheri: I have conversations with folks who think that health care and profit should not be tied together. I don’t disagree with them. Then I try and make the books balance. If you aren’t making a profit, making the books balance is really damn difficult.

    My first son’s birth was picked up by the State of Wisconsin because my wife worked for the University. My second son’s birth was picked up by me. I don’t know which one ended up costing more. I felt the second one much more. Part of the price tag was paying for all the people who didn’t pay, because at the end of the day, the hospital has to pay nurses, equipment, doctors, janitors, orderlies, administrators, etc. Making ends meet often means fund raisers. If the company is for profit, then not so many fund raisers, but the appearance of profiteering is easy to find.

    A family member got sick awhile back. She didn’t have insurance. She didn’t have a job. She racked up a lot in medical bills. She couldn’t pay. Her mother went and talked with the administrators at the hospital and got a deal. If her daughter came in and signed a hardship letter, all would be forgiven. The daughter would not come in. I don’t know why. I don’t know how the hardship letter helped the hospital. But it let them push the number from one line item to a different line item and all would be good. It was too much effort for the daughter to go into the hospital…

    What is the right answer? No matter what answer gets put in place, there will be people figuring out how to scam the system.

  4. Brad: I perhaps should be more clear: Third party payers in health care and profit should not go together. When you add a large pile of money to the picture, costs can easily skyrocket because there is no incentive to control costs.

    There’s also the problem of the piranhas known as personal injury lawyers who make billions suing companies that listed side effects and stupid people didn’t believe side effects would happen to them. If we removed the piranhas, that would help.

    People will indeed scam the system, but that’s so long as they know for a fact they can get stuff for free. Because we think everyone should be treated regardless of ability to pay, this works well. I have a relative that hates doctors but ran immediately to the hospital when problems arose in childbirth. Did she care that she did not pay—no, she complained because the hospital gave her antibiotics after the c-section and complain the hospital drug-tested the baby. Personally, if she didn’t like doctors or drugs, then I figure she can die or the baby die rather than going to the hospital. Her beliefs should not be changed just because the outcome would be poor in this particular case. People should be required to pay for care if they want it. If not in full, then in payments over a five year period. If they are on welfare, they lose part of the benefits. I have other relatives who just didn’t buy insurance and then got sick and declared bankruptcy. All of this encourages bad behaviour. If people are not responsible, they don’t care at all about costs. The fact that everyone else is forced to pay those costs is theft.

  5. This also seems to be missing from the modern version:

    “I will willingly refrain … (in an especial manner) from acts of an amorous nature … (with) those who it may be my duty to cure …”

    I wonder why? The modern version has added this:

    “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.”

    What can this possibly mean? Sounds scary.

  6. The modern tendency to produce pompous and useless when not outright political oaths (codes of ethics) is seen in physics as well. See:

    https://www.cap.ca/en/certification-pphys/pphys-code-ethics

    which is part of the reason that I never became a professional physicist and in fact spoke out against it at the CAP Congress where its introduction was debated. I called it the oath of loyalty.

  7. The pro-aborts always talk about abortion being a personal decision between a woman and her physician, while conveniently ignoring the fact that “her physician” (if she has one) is not the one performing the abortion and is almost as certainly going to advise against it.

  8. Sheri,

    “Third party payers in health care and profit should not go together.”

    The only way to achieve this is to eliminate third party payers altogether. The third party payer (even if it’s the government) has costs of it’s own to cover.

    A third party payer can profit by having more people paying premiums than people making claims that have to be paid, but that only works for health care if you limit it to a true insurance model where the third party is only providing coverage for catastrophic events, not routine health care.

  9. Brad,

    “Her mother went and talked with the administrators at the hospital and got a deal. If her daughter came in and signed a hardship letter, all would be forgiven. The daughter would not come in. I don’t know why.”

    More than likely because with the hardship letter, they could get reimbursed by the county and / or state.

    P.S.

    I am also a Wisconsinite. What part of the state are you in?

  10. MattS: Agreed. I would like to see third party payers eliminated, or limited to catastrophic coverage and not include routine medical care, including most prescriptions. The market will sort itself out.

    I have found that drug prices vary dramatically from one pharmacy to the next, sometimes by over $100 or $200. If people just sought out the best deal instead of going where their insurance dictates, the lower prices would win out in the end.

  11. This perniciously undermines palliative, critical, elderly and neonatal, care, areas where patients need the care most, i.e. when they can’t speak for themselves. The most vulnerable.

    In the case of abortion there is another layer because those performing them don’t consider what they are doing. There is a lot of work to do and feminism has to be knocked on the head before the debate will go anywhere. There are two types of woman. Now many men have given up and many believe what the feminists say while ignoring other women. I can think of a couple of examples on here who only take the feminist woman’s line so how they’ve come to this conclusion is mysterious.

    The changes have implications legally for, pretty obvious reasons. It seems to callously provide a medico-legal framework for”protocols” and “care pathways” which then are passed along the chain rather like a reframing of moral correctness. We have a thing called the “Liverpool care pathway” it is murderous. I believe it will be discontinued. In time, it’s going to take time.

    If we can leave Europe, we can make and enforce our own laws and not have appeals to “The European Court of Human Rights”. When many European nations start to do the same the pressure will not be on the US or others to “conform”. I do believe that politicians and technocrats from Europe and the US use the examples from the two to justify pushing policies. I watched it happen to Britain bit by bit and I have heard the same talk from politicians in the US as if “The EU” were the last word. They are not.

    “Civil liberties” is the Orwellian phrase that means “uncivil restrictions”, things like mandated commerce and forced assembly. A male patient pretending to be a woman (and possibly maimed by another “doctor” in an attempt to resemble one) and insist it is his “civil right” to be treated as a woman, which is to make medicine a farce.

    This argument lies within the field of medicine politics should play no part.
    There is a thing called the broad shoulders of professionalism which means everybody is treated the same and with good grace regardless of the list above anyway. A person who couldn’t with conscience do this wouldn’t be in their chosen field. A surgeon performing sex change surgery would therefore not be doing this against their own will.

    The law itself negates any need of rights or civil liberties.

  12. Scotian:

    As a U.S. physicist I found that fascinating. I’d never heard of such a thing, and in fact have written against letting physics become a profession. It sounds like something copied from some engineers’ code of ethics (and engineering is and should be a profession).

    Is this certification important in Canada? Do physicists there generally bother with it?

  13. Lee, the background to this is a fascinating story in itself. In Canada the Engineering Professional Societies (one for each province) periodically lobby the government to change the engineering act in such a way as to effectively make it illegal to work as a Physicist. Thus the CAP must constantly be on its toes to prevent this from happening. In 1999 they came up with the idea that a professional physicist designation would help in this fashion. It is only a trademark so far and has no legal status. Very few physicists have joined and I don’t believe it has caught on. It is not required for any job as far as I can see and is currently marketed as a CV enhancement.

    I don’t believe that the engineering societies in the USA have the same level of power they do in Canada. I should note that it is possible for a physicist to become a professional engineer, a matter of passing the appropriate exams. The engineers are really anal about the iron ring.

    The problem is not the forming of professional societies. There are many of these and that is what the CAP and APS are. The problem is the restraint of trade that legal protection gives to a professional organization. This has gotten way out of hand and not only with engineers.

  14. Scotian,

    Thanks for the background.

    I agree with your final paragraph; I have no problem with the APS (at least in theory), of which I’m a member. But the barriers to practice for medicine and engineering, which protect public safety (and also, as you note, can maintain scarcity), have no purpose in science.

  15. Lee,
    “… which protect public safety …”
    Thanks for the humorous comment. We recently had a dramatic example of public safety in north west ontario.

    https://en.m.wikipedia.org/wiki/Nipigon_River_Bridge

  16. Scotian: I have degrees in physics and geophysics, and also hold a professional engineer registration in the State of Washington, but there are states within the u.s., such as where I currently live, which effectively prohibit my obtaining a registration via commity because they added new, and sometimes ingenious, requirements. When I lived in California, the engineers there were trying to prohibit geophysicists from doing geophysics, and in Missouri the engineers tried to prohibit geologists and geohydrologists from being able to earn a peaceful living doing their jobs. My years of reviewing board actions in the Washinton State Journal have shown me that a very few involved fraud and perhaps only one in two decades involved incompetence. All the rest were for performing work without a license. All in all it gives a person the idea sometimes that there is not a lot of honor in this profession, even with codes of ethics.

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