Li-Chuan Kuo

 

PhD student, Department of History,

National Cheng Kung University, Tainan, Taiwan

2007/03/19

 

A Historical Approach to the Hippocratic Oath

Father of Western Medicine — Hippocrates

A historian of medical history, Otto L. Bettman, regards the Oath in the Hippocratic Corpus can be seen as “pioneering modern medical ethics with a universal and humanitarian appeal beyond any cultural differences. ”

It is probably because of his famous Oath, Hippocrates has been praised as a paragon of physicians and called the “Father of Medicine”.

Engraving of Hippocrates by Peter Paul Rubens, 1638

Is this Oath timeless values ?

However, do specific medical ethics exist timeless?

What are the ethical implications of the Hippocratic Oath to the contemporaries?

What the Oath says about medical context ?

It is said that the root of modern medical ethics can be traced back to Hippocrates, as if the values of the Oath is timeless and humanistic.

However, the Oath, if based on Ludwig Edelstein’s influential hypothesis, is imbued with Pythagorean doctrines.

In my opinion, the first interpretation may ignore the fact that ancient physicians were restricted to specific historical context and medical environment.

On the other hand, Edelstein’s attempt to return the Oath to a possible historical context is praiseworthy but gives an excessive emphasis on its ideological element. This becomes a matter of hit or miss.

A historical approach

A historical approach would take ancient Graeco-Roman medical art and popular ethics into account, which contributed to the creation of this document.

I hope we could find a reading different from the prevailing ones we are used to. A twelfth-century Byzantine

manuscript of the Oath in the form of a cross.

An ancient physician is a craftsman

In ancient medical profession there was no consensus on medical principles and treatments, no medical organization that offered systematic training and no officially recognized tests that licensed one to practice.

Heteroglossia – “the other voices” in ancient

medical market

Doctors had to complete for clients with other kinds of healers, such as root-cutters (or herbalists), midwives, trainers in the gymnasium, cult-priests, sellers of amulets and so on.

The Hippocratic doctors were only one kind of them and were not necessarily privileged in this business.

Ancient doctor as a craftsman of medical art (Technê)

Though Plato and Aristotle paid a high tribute to Hippocrates as a practitioner of medicine, they thought it lacked a firm epistemological basis.

What this criticism implies is that medicine is a matter of apprenticeship and personal experience as well as tips from good handbooks

Reputation is the key to the Medical Profession

A doctor in the medical market had to rely largely on his reputation (doxa) to attract potential clients and he always looked beyond his customers’ shoulders for more potential customers with all kinds of mechanism that facilitate this purpose.

Reputation is the key to the Medical Profession

That is why Greek doctors paid a great attention to their personal appearance, way of speaking, social decorum and skill in rhetoric and so on.

Rarely has it been mentioned that a better grasp of medical knowledge should be aimed at.

Oath as an admission oath of the medical guild

Because doctors were trained as apprentices and seen as craftsmen, they were often found to be members of the religious cult association called “Asclepiadai,” children of Greek healing god Asclepius. The Oath can therefore be seen as an admission oath that regulated the practices of its members.

Oath as an admission oath of the medical guild

This Oath and its related sacrifices, celebrations, processions and social gatherings would provide a way of identification for its members and gives them a social distinction and solidarity in the competition with other healers.

The Oath was embedded in contemporary Society

The practice and morality in the Oath therefore could not be separated from the social morality at that time.

For example:

I will remain free of all mischief of sexual relationship with both women, men and slaves. I will not speak about anything that I see or hear whether in the course of the

treatment or not.

These moral are general regulations that governed the segregation between different sexes as well as social interactions between citizen-peers, their relatives and possessions in the ancient Greek society at large.

The physician, an unpunished killer?

“Doctors learn by exposing us to risks, and conduct experiments at the expense of our lives. Only a doctor can kill a man with impunity. ”

（ Pliny the Elder, Natural History ）

Pliny the Elder on Mandragora

This statement comes from a cynic Roman senator who suspected anything Greek. But it seems that the Oath is very gingerly about life and so it warns against the use of abortive medicine and the use of surgery and cauterization.

Respect for Life Or Risk-Reward ?

I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect.

I will not give to a woman an abortive remedy.

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.

The Oath warns against amputation and abortion because these practices could cost the patients' life and ruin the reputation of doctors.

It looks that this recommendation is a kind of professional safeguard rather than any expression of humanitarianism.

The Oath has an apologetic undertone

The quotation of Pliny the Elder seems to indicate that the general public in Greek and Roman societies entertained a prejudice against medical practitioners and this put the “medical craftsmen” on the defense.

Evidence from the rest of the Hippocratic Corpus

The Hippocratic Corpus has very precious few works like On Fractures, a practical discussion on how to set bones. Nor is there much about the effect of treatment on patients in the corpus.

Few of the theories are put into practice. It looks there is a great discrepancy between theory and practice.

Evidence from the rest of the Hippocratic Corpus

Surgery was avoided in the Oath:

It ran the great risk of failure and cost life as a result.

A medical failure that brought ruin to medical reputation and a religious pollution, an anathema and impiety to the healing god.

This explains why ancient medical writers were so “rational” and discursive in their writings and used the most conservative methods in healing such as diet, bathing and so on.

A Tentative Conclusion

All the regulations in the Hippocratic Oath, first of all, might be based on the social morality that prevailed in ancient classical world. It is also a kind of apology in answer to possible criticisms.

The Oath provides a set of regulations that define the nature and scope of their profession, with a strong stress on the mechanism.

The Hippocratic Oath safeguards the reputation of its members that would guarantee a competitive edge in the medical market.

All of these can be understood in a more realistic spirit. The ascription of the humanitarianism to the Oath seems more a projection of modern concern rather than a historical truth - at least as far as the Oath is concerned.

Thank you ！

When the Hippocratic Oath is understood as a historical text, which was based on the Graeco-Roman popular morality. Thus it might not be a norm for modern medicine.

I think it is up to us to ask whether standardized ethics do we need for Bioethics? The Hippocratic tree