The Hippocratic Oath and the Ethics of Medicine

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The Hippocratic Oath and the Ethics of Medicine

• Steven Miles, MD
• University of Minnesota

Believed to be the only depiction of Hippocrates.
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Oath -- 400 BC

• Hippocractic Medicine
• Rejected divine explanations for the cause or
  treatment of disease in favor of empirical,
  causal observations.
• Transformed oral traditions passed in families to
  recorded observations and clinical experiences
  shared within a guild.

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Time Line
Columbus Voyage
Fall of Athens
1000
CE
BCE

Oldest Oath Papyrus
Oath
Church Editing
Hippocratic Medical Works
Deontological works
1st Medical School use
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The Cutting Insertion
Fall of Athens
1000
1500
CE
BCE

I will not cut, and certainly not those suffering
from stone, but I will cede this to practitioners
of this activity.
Oldest Oath Papyrus
Oath
Surgery separates from Medicine
Bladder stone surgical innovation 240 BCE
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Oaths EthicsQuestions

• Who is the physician?
• What is the physician committed to?
• Who is the physician accountable to?

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• Who is the physician?

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Opening of Oath An invocation?...

• I swear by Apollo the Physician and by Asclepius
  and by Hygieia and Panacea and by all the gods as
  well as goddesses, making them judges
  witnesses, to bring the following oath to
  fulfillment, in accordance with my power and my
  judgment

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or does it proclaim geneology?

• Is there a man who has not heard of
  meAmphitryon of Argos, son of Alcaeus, grandson
  of Perseus, and father of Heracles. I have lived
  here in Thebes ever since the crop of Sown Men
  sprang full grown out of the Earth.
• From Heracles by Euripides

If geneology, what does it mean?
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The Family of Medicine I(Medicine born of love
and grief)
Apollo Coronis Physician,
prophecy
Asclepius
Chiron (a Centaur) Trainer of Achilles Medical
education
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Apollo Prophecy Prognosis

• Apollo
• God of Reason
• God of Prophecy
• Oracle at Delphi

• Physicians
• Reason- Natural Cause and Effect
• Points to cause, diagnosis, and treatment.
• Prognosis

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Prometheus (Foresight)

• A titan who gave humans fire and creativity to
  invent medicines and imagine a prognosis.
• To prevent despair at foreseeing death in a
  person who was dying.
• Prom I stopped mortals from foreseeing doom.
• Chorus What cure did you discover for that
  sickness?
• Prom I sowed in them blind hope.
• Aeschylus. Prometheus Bound

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The Family of Medicine II
Epione (Hercules Daughter) Soothing
Asclepius Unceasingly Gentle
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Pindars Verdict on Asclepius

• Still, even wisdom yields to hope of profit. And
  gold induced no less than he Asclepius to try
  to resur-rect a man whom death already had
  imprisoned. We must seek from deity the things
  that fit our mortal hearts, keeping our
  cond-ition and our destiny in mind. My vital
  being, do not seek immortal life exhaust,
  instead, all possibility. Pindar. Pythian Odes
  3-63.

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What does the Apollo Genesis Story of Medicine
Say?

• The passion to heal arises from love and grief.
• Physicians must accept mortality as a boundary
  for moral work.
• The names of Asclepius and Epione say that
  healing is not a war but a gentle rebalancing to
  path to health.

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The Family of Medicine III
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The Family of Medicine IV
Asclepius Epione Unceasingly
Gentle Soothing
Podalirius
Machaon

• to regard my teachers as equal to my parents
  Oath

Hippocrates
Each Physician
(Hippocrates dies in Larissa)
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• What is the physician committed to?

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What is the Physician Committed to?
MD in Society Clinical Ethics
Principles I will use regimens for the benefit of the ill in accordance with my ability and my judgment, but from what is to their harm or injustice I will keep them. Into as many houses as I may enter, I will go for the benefit of the ill, while being far from all voluntary and destructive injustice,
Examples (2) I will not give a drug that is deadly to anyone if asked, nor will I suggest the way to such a counsel. I will not give a woman a destructive pessary. especially from sexual acts both upon women's bodies and upon men's, both of the free and of the slaves. About whatever I may see or hear in or without treatment-- things that should not ever be blurted out outside --I will remain silent, holding such things to be profane to speak of.
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What does the Physician Promise to Society?

• I will not give a drug that is deadly to anyone
  if asked, nor will I suggest the way to such a
  counsel.
• Capital punishment?
• Euthanasia?
• Homicide?

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What does the Physician Promise to Society?
I will not give a woman a destructive pessary.
Antiabortion? Pro-life? Anti-trespass in a
woman chattel society? Pessaries are
dangerous.
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What Does the Physician Promise to the Patient? 1

• especially from sexual acts both upon women's
  bodies and upon men's, both of the free and of
  the slaves.

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What Does the Physician Promise to the Patient? 2
About whatever I may see or hear in or without
treatment -- things that should not ever be
blurted out outside I will remain silent,
holding such things to be profane to speak of.
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Who are Physicians Accountable to?

• If I render this oath fulfilled, and if I do not
  blur and confound it may it be to me to enjoy the
  benefits both of life and of techne (art and
  science), being held in good repute among all
  human beings for time eternal.
• If, however, I transgress and perjure myself, the
  opposite of these.

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Oaths Vision
An empirical science, a moral community Self
sustaining by passing accumulating knowledge
Justice Benefi-cence
Physician and Society
Personal Integrity In a pure and holy way, I
will guard my life and my art and science.
Clinical Ethics
Accountability to judgment of history.
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Summary

• Oath conforms to the medical practice and
  rhetoric of Classic Greece.
• Roles education, compiling knowledge, and
  treatment.
• Ethics beneficence and on avoiding injustice in
  public and clinical spheres.
• Progressive and historically accountable rather
  than deistically accountable.

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Steven Miles MDmiles001_at_umn.edu