Thursday, March 09, 2006
Hippocrates: "Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves." The clear call here is active, requiring doctors never to take advantage of patients in any way, with the specific example of engaging in sexual relations included to emphasize the point.
Cornell: "That into whatever house I shall enter, it shall be for the good of the sick. That I will maintain this sacred trust, holding myself far aloof from wrong, from corrupting, from the tempting of others to vice." This is a far more passive and vague approach. If Nuland is right, and a doctor’s own conscience is his only guide, what is deemed to constitute the “good of the patient” will vary from doctor to doctor. Indeed, if a physician believes that a patient’s ill health or serious disability makes his or her life not worth living, it would permit killing as the prescribed remedy — even if the patient never asked to be killed (a common practice, not by mere coincidence, in the Netherlands nowadays). Besides: What does "tempting others to vice" mean in the context of today's anything goes morality?
Another poor substitute for the traditional Oath is the “Christian” physician’s pledge taken by graduates of Loma Linda University. Unfortunately, LLU has also emasculated the robustness of the original. Thus, LLU’s pledge states: "I will maintain the utmost respect for human life. I will not use my medical knowledge contrary to the laws of humanity. I will respect the rights and decision of my patients." Why edit out the explicit promise not to kill, if respecting human life is a priority? And if respecting patient decisions is paramount, that would permit voluntary euthanasia among other potentially harmful “treatments,” such as amputating the healthy limbs of mentally disturbed patients known as “amputee wannabes.”
Of perhaps even greater concern, LLU’s oath adds a clause that could interpose a conflict of interest between doctors and certain of their individual patients. "Acting as a good steward of the resources of society and of the talents granted me, I will endeavor to reflect God's mercy and compassion by caring for the lonely, the poor, the suffering, and those who are dying."
Under the Hippocratic medical principles, the doctor’s sole loyalty was owed to each and every patient as individuals. That is, the doctor is not free to give optimal care to one patient but provide a lower standard to another. In contrast, LLU’s version now requires physicians to treat individual patients in the context of a potentially superseding duty to broader society to steward resources — which, in some hands, could be exercised at the direct expense of patients who are the most expensive to care for. Indeed, a fair reading of the LLU’s oath would justify bedside health-care rationing.
The Hippocratic oath came in to being for a reason. Physicians who subscribed to the ideals of Hippocrates wanted to set themselves apart from shamans and witch doctors. They wanted to make it clear to the patients that they were there to serve in their best interests and their best interests only - not the best interests of their family members. Shamans and witch doctors might poison you if your family paid them enough, or the power dividends were right, but Hippocratic physicians would only try their best to heal. It's a distinction that we still need to keep in these days of creeping euthanasia.
posted by Sydney on 3/09/2006 01:20:00 PM 4 comments
Thank you for calling attention to this issue.I am particularly concerned about a seemingly growing trend to talk about a physician's obligation to "society" as opposed to an obligation to the individual patient, which is what being a doctor is all about.You have to ask what is driving this notion of an imperative to conserve "resources" that may trump the physcian's fiduciary duty to the individual patient.I am alarmed that this thinking has inserted itself into medical student oaths.
The original Hippocrates oath also states:
By 2:09 PM, at
I think the author's concern is valid. The oath came about not because it is an easy one to keep, but because it's not. Watering it down instead of recognizing how hard it is, is not the way to go in my mind. The oath is meant for the hard times, not just the easy. All the points mentioned are so seductively easy to cross over. I realize the abortion issue is a touchy one, but we could just as easily set it up as a speciality field like surgery ;-). They can't take it due to the knife clause. Only 20-30% even used to take the oath. What does it really mean to be a doctor?
By 12:31 PM, at
In my mind the essence of being a professional is to represent the individual against the system. You expect the clergyman, who knows you are a sinner, to defend you in prayer to God. You expect the lawyer, who knows you are guilty, to defend you to the judge. You expect the physician, who knows you are a fat couch potato, to treat your hypertension and save you from stroke.
By 11:44 AM, at