1-1banner
 
medpundit
 

 
Commentary on medical news by a practicing physician.
 

 
Google
  • Epocrates MedSearch Drug Lookup




  • MASTER BLOGS





    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov




    ''Once you tell people there's a cure for something, the more likely they are to pressure doctors to prescribe it.''
    -Robert Ehrlich, drug advertising executive.




    "Opinions are like sphincters, everyone has one." - Chris Rangel



    email: medpundit-at-ameritech.net

    or if that doesn't work try:

    medpundit-at-en.com



    Medpundit RSS


    Quirky Museums and Fun Stuff


    Who is medpundit?


    Tech Central Station Columns



    Book Reviews:
    Read the Review

    Read the Review

    Read the Review

    More Reviews

    Second Hand Book Reviews

    Review


    Medical Blogs

    rangelMD

    DB's Medical Rants

    Family Medicine Notes

    Grunt Doc

    richard[WINTERS]

    code:theWebSocket

    Psychscape

    Code Blog: Tales of a Nurse

    Feet First

    Tales of Hoffman

    The Eyes Have It

    medmusings

    SOAP Notes

    Obels

    Cut-to -Cure

    Black Triangle

    CodeBlueBlog

    Medlogs

    Kevin, M.D

    The Lingual Nerve

    Galen's Log

    EchoJournal

    Shrinkette

    Doctor Mental

    Blogborygmi

    JournalClub

    Finestkind Clinic and Fish Market

    The Examining Room of Dr. Charles

    Chronicles of a Medical Mad House

    .PARALLEL UNIVERSES.

    SoundPractice

    Medgadget
    Health Facts and Fears

    Health Policy Blogs

    The Health Care Blog

    HealthLawProf Blog

    Facts & Fears

    Personal Favorites

    The Glittering Eye

    Day by Day

    BioEdge

    The Business Word Inc.

    Point of Law

    In the Pipeline

    Cronaca

    Tim Blair

    Jane Galt

    The Truth Laid Bear

    Jim Miller

    No Watermelons Allowed

    Winds of Change

    Science Blog

    A Chequer-Board of Night and Days

    Arts & Letters Daily

    Tech Central Station

    Blogcritics

    Overlawyered.com

    Quackwatch

    Junkscience

    The Skeptic's Dictionary



    Recommended Reading

    The Doctor Stories by William Carlos Williams


    Pox Americana: The Great Smallpox Epidemic of 1775-82 by Elizabeth Fenn


    Intoxicated by My Illness by Anatole Broyard


    Raising the Dead by Richard Selzer


    Autobiography of a Face by Lucy Grealy


    The Man Who Mistook His Wife for a Hat by Oliver Sacks


    The Sea and Poison by Shusaku Endo


    A Midwife's Tale by Laurel Thatcher Ulrich




    MEDICAL LINKS

    familydoctor.org

    American Academy of Pediatrics

    General Health Info

    Travel Advice from the CDC

    NIH Medical Library Info

     



    button

    Thursday, March 09, 2006

    Deviating Down: A look at some recent modifications of the Hippocratic oath:

    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

    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.

    By Blogger james gaulte, at 8:19 AM  

    The original Hippocrates oath also states:

    "To please no one will I prescribe a deadly drug nor give advice which may cause his death. Nor will I give a woman a pessary to procure abortion."

    This was fine at the time because health practioners were plentiful and varied. The Æsculapius gang chose to stay clear of life-taking interventions, leaving them to "death doctors".

    The modern landscape is very different. If physicians will not practice abortions and euthanasia, then who will?

    By Anonymous EM, at 2:09 PM  

    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 Anonymous Dara, at 12:31 PM  

    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.

    When the clergy sides with God against you one has the excess of the inquisition. When the lawyer sides with the government one has the excess of totalitarianism. When the physician starts becoming concerned with the resources of society we have a particularly slippery slope. This is the slope that caused German physicians to empty the hospitals of elderly patients to make room for soldiers or the Russian doctors to consign political dissidents to insane asylums, or American doctors to sterilize the menatally defective.

    Eschew entangling alliances

    By Anonymous was698002@yahoo.com, at 11:44 AM  

    Post a Comment

    This page is powered by Blogger, the easy way to update your web site.

    Main Page

    Ads

    Home   |   Archives

    Copyright 2006