Doctors to operate on the Hippocratic oath

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The Independent Online
If you notice a subtle change in your doctor's behaviour in future, the explanation is simple. The British Medical Association has been updating the Hippocratic Oath - the doctors' 2,500- year-old ethical code.

Although there will be those who think that tampering with the oath, which was derived from the writings of the ancient Greek physician Hippocrates, is nothing short of sacrilege, the code does contain certain sentiments which might be considered outdated.

For example, a doctor has to swear by "Apollo the physician, and Aesculapius and ... all the gods and goddesses", that he will regard anyone who taught him medicine as dear to him as his parents.

A generation of students who were taught medicine at the Royal Free Hospital, London, by the present Tory chairman, Brian Mawhinney, might find that hard to do.

The code is also utterly uncompromising on abortion, saying: "I will not give to a woman a pessary to induce abortion", and equally firm on euthanasia, saying: "I will give no deadly medicine to anyone if asked, nor suggest any such counsel."

The new version, drawn up over the last year by the BMA for the World Medical Association, is rather less categoric. It says: "Where abortion is permitted, I agree that it should take place only within an ethical and legal framework."

On the treatment of the terminally ill, it allows doctors to consider the quality of people's lives, as well as the length, saying: "I recognise the special value of human life but I also know that the prolongation of human life is not the only aim of health care."

In both cases, the code lays heavy emphasis on confidentiality and respect for patients. The modern version says: "I will be honest, respectful and compassionate," rather less vivid than the old: `I will abstain from ... the seduction of females, or males, of freemen or slaves.'"

Commenting on the revised wording, Sandy Macara, chairman of the BMA council, said: "It is as important now as ever it was for doctors to have an agreed statement of ethical principles. On qualifying, doctors need such a statement to make a public commitment to the professional responsibilities they are assuming.

"The value of this update will be all the greater if it comes into use by every doctor qualifying from every medical school in the world."

The BMA has been campaigning for the last five years for a revitalisation of the Hippocratic values.

It has gathered examples of ethical codes from all over the world and common points from these have been integrated into the new wording. The draft version, published yesterday has to be approved by the WMA.

It did not receive whole hearted approval from one of Britain's leading medical ethicists yesterday, however. Dr Richard Nicholson, editor of the Bulletin of Medical Ethics, said: "My initial impression is that the new draft is in favour of motherhood and apple pie.

"I am not sure whether I see the purpose of trying to revise it. Writing something by committee is not the best way to get really sharp results.

"I am frightened that we will end up with a code similar to that produced by the Council of Europe's new Bioethics Convention and approved last year, whose sentiments are the lowest common denominator, that could be agreed by people from many diverse cultural and religious backgrounds."

At least the new code is comprehensible. The old code contains the mysterious words: "I will not cut people labouring under the stone".

Inquiries of a small band of medical contacts, all of whom claim to have sworn allegiance to the oath, found no one who knew what this meant.

It means: "I will not remove bladder stones".

Pledge from 5th century BC

The Hippocratic Oath

The methods and details of medical practice change with the passage of time and the advance of knowledge. However, many fundamental principles of professional behaviour have remained unaltered through the recorded history of medicine. The Hippocratic Oath was probably written in the 5th century BC and was intended to be affirmed by each doctor on entry to the medical profession. In translation it reads as follows:

I swear by Apollo the physician, and Aesculapius and Health, and All- heal, and all the gods and goddesses, that, according to my ability and judgement, I will keep this Oath and this stipulation - to reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this Art, if they shall wish to learn it, without fee or stipulation; and that by percept, lecture and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none other. I will follow that system of regimen which, according to my ability and judgement, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to anyone if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion. With purity and with holiness I will pass my life and practise my Art. I will not cut persons labouring under the stone, but will leave this to be done by men who are practitioners of this work. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further, from the seduction of females, or males, of freemen or slaves. Whatever, in connection with my professional practice, not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the Art, respected by all men, in all times. But should I trespass and violate this Oath, may the reverse be my lot.

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