Written By: Laura McPherson, Nursing411.com
The Hippocratic Oath is one of the oldest and most widely known codes of ethics. The original text is attributed to Hippocrates, a Greek physician commonly credited with beginning the practice of medicine as a rational science. Hippocrates differed from some of his contemporaries and the practitioners who came before him in taking a holistic view of medicine, effectively beginning the practice of whole-person care. Let's explore the history of the Hippocratic Oath.
Like modern codes of medical ethics, the classical Hippocratic Oath included a pledge to practice medicine to the best of the individual’s ability and judgement and to defer to the expertise of trained surgeons where necessary. The oath also included the promise of patient confidentiality, perhaps the first such for professional practice committed to writing.
However, contrary to popular belief, “first do no harm” was not included in the original Hippocratic Oath. Rather, classical doctors reciting the pledge promised to “abstain from whatever is deleterious and mischievous,” to “give no deadly medicine to any one if asked,” and to “abstain from every voluntary act of mischief and corruption.”
It is likely that the misconception of “first do no harm” came from a motto found elsewhere in Hippocrates’ writings: “The physician must...have two special objects in view with regard to disease, namely to do good or to do no harm.”
The Hippocratic Oath was modern for its time; in fact, it might have been too modern, as there are few references to the document between its initial appearance around 400 BCE and the Middle Ages. In 1500s Germany medieval scholars rediscovered and updated the document to adhere to Christian practices, though it was still not widely disseminated.
It was not until the 1700s when the document was translated into English that Western medical schools began regularly incorporating the oath in convocations.
The Hippocratic Oath in the Modern Era
Since the 20th century, many updated versions of the Hippocratic Oath have been published, and it is these rather than Hippocrates’ original that medical students commonly swear upon graduation. Widely known modern versions include the Declaration of Geneva, adopted by the World Medical Association in 1948 and periodically updated to today.
This version incorporates Hippocrates’ general principles as well as a pledges not to use medical knowledge to violate human rights or civil liberties and to practice medicine without discrimination or bias.
Another well-known version, the 1964 oath written by Louis Lasagna, then the Dean of the Tufts University School of Medicine, includes pledges to avoid overtreatment and to pursue disease prevention.
Why Is the Hippocratic Oath Still Important?
Although some aspects of the Hippocratic Oath are not directly applicable to modern practice, such as swearing by the Greek gods who were believed to oversee medicine, much of the oath is still important for nurses and others on the medical care team. The overarching theme of the Hippocratic Oath and of its modern descendants is the idea that the individual reciting the pledge is making a personal dedication to ethical and committed care.
There are two branches to this theme:
- The purpose of medical care is to benefit the ill.
- A patient’s needs should be considered above all else - including the need for privacy.
Though the recitation of the Hippocratic Oath may be symbolic, modern day practitioners adhere to these tenets in on a daily basis when following more modern codes such as HIPAA.
Another key theme that the Hippocratic Oath and the modern versions share is the idea that medical professionals should promote health knowledge and skills between one another and between the care team and patients. This aspect of the oath is particularly significant because in the centuries since the oath was first written, medicine has developed into a much more complex and diversified science.
In Hippocrates’ time, a distinction was made between doctors as general practitioners and surgeons-who were most typically barbers, not necessarily medically-trained professionals. Today there are primary, general-practice care teams as well as secondary-care teams in various specialties and treatment modalities.
This has increased, rather than reduced, the need for nurses, doctors, and patients to communicate regularly on all aspects of patient care.
The classical Hippocratic Oath was the foundation of modern medicine, promoting the practice of integrative care and codifying ethical behavior for medical professionals. Significantly, the oath - and all modern versions that are in wide use - also underline the importance of respect between practitioners and patients.
Today the oath is seen as an ideal for the practice of medicine with the guiding light of putting the patient first. Though it is not binding, it serves as a reminder for doctors, nurses, and other medical practitioners that the modern practice of medicine is part of a meaningful and long tradition of patient-centric care.