The Hippocratic Oath
and the Ethics of Medicine
Steven Miles, MD
University of Minnesota
Believed to be the only
depiction of Hippocrates.
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.
BCE
Oath
“Hippocratic”
Medical
Works
1000
Fall of Athens
Time Line
CE
Oldest Oath
Papyrus
Deontological
works
Columbus
Voyage
Church
Editing
1st Medical
School use
Oath
CE
Oldest Oath
Papyrus
Surgery separates
from Medicine
Bladder stone
surgical innovation
240 BCE
1500
BCE
1000
Fall of Athens
The Cutting Insertion
I will not cut, and
certainly not
those suffering
from stone, but I
will cede this to
practitioners of
this activity.
Oaths Ethics‘Questions
•Who is the physician?
•What is the physician
committed to?
•Who is the physician
accountable to?
Who is the physician?
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;
… or does it proclaim geneology?
• “Is there a man who has not heard of
me—Amphitryon 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?
The Family of Medicine I
(Medicine born of love and grief)
Apollo
Physician, prophecy
Asclepius
Chiron (a Centaur)
Trainer of Achilles
Medical education
Coronis
Apollo: Prophecy & Prognosis
Apollo
• God of Reason
• God of Prophecy
– Oracle at Delphi
Physicians
• ReasonNatural Cause
and Effect:
– Points to cause,
diagnosis, and
treatment.
• Prognosis
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
The Family of Medicine II
Epione
(Hercules
’
Daughter)
‘Soothing’
Asclepius
‘Unceasingly
Gentle’
Pindar’s Verdict on Asclepius
• Still, even wisdom yields to hope
of profit. And gold induced no less
than he [Asclepius] to try to resurrect a man whom death already
had imprisoned…. We must seek
from deity the things that fit our
mortal hearts, keeping our condition and our destiny in mind. My
vital being, do not seek immortal
life; exhaust, instead, all
possibility. Pindar. Pythian Odes 3-63.
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.
The Family of Medicine III
Asclepius
Epione
Unceasingly Gentle
Soothing
Iaso
Panacea Telesphorus
Healers Medicines Convalescenc
e
Podalirius
Hygieia
Aigle
Health Radiance
Machaon
The Family of Medicine IV
Asclepius
Epione
Podalirius
Machaon
Unceasingly Gentle
Hippocrates
Soothing
“to regard my
teachers as equal to
my parents” [Oath]
Each Physician
(Hippocrates dies in Larissa)
What is the physician
committed to?
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)
1. I will not give a drug
that is deadly to anyone
if asked, nor will I
suggest the way to such
a counsel.
2. I will not give a
woman a destructive
pessary.
1. especially from sexual acts both
upon women's bodies and upon
men's, both of the free and of the
slaves.
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].
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?
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.
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.
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].
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.
Oath’s Vision
An empirical science, a moral community
Self sustaining by passing accumulating knowledge
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.
Justice
Beneficence
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.
Steven Miles MD
miles001@umn.edu