Kostic

When I’m not busy with my clinical duties or applying for residency programs, I spend my time doing fun things. Things like researching the relationship between modern medicine and the Hippocratic oath. Few endeavors are as rip-roaring fun, I’m sure.

This was a project I completed as a part of a biomedical ethics elective I did. I have various curiosities about the nature of the medical profession, and I thought it was best to start thinking about just what the profession is. The best way to define and unpack something is to get at its roots. Because in philosophy (and history, and analysis) everything is a tree or a box.

I first had a read around the works of the Hippocratic writers. Hippocrates was in all likelihood not an individual who wrote what is now considered the Hippocratic corpus. He is likely a composite figure, made up of stories about one teacher and the notes and claims from his students. This explains why the writings are often contradictory.

The Hippocratics were located on the island of Kos (or Cos) in 400 BCE. They were not the be-all-and-end-all of ancient medicine; they were up against many other theories of medicine, and had to also contend with the huge medical issue of the time: not being able to change very much. Most of their effort went into prognostication, which really meant identifying people who were going to die, so that they could avoid taking on those patients, and not skew their success statistics. Equally, one would look very sage if one proclaimed “This man shall die in three days!” and that actually follows.

There’s one bit of writing that sticks out of the Hippocratic corpus, and that’s the famous oath. The Oath takes issue with things like surgery, while there is a whole work on surgery itself. It also has a lot of fairly mystical sounding language, which is unlike the practical tone of some of the other corpus. In particular, the tract “On the Sacred Disease” is largely about why epilepsy is no more caused by the gods than any other illness.

Now, the real question is: what is the connection between this bit of Greek and modern medical ethics? The answer: There isn’t really one.

The oath does pop up a few times in history, but doesn’t seem to be used by anyone medical for a swearing-in ceremony until some time in the 19th century, at earliest. Medical swearing-in doesn’t even happen until 1604, in a Scottish university. Prior to this, the oath is mentioned in the medieval period, but in the context of “this is what pagans do,” as a contrast for christian physicians. And prior to the medieval period, the big heavyweight of western medical knowledge, Galen, doesn’t ever mention the oath, as far as I know.

The oath that is sometimes used these days is heavily edited from the original. All the swearing on behalf of the gods and such is gone, and usually the indictment against surgery, plus a few other changes. The fact that it’s even called “Hippocratic” is likely an effort to retcon the oath, as a way of establishing the roots of modern medical ethics in the far past. This is likely to give medicine a certain gravitas, and legitimacy when it comes to making difficult decisions, and being allowed to tell people what to do.

The reality is that there is no real connection to the Hippocratic Oath. And I’m fine with that. Modern medical ethics has to face off against issues that were not present in the ancient world. This profession is changing drastically with its technology, and is redefining itself every day. It would be better to realize that the physician as is presently envisioned is a very modern construct, and that we need to make our ethical decisions based on what is thought and felt now. Hearkening back to the Hippocratics is valuable in the same way that history is always valuable, but it is a lie to say that the Hippocratic oath was, is, and should always be a doctor’s ethical compass.

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