Hippocratic Oath

Hippocrates (bust, Pushkin Museum)

The Hippocratic Oath, dating from the 4th century BC, is the first known set of written rules governing medical ethics. Some of its principles are still valid today.

Most sources relating to the life of Hippocrates are indirect, and the authenticity of many of the writings attributed to him is open to question. This makes it difficult to distinguish reality from legend. In any case, he is considered the first to have separated medicine from other fields of knowledge, to have formalized ethical rules for its practice and to have emphasized clinical observation. The therapeutic principles of Hippocratic medicine, however, have little in common with modern medicine.

The original Hippocratic oath

The Hippocratic principles are as follows:

• Medicine is an art to be handed down from doctor to doctor
• The disciple owes respect and assistance to his master and his descendants
• Monopoly of knowledge
• Principle of beneficence (doing good)
• Principle of refusal to harm (including refusal of abortion, assisted suicide and euthanasia)
• Dedication
• Notion of excluding surgery from the field of medicine
• Prohibition of seduction and sexual relations with patients or their relatives
• Medical confidentiality
• Honorability of the profession
• Religious references and authority

Original version

Traduction

OPKOΣ Ὄμνυμι Ἀπόλλωνα ἰητρὸν, καὶ Ἀσκληπιὸν, καὶ Ὑγείαν, καὶ Πανάκειαν, καὶ θεοὺς πάντας τε καὶ πάσας, ἵστορας ποιεύμενος, ἐπιτελέα ποιήσειν κατὰ δύναμιν καὶ κρίσιν ἐμὴν ὅρκον τόνδε καὶ ξυγγραφὴν τήνδε. Ἡγήσασθαι μὲν τὸν διδάξαντά με τὴν τέχνην ταύτην ἴσα γενέτῃσιν ἐμοῖσι, καὶ βίου κοινώσασθαι, καὶ χρεῶν χρηίζοντι μετάδοσιν ποιήσασθαι, καὶ γένος τὸ ἐξ ωὐτέου ἀδελφοῖς ἴσον ἐπικρινέειν ἄῤῥεσι, καὶ διδάξειν τὴν τέχνην ταύτην, ἢν χρηίζωσι μανθάνειν, ἄνευ μισθοῦ καὶ ξυγγραφῆς, παραγγελίης τε καὶ ἀκροήσιος καὶ τῆς λοιπῆς ἁπάσης μαθήσιος μετάδοσιν ποιήσασθαι υἱοῖσί τε ἐμοῖσι, καὶ τοῖσι τοῦ ἐμὲ διδάξαντος, καὶ μαθηταῖσι συγγεγραμμένοισί τε καὶ ὡρκισμένοις νόμῳ ἰητρικῷ, ἄλλῳ δὲ οὐδενί. Διαιτήμασί τε χρήσομαι ἐπ' ὠφελείῃ καμνόντων κατὰ δύναμιν καὶ κρίσιν ἐμὴν, ἐπὶ δηλήσει δὲ καὶ ἀδικίῃ εἴρξειν. Οὐ δώσω δὲ οὐδὲ φάρμακον οὐδενὶ αἰτηθεὶς θανάσιμον, οὐδὲ ὑφηγήσομαι ξυμβουλίην τοιήνδε. Ὁμοίως δὲ οὐδὲ γυναικὶ πεσσὸν φθόριον δώσω. Ἁγνῶς δὲ καὶ ὁσίως διατηρήσω βίον τὸν ἐμὸν καὶ τέχνην τὴν ἐμήν. Οὐ τεμέω δὲ οὐδὲ μὴν λιθιῶντας, ἐκχωρήσω δὲ ἐργάτῃσιν ἀνδράσι πρήξιος τῆσδε. Ἐς οἰκίας δὲ ὁκόσας ἂν ἐσίω, ἐσελεύσομαι ἐπ' ὠφελείῃ καμνόντων, ἐκτὸς ἐὼν πάσης ἀδικίης ἑκουσίης καὶ φθορίης, τῆς τε ἄλλης καὶ ἀφροδισίων ἔργων ἐπί τε γυναικείων σωμάτων καὶ ἀνδρῴων, ἐλευθέρων τε καὶ δούλων. Ἃ δ' ἂν ἐν θεραπείῃ ἢ ἴδω, ἢ ἀκούσω, ἢ καὶ ἄνευ θεραπηίης κατὰ βίον ἀνθρώπων, ἃ μὴ χρή ποτε ἐκλαλέεσθαι ἔξω, σιγήσομαι, ἄῤῥητα ἡγεύμενος εἶναι τὰ τοιαῦτα. Ὅρκον μὲν οὖν μοι τόνδε ἐπιτελέα ποιέοντι, καὶ μὴ ξυγχέοντι, εἴη ἐπαύρασθαι καὶ βίου καὶ τέχνης δοξαζομένῳ παρὰ πᾶσιν ἀνθρώποις ἐς τὸν αἰεὶ χρόνον. παραβαίνοντι δὲ καὶ ἐπιορκοῦντι, τἀναντία τουτέων.

I swear by Apollo the physician, by Asclepius, by Hygie and Panacea, by all the gods and goddesses, taking them as witness, to fulfill, according to my ability and judgment, this oath and this contract; to consider my master in this art as equal to my own parents; to provide him with subsidies and, if he is in need, to pass on to him a share of my property; to consider his descendants as equal to my brothers, and to teach them this art, if they wish to learn it, without salary or contract; to transmit, the precepts, oral lessons and the rest of the teaching to my sons, to those of my master, and to the disciples bound by a contract and an oath, according to medical law, but to no other. I will use the diet for the benefit of the sick, according to my power and judgment; but if it is for their loss or for injustice to them, I swear to stop it. I will not give anyone a lethal drug if asked, nor will I initiate such a suggestion. Nor will I give a woman an abortifacient pessary. It is in purity and piety that I will spend my life and practice my art. Nor will I incise patients suffering from lithiasis, but I will leave that to the men who specialize in this procedure. In all the houses I must enter, I will enter for the benefit of the sick, keeping myself away from all wilful injustice, from all corrupting acts in general, and in particular from amorous relations with women or men, free or enslaved. Whatever I see or hear during treatment, or even outside treatment, concerning people's lives, if it is never to be repeated outside, I will keep silent, considering such things to be secret. Well then, if I carry out this oath and do not break it, may I enjoy my life and my art, honored by all men for all eternity. On the other hand, if I break it and perjure myself, may it be the other way around.

The Hippocratic Oath today

Contrary to popular belief, doctors are not obliged to take the Hippocratic Oath. Depending on the country, various Hippocratic principles are not respected today:

• In all societies, surgery is now part of medicine.
• According to the evolution of moral standards and individual "consciences" specific to each society (e.g.: respect for "masters" and their descendants, euthanasia, abortion, breach of medical confidentiality in certain circumstances, relativity of notions of "good" and "evil", etc.).
• According to the evolution of lifestyles specific to each society (e.g.: the relativity of the notion of "devotion" in the face of the notion of personal fulfillment).
• Infringements imposed by public authorities in various contexts are commonplace to varying degrees:
  • Tending to force the breaking of professional secrecy by judicial decision or arbitrary executive decision
  • Involvement of doctors in police, military or national security operations
  • Involvement of doctors in judicial executions (e.g. China, United States), institutionalized torture (e.g. United States, Israel), the development of chemical or biological weapons (e.g. United States, Syria), institutionalized discrimination (e.g. segregationist United States, South African apartheid, Israel), examinations carried out without their consent (e.g. in the United States)....), examinations carried out without any interest for the patient as part of legal proceedings (all countries), forced sterilizations (e.g. Nazi regime, post-war Australia, Finland, Norway,...) or for payment (e.g. India in the '80s,...),...
• Religious or sacred references are now generally absent from medical practice.

Ethical rules are now governed by law and by the codes of national medical associations. These rules, which vary from country to country, are also sometimes subject to specific situations (e.g.: military doctors, medical officers, etc.). However :

• In some countries, it is customary for doctors to take an "updated" version of the oath when they graduate. When this is the case, however, the authority of the oath is frequently undermined by the fact that :
  • For practical reasons, the oath is often taken by a single representative on behalf of all graduates, without their opinion being sought (e.g.: Université Libre de Bruxelles, where the "representative" is the student in his or her graduating class with the highest marks in examinations).
  • On the ordinal and legal levels, only the codes of ethics and the body of legislation must be respected.
• Generally speaking, there are common principles, proclaimed if not always respected, in the codes of ethics and/or legislative corpus of all countries, as well as certain Hippocratic principles:
  • Duty of beneficence
  • Refusal to harm (the inclusion of abortion, assisted suicide and/or euthanasia in this framework varies from country to country)
  • Devotion
  • Prohibition on using one's influence to obtain undue sexual or pecuniary favors
  • Medical confidentiality
  • Honorability of the profession

Bibliography

Jouanna J, Hippocrate, Paris, Librairie Arthème Fayard, 1992, annexe I

Littré E, Oeuvres complètes d'Hippocrate, vol. 4 (Baillière, Paris 1844), pp. 628-632