First do no harm

The Hippocratic oath as we know is one of the oldest and most binding documents written in history held sacred by doctors. The original version swears by a number of healing gods to uphold ethical standards in healing the sick, upholding a patient’s right to privacy and teaching the value of medicine to the next generation. While the Hippocratic oath does not actually say “do no harm,” it pledges allegiance to mythical gods in fulfilling a covenant by benefiting those who are ill and keeping them from harm.

I am learning that modernized oaths, and in place of the Hippocratic oath, there exists a combination of the idea of doing no harm with vows that will remind both the medical practitioners as well as those on the “other end of the stethoscope” to take into account the social as well as financial well-being in the area of treatment. It seems, as time goes by, there is a wider range of content one looks into other than the physical symptoms and diagnosis. Having said this, perhaps, and in an ever changing world, it explains why medical oaths change. 

A doctor named Louis Lasagna, a former dean at Tufts University School of Medicine, has his own version that was popularly used by medical students based on a 2009 survey. In this version it says, “I will remember there is art to medicine as well as science, and that warmth, sympathy and understanding may outweigh the surgeon’s knife or the chemist’s drug.” At most this is part of the oath in Lasagna’s version that also calls on doctors to admit when they do not know the answer, prevent diseases as well as take responsibility not just for the patient’s health but also the way a certain disease or illness affects a person’s family and economic stability.

Based on some of my research I am also learning that there are a set of other values that may influence a school’s oath. In 1995, Dr. Robert Orr of Loma Linda University joined a panel where they re-wrote the Hippocratic oath. This version showed the pledge to God – something Dr. Orr notes as a factor that had gone missing. Most schools as I have read stick to one of the three main versions of the oath for the sake of tradition – the Hippocratic oath, the Lasagna oath and the Declaration of Geneva which was drafted by the World Medical Association after Nazi doctors orchestrated remorseless and uncivilized medical experiments. The Declaration of Geneva promises to never act against the laws of humanity.

In Harvard, each class of medical students writes its own oaths that happen on two occasions – one at a white coat ceremony and another at graduation when they take their oath as a new doctor. It seems revising oaths puts into the mix old tradition and a vast range of issues that evolve over time. It certainly can make one think therefore how an oath can possibly be revised again considering change is constant, and we are all living in a new normal.

Interesting as it may be, one must never forget to first, do no harm.