Hypocrisy and the Hippocratic Oath

by Joyce Arthur

(also published in Humanist in Canada, Winter 1999/2000, No. 131, Vol.32, #4, pp. 26-28)

The Canadian anti-choice movement wants to revive the use of the Hippocratic Oath by the medical profession. In May, two hundred anti-choice activists picketed the headquarters of the Canadian Medical Association in Ottawa, demanding that the CMA reinstate the Oath. According to protest leader Dr. André Lafrance, the CMA stopped using the Oath in the late 1960's, and has moved from an ethic of protection of human life to one which "increasingly condones killing by doctors."

The Hippocratic Oath has no legal status -- it's become a symbolic ritual that most medical school graduates don't pay much attention to, if they participate at all. Still, the Oath seems to have this air of sacred reverence attached to it, which the anti-choice have eagerly seized upon in an attempt to make themselves look suitably noble and ethical.

No doubt the anti-choice movement likes the Oath because, in its original form, it apparently prohibited abortion and euthanasia. Today, only 8% of American medical schools that use the Oath still include a prohibition on abortion and only 14% include a euthanasia ban. The Oath has been revised and modernized in many other ways over the centuries, to reflect society's evolving values, changing laws, and new medical technologies. However, the anti-choice despise this kind of moral relativism -- to them, abortion was, is, and always will be wrong. So here they are, advocating a back-to-the-basics approach. We expect they will be consistent in their moral absolutism, of course, and take back the entire, original Oath, without exception. They can't go cherry-picking like other revisionists, since this would make them look like sanctimonious hypocrites. So let's take a look at the original Hippocratic Oath to understand exactly what medical doctrines the anti-choice want doctors to uphold.

The Hippocratic Oath

I SWEAR by Apollo the physician and Aesculapius, and Hygiea, and Panacea, and all the gods and goddesses, that, according to my ability and judgment, I will keep this Oath and this stipulation.

To consider him who taught me this Art as dear to me as my parent, to share my substance with him, and to relieve his necessities if required; to look upon his offspring as equivalent to my own brothers, and to teach them this Art, if they wish to learn it, without fee or stipulation.

And that by precept, lecture, and every other form of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others.

I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients and abstain from whatever is harmful and mischievous.

I will give no deadly medicine to anyone if asked, nor suggest any such advice; likewise, I will not give a pessary to a woman to induce abortion.

I will live my life and practice my art with purity and holiness.

I will not cut persons suffering from 'the stone', but will leave this to be done by men who are practitioners of this skill.

Whatever houses I enter, I will enter for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption, and especially from the seduction of females or males, of free persons or slaves.

Whatever I see or hear in connection with my professional practice or not in the life of men, which should not be made public, I will not divulge, considering that all such knowledge should remain secret.

As long as I continue to keep this Oath inviolate, may it be granted to me to enjoy life and the practice of the Art, respected by all men, at all times. But if I should trespass and violate this Oath, may the opposite be my lot.

The Oath is commonly attributed to Hippocrates, the father of modern medicine, who lived in ancient Greece from about 460 to 370 BC. However, modern research has shown that the Oath was probably written between the third and fifth centuries BC by a Pythagorean temple cult that worshipped Apollo. The Oath actually begins by requiring allegiance to a series of pagan gods. Now the vast majority of anti-choice activists are committed Christians, so it's a bit surprising that the pagan origins of the Hippocratic Oath don't bother them. Nonetheless, we certainly welcome this refreshing and unprecedented level of religious tolerance on the part of conservative Christians.

Next, we read that medical students must share their "substance" with their teacher and "relieve his necessities." Could this possibly mean what it seems to mean? Well, most likely -- yes. In ancient Greece, sexual activity between men and youths was very popular and socially accepted. Indoctrination into the art of homo-erotic love was part of most young men's education, including would-be doctors, no doubt. Although the anti-choice should be commended on their sudden advocacy of the gay lifestyle, they need to learn that our society strongly disapproves of persons in authority demanding sexual favours from their underlings.

Incidentally, later Christian versions of the Oath did away with those embarrassing pagan gods, and gave the boot to gay sex with teachers, as well. Now, medical students are expected to pay them off instead of jerk them off, a variant translation that many people -- but perhaps not "pro-life" Christians -- would consider to be only a slight moral improvement over the original.

In one of its more perplexing clauses, the Oath makes doctors promise not to practice surgery, at least abdominal surgery. This was probably because surgery was considered an inferior profession in ancient times -- it usually resulted in the death of the patient. Things have changed, of course, and surgery is now an integral lifesaving tool used every day by highly skilled physicians. So it's quite disconcerting to find that our anti-choice activists want all doctors to swear by the gods that they'll never pick up a scalpel.

A couple of the Oath's directives are admirable and still very relevant today, such as the admonition to maintain patient confidentiality, and not to seduce patients. However, the mention of slaves in this latter context is certainly an anachronism. Perhaps the reason our noble protesters value this reference to slaves, however, has something to do with another ancient document that supports slavery -- the Bible. For example, there's lots of rules in the Old Testament on how to treat your slaves, and in the New Testament epistle of Philemon, St. Paul compels one of his followers, a slave, to return to his master.

If the order of directives in the Oath is any guide, we see that the most important duty of new doctors is to exhibit undying loyalty to teachers and bosses, even at the expense of their own families. Next comes the call to teach the art of medicine to a select few. Finally, almost as an afterthought, comes concern for the patient. Protecting patients' rights was a new and wonderful idea 2000 years ago, but today it is the most obvious and overriding ethic for doctors. It's unfortunate that the anti-choice want to downgrade those rights and elevate the status of elite pederast clubs instead.

What's missing from the original Oath is also revealing -- for example, the concept of informed consent. This vital medical ethic was first incorporated into the Declaration of Geneva in 1948, after the painful lesson of Nazi Germany, where doctors experimented cruelly on people against their will. Any oath today that omits the patient's right to informed consent would be considered morally deficient by thinking people, but perhaps to the anti-choice, ignorance is bliss.

All of these new planks in the anti-choice platform are a novel surprise, but the Hippocratic injunction against abortion and euthanasia finally puts us on familiar ground. It's public knowledge that the anti-choice are solidly against them both. But even these prohibitions are not as clear-cut as they appear to be in the Oath. The clause on abortion has been widely misinterpreted as a blanket injunction against all abortions, but in fact, it only prohibits the use of a "pessary" (a vaginal suppository). This particular method of abortion was likely considered more dangerous to the woman than other methods.

Ironically, the sanctity of life promoted in the Oath was an anomaly in ancient Greece and Rome. Many abortion methods, including herbs, drugs, and physical techniques, as well as pessaries, were recommended and widely practiced by physicians in the ancient world, including Hippocrates himself, the Oath's namesake. As for mercy killing, the Roman stoic Seneca (circa 4 BC to 65 AD) is representative of ancient secular views. He described euthanasia as a blessing in the face of cruel disease, and a service that could be purchased at the "cost of a pin-prick." All of this would seem to be the final nail in the coffin for the alleged sacredness and authority of the Hippocratic Oath. The anti-choice don't even have a tradition to stand on.

By demanding reinstatement of the Hippocratic Oath, anti-abortionists want to toss some exemplary moral developments into the trash can -- not just informed consent. New codes of ethics, such as the Declaration of Geneva, and that of the Canadian Medical Association, put the patient first, and include many directives that are nowhere to be found in the Hippocratic Oath. The CMA's code of ethics promotes, for example, lifelong learning, empathetic communication with patients, the right of patients to refuse treatment, prudent use of health care resources, and many other praiseworthy ethics.

But because of their narrow fixation on the "absolute immorality" of abortion and euthanasia, the anti-choice blindly negate these true ethical advances in favour of ancient directives that are deeply embarrassing to their own cause. We must reluctantly conclude that the anti-choice are morally challenged.