Hippocratic Oath

I’m not totally convinced by this argument, but I want to put it out there to see what others think.

Supposedly the so-called “Hippocratic oath” was written by Hippocrates (“the father of Western medicine’) or one of his students in the early part of the fifth century B.C.E. It is widely recognized and is an oath that is taken by most, if not all, practitioners of the science (art?) of medicine, though in this country a more modern version is sworn to rather than the antiquated version. The modern version was written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, and used in many medical schools today. So far as I know it does not require the swearer to pay allegiance to the almighty dollar, but many physicians seem to have taken that oath as well. In any event, the oath, as written by Dr. Lasagna is (in part) as follows:

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

In a word, the physician vows to take “all measures which are required” to preserve and enhance the lives in his or her care. The question I have is ethical, if not moral: should physicians be required to take this oath in this day and age — given the fact that the world population as of this writing has exploded to 7 billion 319 million (and counting). The growth of the human population so far this year is 34,962,750. Many theorists who have studied this phenomenon insist that the earth has already reached its carrying capacity. And with global warming making future food production problematic, at best, one needs to seriously ask whether it is ethically right to prolong life when it is attacked by a deadly disease. I admit that there are serious questions about who chooses to terminate life and when the decision should be made, but I shall ignore those questions to simply ask the central question: why prolong human life?

The spiritually certain, of course, insist that human life is sacred and they abhor such things as abortion (while at the same time a great many of them support war and capital punishment). Many of us on the fringes of Judeo/Christian belief might agree. But just because large numbers of people think that human life is sacred doesn’t make it the case. It may simply be a strong feeling we have all grown up with and we have been unwilling to question. I question it here, not to be facetious but because I do believe that such hard questions will soon be forced upon us by factors beyond our control — such as major storms, drought, famine, and super viruses that attack living organisms and which are not treatable. Indeed, at some point physicians may not be able to prolong life. The question before us is whether it makes any sense today to be blindly embracing a policy that may increase, rather than decrease, human suffering on this earth.

I’m not advocating a program of enforced euthanasia — though if such a program were in place I would suggest we take a page from Shakespeare and start with the lawyers, or at least the politicians! But we need to keep an open mind about the possibility of euthanasia for the terminally ill; take a more vigorous approach to family planning, including the promotion of the virtue of having small families; keep in mind that abortion is the woman’s choice; and accept as a given fact that there are people in this world who do not want to have children (or shouldn’t have them if they do) and may even want to choose a partner of the same gender. Our thinking about the so-called “sanctity of human life” is little more than a deep-seated prejudice — not shared by many other cultures, as it happens, and relatively recent if we take history in the large. Think about it: why should human life be considered any more sacred than that of other living creature?

So we might want to alter the Hippocratic oath to simply ask physicians to seek to prolong life as long as reasonable, rather than keeping folks alive at huge expense to their families and with little or no hope for recovery in a world where increasing numbers of people are crowding their way to a rather small table.

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23 thoughts on “Hippocratic Oath

  1. Good question.
    For me, it raises 2 issues.
    #1 of course – Who plays God?
    Age old question with never a good answer. In the US, it’s becoming a huge issue. Should health care be free for all or only for the rich?
    Now we are not the ‘land of plenty’ with poverty running in the high teens and low 20 %’s but if we adopt the former, then prevention has to be the back bone of health care.
    If however, we adopt the later, then we add a certain life and death class in what is becoming a very divided class society.

    As to the 2nd issue – rather then look at the END of life as the problem – and an over crowded planet is a HUGE problem – a choice between the wealthy have’s and the slowly starving have not’s – why aren’t we concentrating on the prevention of births?
    Birth control, birth control, birth control.
    That should be free everywhere.
    But of course then the puritans enter and forbid birth control as it encourages sex.

    The answer is of course to use the wealth of this Nation and others to build farms, schools and hospitals to improve the living of the poor and starving.
    But there are wars to be fought and profits to be made so that’s not going to happen.
    Again excellent question.

    • Well said. Of course, I skirted the first question. But I do mention the need to be aggressive in our prevention of unwanted or unnecessary births. This country has supported active family planning programs around the globe in the past, and they have been successful from what I read. But the Republicans cut the programs every time they come into office on the grounds that they support abortion — which is not the case.

      • To the, what is becoming main stream Republican thinking – NOT having sex is an abortion.
        If the ‘person hood’ legislation takes a solid hold here, then the US as a leader in fighting overpopulation is lost.

      • I would also separate the overpopulation question from the dignity with death question. Two completely different issues in my mind. As long as we keep the christian right, clown car republicans out of office, the birth control/abortion question will be resolved. But the decision as to how to die, and where to die, needs to be discussed with family before the time, so there is a clear understanding. We have Do Not Resusitate documents, why not Allow Me to Die with Dignity documents.

        Great discussion

      • The issues are related only in that they both have to do with reducing the number of humans on earth. The ethics of the two issues are, as you say, entirely different.

  2. Hugh, this is thought-provoking, and a key question for our times. Fatherkane makes the point that I would: it would seem more efficient to tackle overpopulation by reducing the number of births, concentrating our time and money to that end, and especially so in deeply impoverished areas of the world. The misery of the young who are mired in hunger without sufficient medical care, often at risk of war or cultural violence, seems to all be exacerbated by population growth in those areas.

    On the end-of-life side of the discussion, as you know, I’ve personally seen one of those cases where investing in chemotherapy and palliative measures has given a much longer life — with good quality of life — to my terminally ill mother. Indeed, this is one case where medical advances have redefined or made obsolete the very phrase terminally ill. So my perspective is biased, certainly. Yet, I am also quite aware that too many cases do involve an unnecessary prolonging — at great cost, and with suffering involved. There was the famous situation in McAllen, Texas, a few years ago, of doctors ordering reams of unnecessary tests, simply because they knew they could reap the Medicare payments.

    Lasagna’s oath seems to set up a few contradictory circumstances, which is interesting, and has to make being a doctor pretty darned hard! It seems to anticipate a doctor’s role in executions or euthanasia, which is very interesting. And the statement, “I must not play at God,” is filled with many meanings. It could be argued that a doctor plays at God every time he treats a patient. When a doctor saves an accident victim, or even someone who severs his own forearm by accident with a saw, from bleeding to death, that doctor is playing God. It seems common sense, and part of the oath, of course, that you do not let a patient bleed to death or die of an infected wound. Yet, the doctor could do so, and let the population be thinned out that way. (I don’t know the statistics, but there has to be a fairly comparable number of seriously wounded crash and other mishap victims as there are cancer patients.) But, ach, here I am talking about end-of-life stuff, which, as I stated before, I am biased on!

    At any rate, this is really good fuel for a meaty and needed discussion. Thank you, Hugh!

    • My mother was turned into a grand experiment by a couple of doctors — who apparently needed the practice or simply wanted more money — before she incurred a staff infection in the hospital, was summarily discharged so she wouldn’t infect the other patients, and then died a painful death. There are times when it simply doesn’t make sense.
      I agree about the contradiction in Lasagna’s statement. Doctors “play at God”
      every day, I suspect.

  3. I would really like to see efforts at making end of life decisions more palatable. The “Death Panel” baloney of the Republicans was so destructive to a very personal decision. The oath implies to take all means possible to preserve life, but living unconsciously hooked to tubes is not a definition of life in my mind. I’ve seen too many doctors do everything possible because they can, not because it was the patients wish or the right thing to do. We also need to overcome the guilt aspect; I never paid much attention to old aunt Ruth, but now that she’s desperately ill, we need to do all possible to preserve her life. (Feel free to substitute “Dad” or “mom” or “brother/sister”)

    Great post, Hugh.

  4. Hugh, interesting and provocative post. I would rather look at a practical issue that affects us all. Letting someone choose how they wish to live out his of her final time. The infamous Death Panels that such a ruckus was made over by a former Governor were merely an attempt to let people have end of life discussions with his or her doctor. People should be permitted a death with dignity and a doctor can enable that. I remember the line Jimmy Stewart as a doctor told John Wayne with cancer in the movie “The Shootist.” He described a painful death with cancer and then said “I would not die a death like I just described.” Thanks, BTG

  5. BTG: The ending of the “The Shootist” has an echo in Clint Eastwood’s “Gran Torino!” “The Shootist” was interesting: Wayne’s final movie and he was, of course, dying of cancer in real life.

    Hugh, you are absolutely right as you discuss your mother’s death. Every terminal patient is different, and when a loved one suffers in her final days, that has to be awful to see, and affect us for a long time. I wouldn’t want my mother to go through what yours did, and I’m really sorry your mother had to.

    My mother, who more or less knows her cancer will eventually run to her brain, isn’t looking forward at all to that day and wants it to go very quickly. She says she’d rather have a heart attack or stroke first. She has had a good run, so maybe it is easier for her to say that now, but she was also saying it almost immediately, nearly 10 years ago, when she got her terminal diagnosis. She did not want an agonizing final days.

    • Dana, good point about “Gran Torino” and Wayne’s real life cancer. On end of life choices, I applaud what Oregon has done. I was also thinking of Dr. Jack Kervorkian. While taken to court, he only was found guilty when he started the drip for someone who could not and asked him to. On the others, he educated the patient and set it up, then the patient started the drip.

      Suffering is hard on the patient as well as the caregiver – Alzheimer’s, which my mother-in-law eventually died from, is traumatic, while less physically painful. My mother-in-law had a DNR and when she got an infection, that took her to the hospital, that is what we let happen per her wishes.

      We should all have that choice. Fighting to death, for some is not the way they want to go out. BTG

  6. I saw Bryan Welch, publisher and author at Ogden Publications, speak last year about the the necessity of death to make room for the living. He said that he has a certain age in mind that he will stop trying to prolong his life. He said that he wouldn’t just kill himself, but that he would not take extraordinary measures to continue to live. He joked that he might take up riskier behaviors such as sky-diving. An essay he wrote about the matter caused a bit of controversy: http://www.motherearthnews.com/nature-and-environment/human-mortality-zb0z1501zbwel.aspx His perspective is interesting and he has a book coming out about the topic.

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