Doctors and the Hippocratic Oath

Dr Derrick Aarons

Sunday, June 25, 2017

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Historically, medical doctors have been expected to practise medicine in keeping with the ethical dictates of the Hippocratic Oath.

The oath was the first guideline in medical ethics recorded in the history of western medicine, and originated in the body of writings known as the Hippocratic Corpus, originating in ancient Greece around the 4th Century BC. It requires doctors to uphold specific ethical standards, including doing no harm ( primum non nocere).

The relevance of the oath

Whilst no such research has been done in Jamaica, a recent study among doctors in the USA has revealed some very interesting findings. The research polled 2,674 doctors and 134 medical students. Some comments were noteworthy:

“The Hippocratic Oath is quite relevant today as it gives our newly trained colleagues an idea of the principles our once noble profession espoused, when we served patients for their good, and not bureaucrats for theirs.”

Another comment, however, took a different view, writing that the oath is “sadly, irrelevant. Medicine has evolved from a profession into a huge service industry that involves many other players. These players, like the health insurance, hospital employers and pharmaceuticals, do not pray to the same god as the medical profession. Their priority is financial profit — within or without the Hippocratic Oath”.

The responses by doctors were grouped by their ages, and included an under 34 years age group, and a 65 years and older age group. Interestingly, only 39 per cent of doctors in the under 34 years age group thought that the Hippocratic Oath was still very meaningful, while 70 per cent of doctors in the 65 years and older age group thought the oath was still very meaningful. The medical students' responses regarding the relevance of the oath were similar to those of doctors under 34 years of age, with 41 per cent of the students indicating that they thought the oath was still very meaningful.

Should the oath be changed?

When asked whether the oath should be kept, revised, or replaced, those doctors 65 years and older answered with more certainty that it should be kept, 72 per cent of them agreeing with that approach. Twenty per cent of them said revise or replace it, while eight per cent said get rid of it.

However, the poll told a different story among the younger age group. Fewer than half (43 per cent) wanted to keep the oath, 40 per cent recommended revising or replacing it, while 16 per cent favoured getting rid of it.

The ethical dictates of the Hippocratic Oath requires that doctors put their patients first in all considerations within the health care setting. The research poll in the USA asked two questions related to that aspect: 1) Whether the dictates of the oath contributed to physician burnout; 2) How often were doctors able to put patients first in today's health care environment?

Obeying the oath and physical burnout

The younger group of doctors was much more likely to say that the oath's patient-first focus contributed to doctors' burnout. Almost half (47 per cent) of the doctors in the younger group responded that it did, compared to 27 per cent of doctors in the 65 years and older group. Medical students were split on the subject, with 33 per cent responding yes, 32 per cent responding no, and 35 per cent being unsure.

When asked, given the current health care environment, how frequently they were able to put patients first, the responses were strikingly different according to age. Only 12 per cent of those under 34 years said 'always', whereas 40 per cent of those 65 years and older responded 'always'.

Some respondents were unequivocal in stating that the Hippocratic Oath should rule the medical profession, with one doctor quoted as saying: “The oath is like constitutional law. It should be preserved.”

Another stated: “We must do the right thing by the patient with or without taking an oath, as it is implied when we decide to become doctors.”

Health care challenges in Jamaica

Given the numerous challenges currently existing in Jamaica's health care system, it would be instructive to ascertain what a poll with similar questions would find among doctors working in Jamaica. Doctors are challenged by heavy patient load daily in the public sector, inadequate supplies and equipment for their work within the public health care system, insufficient human resources within the health care team, and competing obligations within and outside the medical profession.

Whilst there are several social determinants of health, doctors still play a critical role in the health of the nation. Consequently, the policymakers and leaders within the health care industry should heed the multifaceted challenges and work constructively with all stakeholders to improve health and health care (health equity) for all people in the society.

Derrick Aarons MD, PhD is a consultant bioethicist/family physician, a specialist in ethical issues in medicine, the life sciences and research, and is the ethicist at the Caribbean Public Health Agency — CARPHA. (The views expressed here are not written on behalf of CARPHA)




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