What is the Hippocratic oath?

The Hippocratic Oath

The Hippocratic Oath is an ancient ethical code that specifically prohibits physician-assisted suicide, euthanasia, and sexual relationships between physicians and patients while establishing the duties of patient confidentiality and acting in the patient's best interests. 1 This historical document has served as the foundation for medical ethics for approximately 2,500 years, though it is not followed word-for-word in modern practice.

Historical Context and Evolution

The Hippocratic Oath emerged during a time when physician-assisted suicide and euthanasia were common practices, which explains its explicit prohibition of these actions 1. The Oath was revolutionary not only for medicine but for all of humanity by establishing clear ethical boundaries in the physician-patient relationship.

Key historical aspects include:

• The Oath originated in ancient Greece around the 5th century BCE
• It represented a significant shift in medical ethics by prioritizing patient welfare
• It established the therapeutic alliance concept that continues to guide modern medicine

Core Principles of the Hippocratic Oath

The Oath embodies several fundamental ethical principles that remain relevant today:

• Beneficence: Acting for the benefit of patients and putting their welfare first 1, 2
• Non-maleficence: "First, do no harm" - avoiding actions that harm patients 1, 2
• Confidentiality: Maintaining patient privacy and the security of medical information 1
• Professional boundaries: Prohibiting sexual relationships with patients 1
• Respect for human dignity: Honoring the cultural and spiritual uniqueness of every patient 1

These principles create ethical boundaries that prevent misunderstandings and misuse of medical authority while encouraging patients to be open and honest in a safe therapeutic environment 1.

Modern Interpretation and Application

While not followed literally today, the Oath has been analyzed and applied over time based on its fundamental principles 1. Modern medical ethics continues to draw from these principles:

• The Oath provides the general context for medical ethics in the physician-patient relationship 3
• It has established long-lasting moral values that still define the medical profession 3
• Its foremost message focuses on patients' best interests rather than specific prohibitions 3

The American Society of General Surgeons requires its expert witnesses to "abide by the oath of ethics of the ASGS, the fellowship pledge of the American College of Surgeons, the principles of medical ethics of the American Medical Association, and the oath of Hippocrates" 1, demonstrating its continued relevance in professional standards.

Contemporary Relevance

Despite being 2,500 years old, the Hippocratic Oath continues to influence modern medical practice:

• It exemplifies fundamental modern ethical principles of beneficence, non-maleficence, and confidentiality 3
• It has had a powerful impact on modern judicial opinions regarding medical ethics 3
• It serves as a code of professional identity that distinguishes medicine as a profession 1

Some medical schools continue to use versions of the Oath in graduation ceremonies, though practices vary. The Oath represents an ideal of medical behavior and a life project that extends beyond specific clinical decisions 4.

Evolution for Modern Medicine

As medicine evolves, some scholars have proposed updates to the Oath to reflect contemporary challenges:

• Recent proposals include additions to address digital health technologies and their ethical implications 5
• The World Medical Association revised the Oath in 1948 to better reflect post-WWII medical ethics 5
• Modern versions often maintain the core principles while adapting language to contemporary practice

Pitfalls in Interpretation

When considering the Hippocratic Oath, it's important to avoid these common misunderstandings:

• Assuming the Oath is merely historical without contemporary relevance
• Focusing only on specific prohibitions rather than understanding the broader ethical framework
• Failing to interpret the Oath within its historical context
• Overlooking how its principles apply to modern ethical dilemmas in medicine

The Oath should be understood as establishing a foundation of values that guide physician behavior rather than as a rigid set of rules that apply literally in all circumstances.