Skip to main content
Top
Published in: European Spine Journal 7/2018

01-07-2018 | Review

The relevance of the Hippocratic Oath to the ethical and moral values of contemporary medicine. Part I: The Hippocratic Oath from antiquity to modern times

Authors: Helen Askitopoulou, Antoniοs N. Vgontzas

Published in: European Spine Journal | Issue 7/2018

Login to get access

Abstract

The present paper discusses the relevance and significance of the Hippocratic Oath to contemporary medical ethical and moral values. It attempts to answer the questions about some controversial issues related to the Oath. The text is divided in two parts. Part I discusses the general attributes and ethical values of the Oath, while Part II presents a detailed analysis of each passage of the Oath with regard to perennial ethical principles and moral values. Part I starts with the contribution of Hippocrates and his School of Cos to medicine. It continues by examining the moral dilemmas concerning physicians and patients in the Classical Times and in the Modern World. It also investigates how the Hippocratic Oath stands nowadays, with regard to the remarkable and often revolutionary advancements in medical practice and the significant evolution in medical ethics. Further, it presents the debate and the criticism about the relevance of the general attributes and ethical values of the Oath to those of modern societies. Finally, it discusses the endurance of the ethical values of the Hippocratic Oath over the centuries until today with respect to the physicians’ commitment to the practice of patient-oriented medicine. Part I concludes with the Oath’s historic input in the Judgment delivered at the close of the Nuremberg “Doctors’ Trial”; this Judgement has become legally binding for the discipline in the Western World and was the basis of the Nuremberg Code. The ethical code of the Oath turned out to be a fundamental part of western law not only on medical ethics but also on patients’ rights regarding research.
Footnotes
1
For the purposes of the present paper, we have adopted the definitions of the World Medical Association about ethics and morality. These definitions refer to them as follows: “Ethics is the study of morality−careful and systematic reflection on and analysis of moral decisions and behaviour, whether past, present or future. Morality is the value dimension of human decision making and behaviour […] According to these definitions, ethics is primarily a matter of knowing whereas morality is a matter of doing [3, p. 9].
 
2
Thales, Heraklitos, Anaxagoras among the most famous.
 
3
The letters M and V are abbreviations given by WHS Jones to these manuscripts.
 
4
The first Arabic translations from Greek texts including medicine appeared in the 9th century.
 
5
It is worth noting that in Greece, the birthplace of the Oath, the original Hippocratic Oath without the invocation to the ancient Gods is taken upon graduation in only two of the seven medical schools. The other five schools have devised graduation oaths which reflect social changes and modern values.
 
Literature
1.
2.
go back to reference Pellegrino ED, Thomasma DC (1993) The virtues in medical practice. Oxford University Press, New York Pellegrino ED, Thomasma DC (1993) The virtues in medical practice. Oxford University Press, New York
3.
go back to reference World Medical Association (2015) Medical ethics manual. 3rd edn. France World Medical Association (2015) Medical ethics manual. 3rd edn. France
4.
go back to reference Veatch RM (1984) The Hippocratic ethic is dead. New Physician 48:41–42PubMed Veatch RM (1984) The Hippocratic ethic is dead. New Physician 48:41–42PubMed
5.
go back to reference Nutton V (1995) What’s in an Oath? J R Coll Physicians Lond 29:518–524PubMed Nutton V (1995) What’s in an Oath? J R Coll Physicians Lond 29:518–524PubMed
6.
go back to reference Morgenstern J (2008) The medical oath: honorable tradition or ancient ritual? Univ West Ontario Med J 78(1):27–29 Morgenstern J (2008) The medical oath: honorable tradition or ancient ritual? Univ West Ontario Med J 78(1):27–29
7.
go back to reference Ors Y (1994) The Hippocratic Oath: an anachronism. World Health Forum 15(4):57–58PubMed Ors Y (1994) The Hippocratic Oath: an anachronism. World Health Forum 15(4):57–58PubMed
8.
go back to reference Woodbury E (2012) The fall of the Hippocratic oath: why the Hippocratic oath should be discarded in favor of a modified version of Pellegrino’s precepts. GUJHS 6(2):9–17 Woodbury E (2012) The fall of the Hippocratic oath: why the Hippocratic oath should be discarded in favor of a modified version of Pellegrino’s precepts. GUJHS 6(2):9–17
9.
go back to reference Dickstein E, Erlen J, Allen JA (1991) Ethical principles contained in currently professed medical oaths. Acad Med 66:622–624CrossRefPubMed Dickstein E, Erlen J, Allen JA (1991) Ethical principles contained in currently professed medical oaths. Acad Med 66:622–624CrossRefPubMed
10.
go back to reference Miles SH (2005) The Hippocratic oath and the ethics of medicine. Oxford University Press, Oxford Miles SH (2005) The Hippocratic oath and the ethics of medicine. Oxford University Press, Oxford
11.
go back to reference Carrick P (2001) Medical ethics in the ancient world. Georgetown University Press, Washington, DC Carrick P (2001) Medical ethics in the ancient world. Georgetown University Press, Washington, DC
12.
go back to reference Jones WHS (2004) General introduction. In: Page TE (ed) Hippocrates. Loeb Classical Library, vol 1. Harvard University Press, Cambridge Jones WHS (2004) General introduction. In: Page TE (ed) Hippocrates. Loeb Classical Library, vol 1. Harvard University Press, Cambridge
13.
go back to reference Daikos GK (2007) History of medicine: our Hippocratic heritage. Int J Antimicrob Agents 29:617–620CrossRefPubMed Daikos GK (2007) History of medicine: our Hippocratic heritage. Int J Antimicrob Agents 29:617–620CrossRefPubMed
14.
go back to reference Nutton V (1995) Medicine in the Greek world, 800–50 BC. In: Conrad LI, Neve M, Nutton V, Porter R, Wear A (eds) The western medical tradition. 800 BC to 1800 AD. Cambridge University Press, Cambridge Nutton V (1995) Medicine in the Greek world, 800–50 BC. In: Conrad LI, Neve M, Nutton V, Porter R, Wear A (eds) The western medical tradition. 800 BC to 1800 AD. Cambridge University Press, Cambridge
15.
go back to reference Jones WHS (2004) Introduction. In: Page TE (ed) Hippocrates. The Oath, Loeb Classical Library, vol 1. Harvard University Press, Cambridge, pp 291–297 Jones WHS (2004) Introduction. In: Page TE (ed) Hippocrates. The Oath, Loeb Classical Library, vol 1. Harvard University Press, Cambridge, pp 291–297
16.
go back to reference Jotterand F (2005) The Hippocratic Oath and contemporary medicine: dialectic between past ideals and present reality? J Med Philos 30:107–128CrossRefPubMed Jotterand F (2005) The Hippocratic Oath and contemporary medicine: dialectic between past ideals and present reality? J Med Philos 30:107–128CrossRefPubMed
17.
go back to reference Askitopoulou H (2016). The Hippocratic physician–patient relationship: lessons for contemporary medicine. In: Cooper MG, Ball CM, Thirlwell JR (eds) History of Anaesthesia VIII. Proceedings of the 8th International Symposium on the History of Anaesthesia. Sydney, Australian Society of Anaesthetists, pp 585–595 Askitopoulou H (2016). The Hippocratic physician–patient relationship: lessons for contemporary medicine. In: Cooper MG, Ball CM, Thirlwell JR (eds) History of Anaesthesia VIII. Proceedings of the 8th International Symposium on the History of Anaesthesia. Sydney, Australian Society of Anaesthetists, pp 585–595
18.
go back to reference Von Staden H (1996) “In a pure and holy way”. personal and professional conduct in the Hippocratic Oath? J Hist Med Allied Sci 51(4):404–437CrossRef Von Staden H (1996) “In a pure and holy way”. personal and professional conduct in the Hippocratic Oath? J Hist Med Allied Sci 51(4):404–437CrossRef
19.
go back to reference Hippocrates (1998). Law. In: Page TE (ed). Jones WHS (transl). Loeb Classical Library, vol 2. Harvard University Press, Cambridge, para I. pp 1–7 Hippocrates (1998). Law. In: Page TE (ed). Jones WHS (transl). Loeb Classical Library, vol 2. Harvard University Press, Cambridge, para I. pp 1–7
20.
go back to reference Jouanna J (1999). Hippocrates. DeBevoise MB (transl). The John Hopkins University Press, Baltimore Jouanna J (1999). Hippocrates. DeBevoise MB (transl). The John Hopkins University Press, Baltimore
21.
go back to reference Jones WHS (2004) The doctor’s Oath: an essay in the history of medicine. Cambridge University Press, Cambridge Jones WHS (2004) The doctor’s Oath: an essay in the history of medicine. Cambridge University Press, Cambridge
22.
go back to reference Edelstein L (1987) The Hippocratic Oath: text, translation, and interpretation. In: Temkin O, Temkin CL (eds) Ancient medicine. The John Hopkins University Press, Baltimore Edelstein L (1987) The Hippocratic Oath: text, translation, and interpretation. In: Temkin O, Temkin CL (eds) Ancient medicine. The John Hopkins University Press, Baltimore
23.
go back to reference Edelstein L (1987) The genuine works of Hippocrates. In: Temkin O, Temkin CL (eds) Ancient medicine. The John Hopkins University Press, Baltimore, pp 133–144 Edelstein L (1987) The genuine works of Hippocrates. In: Temkin O, Temkin CL (eds) Ancient medicine. The John Hopkins University Press, Baltimore, pp 133–144
24.
go back to reference Littré E (1839). Oeuvres Complètes d’ Hippocrate. Traduction Nouvelle, vol 1. JB Baillière, Paris Littré E (1839). Oeuvres Complètes d’ Hippocrate. Traduction Nouvelle, vol 1. JB Baillière, Paris
25.
go back to reference Daremberg CV (1855) Oeuvres Choisies d’ Hippocrate. Lahure, Paris Daremberg CV (1855) Oeuvres Choisies d’ Hippocrate. Lahure, Paris
26.
go back to reference Jonsen AR (2000) A short history of medical ethics. Oxford University Press, New York, pp 1–12 Jonsen AR (2000) A short history of medical ethics. Oxford University Press, New York, pp 1–12
27.
go back to reference Prioreschi P (1995) The Hippocratic Oath: a code for physicians, not a Pythagorean manifesto. Med Hypotheses 44(6):447–462CrossRefPubMed Prioreschi P (1995) The Hippocratic Oath: a code for physicians, not a Pythagorean manifesto. Med Hypotheses 44(6):447–462CrossRefPubMed
28.
go back to reference Wellcome Library. Archives & Manuscripts. Fragment of Hippocratic oath: (verso). Oxyrhynchus papyrus No. 2547. Library reference: WMS 5754. London Wellcome Library. Archives & Manuscripts. Fragment of Hippocratic oath: (verso). Oxyrhynchus papyrus No. 2547. Library reference: WMS 5754. London
29.
32.
go back to reference Veatch RM (1995) Medical codes and Oaths. In: Reich WT (ed) The encyclopedia of bioethics, vol 3. Simon & Shuster MacMillan, New York, pp 1419–1422 Veatch RM (1995) Medical codes and Oaths. In: Reich WT (ed) The encyclopedia of bioethics, vol 3. Simon & Shuster MacMillan, New York, pp 1419–1422
33.
go back to reference Davey LM (2001) The Oath of Hippocrates: a historical review. Neurosurgery 49:554–566PubMed Davey LM (2001) The Oath of Hippocrates: a historical review. Neurosurgery 49:554–566PubMed
34.
go back to reference Fu-Chang Tsai D (1999) Ancient Chinese medical ethics and the four principles of biomedical ethics. J Med Ethics 25:315–321CrossRef Fu-Chang Tsai D (1999) Ancient Chinese medical ethics and the four principles of biomedical ethics. J Med Ethics 25:315–321CrossRef
35.
go back to reference Beauchamp TL, Childress JF (2009) Principles of biomedical ethics. Oxford University Press, Oxford Beauchamp TL, Childress JF (2009) Principles of biomedical ethics. Oxford University Press, Oxford
36.
go back to reference Pellegrino ED, Thomasma DC (1987) The conflict between autonomy and beneficence in medical ethics: proposal for a resolution. J Contemp Health Law Policy 3(1):23–46PubMed Pellegrino ED, Thomasma DC (1987) The conflict between autonomy and beneficence in medical ethics: proposal for a resolution. J Contemp Health Law Policy 3(1):23–46PubMed
37.
go back to reference Veatch RM (1991) The patient-physician relation: the patient as partner 2. Indiana University Press, Bloomington Veatch RM (1991) The patient-physician relation: the patient as partner 2. Indiana University Press, Bloomington
38.
go back to reference Veatch RM (2009) Patient, heal Thyself. How new medicine puts the patient in charge. Oxford University Press, Oxford, pp 33–38 Veatch RM (2009) Patient, heal Thyself. How new medicine puts the patient in charge. Oxford University Press, Oxford, pp 33–38
39.
go back to reference Pellegrino ED (2002) Professionalism, profession and the virtues of the good physician. Mount Sinai J Med 69(6):378–384 Pellegrino ED (2002) Professionalism, profession and the virtues of the good physician. Mount Sinai J Med 69(6):378–384
40.
go back to reference Hippocrates (2004) Epidemics I. In: Page TE (ed) Jones WHS (transl). Loeb Classical Library, vol. 1. Harvard University Press, Cambridge, section XI.14–15, p 165 Hippocrates (2004) Epidemics I. In: Page TE (ed) Jones WHS (transl). Loeb Classical Library, vol. 1. Harvard University Press, Cambridge, section XI.14–15, p 165
41.
go back to reference Plato (1926) Laws. In: Henderson J (ed). Books I–VI. Bury RG (transl). Loeb classical library, vol X, Harvard University Press, Cambridge, book IV.720D-E, p 309 Plato (1926) Laws. In: Henderson J (ed). Books I–VI. Bury RG (transl). Loeb classical library, vol X, Harvard University Press, Cambridge, book IV.720D-E, p 309
42.
go back to reference Guinan P (2002) Why not give Hippocrates a place at the table? Ethics Med 18(3):155–158PubMed Guinan P (2002) Why not give Hippocrates a place at the table? Ethics Med 18(3):155–158PubMed
43.
go back to reference Pellegrino ED (1987) Toward an expanded medical ethic: the Hippocratic ethic revisited. In: Bulger RJ (ed) In search of the modern Hippocrates. University of Iowa Press, Iowa City, pp 45–64 Pellegrino ED (1987) Toward an expanded medical ethic: the Hippocratic ethic revisited. In: Bulger RJ (ed) In search of the modern Hippocrates. University of Iowa Press, Iowa City, pp 45–64
44.
go back to reference Hippocrates (2004) The Oath. In: Page TE (ed) Jones WHS (transl). Loeb classical library, vol. 1. Harvard University Press, Cambridge, pp 298–301 Hippocrates (2004) The Oath. In: Page TE (ed) Jones WHS (transl). Loeb classical library, vol. 1. Harvard University Press, Cambridge, pp 298–301
45.
46.
go back to reference Kluge E-HW (2007) Resource allocation in healthcare: implications of models of medicine as a profession. Medscape Gen Med 9(1):57 Kluge E-HW (2007) Resource allocation in healthcare: implications of models of medicine as a profession. Medscape Gen Med 9(1):57
47.
go back to reference Grodin MA, Annas GJ (1996) Legacies of Nuremberg: medical ethics and human rights. JAMA 276:1682–1683CrossRefPubMed Grodin MA, Annas GJ (1996) Legacies of Nuremberg: medical ethics and human rights. JAMA 276:1682–1683CrossRefPubMed
48.
go back to reference International Military Tribunal (1949) Trials of war criminals before the Nuremberg Military Tribunals under Control Council Law No. 10. “The Medical Case”, vol 2. US Government Printing Office, Washington, DC International Military Tribunal (1949) Trials of war criminals before the Nuremberg Military Tribunals under Control Council Law No. 10. “The Medical Case”, vol 2. US Government Printing Office, Washington, DC
49.
go back to reference Annas GJ, Grodin MA (1992) Introduction. In: Annas GJ, Grodin MA (eds) The Nazi doctors and the Nuremberg code: human rights in human experimentation. Oxford University Press, New York, pp 3–5 Annas GJ, Grodin MA (1992) Introduction. In: Annas GJ, Grodin MA (eds) The Nazi doctors and the Nuremberg code: human rights in human experimentation. Oxford University Press, New York, pp 3–5
50.
go back to reference Jonsen AR (2003) The birth of bioethics. Oxford University Press, Oxford, p 134 Jonsen AR (2003) The birth of bioethics. Oxford University Press, Oxford, p 134
51.
go back to reference Grodin MA (1992) Historical origins of the Nuremburg code. In: Annas GJ, Grodin MA (eds) The Nazi doctors and the Nuremberg code: human rights in human experimentation. Oxford University Press, New York, pp 121–144 Grodin MA (1992) Historical origins of the Nuremburg code. In: Annas GJ, Grodin MA (eds) The Nazi doctors and the Nuremberg code: human rights in human experimentation. Oxford University Press, New York, pp 121–144
52.
go back to reference Perley S, Fuss SS, Bankowski Z, Simon F (1992) The Nuremberg code: An international overview. In: Annas GJ, Grodin MA (eds) The Nazi doctors and the Nuremberg code: human rights in human experimentation. Oxford University Press, New York, pp 151–152 Perley S, Fuss SS, Bankowski Z, Simon F (1992) The Nuremberg code: An international overview. In: Annas GJ, Grodin MA (eds) The Nazi doctors and the Nuremberg code: human rights in human experimentation. Oxford University Press, New York, pp 151–152
53.
go back to reference Katz J (1992) The consent principle of the Nuremberg code: its significance then and now. In: Annas GJ, Grodin MA (eds) The Nazi doctors and the Nuremberg code: human rights in human experimentation. Oxford University Press, New York, pp 227–239 Katz J (1992) The consent principle of the Nuremberg code: its significance then and now. In: Annas GJ, Grodin MA (eds) The Nazi doctors and the Nuremberg code: human rights in human experimentation. Oxford University Press, New York, pp 227–239
55.
go back to reference Carey EJ (1928) The formal use of the Hippocratic Oath for medical students at commencement exercises. Bull Assoc Am Med Coll 3:159–166CrossRef Carey EJ (1928) The formal use of the Hippocratic Oath for medical students at commencement exercises. Bull Assoc Am Med Coll 3:159–166CrossRef
56.
go back to reference Orr RD, Pang N, Pellegrino EJ, Siegler M (1997) Use of the Hippocratic Oath: a review of 20th century practice and a content analysis of oaths administered in medical schools in the U.S. and Canada in 1993. J Clin Ethics 8(4):374–385 Orr RD, Pang N, Pellegrino EJ, Siegler M (1997) Use of the Hippocratic Oath: a review of 20th century practice and a content analysis of oaths administered in medical schools in the U.S. and Canada in 1993. J Clin Ethics 8(4):374–385
Metadata
Title
The relevance of the Hippocratic Oath to the ethical and moral values of contemporary medicine. Part I: The Hippocratic Oath from antiquity to modern times
Authors
Helen Askitopoulou
Antoniοs N. Vgontzas
Publication date
01-07-2018
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue 7/2018
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-017-5348-4

Other articles of this Issue 7/2018

European Spine Journal 7/2018 Go to the issue