Tuesday, April 05, 2005

Our Modern Watered-Down Hippocratic Oath

Now I'm reminded of why I included So many lawyers, so little time... in my blogroll. Look at this April 2, 2005 post. He linked an essay by Dr. John Patrick discussing some of the more fundamental concepts of the Hippocratic Oath.

I can't say that Patrick is a very clear writer. If you don't get what he's trying to express after a first reading, I'd definitely recommend going over it again until the message sinks in. Deep stuff and worth it.

I have always been uneasy with the watered-down versions of the "Oath" that modern medical schools administer. Patrick gives me a little more insight as to why. The main gist of his thesis is that as doctors, we've come to think of the ethical practice of medicine more as following a code of morality as opposed to an oath.

The first paragraph of the original oath is:

"I swear by Apollo and Aesclepius and Hygeia and Panacea and all the gods and goddesses, making them my witness, that I will fulfil according to my ability and judgment, this oath and this covenant"
Obviously, we wouldn't be expected to swear an allegiance to Greek or Roman polytheism but the original intent was an oath whose authority arose from God. This is very different from a code which essentially has no authority other than the good will of the person agreeing to be bound by it.

To remove the notion of a deity from the oath reduces its meaning and relegates it to mere ceremonial ritual. How many of us involved in the practice of medicine view what we do as a sacred profession?

Before the modern age, healthcare providers saw themselves as caretakers of God's creations. Can there be a more powerful concept for focusing on the true magnitude of our work be it physician, PA, nurse, social worker, etc? Concerns about malpractice litigation pale by comparison.

We can understand the desirability of avoiding any religious "controversy" during a medical school graduation and I certainly don't want to go into a religious polemic but there is a large issue here. With the increasing secularization of society, perhaps we in the healing arts have also lost sight of the importance of what we do.

In his essay, Patrick makes the excellent point that there is a social trend towards promoting patient autonomy. The idea is to give patients an increasing say in their healthcare decision-making. The term patient advocacy is a buzzword throughout the medical community. The real question is why do we feel that patient autonomy must be protected? Why does the patient need an advocate other than his primary care provider? The concept obviously fulfills a genuine need in society, a need arising from our own shortcomings.

That need stems from the perception among patients that their interests have ceased to be paramount in the minds of those of us encharged with their care. As caretakers of God's creatures, have we let our patients down? Have we lost the trust of our patients? Do we deserve the trust of our patients?

I'm not advocating a "religious test" to be qualified to practice medicine, but perhaps all of us in healthcare need to ponder the true motivation behind our actions in taking care of patients. Maybe we need to think a little more about God and His expectations of us. While not casting aspersions on the patient advocacy movement, I agree with Dr. Patrick. If all of us in healthcare focus on the "ultimate" moral justification for decisions on behalf of our patient, if all of us take ownership in our patients' well-being as fellow creations of God, patient advocacy offices and ombudsmen become irrelevent and unnecessary.

Each of us should view every decision we make for those under our care as an opportunity to regain our patients' trust and an opportunity to serve a higher being regardless of the name we give to it.



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