Dr. Sweet is Professor of Reproductive Biology in Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri.
Dr. Sweet reports no commercial conflicts of interest.
Release Date: 10/15/2007
Termination Date: 10/15/2010
Estimated time to complete: 1 hour(s).
Albert Einstein College of Medicine designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
- Discuss the history and derivation of modern medical ethics
- Trace the twists and turns of Hippocrates' traditional ethics through the 20th century
- Discuss the controversial patient care and biomedical research issues facing today's physicians and researchers.
Definition of Medical Ethics
"The principles of proper professional conduct concerning the rights and duties of the physician, patients, and fellow practitioners, as well as the physician's actions in the care of patients and in relations with their families."
http://cancerweb.ncl.ac.uk/cgi-bin/omd?medical+ethics
-- According to the On-Line Medical Dictionary
Published at the Dept. of Medical Oncology
University of Newcastle upon Tyne
[accessed 41,771,900 times]
Author's Operating Hypothesis
Laws contain the codification of the minimum community standards set down by legislative bodies, reflecting a consensus of behavioral standards set by the community at large. As such, the law represents a minimal set of standards that, if violated, provide for penalties, prescribed by legislators. However, medical ethics constitute a set of standards that are higher than the legal standards. They are set by members of the medical profession, based on the medical community's standards for the professional conduct of its members. Accordingly, medical ethics embody higher standards than legal standards -- or at least they ought to.
Early Medical Ethics: Hippocrates' Oath
The classical medical oath by Hippocrates can be found at the Public Broadcasting System's (PBS) Web site: http://www.pbs.org/wgbh/nova/doctors/oath_classical.html
This site is permanently maintained in conjunction with its four-part NOVA doctors series produced by Michael Barnes. The PBS site contains numerous responses by practicing physicians under Doctors' Responses and by the public under Non-Doctors' Responses. Additionally, PBS provides many links to discussions on the pros and cons of the Hippocratic Oath. See also, PBS's Survivor M.D. Site Map at: http://www.pbs.org/wgbh/nova/doctors/textindex.html.
The first recorded administration of the Hippocratic Oath in a medical school was at the University of Wittenberg in Germany in 1508.(1) Yet, the oath did not become a standard part of formal medical school graduation ceremonies until 1804, when it was incorporated into the commencement exercises at Montpellier, France.(3) Thereafter, during the 19th century this custom spread to both sides of the Atlantic Ocean. However, well into the 20th century, relatively few American physicians had formally taken this oath. In 1928, according to a survey by the Association of American Medical Colleges, only 19 percent of medical schools in North America included the oath in their commencement exercises.(4)
Hippocrates, an ancient Greek physician, probably lived between 460 and 380 B.C.
Figure 1. Hippocrate Refusant Les Presents D'Artaxerces (1792).
Anne Louis Girodet de Roussy (1767-1824)
While Hippocrates (Khios, Greece) is seated, D'Artaxerces is pouring money at his feet. Courtesy, National Library of Medicine.
Interestingly, the oath bearing Hippocrates' named is at the same time one of the most revered and yet misunderstood words in the history of medicine.(1) It is often misquoted. For example, the well known phrase, "First, do no harm" (translated into Latin as Primum non nocere), is mistakenly ascribed to Hippocrates' oath despite the fact that it doesn't appear anywhere in the pledge ascribed to him. Rather, Hippocrates came closest to issuing this directive among his writings in Epidemics, "As to diseases, make a habit of two things -- to help, or at least, to do no harm."(1)
The differences between the promises made in the original version of Hippocrates' oath and the oaths sworn today are nearly unrecognizable. The most obvious example is that few, if any of us, still believe in the ancient Greek gods Apollo, Asclepius, Hygieia and Panaceia. Therefore, we no longer pledge allegiance to them. By contrast, today, spirituality in general has little connection with medical science. In 1993, a content analysis of the oaths administered at 147 U.S. and Canadian medical schools revealed that only 11 percent of the various forms of the Hippocratic Oath invoked a deity.(5)
Today, nearly every U.S. medical school administers some form of professional oath to its some 16,000 men and women eager to receive their medical degrees. However, Hippocrates would not recognize most of the pledges ascribed to him. This revisionism is not unique to our time. In fact, alterations of the Hippocrates' oath began soon after its first recitation, generally reflecting changing values, customs and beliefs associated with medical ethics.
Two controversial vows in the original oath formulated by Hippocrates still divide many medical doctors: the pledges never to participate in euthanasia and abortion.(1),(2) These prohibitions had applied primarily to those identified as Hippocratic physicians, a medical sect representing a relatively small minority of all self-proclaimed healers. The early refusal to participate in euthanasia may have been based on philosophical or moral beliefs in preserving the sanctity of life or simply on their wish to avoid involvement in any act of assisted suicide, murder or manslaughter.
Reliable historical documents record that ancient Greek and Roman physicians were confronted with terminally ill patients who preferred a quick, painless death by means of poison rather than letting nature take its course.(2) There certainly were no laws in the ancient world against suicide. Indeed, it was fairly common for physicians to recommend this "option" to a patient with an incurable disease.
In both the ancient Greek and the Roman Empire, abortion (typically effected by means of a pessary to induce premature labor) was practiced as commonly as euthanasia. But later, in predominantly Christian countries, especially the oaths written during the Middle Ages revised the Hippocratic Oath to prohibit abortion. Today, the debate over euthanasia and abortion continues, although the relevant sections of Hippocrates' oath are simply omitted from most oaths administered by U.S. medical schools. As of 1993, only 14 percent of medical school oaths had prohibited euthanasia and only 8 percent prohibited abortion.(5)