Hippocratic, Religious, and Secular Medical Ethics: The Points of Conflict

CHAPTER 1 The Hippocratic Oath and the Ethic of Hippocratism

C H A P T E R 1 THE HIPPOCRATIC OATH AND THE ETHIC OF HIPPOCRATISM R egardless of the modern widespread acceptance of the Hippocratic Oath as an uncontroversial, platitudinous statement with universal application, its origins are more eccentric. It is associated with the Hippocratic school of medicine in ancient Greece, one among many competing medical schools of thought. Its adherents came up against the Empiricists, Rationalists, Methodists, and Asclepions . The Hippocratic school, sometimes referred to as the Coan school, was apparently centered on the island of Cos in the Aegean Sea, far removed from mainland Greece and some four kilometers from the Turkish coast.1 The Oath was, in all likelihood, not written by a historical figure named Hippocrates but more likely by one of his followers some decades after the death of the teacher for whom the school is named. This would place the Oath in the fourth century before the common era.2 For our purposes, it is critical to understand that the Oath reflects characteristics that suggest an initiation ritual into a kind of Greek cult. Ludwig Edelstein , the twentieth-century German physician-historian, sees the group responsible for the Oath as Pythagorean.3 The Pythagoreans were a 10 The Normative Peculiarities of the Oath  11 quasi-religious, scientific, mathematical, and philosophical group that reflected many of the characteristics of the Oath, including its tripartite division of medicine into dietetics, pharmacology, and surgery. Scholarship since the eighteenth century has proposed that the Oath could be Pythagorean.4 More recent scholarship has questioned the Pythagorean hypothesis put forward by Edelstein and his predecessors.5 Some claim that all that can be said is that the Oath represents the thinking of a group with some characteristics resembling the Pythagoreans. We need not resolve this dispute. The origin is either from a Pythagorean group or from a group that is in many ways similar. To avoid taking sides in this scholarly feud, I refer to the Hippocratic cultic group as ‘‘Pythagorean-like.’’ Regardless of how that dispute is resolved, the critical point is that the Hippocratic Oath represents the moral and religious views of one particular group with a rather special view of how medicine should be practiced. Only by crude, simplistic, reductionist maneuvers can the unique and peculiar characteristics of the Hippocratic Oath be extended to an all-purpose, universal codification for the proper moral conduct of all physicians. My focus is not primarily on the original meaning and content of the Oath as used by some ancient pagan religious school of physicians, whoever they may have been, but on the use of the Oath as a codification of moral norms for health care professionals in the modern world. In criticizing the moral content of the Oath as a source of guidance for modern physicians, my aim is not to suggest it was inappropriate for the group practicing Hippocratic medicine in ancient Greece. Rather, I am saying the Oath is seriously deficient for dealing with the medical morality of the present day. I argue that it is incompatible with both modern secular ethical systems and major religious traditions of contemporary medical morality. The Normative Peculiarities of the Oath The peculiarities and religious uniqueness of the Oath as a source relevant to modern medical practice are apparent in the first line, even if 12  The Hippocratic Oath and the Ethic of Hippocratism that line provides only the most superficial problems for modern medical practitioners. The Oath begins by having the physician swear by ‘‘Apollo the Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses.’’6 Already the Oath text should give the modern physician (and layperson) pause. In its classic form, the Oath is not only a religious document; it is one of a pagan Greek religion that should offend the practitioner as well as the patient of any modern religious or secular persuasion. Almost all modern versions of the Oath edit out the embarrassing pagan deities. In doing so, however, they erase the initial signal that the Oath is grounded in a religious alternative to the views of virtually all modern health providers and patients. Moreover, cleansing the Oath of its most explicit religious references merely masks the more subtle problems buried in the text. The Peculiar Oath of Initiation The Oath is divided into two main sections: a pledge of loyalty resembling an...