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

CHAPTER 2 The Hippocratic Tradition: A Sporadic Retreat

C H A P T E R 2 THE HIPPOCRATIC TRADITION A Sporadic Retreat A lthough there is evidence of the Hippocratic school in ancient Greece (Hippocrates is mentioned in Plato), it was not the dominant Greek school of medical thought.1 Others prevailed alongside it. Thus, when some follower of Hippocrates created an oath named in his honor, it is reasonable to assume the Oath applied, at most, only to one among many schools of medical practitioners. Kudlien emphasizes that the Oath is utterly unique even among Hippocratic writings. There was no hint of its acceptance in Greek or Roman medicine. He suggests it is even possible that it was written by a single, isolated physician with a peculiarly religious mind who was inspired to produce a literary document with religious and cult-like elements.2 This raises the question of how the Hippocratic Oath rose to such prominence that it is often, if mistakenly, seen as the universal foundation for ethics in medical practice. The Survival of the Hippocratic Tradition in Ancient and Medieval Culture The first clear reference to the Oath occurs in the first century of the common era when Scribonius Largus refers to Hippocrates as ‘‘the 30 The Survival of the Hippocratic Tradition in Ancient and Medieval Culture  31 founder of our profession’’ and then indicates that Hippocrates began his instruction with an oath.3 Existing texts of Galen, a century later, never refer to the Oath.4 The evidence for the presence of the Hippocratic Oath in the medieval period is hard to come by. Carlos Galvao-Sobrinho says that references to the Hippocratic Oath are rare in late antiquity.5 Antonio Garzya, analyzing medical ethics in the Byzantine Empire, makes reference to the Hippocratic corpus but no mention of the Hippocratic Oath.6 He describes medical ethics of the Byzantine Empire as a hybridizing of Greek and Christian ethics. Jacques Jouanna notes that the Hippocratic Oath was not a major reference during the Byzantine period.7 The Oath is not present in the known texts translated into Latin in the fifth and sixth centuries. Carol Mason Spicer and I, searching for references to the Hippocratic Oath in the Patristic church fathers, found only two references to the Oath in the first eight centuries of Christian history.8 Both come from the fourth century, and both self-consciously distinguish Christian ethics for physicians from Hippocratic. The first reference is found in Jerome’s Letter LII: It is your duty to visit the sick, to know the homes and children of ladies who are married, and to guard the secrets of noblemen. Make it your object, therefore, to keep your tongue chaste as well as your eyes. Never discuss a woman’s figure nor let one house know what is going on in another. Hippocrates, before he will teach his pupils, makes them take an oath and compels them to swear fealty to him. He binds them over to silence, and prescribes for them their language, their gait, their dress, their manners. How much more reason have we to whom the medicine of the soul has been committed to love the houses of all Christians as our own homes.9 While Jerome speaks without hostility about the Hippocratic Oath, he clearly differentiates Christian ‘‘medicine of the soul’’ and reveals that Christians are not expected to swear such an oath. The second reference, also in the fourth century, is in the writing of Gregory of Nazianzus, who refers to his younger brother, Caesarius of 32  The Hippocratic Tradition Nazianzus, who held a number of court offices including that of physician . Gregory differentiates his brother from Hippocratic physicians: ‘‘Among physicians he gained the foremost place with no great trouble, by merely exhibiting his capacity, or rather some slight specimen of his capacity , and was forthwith numbered among the friends of the Emperor, and enjoyed the highest honors. . . . By his modesty he so won the love of all that they entrusted their precious charges to his care, without requiring him to be sworn by Hippocrates, since the simplicity of Crates was nothing to his own.’’10 Once again, the Hippocratic Oath is recognized but clearly differentiated from Christian medicine, which is deemed superior. According to Galvao -Sobrinho, the only other instance of the Hippocratic Oath explicitly used as an oath prior to the eleventh century occurs in an anonymous treatise dated in the ninth or...