To the Editor: The Hippocratic Oath (henceforth, the Oath) provides a rich vision of moral medicine that still informs contemporary practice.1 We offer three suggestions to amend practices surrounding the Oath to garner a more robust understanding of the Hippocratic vision for medical students.
First, educate students on the Hippocratic Oath’s rich history, authors, and historical context; provide information on how it has changed over the years and how it intersects with contemporary medical and societal issues. For example, social justice and attempts to reform to ameliorate health disparities are increasingly prevalent themes in contemporary medical school curricula. What parallels might there be between these movements and the original Oath’s origins as espousing a view of medical ethics that was not widely shared at the time, that described modes of practice distinct from the then-current standards?2,3 This education should also allow for an open conversation about the difficult components of the original Oath and how they differ from contemporary versions. The ability to dissent could provide, for those who feel that they cannot swear the Oath, a rich opportunity for discovering and exploring how the Hippocratic view of medicine both informs and potentially complicates contemporary challenges.
Second, discourage the practice of individual students writing their own oaths and using these in place of the Oath. Such a practice contradicts the purpose of an oath, which draws its adherents into a community and acknowledges the presence of an authority greater than the oath takers themselves. Moreover, creating one’s own standards of success suggests that good medicine is tantamount to personal preference, which the Oath (and any morally serious understanding of medicine) strongly argues against. While the original wording of the Oath may preclude physicians from endorsing it in good faith, modern versions which still contain the ethos of the Oath—namely, the call towards an objective view of good medicine—exist and should be recited, rather than individual oaths.
Third, reserve the Oath for graduation commencement ceremonies, not white coat ceremonies. Reciting an oath when one only marginally appreciates the gravity of its claims trivializes its importance. Additionally, medical students’ commitment to learning may conflict with full dedication to the demanding Hippocratic vision of patient care since their vocational responsibilities are different from those of practicing physicians. As such, swearing the Oath prior to medical school likely holds medical students to standards they can neither fully appreciate nor fully achieve. Indeed, medical school is where students ought to learn the vision of Hippocratic medicine which is outlined in the Oath before swearing to adhere to it.
Benjamin W. Frush, MA
Medical student, University of North Carolina School of Medicine, Chapel Hill, North Carolina; [email protected]
John Brewer Eberly Jr, MA
Medical student, University of South Carolina School of Medicine, Columbia, South Carolina.
Calvin R. Gross
Medical student, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
1. Nutton VAncient Medicine (Sciences of Antiquity). 2013:2nd ed. New York, NY: Routledge; 6771.
2. Miles SHThe Hippocratic Oath and the Ethics of Medicine. 2004:Oxford, UK: Oxford University Press; 3.
3. Lloyd GERHippocratic Writings. 1983:New York, NY: Penguin Classics; 20.