...And what an ancient Greek document has to do with it...
An oath is a solemn promise regarding one’s future action or behavior. For over 2,000 years, new medical practitioners have been taking an oath in one form or another - promising to conduct themselves according to the common medical standards and ethics of their time. The physician’s oath protects the profession, the patient, the practitioner and society as a whole. For the individual doctor, it also serves as a rite of passage and induction into a select group of newly trained professionals.
A version of the Hippocratic Oath (generally Lasagna’s version or The Declaration of Geneva) is still widely used among medical schools today. However, there is a growing concern among medical students that their graduation oath incorporate modern bioethics and social justice issues related to health-resource disparities. This growing trend has resulted in some schools, including the revered Harvard Medical School and the new Dell Medical School at the University of Texas, to allow its graduates to select and revise their own oath.
The original Hippocratic Oath was most likely written between the Third and Fifth Centuries B.C. Many proponents of euthanasia believe that the Hippocratic Oath included the phrase ‘first do not harm’; however, this phrase was not part of the original oath. The earliest known copy of the Hippocratic Oath, written in Greek is from the Third Century A.D. The English translation of this document includes the following verbiage widely believed to be a prohibition against euthanasia, “I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course.” (Although, some scholars believe that this language may actually have been incorporated to prevent physicians from using their knowledge and skills to be employed as political assassins!)
The Hippocratic Oath has been modified several times to reflect the evolution of the medical profession and medical practice over time. Louis Lasagna, Academic Dean of the School of Medicine at Tufts University rewrote the oath in 1964. This version is still widely used by medical schools in the U.S. today. It contains the following language, “Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.” Lasagna’s version appears to take a more rounded approach to the idea of a physician’s role in life and death matters and does not directly preclude euthanasia. Although many argue that euthanasia is ‘God-playing’.
Another modified version of the Hippocratic Oath, The Declaration of Geneva (Physician’s Pledge) was adopted by the General Assembly of the World Medical Association in 1942 and most recently amended in 2017. The current pledge includes the following, “The health and well-being of my patient will be my first consideration; I will respect the autonomy and dignity of my patient; I will maintain the utmost respect for human life.” The most recent amendment added the words "and well-being" to “the health and well-being of my patient will be my first consideration”. This is an important change because it reminds the physician to consider both the physical health and emotional well-being of each patient. The Declaration of Geneva also contains nothing that directly precludes euthanasia.
Today’s physician oaths are no longer sworn to the God Apollo nor do they preclude euthanasia – so it is ill-founded to use the Hippocratic Oath as an argument against physician-assisted ending-of-life!
So where DOES the phrase ‘do no harm’ come from? – And what does it mean for Death with Dignity?
STAY TUNED for Part II of…
Say Doctor – You Promised to What?!