The Hippocratic Oath Is Overrated

A textual analysis

Those scalpels had better not be used by physicians. Photo by Jonathan Borba on Unsplash

I don’t care for the Hippocratic Oath. It’s given too much reverence, most of the stuff in it is wrong or irrelevant, and there are significant omissions. It’s not only bad as an ethical heuristic, it also constitutes one big fallacious appeal to authority, which makes it bad for the field of medicine because it prevents physicians from thinking through issues more deeply.

I press back on it when I can. I swear that the following story is true. A medical student in Texas once appealed to the Hippocratic Oath in a class I was teaching. I asked, “Why should we care about the Hippocratic Oath?” and she gasped. Socrates 1, Hippocrates 0. (As this example shows, the ancient Greeks are a mixed bag. Tom Hurka was my PhD supervisor, but you don’t have to spend much time around him for his anti-Aristotelian views to rub off on you.)

The first problem with the Oath is that its most famous line wasn’t added until the 17th century. You know how physicians are always walking around saying “first, do no harm”? Well, that’s not actually in the Oath. It does say “I will do no harm or injustice to [patients],” but that’s after you swear to treat your med school teachers like your parents, to “fulfill [your teachers’] needs when required,” and that you’ll use dietary regimens to benefit patients.

But let’s take it from the top. The Oath begins by swearing to Apollo, sometimes translated as “Apollo the physician” or “Apollo Healer”. I’ve argued elsewhere that, contrary to a common claim, healing isn’t the central goal of medicine, so we should get rid of that part. Next comes the paragraph about loving your teachers, which finishes with this sentence: “I will impart a knowledge of the art to my own sons, and those of my teachers, and to students bound by this contract and having sworn this Oath to the law of medicine, but to no others.” This sounds more like something for the Alliance of Magicians and, thankfully, physicians don’t follow it now. Keeping medical knowledge a secret is bad policy.

Next is the bit about dietary regimens (strange) and doing no harm or injustice (good). After that, we finally get to something we can sink our teeth into: “I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.”

Unfortunately, there’s no justification for this point (or any other). It would be interesting to know what the author’s problem with assisted dying and abortion is, especially since both were common practices of physicians at the time. Since I think that both abortion and assisted dying can be ethical and within the scope of medicine, I’m unmoved by this part of the Oath. Moreover, I give arguments. One read of the lethal drug point is that it’s not about assisted dying, but people asking for drugs so they can murder people. In that case, sure. Doctors shouldn’t do that.

Then there’s a bit about divine law (pass), followed by this part: “I will not use the knife, even upon those suffering from stones, but I will leave this to those who are trained in this craft.” If the point is that those who aren’t trained in surgery shouldn’t be doing surgeries, then it seems reasonable. But the literal reading—that physicians can’t use knives—is implausible.

The next bit is my favourite:

Into whatever homes I go, I will enter them for the benefit of the sick, avoiding any voluntary act of impropriety or corruption, including the seduction of women or men, whether they are free men or slaves.

Don’t seduce people! What does it say about medicine at the time that, of 377 words, the author considered it central to include that physicians shouldn’t seduce people?

Finally, the Oath has a genuinely valuable part about the importance of patient privacy. Some hospital elevators have signs reminding providers not to speak about patients in public. To promote compliance, the signs could say that privacy is part of the Hippocratic Oath.

For those keeping score, we aren’t left with much worth keeping. I’ve created a revised document so you can see the results.¹ I left the last paragraph in so that it retains some oathiness.

The Oath also has some obvious omissions. For instance, it doesn’t say anything about telling patients the truth. To be fair, medicine didn’t figure this out until the 1960s, but Hippocrates could have helped us out by mentioning it. Second, the Oath doesn’t mention the importance of promoting patient values, which is the real point of medicine. Also, nothing about patient autonomy. Or informed consent. 

The upshot is that medicine should do away with the Hippocratic Oath, besides to investigate how much it gets wrong. It’s an overrated founding document. The broader lesson here is that ancient documents don’t entail ancient wisdom. We’ve made a lot of progress since then, and patients everywhere should be grateful.

1. The original is from here: https://www.nlm.nih.gov/hmd/greek/greek_oath.html