Resurgence of interest in medical oaths and codes of conduct

Editor—By missing out the first line of the Hippocratic Code, Hurwitz and Richardson have altered the meaning,¹ which begins: “I swear by Apollo the physician, by Aesculapius, Hygeia and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and judgement the following oath.” Clearly, 2500 years ago the Greeks thought that judgment of success was divine as well as secular.

In developing a universal code there is the problem of: “How to develop an all embracing ethical code of practice if one makes the code relative to local circumstances?”¹ The draft revision of the Hippocratic Oath states: “Where abortion is permitted, I agree that it should take place only within an ethical and legal framework.” Will the Dutch Medical Association want to include euthanasia?

The Gordian knot concerns the relation between morals based on ideas of community, values, and the worth of individuals, and the law based on encoded practice.

When moral values are in disagreement with the law of the land, conflict ensues. The Hippocratic Oath was based upon a Pythagorean concept of respect for life. After the Nuremberg trials, the Geneva Convention included the line: “I will maintain the utmost respect for human life from its beginning, even under threat, and I will not use my specialist knowledge contrary to the laws of humanity; I make these promises solemnly, freely, and upon my honour.” By making the gift of life a material choice the medical profession opened Pandora’s box.

Myself and a colleague recently reported on a three year study of the practical problems doctors and nurses face about decision making at the end of a patient’s life.² The participants were confused about questions such as “Who is responsible for death when treatment is withdrawn?” and “Why is it not necessary always to treat?” To overcome this confusion we proposed three moral principles that should govern clinical practice: (a) Treatment of patients must reflect the inherent dignity of every person irrespective of age, debility, dependence, race, colour, or creed; (b) Actions must reflect the needs of the patient where he or she is; and (c) Decisions taken must value the person and accept human mortality.

These principles put clinical judgment into an ethical concept of tending. The tending that patients receive will be limited by the doctor’s skills, the expert opinion available to him or her, and resources, but it will always be patient centred.

In constructing a new set of values to take note of modern times the taskforce could begin by adopting these values as the basis for decision making at the end of life.