Declarations for new doctors are unnecessary

Editor—The declaration for new doctors devised by Sritharan et al and shown in their editorial is nonsense.¹ It is meaningless waffle and unlikely to benefit anyone, and the statement that a professor of medical ethics was involved engenders little confidence.

The stated ideals of the declaration, like those of Christianity, are impossible to attain. The first hurdle comes in the first line: “I will to the best of my ability serve humanity.” When in imminent danger of falling from a rockface it is indeed possible for me to hang on to the best of my ability, but it can't be done for very long. Do these authors have no sense of the ridiculous?

Christians counsel against letting the perfect be the enemy of the good, in the sense of making the best use of Christian principles, which are already well known. This is no excuse for the deliberate introduction of a new set of aims that are plainly unachievable from the outset.

The declaration says, “I shall never intentionally do or administer anything to the overall harm of my patients.” What about intentionally giving thrombolytic drugs after myocardial infarction? Some of those patients will have strokes, and some of them will not derive any cardiac benefit from the thrombolysis. We know that before we start, but we hope that the numbers come out right in the end. “I shall not do or give anything to my patient with the intent of overall harm” would be better, but such tinkering cannot restore this document to sense.

Do not put your faith in medical ethicists. When you are dealing with real patients in the middle of the night they won't be there; they will be on television affecting to agonise over difficulties while secure in the knowledge that they won't have to deal with them. You will be the one who gives the thrombolysis that gives a patient a stroke or who performs the operation that turns out badly. I suggest that adverse events, culpable or otherwise, will be no less (and, to be fair, no more) likely when the practitioner has made this declaration.

The Hippocratic Oath had the merits of traditional ceremony, which was not expected to mean anything and was rarely used. The credulous are now exhorted to make this silly public declaration for fear of seeming deficient in “caring and sharing” credentials. I urge that this notion is rejected. All you really need to swear to yourself is, “I promise to try reasonably hard to do a reasonably good job.” But you have to mean it.