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. 2002 Aug 31;325(7362):496. doi: 10.1136/bmj.325.7362.496/a

On Hippocrates

Hippocratic ideals are alive and well in 21st century

Edward Roddy 1,2, Elin Jones 1,2
PMCID: PMC1124014  PMID: 12202343

Editor—Loefler regards the Hippocratic ethics as taking no account of modern medicine and that craving for the simplicity of Hippocratic medicine is pointless nostalgia.1 We argue that his article takes a simplified view of the application of the Hippocratic ideals to modern medicine and that these are as relevant today as they were in the 4th century bc.

At the very centre of the Hippocratic ideals are the principles of “doing no harm” and “absolute regard for life.” Loefler argues that harm is an inevitable consequence of the powerful array of interventions available to the modern doctor. Although many investigations and interventions have potential adverse effects and complications, it is the balance of potential benefit and harm of each intervention that is the most important consideration. If overall benefits outweigh potential complications, this Hippocratic ideal is still respected.

Harm—often in the form of death—can also be incurred by failing to intervene. Guidelines regarding consent for examination or treatment state that to give valid consent a patient needs to understand the nature and purpose of the procedure and that it is advisable to inform the patient of any risks in the proposed treatment, any alternatives to it, and the risks incurred by doing nothing.2 By fully involving patients and their next of kin in such decisions, we respect the individual and uphold another tenet of Hippocratic medicine.

Loefler says that the principle of absolute respect for life is no longer held in regard concerning orders not to resuscitate. In doing so, he addresses the wrong Hippocratic ideal, for when weighing up a patient's wishes, prognosis, coexistent medical problems, and the likely success of an attempt to resuscitate, the principle of doing no harm often takes precedence over absolute regard for life. Loefler finds piety and serenity lacking in modern medicine and yet in making an order not to resuscitate, the aim is often to facilitate a pious and serene passing while maintaining a patient's dignity.

In an age when technological advancement has inevitably amplified the potential risk to patients and has increased longevity sometimes at the expense of quality of life, we believe that the Hippocratic ideals are more important than ever and remain the cornerstones of ethics in modern medicine.

References

  • 1.Loefler I. Why the Hippocratic ideals are dead. BMJ. 2002;324:1463. . (15 June.) [Google Scholar]
  • 2.Department of Health. Reference guide to consent for examination or treatment. London: DoH; 2001. [Google Scholar]
BMJ. 2002 Aug 31;325(7362):496.

Either help or do not harm the patient

Arthur L Yeager 1

Editor—Loefler, like many others, believes (incorrectly) that the concept, “First, do no harm” has its origin in the Hippocratic oath.1-1 The Latin phrase, “Primum non nocere” (above all else, do no harm) is cited often and believed to be a major component of the oath. The phrase does not actually appear in the oath. Further, one must wonder why Hippocrates, a Greek, would, for centuries, continue to be quoted in Latin.

The confusion may have arisen from the fact that during the time of Hippocrates, doctors were used to administer (for a price) fatal potions to dispatch unwanted individuals to their heavenly reward. Hippocrates strongly disapproved of these Hellenic hitmen and did include in the oath the phrase, “I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect.”1-2

Further, it seems as if “do no harm” is a distortion, a phrase taken out of context. According to John Morrison, a doctor and scholar of Greek antiquity, the phrase is not from the oath but from the Hippocratic corpus, “Of the Epidemics,” Book I, section 11, 5 which states: “Practise two things in your dealings with disease: either help or do not harm the patient” (personal communication).

Obviously, what Hippocrates had in mind was that doctors are there to help the patients, but if they are unable to help, the doctor should take care not to harm. The significance of the distinction cannot be overlooked.

If a modern practitioner believes that treatments are ethically acceptable so long as they “do no harm” to the patient, then it follows that ineffective treatment is morally permissible. Overtreatment, superfluous tests, and unneeded procedures would also be justified as long as no harm results. Since a profession that foolishly clings to such a concept will ultimately face a justified storm of public indignation, doctors are urged to take care to avoid such practices.

References

  • 1-1.Loefler I. Why the Hippocratic ideals are dead. BMJ. 2002;324:1463. . (15 June.) [Google Scholar]
  • 1-2. Ancient medicine: selected papers of Ludwig Edelstein. In: Temkin O, Temkin CL, eds. “The Hippocratic oath: text, translation and interpretation.” Baltimore: Johns Hopkins Press, 1967:4.

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