“It is more important to know what sort of person has a disease than to know what sort of disease a person has.”
Hippocrates
Medicine is a very old profession that has evolved slowly over thousands of years. The first reports date back to the Egyptian and Oriental civilizations and little is known to us about its early history. Initially, medicine evolved in two directions: one approach was technological, typical of the Egyptian culture, and one was the Greek social-philosophical approach which has profoundly influenced the ethics of the medical profession.
A visit to the island of Kos was an opportunity for us to think about the meaning of our profession. On this island, in the shade of a plane tree which according to the locals still exists and which is pointed out to curious tourists (Fig. 1), Hippocrates taught the secrets of a medical science that did not include technology but only ideas, principles and “aphorisms”. Far from the “noise” that pollutes our lives in the cities and hospitals, we felt the urge to review the things we do everyday, to reflect on the patients who come to us with the desire to be treated, but above all with the hope that they may recover from diseases and disorders affecting the body and particularly the mind.
Fig. 1.
The plane tree of Hippocrates
On Kos, you can visit the Asclepieion (Fig. 2), a large sanctuary dedicated to Asclepius, the god of medicine. In this place, Hippocrates founded the School of Medicine, and this is where the largest hospital in the ancient Greece was built. Everything seems simple on this small island, which is part of the Dodecanese island chain. However, one is immediately overwhelmed by the thought of economic problems besetting public health care, such as the financial spread, conflicts between the State and the trade unions, spending reviews and wars that afflict the world leading to hunger and death.
Fig. 2.
The Asclepieion
The new Italian Code of Medical Ethics was released a few months ago, and it has since then been subjected to discussions and protests from many medical doctors and associations, mainly referred to some particular articles.
Hippocrates was the first to separate medicine (as a science) from philosophical concepts and magic, which prevailed in patient care in those days. However, many of these principles still survive after 2500 years.
Hippocratic medicine can be compared to a social contract, as the code of ethics lays down a set of rules that society expects a medical doctor to follow. The Hippocratic Oath was written in ancient Greek as a synthesis of this contract, and also Herodotus and perhaps Homer have contributed to the text. The original Greek text (fig. 3 for those who are able to read Greek) as well as the Italian and English translations are reported below. The modern Oath is a bit different, but essentially it lists the same ethical rules.
Fig. 3.
The original Greek text of the oath
Art.1 of the Code of Medical Ethics explicitly establishes that a medical doctor has to take this professional oath. However, many have never carefully read it and reflected on the individual points and on what our daily attitude towards colleagues and patients is or should be. For this reason, we believe that it might be useful to present it again and read it carefully to fully understand that our profession has its origin in something special which goes beyond the cultural differences and opinions that have characterized the history of mankind.
Aware of the importance and solemnity of this act and the commitment that I am taking upon myself, I swear that I shall:
practice medicine in freedom and independence of judgment and behavior avoiding any undue influence;
pursue the defense of life, protection of physical and mental health of man and relief of suffering; all my professional activity will be carried out with responsibility and constant scientific, cultural and social commitment;
treat each patient with equal care and commitment, regardless of ethnicity, religion, nationality, social status, and political ideology, promoting the elimination of all forms of discrimination in health care;
never commit acts likely to deliberately cause the death of a person;
refrain from performing any diagnostic and therapeutic futility;
promote the therapeutic alliance with my patients based on trust and mutual information, in respect of the principles that inspire the medical art;
adhere to the ethical principles of human solidarity against which I shall never use my knowledge in accordance with my respect for the human person and life;
make my knowledge available to progress in the field of medicine;
commit my professional reputation exclusively to my skills and my moral qualities;
avoid, even outside my professional activity, any act and conduct prejudicial to the honor and the dignity of the profession;
respect my colleagues also in cases of conflicting opinions;
respect and facilitate the medical doctor’s right to make a free choice;
provide emergency assistance to those who are in need and be available to the authorities in case of public calamity;
observe professional secrecy and protect the confidentiality of the information I receive, what I see or I have seen, understood or realized in the course of my practice or because of my position;
carry out my professional activity, in science and in conscience, with diligence and care and on the basis of objective considerations, observing the ethical rules governing the practice of medicine and the legal rules that are not inconsistent with these purposes.
The original Hippocratic Oath—in English
I swear by Apollo the physician, and Aesculapius the surgeon, likewise Hygeia and Panacea, and call all the gods and goddesses to witness, that I will observe and keep this underwritten oath, to the utmost of my power and judgment.
I will reverence my master who taught me the art. Equally with my parents, will I allow him things necessary for his support, and will consider his sons as brothers. I will teach them my art without reward or agreement; and I will impart all my acquirement, instructions, and whatever I know, to my master’s children, as to my own; and likewise to all my pupils, who shall bind and tie themselves by a professional oath, but to none else.
With regard to healing the sick, I will devise and order for them the best diet, according to my judgment and means; and I will take care that they suffer no hurt or damage.
Nor shall any man’s entreaty prevail upon me to administer poison to anyone; neither will I counsel any man to do so. Moreover, I will give no sort of medicine to any pregnant woman, with a view to destroy the child.
Further, I will comport myself and use my knowledge in a godly manner.
I will not cut for the stone, but will commit that affair entirely to the surgeons.
Whatsoever house I may enter, my visit shall be for the convenience and advantage of the patient; and I will willingly refrain from doing any injury or wrong from falsehood, and (in an especial manner) from acts of an amorous nature, whatever may be the rank of those who it may be my duty to cure, whether mistress or servant, bond or free.
Whatever, in the course of my practice, I may see or hear (even when not invited), whatever I may happen to obtain knowledge of, if it be not proper to repeat it, I will keep sacred and secret within my own breast.
If I faithfully observe this oath, may I thrive and prosper in my fortune and profession, and live in the estimation of posterity; or on breach thereof, may the reverse be my fate!
The original Hippocratic Oath—in Italian
Giuro per Apollo medico e Asclepio e Igea e Panacea e per tutti gli dei e per tutte le dee, chiamandoli a testimoni, che eseguirò, secondo le forze e il mio giudizio, questo giuramento e questo impegno scritto:
di stimare il mio maestro di questa arte come mio padre e di vivere insieme a lui e di soccorrerlo se ha bisogno e che considererò i suoi figli come fratelli e insegnerò quest’arte, se essi desiderano apprenderla, senza richiedere compensi né patti scritti; di rendere partecipi dei precetti e degli insegnamenti orali e di ogni altra dottrina i miei figli e i figli del mio maestro e gli allievi legati da un contratto e vincolati dal giuramento del medico, ma nessun altro.
Regolerò il tenore di vita per il bene dei malati secondo le mie forze e il mio giudizio; mi asterrò dal recar danno e offesa.
Non somministrerò ad alcuno, neppure se richiesto, un farmaco mortale, né suggerirò un tale consiglio; similmente a nessuna donna io darò un medicinale abortivo.
Con innocenza e purezza io custodirò la mia vita e la mia arte.
Non opererò coloro che soffrono (n.d.r. calcolosi o litiasi) ma mi rivolgerò a coloro che sono esperti di questa attività.
In qualsiasi casa andrò, io vi entrerò per il sollievo dei malati, e mi asterrò da ogni offesa e danno volontario, e fra l’altro da ogni azione corruttrice sul corpo delle donne e degli uomini, liberi e schiavi.
Ciò che io possa vedere o sentire durante il mio esercizio o anche fuori dell’esercizio sulla vita degli uomini, tacerò ciò che non è necessario sia divulgato, ritenendo come un segreto cose simili.
E a me, dunque, che adempio un tale giuramento e non lo calpesto, sia concesso di godere della vita e dell’arte, onorato degli uomini tutti per sempre; mi accada il contrario se lo violo e se spergiuro.
Compliance with ethical standards
Conflict of interest
The authors Massimo Valentino and Pietro Pavlica have no conflict of interest.
Human and animal studies
The study described in this article does not contain studies with human or animal subjects performed by any of the authors.
Ethical standard
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed consent
For this type of study formal consent is not required.