Abstract
Almost every medical school’s graduation ceremony includes some sort of professional medical oath. The Hippocratic Oath, written over 2400 years ago, is the oldest and most well-known of these vows. The essential components of modern medical ethics—beneficence, nonmaleficence, autonomy, and justice—outlined in the Hippocratic Oath persist to this day. The substance of the Hippocratic Oath has been altered and its authorship questioned, yet the major world religions, Baha’i, Buddhism, Christianity, Confucianism, Hinduism, Islam, Jainism, Judaism, Shinto, Sikhism, Taoism, and Zoroastrianism, had versions of the Hippocratic Oath to emphasize the importance of beneficence, nonmaleficence, autonomy, and justice for newly initiated physicians. By investigating these alternative versions of the Hippocratic Oath, similarities between different faiths emerge, reinforcing a common thread of humanity that spans across time.
Keywords: Ethics, Hippocratic Oath, interfaith dialogue, world religions
Many graduating medical students or professionals take the contemporary Hippocratic Oath, which states their intentions to conduct medicine justly and ethically. The Hippocratic Oath is ceremonial and optional, similar to the oath made by a judge, president, or other politician when sworn into office. Nonetheless, many institutions see it as a rite of passage for physicians. Though this most famous treatise in Western medicine is credited to the Greek physician Hippocrates of Kos, the most well-known doctor of his day, the true author is uncertain, and there may have been many writers.1 The substance of the Hippocratic Oath has been altered and its authorship questioned in contemporary times, particularly throughout the 20th century. At the same time, the major world religions—Baha’i, Buddhism, Christianity, Confucianism, Hinduism, Islam, Jainism, Judaism, Shinto, Sikhism, Taoism, and Zoroastrianism—have versions of the Hippocratic Oath to emphasize the importance of beneficence, nonmaleficence, autonomy, and justice, which are essential components of modern medical ethics outlined in the Hippocratic Oath. By investigating these alternative versions, similarities between different faiths emerge.
Original Hippocratic Oath
The opening of the Hippocratic Oath was an invocation between the oath-taker and an ever-present medical community and society.2,3 Hippocrates wrote:
I swear by Apollo Physician, by Asclepius, by Health, by Heal-all, and by all the gods and goddesses, making them witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture:
To regard my teacher in this art as equal to my parents; to make him partner in my livelihood, and when he is in need of money to share mine with him; to consider his offspring equal to my brothers; to teach them this art, if they require to learn it, without fee or indenture; and to impart precept oral instruction, and all the other learning, to my sons, to the sons of my teacher, and to the pupils who have signed the indenture and sworn obedience to the physicians’ Law, but to none other.
I will use treatment to help the sick according to my ability and judgment, but I will never use it to injure or wrong them.
I will not give poison to anyone though asked to do so, nor will I suggest such a plan. Similarly I will not give a pessary to a woman to cause abortion. But in purity and in holiness I will guard my life and my art.
I will not use the knife either on sufferers from stone, but I will give place to such as are craftsmen therein.
Into whatsoever houses I enter, I will do so to help the sick, keeping myself free from all intentional wrongdoing and harm, especially from fornication with woman or man, bond or free.
Whatsoever in the course of practice I see or hear (or even outside my practice in social intercourse) that ought never to be published abroad, I will not divulge, but will consider such things to be holy secrets. Now if I keep this oath and break it not, may I enjoy honor, in my life and art, among all men for all time; but if I transgress and forswear myself, may the opposite befall me.4
The Hippocratic Oath has been a source of curiosity and discussion among physicians, researchers, and historians for about 2500 years. During the same period, many of the world’s major religions created their own version of the Hippocratic Oath. Table 1 reports the alternate versions of the Hippocratic Oath as expressed by Judaism, Christianity, Islam, Buddhism, Hinduism, Baha’i, Humanism, and Daoism/Confucianism.5–13
Table 1.
Alternative physician oaths in different religious traditions
| Tradition | Text |
|---|---|
| Judaism | “The eternal providence has appointed me to watch over the life and health of Thy creatures. May the love for my art actuate me at all times; may neither avarice nor miserliness, nor thirst for glory or for a great reputation engage my mind; for the enemies of truth and philanthropy could easily deceive me and make me forgetful of my lofty aim of doing good to Thy children. May I never see in the patient anything but a fellow creature in pain. Grant me the strength, time and opportunity always to correct what I have acquired, always to extend its domain; for knowledge is immense and the spirit of man can extend indefinitely to enrich itself daily with new requirements. Today he can discover his errors of yesterday and tomorrow he can obtain a new light on what he thinks himself sure of today. Oh, God, Thou has appointed me to watch over the life and death of Thy creatures; here am I ready for my vocation and now I turn unto my calling.”5 |
| Christianity | “With gratitude to God, faith in Christ Jesus, and dependence on the Holy Spirit, I publicly profess my intent to practice medicine for the glory of God. With humility, I will seek to increase my skills. I will respect those who teach me and who broaden my knowledge. In turn, I will freely impart my knowledge and wisdom to others. With God’s help, I will love those who come to me for healing and comfort. I will honor and care for each patient as a person made in the image of God, putting aside selfish interests. With God’s guidance, I will endeavor to be a good steward of my skills and of society’s resources. I will convey God’s love in my relationships with family, friends, and community. I will aspire to reflect God’s mercy in caring for the lonely, the poor, the suffering, and the dying. With God’s blessing, I will respect the sanctity of human life. I will care for all my patients, rejecting those interventions which either intentionally destroy or actively end the lives of the unborn, the infirm, and the terminally ill. With God’s grace, I will live according to this profession.”6 |
| Islam | “Praise be to Allah (God), the Teacher, the Unique, Majesty of the heavens, the Exalted, the Glorious, Glory be to Him, the Eternal Being Who created the Universe and all the creatures within, and the only Being Who containeth the infinity and the eternity. We serve no other god besides Thee and regard idolatry as an abominable injustice. Give us the strength to be truthful, honest, modest, merciful and objective. Give us the fortitude to admit our mistakes, to amend our ways and to forgive the wrongs of others. Give us the wisdom to comfort and counsel all towards peace and harmony. Give us the understanding that ours is a profession sacred that deals with your most precious gifts of life and intellect. Therefore, make us worthy of this favored station with honor, dignity and piety so that we may devote our lives in serving mankind, poor or rich, literate or illiterate, Muslim or non-Muslim, black or white with patience and tolerance, with virtue and reverence, with knowledge and vigilance, with Thy love in our hearts and compassion for Thy servants, Thy most precious creation. Hereby we take this oath in Thy name, the Creator of all the Heavens and the earth and follow Thy counsel as Thou hast revealed to Prophet Mohammad (pbuh). ‘Whoever killeth a human being, not in lieu of another human being nor because of mischief on earth, it is as if he hath killed all mankind. And if he saveth a human life, he hath saved the life of all mankind’ (Qur’an v 35).”7 |
| Buddhism | “The Lord said: ‘Health is the greatest gain.’ He also said: ‘He who would minister to me should minister to the sick.’ I too think that health is the greatest gain and I would minister to the Buddha. Therefore: I will use my skill to restore the health of all beings with sympathy, compassion and heedfulness. I will be able to prepare medicines well. I know what medicine is suitable and what is not. I will not give the unsuitable, only the suitable. I minister to the sick with a mind of love, not out of desire for gain. I remain unmoved when I have to deal with stool, urine, vomit or spittle. From time to time I will be able to instruct, inspire, enthuse, and cheer the sick with the Teaching. Even if I cannot heal a patient with the proper diet, proper medicine and proper nursing I will still minister to him, out of compassion.”8 |
| Hinduism | “You must put behind you desire, anger, greed, folly, pride, egotism, jealousy, harshness, calumny, falsehood, sloth, and improper conduct. With short-cut nails, ritually clean and clad in the orange garment, you must be pledged to truth, and full of reverence in addressing me; If, however, you behave perfectly, while I profess false views, I shall be guilty of sin and my knowledge shall bear me no fruit; [after having finished your studies] with your medicaments you shall assist Brahmins, venerable persons, poor people, women, ascetics, pious people seeking your assistance, widows and orphans, and any one you meet on your errands, as if they were your own relatives. This will be right conduct.”9 |
| Baháʼí | “Whenever ye fall ill, refer to competent physicians. Verily, We have not abolished recourse to material means, rather have We affirmed it through this Pen which God hath made the Dawning Place of His luminous and resplendent Cause. The secretaries of the Guardian have conveyed his guidance on this point in many letters to individual believers in passages such as these: ‘… refer to competent physicians, and abide by their considered decisions’; … ‘invariably consult and follow the treatment of competent and conscientious physicians’ … and … ‘consult the best physicians … doctors who have studied a scientific system of medicine.’ Thus the obligation to consult physicians and to distinguish between doctors who are well trained in medical sciences and those who are not is clear, but the Faith should not be associated with any particular school of medical theory or practice. It is left to each believer to decide for himself which doctors he should consult, bearing in mind the principles enunciated above.”10 |
| Humanism | “As a member of the medical profession: I solemnly pledge to dedicate my life to the service of humanity; the health and well-being of my patient will be my first consideration; I will respect the autonomy and dignity of my patient; I will maintain the utmost respect for human life; I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient; I will respect the secrets that are confided in me, even after the patient has died; I will practise my profession with conscience and dignity and in accordance with good medical practice; I will foster the honor and noble traditions of the medical profession; I will give to my teachers, colleagues, and students the respect and gratitude that is their due; I will share my medical knowledge for the benefit of the patient and the advancement of healthcare; I will attend to my own health, well-being, and abilities in order to provide care of the highest standard; I will not use my medical knowledge to violate human rights and civil liberties, even under threat; I make these promises solemnly, freely, and upon my honor.”11 |
| Daoism/ Confucianism | “I promise to follow the way of the Great Physician, to live in harmony with nature, and to teach my patients to do the same. I will strive to maintain a clear mind and hold myself to the highest standards. I shall look upon those who are in grief as though I myself have been afflicted, and I will respond with empathy. I shall develop an attitude of compassion, of benevolence, and of care for all patients, regardless of their particular circumstances. I promise to perform my responsibilities carefully, thoughtfully, and to the best of my ability. Above all, I will maintain a peaceful presence and an open heart.”12,13 |
Interfaith dialogue and the Hippocratic Oath
There are many distinct cultures throughout the world whose values and ideas are reflected in their physician oaths. Medicine offers a life based on knowledge, skill, and service to the critical needs of each patient. Regardless of the era or the location of medical school, physicians strive to maintain the goal of the profession, namely, to earn continued trust by protecting and safely treating the individual patient. Each oath emphasizes caring for one’s neighbor. Specifically, putting the patient’s interests above everything else is one of the few aspects of the Hippocratic Oath that have persisted across time, religion, and cultures.
There is an implicit understanding that our shared humanity underlies both the oaths and the values embodied by each religion’s version of the Hippocratic Oath. This common thread is what underlies interfaith dialogue, whose objective is to foster mutual collaboration and discussion among many religious traditions. The ongoing investigation of interfaith discourse is akin to a lifelong pilgrimage in pursuit of refining one’s views while maintaining one’s own search for truth. Despite the tremendous obstacles of reconciling modern society’s polarizations, physicians have established a new route for reconciliation and healing throughout history. We achieve our fullest potential as human beings when we work together.
Conclusion
Medicine and religion have worked together to improve health care delivery while also addressing mental and physical illnesses. Religious institutions from Buddhist, Hindu, Islamic, and Christian traditions built the earliest hospitals and clinics throughout human history.14,15 Through their publications, conversations, and medical humanitarianism, clinicians from many faith systems, time periods, and cultures have crossed social, political, and societal barriers. As physicians and health care professionals, we have a unique opportunity to collaborate with the community and religious groups to close the growing divide that exists at all levels of society. We realize our fullest potential as human beings when we live, work, and play with and for one another.14,15 This idea is embodied by portions of the Hippocratic Oath and its variants across world religions. As Thomas Sydenham (1624–1689) summarized in his own physician oath:
It becomes every person who purposes to give himself to the care of others, seriously to consider the four following things: First, that he must one day give account to the Supreme Judge of all the lives entrusted to his care. Second, that all his skill and knowledge and energy, as they have been given him by God, so they should be exercised for His glory and the good of mankind, and not for mere gain or ambition. Third, and not more beautifully than truly, let him reflect that he has undertaken the care of no mean creature; for, in order that he may estimate the value, the greatness of the human race, the only begotten Son of God became Himself a man, and thus ennobled it with his divine dignity, and far more than this, died to redeem it. And fourth, that the doctor being himself a mortal human being, should be diligent and tender in relieving his suffering patients, inasmuch as he himself must one day be a like sufferer.6
References
- 1.Hulkower R. The history of the Hippocratic Oath: outdated, inauthentic, and yet still relevant. Einstein J Biol Med. 2016;25:41–44. doi: 10.23861/EJBM20102542. [DOI] [Google Scholar]
- 2.Askitopoulou H, Vgontzas AN.. The relevance of the Hippocratic Oath to the ethical and moral values of contemporary medicine. Part I: the Hippocratic Oath from antiquity to modern times. Eur Spine J. 2018;27:1481–1490. doi: 10.1007/s00586-017-5348-4.. [DOI] [PubMed] [Google Scholar]
- 3.Askitopoulou H, Vgontzas AN. The relevance of the Hippocratic Oath to the ethical and moral values of contemporary medicine. Part II: interpretation of the Hippocratic Oath—today's perspective. Eur Spine J. 2018;27:1491–1500. doi: 10.1007/s00586-018-5615-z. [DOI] [PubMed] [Google Scholar]
- 4.Hippocrates of Cos—the Oath. Loeb Classical Library. 1923;147:298–299. [Google Scholar]
- 5.Sarton G. Maimonides: philosopher and physician (1135–1204). In: Stimson D, ed. Sarton on the History of Science. Cambridge, MA: Harvard University Press; 1962:78–101. [Google Scholar]
- 6.Christian Medical and Dental Associations . Christian physician’s oath. https://cmda.org/product/christian-physicians-oath-framed-art/. Published 2021. Accessed September 30, 2021.
- 7.Ahmad WD, El-Kadi A, Zikria BA.. Oath of a Muslim physician. J Islamic Med Assoc N Am. 1988;20:11–14. doi: 10.5915/20-1-13050. [DOI] [Google Scholar]
- 8.Dhammika S. Vejjavatapada: The Buddhist Physician’s Vow. Singapore: Buddha Dhamma Mandala Society; 2013. [Google Scholar]
- 9.Sandlow LJ. Oaths, codes, and charters in medicine over the ages. Hektoen Int. 2011;3:1–8. [Google Scholar]
- 10.Hornby HB, Bahá’u’lláh, Abdu’l-Bahá, et al. Lights of guidance (second part): a Bahá’í reference file. https://bahai-library.com/hornby_lights_guidance. Published 2021. Accessed September 30, 2021.
- 11.World Medical Association . The physician’s pledge. https://www.wma.net/policies-post/wma-declaration-of-geneva/. Published 2017. Accessed September 30, 2021.
- 12.Simiao S. Oath of Sun Simiao. https://www.acupuncturewithzen.com/oathofsunsimiao/. Published 2018. Accessed September 30, 2021.
- 13.Tan SY. Sun Si Miao (581–682 ad): China’s pre-eminent physician. Singapore Med J. 2002;43:224–225. [PubMed] [Google Scholar]
- 14.Kopel J, Gorga C, Thomas P, Strickland RK, Wunsch DC II. Neurotheology in interfaith dialogue. Proc (Bayl Univ Med Cent). 2020;33:295–297. doi: 10.1080/08998280.2019.1698881. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Kopel J, Mackenzie D, Gorga C, Wunsch DC II.. Interfaith dialogue in medicine. Proc (Bayl Univ Med Cent). 2020;33:140–143. doi: 10.1080/08998280.2019.1670029. [DOI] [PMC free article] [PubMed] [Google Scholar]