The Hippocratic Tradition and Medical Trends
by Heather Zeiger, MS (chemistry), MA-in-progress (bioethics)
The Hippocratic Oath [1]: I swear by Apollo Physician, by Asclepius, by Hygeia, by Panaceia, and by all 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 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 will give place to such as are craftsmen therein.
Into whatsoever house I enter, I will do so to help the sick, keeping myself free from all intentional wrong-doing 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 consider such things to be holy secrets.
Now if I keep this oath and break it not, may I enjoy honour, in my life and art, among all men for all time; but if I transgress and forswear myself, may the opposite befall me.
The Hippocratic Tradition
Medicine has seen changes and trends over the last century. For example, the doctor-patient relationship used to be much more paternalistic than it is today. Today patient autonomy is valued more than it once was. Technology has changed the practice of medicine, as has specialization and online resources. One of the trends in medicine today is veering away from Hippocratic ideals and more towards a science-based or technology-based ethic.
Traditional medicine is founded on the principles outlined in the Hippocratic Oath. The Oath, while pagan in origin, has been co-opted by several theistic religions because its principles and covenantal language square with the tenants of many traditions. Overall, the Oath provided a moral foundation for the practice of medicine that seemed to transcend time and culture.
Nigel Cameron in The New Medicine outlines the history, structure, and cultural impact of the Hippocratic Oath, and addresses medicine in our post-Hippocratic culture. He contends that the there is now a conflict in our understanding of the goals of medicine. The role of the doctor used to be that of a healer. Now the role of the doctor is to relieve suffering. Cameron considers this a symptom of a greater transition away from Hippocratic ideals. Is medicine about healing or relieving suffering? Furthermore, if medicine is about the relief of suffering, then “suffering” can come in many forms, including displeasure with one’s identity or natural limitations.
On the other hand, one can easily see the influence of the Hippocratic tradition in modern medical ethics. The principle “do no harm” comes from the Hippocratic Oath, and its influence is seen in Beauchamp and Childress’ principles of medical ethics, now considered the quintessential work on “due care,” or what a patient should expect from medical care. Beauchamp and Childress’ principles are 1) Patient autonomy, 2) Beneficience, 3) Nonmaleficience, and 4) Justice. “Nonmaleficence” means to do no harm. “Beneficence” means to help others when one is able to do so. Both of these principles are derived from the Hippocratic Oath, “As to diseases, make a habit of two things – to help or at least to do no harm” [2].
The Hippocratic influence can be seen in Junkerman’s book Practical Ethics for Students, Interns, and Residents which summarizes the fundamental goals of medicine, as [3]:
- Prevention of disease and untimely death
- Cure of disease, when possible
- Improvement or maintenance of functional status when cure is not possible
- Palliation, pursuits of peaceful death, and comfort care in all situations
- Patient education and counseling
In post-Hippocratic medicine, the moral foundation has been removed, and like a house without a foundation, the principles drawn from the Hippocratic tradition do not stand up to changing cultural trends. In its place have arisen new perspectives on medicine.
One trend in medicine is not necessarily new because it vaguely draws from Hippocratic and traditional medical principles, but is ultimately much more relativistic. Today many medical school graduates will take a modernized version of the Hippocratic Oath at graduation. This version removes anything about abortion, euthanasia, not paying tuition, not performing surgery, and not having sex with patients because some of these issues are moot points in today’s culture and some are open for debate. As one medical professor at Cornell points out, he does not want to impose an oath on students that probably half of them could not agree to. Instead the Oath is no longer a covenant with consequences, but more of a summary of best practices, which some argue is appropriate for today’s culture. See here for a brief article and the text of the modern version and here for an article about updating the Oath. Many view taking the Oath (in any version) as ceremonial rather than a binding moral code.
The Darwinian Physician
One trend in modern medicine is the field of evolutionary medicine. There are several ways to view evolutionary medicine. One view is to look at adaptation of pathogens to their particular environment. In this case, scientists look at the pathogen’s response to environmental pressures, including adding medications to the environment. This type of research has been used to look at drug resistance in HIV and AIDS as well as other diseases such as malaria and the common cold.
Another application of evolutionary medicine is in the clinical setting. This is the Darwinian physician. Rather than looking at how a pathogen evolves, this perspective considers how man (the patient) has evolved. This perspective usually does not consider an individual patient or small population, like the scientists do when looking at pathogens, but rather man’s evolutionary history. Often this is used as an explanation for his responses to ailments today. Medical decisions can, at times, be made based on the idea that the body has adapted to certain diseases. For example, one Darwinian physician suggests that anti-inflammatory medicines are not always necessary for injuries because inflammation is the body’s adapted response to injury. However, medical decisions of this sort do not require an evolutionary explanation. They can just as easily be based on one’s knowledge of pharmacology and physiology as well as observation.
See here for a more extensive article on this subject:.
Physician as Provider, Patient as Consumer
The other side of the coin of Darwinian medicine is a type of Nietschzian medicine where man strives to be stronger, better, and faster. Medicine is no longer just about healing, but about being “Better than Well.” Carl Elliot wrote the book by this title, Better than Well: American Medicine Meets the American Dream, and in it describes a medical industry whose job it is to help people be what they want to be. Medicine has become a way for people to construct an identity. While Elliot addresses such disparate topics as the prevalence of Prozac, elective amputations, and sex-change surgery, he is stringing together a cultural thread that says a person’s identity, and therefore their happiness, can be found in the doctor’s office.
In this type of medicine, the lines between enhancement and therapeutic are blurred. If the greatest good is to prevent patient suffering, then anything, including dissatisfaction within one’s identity is a form of suffering. Certainly, having a low self-esteem or a lack of sense of self can cause depression, and therefore, many think doctors should “fix” low self-esteem and self confidence. This is not to say that medicine cannot help with the symptoms of depression, but, in the past, it was not the role of medicine to fix the causes of depression.
Perhaps the most extreme (and probably most logically consistent) groups that adhere to this perspective are the transhumanists. The transhumanists seek to use technology and medicine to improve the human condition, and anticipate the extensive use of medicine and technology to become a posthuman race. Transhumanists describe this as human beings controlling their evolution and taking the next steps to become an improved (or a new) species. For the transhumanist there is no distinction between enhancement and therapeutic medicine and there is little distinction between the practice of medicine and the advancement of technology. Yesterday’s prosthetic is tomorrow’s enhancement.
There is a fine line between adjusting to a changing culture and disregarding timeless principles. The Hippocratic Oath was written in the 5th century, B.C. Certainly, the language is out-of-date, and the Oath does not take into account changes in the practice of medicine. This does not mean that the principles, themselves, are outdated. According to Cameron’s research on the Hippocratic tradition, it was written in response to a relativistic culture that permitted questionable medical practices. While the methods and means may change, these timeless principles are valuable because they address aspects of society that do not change, such as relativism and human nature.
[1] Quoted from: Cameron, Nigel The New Medicine: Life and Death after Hippocrates, Crossway Books, 2001, pages 24, 25.
[2] Munson, Ronald Intervention and Reflection: Basic Issues in Medical Ethics, 8th ed. Thomson Wadsworth, 2008, pages 770-773.
[3] Junkerman, Charles, Arhur Derse, David Schiedermayer Practical Ethics for Students, Interns, and Residents: A Short Reference Manual, 3rd ed. University Publishing Group, 2008, page 78.
Heather Zeiger graduated magna cum laude from the University of Texas at Dallas with a B.S. in chemistry and a minor in government and politics. She received her M.S. in chemistry, also from UTD; her research was in organic synthesis and materials. She served for four years (2006-2010) at Probe Ministries as a Research Associate in the area of science and culture. Currently, Heather is a freelance science writer, teaches SAT/ACT prep classes, and is working on a M.A. in bioethics from Trinity International University.