Many professions extrapolate moral principles from ethical theories. These principles are both define what it means to be a member of the profession and also guide how a member of the profession is to behave. Essentially, certain assumptions can be made about the character (who the professional is) and the behavior (what the professional should do) of members of the profession, based on these shared professional moralities.
The Hippocratic Oath
Written between the fifth and third century BCE, the Hippocratic Oath is taken in some form by most all physicians. While it is believed by many to contain many of the essential ethical principles foundational to the practice of medicine, others hold that particularly the prohibitions against assisting a patient with suicide or performing an abortion are archaic. Setting aside the debate over the literal or figurative prohibitions in the Oath, some aspects of the Oath are informative and seem to be as applicable today as when the Oath was first composed.
The first aspect is the matter of profession of an oath. Those professing a common oath are publicly declaring both their belief and their commitment. It focuses on the physician’s agency in stating what is important and binds her or him to a longer tradition. It is a rite of entry into association with a group of people who have in common professing the same beliefs and commitments. There is also appeal to the transcendent in the Hippocratic Oath. The oath is sworn by the Greek gods Apollo the physician as well as his son, Asclepius. Myth says that Asclepius was so good at healing and bringing people back from near death that Zeus killed him because Asclepius was disturbing the balance of the living and the dead. The Oath is also sworn by Asclepius’ daughters Hygieia, who oversaw the prevention of sickness, and Panaceia, who was responsible for universal remedy. Hippocrates is acknowledging his inheritance of the practice of medicine from the gods who would naturally have a shared interest in medicine being practiced ethically.
Ethical Precepts in The Hippocratic Oath
Beneficence and Nonmaleficence
Regimens to be used for benefit.
What is used for harm or injustice will be kept away from the sick.
Will not administer a poison or advise how.
Will not give an agent to induce an abortion.
Herein the Oath directs the physician’s tools to be used for benefit and not for harm, beneficence and nonmaleficence. These professed commitments direct all the physician’s activities and are foundational in the relationship with patients. They further commit to trust which frames the physician-patient relationship. The literal relevance of the prohibitions against administering a poison and inducing an abortion are debated. It seems safe to say that the common factor is a reflection of the earlier commitment to direct care of the patient towards that which is beneficial and away from that which is harmful or unjust.
Will watch over life and art purely and piously.
This commitment seems to make explicit the humility of the physician both in character (life) and in practice (art). There also appears to be a recognition that in order to gain the trust of the patient, the physician must possess a worthy character. The physician is making a moral statement about the kind of person he or she will be. Purity here can also be interpreted as being free of conflicts which would cause patients to call into question the trustworthiness of the physician.
According to ability and judgment.
Will not cut but will give way to those who do so.
Accountability and judgement, as we will see, are the foundations of professional autonomy. In these commitments, in addition to asking, “What Should Be Done?” which is a function of ethical judgement, physicians must also ask, “Should I do it?”. Part of answering that question is an assessment of one’s ability, such that if a physician lacks the ability to treat a disease or perform a procedure, she or he will not do so. The same seems to apply to performing surgery, in that cutting will only be done by those specifically trained to do so.
Conflicts of Interest
Enter homes for the benefit of the sick and free of injustice.
No sexual acts; male or female; slave or free.
These commitments acknowledge the implicit power difference between the sick patient and the physician. The physician promises not to exploit the relationship in any way for her or his gain. The sole purpose of the physician visiting the home is the benefit of the sick. Eschewing sexual acts, regardless of status in the household, underscores the essential trust in the physican-patient relationship.
Will not repeat what is learned in the home.
The commitment to confidentiality once again shows the centrality of trust in the physician-patient relationship. The physician distinguishes herself or himself from any other visitor to the house. The physician’s purpose is different, is for the benefit of the patient. This preserves both the trust of the patient and the other people living in the household. It is important to note here that it was unusual for non-family members to enter another person’s home in ancient Greece. To invite a stranger in was to make the household’s possessions, occupants and reputation vulnerable. Because of this, the commitment to confidentiality also removes a possible barrier to a household contacting a physician to tend to the sick.
Other Ancient Sources of Medical Ethics
Plato’s The Republic
In The Republic, Socrates speaks to the altruism and divestment of self interest which marks the physician. Socrates holds that physicians, when rightly ordered, seek not their own benefit but that of the patient. There is a unique divergence here from other jobs, and some professions, that permit or reward those who seek their own benefit. Professional moralities, such as in medicine, may have distinct obligations that are not part of the universal morality, or are not shared by other professional moralities.
Galen, a Greek physician and philosopher writing in the 2nd century CE, notes: “as to diseases, practice two: help or do no harm”. This sentiment reflects the The Hippocratic Oath in that regimens are to be used for benefit, and what is used for harm or injustice will be kept away from the sick. This is also reflective of the generalized moral edict to do good and avoid evil.