Hello again, friends, and welcome to another episode of Scholar Minor.
As Scholar Minor slowly creeps up on its first birthday - can you believe it?! - this week’s topic will be a little different than our usual fare. While I’ll be approaching it from a historical standpoint, there is a significant amount of controversy surrounding this tradition today in the medical community.
As I am obviously not a physician, I can’t say for certain who is right or wrong. But it is a wonderful example of history’s influence on our modern world - and we’ll be learning about what it is and why it’s still around.
I hope you enjoy our introduction to the Hippocratic Oath this week. It’ll be a short episode this time, but I promise episodes will be back to their regular lengths and release intervals later this month. Thanks for your patience in the meantime, and I hope you enjoy.
Hippocrates is often considered the father of medicine, credited with many important writings, but in reality, his story is a little hard to pin down. We know that Hippocrates was a Greek physician, living in the 5th and 4th centuries BCE. We know that he was short, as recorded by Aristotle. And we know that he was a well-respected Asclepiad, a doctor from a long family line of doctors.
About 100 years after Hippocrates' death, the works attributed to his name were collected as the Corpus Hippocraticum. This collection was used extensively in the following centuries, as it possessed a wealth of scientific information. While historians agree that inconsistencies in opinion and writing style suggest multiple authors, the Corpus Hippocraticum shares an unadorned, direct style and simple instructions for practicing Greek physicians.
While over 50 written documents exist that bear Hippocrates' name as author, including the Hippocratic Oath, it is suspected that many - if not most - of these writings were, in fact, written by other people. While his contemporaries appeared to respect him, Hippocrates' reputation really took off almost five hundred years after his death with an imaginative and likely inaccurate biography published by Soranus Of Ephesus.
Over time, even more works were attributed to Hippocrates and included in the Coprus Hippocraticum. One of these was the ethical writing, the Hippocratic Oath. It was almost certainly not authored by Hippocrates himself, having been added after the Corpus Hppocratum was put together - but it remains one of the most influential medical texts in history.
The Hippocratic Oath has evolved over the centuries from necessity. Generally, if a modern medical school or organization makes use of the Oath, they use a modern version - not the Classical translation. Let’s take a look first at the original Oath - for our purposes, we’ll be using the 1849 Francis Adams translation.
"I swear by Apollo the physician," the oath begins, "and ES CU LAEPIUS Aesculapius, and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgement, I will keep this Oath." Following the introduction, the author promises to respect and support their teacher - and to relay their knowledge of medicine to their teacher's family line without charging a fee.
While it's generally agreed that Hippocrates was not directly responsible for many of "his" writings, this initial section does give us a clue as to who might have been. Hippocrates himself learned medicine from his father and a physician Herodicus, and in turn taught his own two sons his practice - travelling widely and opening a school of medicine around 400 BCE.
In the original Hippocratic Oath, this teaching segment makes up probably a third of the length. In modern versions - we’ll be using Louis Lasagna's 1964 version, which is still commonly used today - the portions about family lines and lecturing and teaching for free are absent, as you might imagine. Instead, the modern version condenses the segment into the following statement: "I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow."
As mentioned in our introduction to this episode, the Hippocratic Oath is a controversial topic in the medical community. While I am not a member of that community, you don’t have to be to see why the original oath is considered fairly problematic in our modern era.
While the Hippocratic Oath does contain sentiments that have been carried over to the modern versions - that patients have a right to privacy, for example - there are some that don’t exactly mesh well with today’s needs.
The original Oath includes: "Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further from the seduction of females or males, of freemen and slaves." While it’s true that modern physicians should also avoid mischief and seduction, this is one of the points that you’ll understandably find heavily edited or excluded from modern versions.
In the original version of the Hippocratic Oath, the oath-taker also promises not to supply anyone with the tools to take their own life or the life of an unborn child. As you might imagine, this portion has caused many to take a long hard look at whether the Hippocratic Oath should be utilized by the medical community at all anymore. With issues like physician-assisted dying and abortion frequently at the forefront of medical and social debate, it’s easy to see how the oath itself has attracted controversy in recent decades.
In response to these issues, the modern versions of the Hippocratic Oath have been heavily altered in an attempt to make them more relevant. Because so much of the original Oath’s content is unusable by medical practitioners today, the newer versions are largely unrecognizable. With the content changed so drastically, from necessity, many in the modern medical community wonder whether the antiquated custom is worth hanging onto at all.
"Many modern oaths have a bland, generalized air of 'best wishes' about them," writes Dr. David Graham in the Journal of the American Medical Association, "being near-meaningless formalities devoid of any influence on how medicine is truly practiced."
Interestingly, one of the most often quoted statements from the oath is “First, do no harm.” - despite this phrase not actually appearing in the original version, or in most of its rewrites. Doctor Robert H. Shmerling of Harvard Health points out that even if such a sentiment were included in a physician’s oath, it would not be attainable to those practicing real medicine. Biopsies on growths that turn out non-cancerous, for example, would be technically harm - though the biopsy process is obviously very necessary.
It seems pretty clear that the Hippocratic Oath has some pretty major issues that need to be worked out, and it’s understandable why there’s hesitation in perpetuating it in the medical community. So why has it stuck around this long?
It all comes down, as most things do, to the human brain and anthropology. Oaths, vows, and promises have been around since the dawn of mankind and are still everywhere - having become a fundamental, comforting gesture in many circumstances. Think about wedding vows, the oaths taken by a witness in court proceedings, or the swearing-in ceremonies of newly elected leaders.
These promises often carry with them the threat - or at least, the implication - of divine retribution should they be broken. Not all oaths are religious in nature, with some historically being sworn over weapons or family lines, but at their heart they serve the same purpose - to add gravity and accountability to a declaration.
The Hippocratic Oath follows in this tradition, as it addresses one of the weightier aspects of the human experience - illness, life, and death. Medical professionals have a huge amount of responsibility. In order to do their jobs properly, they need trust - and the Hippocratic Oath has stuck around so long because it adds that necessary gravitas.
The Oath is usually taken at graduation from medical school, so it makes sense that some physicians believe it should maintain - as it’s a tradition that impresses upon recent graduates the importance of their new role in society. As summarized by Patricia Chaney of UCLA Health, "While the creators intended [the Hippocratic Oath] to be a binding covenant, modern doctors see the oath as a promise to uphold the art of medicine and act in patients' interests."
That’ll do it for our truly bite-sized episode this week, but not to worry, I promise that things will be back on schedule soon. In the meantime, thank you for your patience, and please subscribe to Scholar Minor if you haven’t already so you’ll be notified as soon as episodes are released.
Previous episodes are available on my website, www.ursaminorcreations.com, as well as on the Scholar Minor YouTube channel. If you have any questions, comments, or just want to say hello - my email is in the show description, please feel free to send a note along.
Thank you, friends, and be safe. I’ll talk to you again soon.