Medical Elite at War With Hippocratic Oath
Yes, yes, I know: Very few doctors take the Hippocratic Oath anymore--which I have repeatedly written about here at SHS and elsewhere--because it interferes with modern cultural norms (and that includes the Hippocratic proscription against having sex with patients). But surely, physicians who still adhere to orthodox Hippocratic values should be able to practice medicine in the specialty of their choosing under what was until not very long ago, the expected approach for all doctors.
Apparently not--at least according to the medical elite. The New England Journal of Medicine has become the latest publication to publish an opinion piece that, in essence, tells physicians who don't want to violate the Hippocratic Oath to get out of areas of medicine where non Hippocratic procedures are now allowed. From the column by Julie D. Cantor, M.D., J.D. attacking the Bush conscience clause regulations:
Medicine needs to embrace a brand of professionalism that demands less self-interest, not more. Conscientious objection makes sense with conscription, but it is worrisome when professionals who freely chose their field parse care and withhold information that patients need. As the gatekeepers to medicine, physicians and other health care providers have an obligation to choose specialties that are not moral minefields for them. Qualms about abortion, sterilization, and birth control? Do not practice women's health. Believe that the human body should be buried intact? Do not become a transplant surgeon. Morally opposed to pain medication because your religious beliefs demand suffering at the end of life? Do not train to be an intensivist. Conscience is a burden that belongs to the individual professional; patients should not have to shoulderWhy do I suspect she wouldn't be opposed to futile care theory? But that aside, the hubris is palpable--particularly the thinly veiled attack on Catholicism and the canard that the faith "demands suffering at the end of life." Also, realize that if the issue is a physician refusing to participate in assisted suicide--which the Bush conscience regulations also protect--it would mean that any doctor who didn't want to help kill patients might have to become podiatrists.
Cantor, M.D., J.D. concludes:
Health care providers already enjoy broad rights--perhaps too broad--to follow their guiding moral or religious tenets when it comes to sterilization and abortion. An expansion of those rights is unwarranted. Instead, patients deserve a law that limits objections and puts their interests first. Physicians should support an ethic that allows for all legal options, even those they would not choose. Federal laws may make room for the rights of conscience, but health care providers--and all those whose jobs affect patient care--should cast off the cloak of conscience when patients' needs demand it. Because the Bush administration's rule moves us in the opposite direction, it should be rescinded.I italicized the key phrase that I think should be carefully pondered when thinking about this post: Cantor would seem to support the government legally forcing physicians who practice OB/GYN to perform abortions. That same coercive principle could also force internists, family care specialists, oncologists, hospice physicians, cardiologists, anesthesiologists, etc., to perform assisted suicide wherever that non medical act is redefined as a legal "treatment."
I keep saying it: The culture of death brooks no dissent. But there is no reason why Hippocratic doctors have to cooperate with their own undoing. One antidote I suggest: Mass public recitations of the principles of the Oath by physicians to prove they are not cowed by the likes of Dr. Cantor, M.D., J.D.
Labels: Conscience Clauses. Culture of Death. Bush Regulations.
posted by Wesley J. Smith @ 10:16 PM
23 Comments
23 Comments:
I don't know what doctors are going to do when they feel that performing an abortion or assisted suicide violates their conscience. I have a good friend who is going to be a pediatrician who I know would never consent to perform either procedure, although, luckily, these aren't part of a pediatrician's job. I cringe to think of OBGYNs who are dedicated to preserving the lives of their patients, both born and unborn, and the shortage of care that could result if they are forced out of practice. One can only hope that if this does happen, it will cause a backlash that will cause things to swing back the other way and even out.
P.S.-where did the mention of sterilization come from? That's certainly not a common medical procedure in terms of demand. Is this opening the doorway to forced sterilization?
SAFEpres: 31% of pediatricians in the Netherlands have killed babies according to The Lancet. The age of consent for euthanasia there is 16, still within pediatricians' age limits. Serious proposals have been made to lower that age of consent to 12.
I'm not clear on whether most physicians do, or do not, take the oath now.
I know her type.
Says SHE.
There's a GATE? Is this, like, a gated community or something? Where everyone has to be the same according to certain standards, otherwise they can't live there? Who's talking about gates and gateways and saying what everybody has to do? She is. FEH!
How come the doctors' rights have to be limited and the patients' don't? Forget the Bush law; this is just plain unconstitutional.
Cast off the cloak of conscience? Conscience is a cloak that can be put on or off? Not something within? Well, maybe to her it is.
I swear, the women's movement had a lot to do with this whole mess. I'm not talking about abortion or birth control; I'm talking about look how a lot of women vote, drive, how they get when they think they've advanced beyond "traditional female roles" and get degrees, how it's ruined men, etc. A lot of women just weren't ready for these things and now they're opining in just as screwed-up a way as the stereotypical woman driver. And tell me this one isn't a Democrat. (If not I'll have to start worrying even more about what has happened to Republicans.)
Incredible - where, in all of this, is the patient's right to choose a doctor that does live by and uphold the Hippocratic oath (to the best of their ability)? Do patients have the right to choose such a doctor? I know that's what I have and that's what I'd want.
What if health care professionals marketed themselves in this way? Wouldn't it make the distinction between Hippocratic clinics and non-Hippocratic clinics ridiculous?
Can you imagine children asking their parents what makes a Hippocratic clinic different from the other clinics? 'Well, they both look after people, but if you want an abortion, or if you want help committing suicide, or if you want embryonic stem cell treatments, or if you want your doctor to make a pass at you, you'll have to go to the non-Hippocratic clinic.'
Wouldn't that be ridiculous?
What about the Arnold Gold Foundation White Coat Ceremony? This foundation encourages humanism in medicine from the inception of a doctor's career. Like you, they are fighting an uphill battle. This also leads me to ask if you know Arnold and Sandra Gold. He was my pediatric neurologist when I was a child and a living example of how humane a doctor can be.
This is obscene. As far as "woman's health" is concerned, as a woman, I would prefer knowing that the treatment given to me was done so freely. Perhaps I expect too little from my OBGYN - my only requirement is that she keep me alive and reproductively healthy. But this idea that elective procedures (such as abortion and sterilization) should be a mandate is more than laughable. I'd hate to be under the knife with a doctor who wasn't morally comfortable performing the procedure.
Becky-Exactly-why in the world would one consent to a procedure performed by someone who went to the operating room kicking and screaming?
I notice her assumption that performing an abortion is "practicing women's health." Just a part of her hubris is the refusal even to consider the possibility that killing their babies is not an actual service to women's health.
Yes: I believe doctors should market themselves as Hippocratic, have a professional association promoting Hippocratic values, and state their views publicly. Then patients can decide whether they want a doctor with those ethics or not.
Good idea, Wesley.
Saying you can't be in "Women's Health" (a phrase chosen carefully by the author) if you aren't willing to perform abortions is like saying you can't be a chef if you don't like brussel sprouts.
It's ridiculous.
Specialization allows for people to work at places that limit/prevents their exposure to certain types of work. It's not even a medical issue, it's true across the board. If you can find a way to make money doing a limited set of things, there's no reason ANYONE, much less the govermnent should require that you do more.
Dr. Cantor: "Morally opposed to pain medication because your religious beliefs demand suffering at the end of life? Do not train to be an intensivist."
That's the most ridiculous slander I've ever heard of the anti-assisted suicide POV. It's a bald demonstration of either her dishonesty or ignorance of the debate.
"Federal laws may make room for the rights of conscience, but health care providers--and all those whose jobs affect patient care--should cast off the cloak of conscience when patients' needs demand it."
Whoa. That means nurses, medical assistants, lab technicians - everybody. So, everybody should just "cast off the cloak of conscience" in regard to, say, stealing drugs for someone who doesn't have a prescription? If a patient "needs" food but they're NPO for some reason, you can give it to them? If a patient "needs" you to have sex with them, it's OK?
Excuse me, but - WTF?? It's like she's actively trying to destroy the structure not just of the practice of medicine by doctors, but the entire field.
I agree with Becky - this is obscene.
Ken-right. Whenever I go to the gynecologist, I am accessing "women's health." I cannot see myself having an abortion. Does that mean that I have not participated in women's health care? Would having an abortion make me an "official" woman?
Let's take a closer look at what the Hippocratic Oath actually says, and let’s analyze it line by line:
"I swear by Apollo the physician, by Æsculapius, Hygeia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath.”
I always find it interesting that any professing Christian would take seriously an oath sworn to pagan deities.
“To consider dear to me as my parents him who taught me this art; to live in common with him and if necessary to share my goods with him; to look upon his children as my own brothers, to teach them this art if they so desire without fee or written promise;”
In other words, salaried medical school faculty in institutions that charge tuition are in violation of the Oath.
“[T]o impart to my sons and the sons of the master who taught me and the disciples who have enrolled themselves and have agreed to the rules of the profession, but to these alone the precepts and the instruction.
Sorry, ladies: no med school for you, because the Greeks didn't let women practice medicine.
“I will prescribe regimen for the good of my patients according to my ability and my judgment and never do harm to anyone.”
OK, I suppose we’ll have to stop using medical personnel to set up the IV lines for executions by lethal injection.
“To please no one will I prescribe a deadly drug nor give advice which may cause his death.”
However, many prescription drugs can and do have lethal side effects if misused. If the doctor tells the patient, “Be sure not to take more than one of these pills every twelve hours, or you’ll die” isn’t he violating the Oath?
“Nor will I give a woman a pessary to procure abortion.”
OK, no pessaries. But abortion by other means isn’t prohibited. There were other methods of causing an abortion in Classical times, so the Oath can’t be interpreted as forbidding ALL abortions; only the use of pessaries.
“But I will preserve the purity of my life and my art. I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.”
OK. All this says is that a physician should refer surgical patients to a surgeon.
“ In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.”
That also happens to be the law in most jurisdictions (excepting the part about slaves).
“All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.”
Confidentiality also happens to be the law, except where requirements for reporting crimes take precedence.
“If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot."
Will Apollo smite you? Will Zeus strike you down with a thunderbolt?
Ohhh, I forgot. Christians don't believe in those gods. We also need to consider the fact that while the Greeks may have been impressive playwrights, artisans, architects, mathematicians and philosophers, they knew very little about medicine, or about the causes and treatments of diseases.
So why should anyone place so much emphasis on an oath that's really an anachronism?
History Writer: Oh that was so boringly predictable, the comment about the Greek gods. I stated the "principles" of the Oath. Who or what one swears to, in fact, it could easily start with "I promise my patients and profession." The important thing is the values the Oath created as understood and accepted in Western medicine until very recently.
History writer, the point of the oath is not the deities to whom the oath is sworn (not that believe them to be deities - I am a Christian pastor). The point of the oath is the standard or, as Wesley Smith put it, principles or values for which it stands.
Greek society was very religious, but the religion was not uniform. It would be difficult to find a modern equivalent of the religious climate there. That said, you don't interpret the oath like a Greek, but instead you read it as if it were meant to be circumvented. The letter of the oath says one thing, but the spirit of the oath is clearly another. When you ask yourself, 'what's the least I have to do to uphold this oath,' you are already on shaky ground.
The Hippocratic oath is no divine document - it governs (or used to) a profession. It would bring about very interesting results if doctors began advertising this way. Doubtless, there would be doctors who would interpret the oath as literally as possible - like History writer, and there would be other doctors who would uphold the spirit of the oath, protecting life. Maybe it'd precipitate an updated version of the oath.
Then again, there's something to be said for antiquity - doctors have a responsibility in the training of future doctors to pass along not only the information of medicine but also the morality of medicine. Part training future doctors ought to include teaching them to properly understand the Hippocratic oath. There's theory in every discipline, and perhaps the variances we see in modern medicine (legal abortion, euthanasia, embryonic stem cell research, futile care theory, etc.) mean that this part of the training is lacking?
I don't wish to cast doctors in an unfavorable light or paint any with a broad brush - surely there are many doctors who would disagree with that appraisal. I also don't wish to be calling the kettle black - the same issues of fidelity to ancient patterns of thought is a very divisive issue in my field as well. One need not look at Christianity long to see that there are competing interpretations of the same ancient documents. Our training needs to be just as thorough.
I noticed that she used the same tactic that EVERY other opinion piece by doctors that I have read does: listing the abortion objection as one example among a list of otherwise absurd ones.
Here she says: are you against organ donation? Don't be a transplant surgeon (as if!) Elsewhere, the scary scenarios include GYN office receptionists who refuse to schedule you for your diaphragm fitting....janitors who won't let you into a building when you show up for a hsterectomy....you get the picture.
It's partly geared to make objections to abortion and euthanasia seem as silly as those other things. Or, maybe, these people really don't have that conscious agenda; they just don't have the moral imagination or "diversity" of thought to comprehend that there is such a thing as a legitimate philosophical objection to what they think is perfectly fine.
Wesley: You never addressed any of the matters raised in connection with the oath. The "boringly predictable" remark, besides being a cheap shot, is a plain and simple cop-out. So why don't you enlighten all of us by telling us what THE interpretation of the Hippocratic Oath is, according to you. I mean it's nice to talk about it in the abstract, but if you're going to get down to reality you ought to be able to say: "THIS is what the Oath requires that you do, and THIS is what it forbids. Yes?
History Writer: Hardly a cheap shot. It is brought up everytime someone wants to disgregard the Oath's maxims.
I and others have written on this question. I like Meilander's take that it commits doctors to the bodily lives of the patient, as quoted in my piece on the watering down of the Oath, which is being done to allow acts to be taken that violate the bodily lives of human beings and weaken the fiduciary professionalism of modern medicine.
http://www.nationalreview.com/smithw/smith200603090830.asp
History Writer
In regard to the gods thing, I believe that objection has been dealt with. Onto other matters...
1. your example of salaried faculty makes no sense when considered in the context of the quote you provided-it says that one will provide medical training and other forms of care for other physicians if necessary, indicating that it is not required to be free if the physician can pay and/or can take care of him/herself
2. Your example about women is about as good as any of the many examples about women in the Bible and statements related to them. For instance, the book of Timothy admonishes women not to braid their hair or pierce their ears. The admonishment was made in the context of a culture in which braids and earrings were the attire of prostitutes and had a place in pagan sexual worship.
Thus, it is the purpose of that statement: 'don't put yourself in a position of participating in something that violates Jesus' teachings,' not the braids or piercings themselves that are important. Similarly, the Hypocratic oath was developed in a male dominated culture and reflects that bias. Today, the principle of passing the information unto the next generation is preserved while the restriction to men is not.
Surely, as a history buff, you must be aware of all of this. This is all obvious, of course, and,I'm sure, you know that you are taking these things out of context.
In fact, one need only look up the HO to see that it has also been modernized to the wording often used today, so that the reference to the Greek gods and goddesses isn't in there:
The Hippocratic Oath
(Modern Version)
I SWEAR in the presence of the Almighty and before my family, my teachers and my peers that according to my ability and judgment I will keep this Oath and Stipulation.
TO RECKON all who have taught me this art equally dear to me as my parents and in the same spirit and dedication to impart a knowledge of the art of medicine to others. I will continue with diligence to keep abreast of advances in medicine. I will treat without exception all who seek my ministrations, so long as the treatment of others is not compromised thereby, and I will seek the counsel of particularly skilled physicians where indicated for the benefit of my patient.
I WILL FOLLOW that method of treatment which according to my ability and judgment, I consider for the benefit of my patient and abstain from whatever is harmful or mischievous. I will neither prescribe nor administer a lethal dose of medicine to any patient even if asked nor counsel any such thing nor perform the utmost respect for every human life from fertilization to natural death and reject abortion that deliberately takes a unique human life.
WITH PURITY, HOLINESS AND BENEFICENCE I will pass my life and practice my art. Except for the prudent correction of an imminent danger, I will neither treat any patient nor carry out any research on any human being without the valid informed consent of the subject or the appropriate legal protector thereof, understanding that research must have as its purpose the furtherance of the health of that individual. Into whatever patient setting I enter, I will go for the benefit of the sick and will abstain from every voluntary act of mischief or corruption and further from the seduction of any patient.
WHATEVER IN CONNECTION with my professional practice or not in connection with it I may see or hear in the lives of my patients which ought not be spoken abroad, I will not divulge, reckoning that all such should be kept secret.
WHILE I CONTINUE to keep this Oath unviolated may it be granted to me to enjoy life and the practice of the art and science of medicine with the blessing of the Almighty and respected by my peers and society, but should I trespass and violate this Oath, may the reverse by my lot.
So, your argument about greek gods and godesses just went out the window, as is your reliance on the technical word "pessary" in regard to abortion, as abortion itself is specifically forbidden in the modern version.
SAFEpres: Wherever did you get that version of the Oath? Can you tell us which medical school administers it? I was particularly intrigued by: "I will neither prescribe nor administer a lethal dose of medicine to any patient even if asked nor counsel any such thing nor [sic] perform the utmost respect for every human life from fertilization to natural death and reject abortion that deliberately takes a unique human life."
Except for that out-of-place "nor" I could have sworn you got Wesley to dictate it for you.
I gave you a fair translation of the Oath as it was given to the world by Hippocrates, not by Operation Rescue or the Archdiocese of New York. While you're certainly free to believe whatever you like, and to cite whatever revisionist writers you wish, don't go calling their output "the Hippocratic Oath", since that is most definitely NOT the Oath as given by Hippocrates. Fair enough?
HW:
The modern version, placed next to the original, is found here, on a link from the National Kidney and Transplant Insitute, department of Urology, in Manila, Phillipinnes. You can follow the link to read it here:
http://members.tripod.com/nktiuro/hippocra.htm
Or, if you want to go even further in expanding your salient store of knowledge, you can even go to this wikipedia link and find the history of the modern version of the Hypocratic oath and why it was abandoned by some medical schools:
http://en.wikipedia.org/wiki/Hippocratic_Oath
And, you can read about Luis Lasagna,the author of the modern oath, here:
http://en.wikipedia.org/wiki/Louis_Lasagna
If you wish to read the Association of American Medical Colleges statement on the modern vs. original versions, you can find it here:
http://www.aamc.org/newsroom/reporter/sept2001/hippocraticoath.htm
So, this wasn't made up by Operation Rescue, Wesley, or myself. The Hyppocratic oath as it it has been used over time simply doesn't lend itself to your deconstruction.
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