This article appears in the Feb 2006 edition of the Catholic Medical Quarterly
The Hippocratic Oath II
The declaration of Geneva and other modern adaptations of the classical doctors' oath
David Albert Jones
In a previous article I argued that the Hippocratic oath was ‘an ethically acute and thoughtful document’ which has rightly been esteemed through many periods of history (1). The present article outlines some of the many attempts to modernise the oath for use in contemporary medicine. It is necessary to start with a detailed examination of the declaration of Geneva, for this remains the most significant and enduringly influential restatement of the Hippocratic Oath.
The declaration of Geneva
The declaration of Geneva is an affirmation of ethical medicine agreed at the second general assembly of the World Medical Association in 1948. It was drawn up in the aftermath of the Nuremberg trials of Nazi war criminals in 1947, trials which included the prosecution of several physicians. The declaration was fashioned in conscious opposition to such abuses, as a reaffirmation of the intrinsic ethic of the medical profession. It was ‘a revision of the ancient Hippocratic Oath’ (2), which sought to restate the moral truths of the ancient oath in a form that could be understood and accepted in the twentieth century. In context and approach it was thus similar to the United Nations’ universal declaration of human rights, also adopted in 1948. The text of the declaration of Geneva (1948) runs as follows:
At the time of being admitted as a member of the medical professions:
I solemnly pledge myself to consecrate my life to the service of humanity
I will practise my profession with conscience and dignity;
I will give to my teachers the respect and gratitude which is their due;
The health and life of my patient will be my first consideration;
I will respect the secrets which are confided in me;
I will maintain, by all means in my power, the honour and the noble traditions of the medical profession;
My colleagues will be my brothers;
I will not permit considerations of religion, nationality, race, party politics, or social standing to intervene between my duty and my patient;
I will maintain the utmost respect for human life from the time of its conception; even under threat, I will not use my medical knowledge contrary to the laws of humanity;
I make these promises solemnly, freely and upon my honour.
The most striking difference between this declaration and the ancient oath is that, whereas the oath begins by calling upon Apollo, Asclepius and the gods of healing (3), the declaration does not mention God, the gods, or any sacred power. It is not an oath sworn before God, but a declaration and promise. A question nevertheless arises, to whom is this promise made? It may be made publicly, but it does not seem to be a promise made to a specific audience nor even to the medical profession as a whole. It is not a pact between individuals nor is it an agreement to abide by institutional rules. The words used are not the language of contract. Still less does the oath use the language of consequences or utility. There is rather an appeal to conscience, dignity, respect, gratitude, honour, noble traditions, to duty and to what is due, and to the service of and laws of humanity. The person makes not a simple promise but a ‘solemn pledge’, ‘consecrating’ himself or herself to what is, implicitly, a holy way of life. Thus, while the declaration does not invoke the gods explicitly, it uses terms such as ‘nobility’, ‘honour’ and ‘dignity’, which imply a sacred or transcendent aspect to human life, and which seem to draw their meaning from a theological context. The declaration can thus be seen as a thinly disguised oath, and none the worse for that.
With regard to content, the declaration begins, like the Hippocratic oath, with respect and gratitude for teachers. However, in the declaration the implications of this are kept unspecified, whereas in the Hippocratic oath there is a definite duty to share one's livelihood with one's teacher. An element that is missing from the declaration is the obligation to pass on medical knowledge. This is an unfortunate oversight for, while not every doctor lectures in medicine, there does seem to be a common duty on medical professionals to facilitate the training of new doctors.
In relation to the patient, the declaration says that ‘the health and life of my patient will be my first consideration’. This corresponds to the fundamental aim of the Hippocratic physician which is ‘to help the sick’. Again in parallel to the oath, the declaration expresses the duty of confidentiality, though there are some differences: the declaration refers to secrets ‘confided’ to the physician by the patient, and does not appear to admit of exceptions. In contrast the oath refers to what a physician sees or hears in the course of attending the sick, or even outside that context. Confidentiality thus embraces much more than secrets confided by patients. Nevertheless, there seems to be an acknowledgement that not all that is seen or heard is confidential. Secrecy is required only in regard to those things ‘that ought never to be published abroad’. In both respects the oath shows more nuance than does the declaration.
Another contrast between the oath and the declaration is that the oath contains an explicit prohibition on seduction or sexual abuse of patients, whereas this issue is not covered in the declaration. This omission is particularly to be regretted, for cases continue to occur in which physicians take advantage of their position of trust, and engage in unequal or abusive sexual relations with patients. It is a constant feature of medical practice that it involves touching, intimate examination, and private consultation with people in a vulnerable condition. The protection of patients from sexual abuse is rightly highlighted in the oath; the declaration is weak in comparison.
In relation to medical homicide, the declaration requires ‘utmost respect for human life from the time of its conception’ but contains no explicit prohibition of assisting suicide or of abortion. Here again the declaration suffers from appeal to abstractions whereas the oath is clearer and more specific in its injunctions, explicitly prohibiting the giving of poison even on request and the application of a destructive pessary to cause abortion. Nevertheless, ‘utmost respect for life’ implicitly excludes deliberate killing. If poison is given to someone who requests it, then that person's life can hardly be said to be treated with ‘utmost respect’. Furthermore, the additional specification ‘from the time of its conception’ seems designed to emphasise that unborn children also deserve ‘utmost respect’. Again, this implicitly excludes abortion, with the possible exception only of cases where the life of the mother is in jeopardy, for her life is equally worthy of ‘utmost respect’.
One area where the declaration represents an advance on the oath is in its explicit rejection of discrimination on the basis of ‘religion, nationality, race, party politics, or social standing’. It could be argued that in specifying that the role of the physician is ‘to help the sick’ without further qualification, and in excluding sexual abuse of ‘woman or man, bond or free’, the Hippocratic oath implicitly excludes all forms of discrimination. Nevertheless, even if this is so, it is implicit rather than explicit, and the declaration does well to make it explicit. It is not difficult to deduce the cause of the greater moral acuity of the declaration in this respect. The declaration was written as a conscious rejection of the corruption of medicine under Nazism, a corruption typified by racism and other forms of discrimination.
It is also noticeable that, whereas the oath refers to `physician's law', the declaration refers to `the laws of humanity' and also to `the service of humanity'. Here again the declaration expresses that form of humanism evident in the UN declaration of human rights. Nevertheless, it should not be thought that this humanistic vocabulary is alien to the Hippocratic tradition. Another Hippocratic text, the Precepts, contains the line `for where there is love of man (philanthropia) there is also love of the (medical) art (philotechnia)' (4). It is not clear that, in their fourth century context the word philanthropia meant much more than a general attitude of kindness. Nevertheless by the time of Scribonus Largus (40 CE) and Galen (160 CE) the good physician was one motivated by a love of humanity (5), therefore even if it is not explicit in the oath, the`service of humanity' was certainly an element of the broader Hippocratic tradition of ethical medicine.
The 1948 declaration thus stands squarely in the Hippocratic tradition. It succeeds in its aim of being a faithful modern restatement of the oath and is an appropriate pledge of ethical commitment for present day students entering the medical profession.
Amendments to the declaration of Geneva
The World Medical Association has amended the text of the declaration of Geneva four times: at Sydney in 1968, at Venice in 1983, at Stockholm in 1994, and most recently at Divonne-les-Bains, France in May 2005. The amendments are interesting for the concerns they express or imply, some of which are indicative of worldwide shifts in the ethos of the profession. The following text shows how the declaration was amended successively from 1948 to the present.
At the time of being admitted as a member of the medical profession:
I solemnly pledge
myself(2005) to consecrate my life to the service of humanity;
I will practice my profession with conscience and dignity;
I will give to my teachers the respect and gratitude
whichthat (2005) is their due;
and life(1968) of my patient will be my first consideration;
I will respect the secrets
whichthat (2005) are confided in me, even after the patient has died (1968);
I will maintain by all the (1968) means in my power, the honour and the noble traditions of the medical profession.
My colleagues will be my sisters and (1994) brothers;
I will not permit considerations of
religionage, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, party politics, sexual orientation (1994), or(2005) social standing or any other factor (2005) to intervene between my duty and my patient;
I will maintain the utmost respect for human life
from(2005) the time of its conception(1984) its beginning(added 1984 deleted 2005) even under threat(2005) and(added 1984 deleted 2005) I will not use my medical knowledge contrary to the laws of humanity, even under threat(2005)
I make these promises solemnly, freely and upon my honour.
The first amendment involved both an addition and a deletion. The defence of patient confidentiality was extended beyond the grave (line 6). This strengthened even further the idea of confidentiality and gave it an application that is nowhere to be found in the Hippocratic tradition. This move can be related to a modem concern with privacy expressed in terms of rights, though it seems to be understood differently in different parts of the world: certainly in English medical practice, as regulated by the General Medical Council, it is qualified by numerous exceptions (6).
Also in 1968, the words `and life' were deleted from the aim of medicine (line 4). This may express an ambivalence whether extending life is, of itself, a proper end of medicine (7), for even if a treatment can extend life, the treatment might be so costly or burdensome that it would be better to withhold it or to withdraw it. It should be noticed that the declaration kept unaltered the commitment to `maintain' the utmost respect for human life' (line 9). What seems to be at issue here is not assisted suicide and the inviolability of human life but the distinct question whether extending life should always be the `first consideration’ of the physician.
If the amendments of 1968 did not impinge on the inviolability of human life, the same cannot be said of the amendments of 1983. Whereas the 1948 declaration had pledged to respect every human life `from the time of its conception', this was amended in 1983 to `from its beginning'. Here we see very clearly the shadow of abortion. If the 1948 declaration had prohibited abortion, at least implicitly, the 1983 declaration prohibits only those abortions carried out after human life has had `its beginning'. It thus offers a possibility of justifying at least early abortion, if an argument can be presented for holding that human life has not truly begun at that point. It is true that the 1983 wording is wholly compatible with holding that human life begins at fertilisation, and that, by raising the question of when life begins, this formulation might still do much to discomfort someone intent on abortion. Nevertheless, the change of wording seems calculated deliberately to withdraw respect and protection from the human embryo.
A second and much more subtle change is the insertion of the word `and' between the first and second parts of line 9. The result of this change is that maintaining `the utmost respect for human life' and refraining from using medical knowledge `contrary to the laws of humanity' are presented as distinct commitments. However, the 1948 version seemed to imply that the failure to `maintain the utmost respect for human life' was itself `contrary to the laws of humanity'. At the time of the Nuremberg trials forced abortion was explicitly cited as a crime against humanity (8), but after the liberal abortion laws of the 1960s and 1970s, there was a reluctance to regard abortion, either in general or in particular circumstances, as a crime against humanity. Both the 1983 amendments thus take the declaration further from the Hippocratic tradition. Nevertheless, even in this form, the declaration does not positively endorse abortion.
The changes of 1994 reflect an agenda of inclusion, hence the reference to brothers (line 7)is amended to `sisters and brothers'. Hence also the list of forms of discrimination to be avoided (line 8) is expanded, from five (religion, nationality, race, party politics and social standing) to eleven (age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation and social standing). Some of these categories (gender, sexual orientation, disability) are reflective of contemporary political movements which, while diverse, are sometimes associated with particular moral claims (e.g. the claim of a right to access to abortion, the claim that homosexuality is not a psychopathology, the claim that disability is a social construction). However, in stating that these categories must not intervene between the physician's duty and his patient, the declaration does not thereby endorse these or similar claims. A commitment to treat people equally and according to one's duty is not necessarily a commitment to agree with their self-understanding (9). The amendments of 1994 should thus be seen as a valid expansion of the 1948 declaration which keeps the spirit and rationale of the original, and which are expressive of an important ethical principle - equal respect for every human person.
The `editorial revision' of 2005
At the 2004 WMA General Assembly in Tokyo, a new procedure for revising existing policies was adopted. This ceded to the Council the prerogative to approve minor changes such as `editorial corrections' and `deletion of outdated references' but not `changes to the substance of the policy' (10). The context for this was the need to keep updated an increasing number of WMA statements and declarations on various subjects.
In May 2005,the Council (which consists of just sixteen voting and three non-voting members) approved `minor revisions' to twelve documents, among them the declaration of Geneva. These include a number of minor grammatical changes (for example from `which' to `that') which do not alter the content of the oath. To the rejection of discrimination (line 8) they add the catch-all phrase `or any other factor'. This helpfully generalises the content of that line without changing it. However, to the requirement to maintain the `utmost respect for human life' (line 9) they make a substantial change, by deleting the phrase `from its beginning'. This has the effect of removing a direct allusion to abortion from the declaration. It is true that `utmost respect for human life' implicitly applies to all human life from its beginning. Nevertheless, the 1983 formulation had the virtue of raising an important and perhaps unsettling question: when does human life begin? Its removal glosses over this question and cuts an important link with the Hippocratic ethic just at a time when the respect given to unborn human life is being eroded. The change is therefore much more than an uncontroversial grammatical revision or the deletion of an outdated reference.
This change is therefore doubly unjustifiable. It is unjustifiable in itself as it removes the last foothold of an important element of the Hippocratic ethic: the utmost respect for unborn human life. It is also unjustifiable in regard to procedure, for it was not instituted by the assembly but by a small committee delegated only to make minor revisions; and it is not a minor revision but a change of content. Though the change was flagged up in the World Medical Journal in June 2005, it was not announced in any press release nor has it been taken up by the world's media. It also seems to have slipped unnoticed past the WMA assembly of October 2005. Under the new procedures, a vote of approval from the assembly was neither needed nor sought, even though the declaration of Geneva is `one of the earliest and fundamental declarations of the World Medical Association’. From the perspective of procedure alone, this revision needs to be subject to an open debate and a vote by the whole assembly. This is a revision which is worth opposing and an abuse of procedure which is worth criticising. Nevertheless, even though the 2005 version is worth opposing, it does not postively endorse abortion. Furthermore, the `utmost respect for human life' still offers a basis for arguing that, if a human embryo is a human life, then he or she deserves the utmost respect.
The subsequent amendments to the declaration of Geneva are mixed, with some strengthening and others weakening the moral content of the original. However, none of the changes, not even the most regrettable 1983 and 2005 amendments, render the declaration incompatible with the Hippocratic tradition. The declaration remains a valid profession of ethical medicine in the tradition of the Hippocratic oath.
Louis Lasagna and other poets
The 1948 declaration of Geneva and its subsequent amendments comprise the most influential set of modem adaptations of the Hippocratic oath, but they are by no means the only ones. Another version that is used in several medical schools in the United States was written in 1964 by Louis Lasagna, then Academic Dean of the School of Medicine at Tufts University (12).
In places this modem version very closely echoes the words of the ancient oath, for example: `I swear to fulfill, to the best of my ability and judgement, this covenant'. At other points the modem oath introduces new themes in terms quite foreign to the original, for example: `I will remember that there is art to medicine as well as science, and that warmth, sympathy and understanding may outweigh the surgeon's knife or the chemist's drug' or again `I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability.' In such passages neither the mode of expression nor the content has any parallel in the ancient oath. It is both sentimental and over-wordy and, while it has been adopted by a number of medical schools in America, it has not travelled well outside that context.
Like the 2005 revision of the declaration of Geneva, the Louis Lasagna version of the oath omits any reference to abortion. On the question of giving poison, it is also unclear:
`Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.'
These words are less satisfactory than the already abstract language of `utmost respect forhuman life' used by the declaration of Geneva. They make no definite commitment to refrain from any specific course of action and, in particular, they seem to be compatible with assisting suicide. The oath of Louis Lasagna is thus close to the ancient oath in form, at least at certain points, but in other respects is neither as strong nor as concisely formulated as the declaration of Geneva.
In the 1990s, in the pages of the British Medical Journal, there were a number of suggested adaptations of the Hippocratic oath. These generally show little concern to maintain links with the original oath. The version proposed by Eugene Robin (13), for example, includes no reference to abortion, to assisted suicide, to confidentiality, or to the sexual abuse of patients, nor is their any reference to the fundamental aim of medicine to benefit the sick. It is also much wordier than the original, and considerably longer even than the Louis Lasagna version. Robin's oath focuses largely on issues of patient autonomy, for example: `I will allow patients to make the ultimate decision about their own care. In circumstances where my patients are incapable of making their own decisions I will accept the decision of family members or loved ones, encouraging these surrogates to decide as they believe that patient would have decided'. The naivety of this proposal was criticised in a letter published later in the BMJ (14), but what is of greater significance than issues of precise wording is the eclipse of traditional ethical concerns.
In 1997, David Hart, a freelance writer and poet, was commissioned by The Observer newspaper to produce translation of the Hippocratic oath into poetry' (15). It was published in the BMJ in 1998 (16). It follows the original a little more closely than does Robin, in that it covers patient confidentiality and the duty not to do harm. However, the style excels that of Louis Lasagna in its florid sentimentality. One example should suffice: `I will not knowingly do harm to those in my care, I will smile at them and encourage them to attend to their dreams and so hear the voices of their inner strangers'. This `translation' may be inspiring to some, and it is worth taking a look at, but it is difficult to envisage it being accepted for common use by the medical profession.
In 2001, the students of Imperial College, under the guidance of Raanon Gillon, devised their own medical declaration(17). The form and much of the content of the declaration is taken from the declaration of Geneva, with the addition of language of `human rights'. Its relation to the Hippocratic oath is thus indirect and (unlike other modern , oaths and declarations) it does not claim to be a version of the Hippocratic oath. As with the Robin oath there is great emphasis on respecting the informed decisions of the patient, but there is no reference to the utmost respect for human life.
The United Kingdom has thus seen a resurgence of interest in oath taking. When Irvine Louden wrote a letter to the BMJ in 1994 suggesting that `the administration of the oath to medical graduates is, and possibly always was, a myth’(18), he was inundated with responses. He conceded that he had been `magnificently' wrong: `oath taking is no myth. It is alive and well in a large number of medical schools' (19). At that time, of the twenty-seven medical schools in the United Kingdom, three used the Hippocratic oath, four used the declaration of Geneva and seven used other oaths or declarations. A similar patter is found in the United States. Whereas in1928, only 24% of US medical schools administered an oath, in 1958 this had risen to 72% and by 1989 the proportion had reached a staggering 98%. Of these medical schools, around a half use some version of the Hippocratic oath and a further quarter use the declaration of Geneva (20).
Nevertheless, while the number of schools using an oath or declaration has risen consistently through the twentieth century, the content of these oaths seems to have become progressively further and further from that of the original oath. Analysis of the oaths in use in North America in 1993 showed:
- 100% pledged a commitment to patients
- 86% pledged a commitment to teaching
- 43% vowed to be accountable for their actions
- 14% included a prohibition against euthanasia
- 11% invoked a deity
- 8% foreswore abortion
- 3% retained a proscription against sexual contact with patients. (21)
In short more and more medical students were swearing to do less and less, or more accurately they might swear to do as much, but their concerns had shifted from behaviour imcompatible with the role of a physician (administering poison, seducing patients) to the requirement to respect the stated wishes of patients.
The BMA draft revision of the Hippocratic Oath
The rise of interest in the Hippocratic oath in the mid 1990s, was sufficiently prevalent among the members of the British Medical Association for its 1995 annual meeting to call for an updated version of the oath. The aim was to produce an oath that might be taken by all doctors on graduation. Not short of ambition, the BMA working party also planned to present this to the World Medical Association in 1998. If accepted, the BMA draft revision of the Hippocratic oath would them constitute an alternative to, or even a replacement of, the declaration of Geneva.
The BMA draft is more wordy than the ancient original and almost three times the length of the declaration of Geneva. Like the Robin oath, this expansion is largely concerned with matters of patient choice and the provision of adequate information for patients to make decisions. However, on the life and death issues of assisting suicide and procuring abortion, the BMA revision is hopelessly weak. There is no prohibition on giving poison, instead there is a highly ambiguous remark about the `special' value of human life:
`I recognise the special value of human life but I also know that the prolongation of human life is not the only aim of health care.'
The first part of this proposition falls far short of the `utmost respect' spoken of in the declaration of Geneva and indeed is reminiscent of the `special' respect that is allegedly extended to those human embryos who are consigned to lethal experimentation (22). The second half of this proposition is true and important, but if it is not balanced by a prohibition on killing, it seems by default to promote assisted suicide. A further sentence deals with the issue of withholding and withdrawal of treatment.
`I will not provide treatments which are pointless or harmful or which an informed and competent patient refuses.'
The first half of this proposition is ethically sound and reflects an important principle also enuciated by the Vatican declaration on euthanasia (23). However, the second half fails to acknowledge the possibility of suicidally motivated refusals (for example, in the case of someone who attempts suicide and leaves a note expressing the desire not to be resuscitated). Suicidal refusals embody a plan which is neither ethical nor lawful and thus does not demand acquiescence by the physician.
If the revised oath is weak in its treatment of euthanasia, its treatment of abortion is far worse. It states that:
'Where abortion is permitted, I agree that it should take place only within an ethical and legal framework.'
This fails to acknowledge that the permission of abortion is itself an ethical question, and one which the ancient Hippocratic oath spoke against with great clarity. The BMA revision seems to assume that abortion is ethically acceptable and excludes only those abortions that fall outside an unspecified `ethical and legal framework'. The appearance of reasonable compromise is unmasked if one substitutes `infanticide' for `abortion'. Who could then accept this formulation? - only someone who already accepted the general permissibility of infanticide. No one who maintains the utmost respect for the life of the unborn child from its beginning could with conscience swear the revised BMA oath (24). Rather than a consensus document, the BMA have thus produced a revision of the Hippocratic oath that would actually exclude those (Hippocratic) physicians who refuse to practice abortion!
Happily the World Medical Association showed no interest in this wordy, parochial and contentious document. What had such an oath possibly to recommend it over the hard won status of the declaration of Geneva? Furthermore, having been summarily dismissed by the WMA, the grand plans for the draft revision seem to have been quietly shelved. There is not one medical school that has adopted it; recent interest has turned to writing one's own oath (25) or to the declaration of Geneva (26).
The Value of life committee
A quite different restatement of the oath was produced in 1995 by an ad hoc group of physicians, theologians and philosophers in the United States (27). It was written with the intention of making stronger and more explicit the passages glossed over by Louis Lasagna and contradicted by the BMA draft revision. This version rejects not only assisting suicide but also euthanasia by omission. In an echo of the declaration of Geneva it pledges to maintain `the utmost respect for every human life' but rather than conception it refers to `fertilization', thus clarifying the meaning of the term contraception (which pro-abortion advocates have sometimes sought to identify with implantation). Furthermore it returns to the original approach of the oath in explicitly prohibiting abortion. Hence:
`I will neither prescribe nor administer a lethal dose of medicine to any patient even if asked nor counsel any such thing nor perform act or omission with direct intent deliberately to end a human life. I will maintain the utmost respect for every human life from fertilization to natural death and reject abortion that deliberately takes a unique human life.'
The Value of Life Committee (VLC) restatement of the oath is not intended as a consensus document which would be acceptable to all medical students, but as the expression of a reforming minority. There is some reason to think this was the approach of the original oath (28), and the VLC restatement is certainly closer to the original both in letter and in spirit than most other modern versions. Nevertheless, the committee did not altogether resist the desire to add new passages to the oath. Thus there is a commitment to `treat without exception all who seek my ministrations' and another passage is concerned with `valid informed consent' in the context of `research on human beings'. These are certainly worthwhile commitments, but this author at least would have preferred it if the VLC had confined itself to restating those elements that were explicit, or at least implied, in the ancient oath.
The enduring significance of the Hippocratic oath
This is by no means a comprehensive overview of modern attempts to revise the Hippocratic oath. For example, we have not considered various modern Christian version (29). Furthermore, there seems no end to the generation of new versions of the oath. For example, in the spring of 2005, Weill Cornell Medical College crafted a revised Hippocratic oath which was taken by medical graduates in June the same year (30). It follows the oath fairly closely, except that it contains no prohibition of assisting suicide or of causing abortion.
On the whole, it seems that the revival of interest in medical oaths, and in the Hippocratic oath in particular, is a positive thing. It helps give prominence to the fact that a commitment to respect life, and to refrain from assisting suicide and from abortion, has traditionally been a central element in ethical medicine. While several modern revisions seek to obscure this, they remain shadows of the original oath and, in formulating new versions, generations of doctors contine to return to the ancient and original oath.
Among the plethora of modem versions the declaration of Geneva is outstanding, especially in its original 1948 formulation. It remains the most popular and most effective modern restatement of the Hippocratic tradition. The Value of Life Committee has produced what is a promising restatement, but how useful this will be depends on how widely it is used; this is yet to be seen. It is only ten years since it was written. The story of the rapid rise and fall of the BMA draft revision of the Hippocratic oath contrasts with the enduring power of the ancient oath and of the declarationof Geneva, and the difficulty of emulating the success of these.
While the humiliation of the BMA draft revision is encouraging, it leaves no room for complacency. It is important that the 2005 editorial revision of the declaration of Geneva does not go unchallenged, and that the right to amend the declaration returns to the assembly which is, in general, a more reliable source of ethical insight (the amendments of 1983 notwithstanding). It may yet happen that some amendment is proposed to the declaration which vitiates it altogether as an expression of ethical medicine and makes it impossible for a conscientious Catholic to assent to it, but this has not happened yet, and it is important to strive to prevent this occurring. It would represent a great loss, for the declaration of Geneva constitutes an important resource for modern ethics to which Catholic physicians can still appeal.
Jones DA (2003) `The Hippocratic Oath: Its content and the limits of its adaptation' Catholic Medical Quarterly August.
World Medical Association (1997) press release 12 May.
Jones, WHS (1924) The Doctor's Oath. Cambridge UP:11-12.
Jones, WHS (1868) Hippocrates Collected Works Vol. 1, Cambridge MA: Harvard University Press (Precepts 6):236
Macer, D (1990) Shaping Genes: Ethics, Law and Science of Using New Genetic Technology in Medicine and Agriculture Eubios Ethics Insitute:49.
GMC (2004) Confidentiality: Protecting and Providing Information.
Gormally, L (1999) `Medicine as a profession and the meaning of health as its goal' in L Gormally (ed) Issues for a Catholic Bioethic London: Linacre Centre: 173-183.
Hunt, J (1997) `Abortion and the Nuremberg Prosecutors: A deeper Analysis' Life and Learning VII, Proceedings of the Seventh University Faculty for Life Conference: 1999-2009
See, for example Congregation For The Doctrine Of The Faith (1986) Letter to the Bishops of the Catholic Church on The Pastoral Care of Homosexual Persons.
A Schedule Of Function And Operating Policies As Last Revised By The World Medical Association Council And General Assembly, Tokyo 2004.
`The World Medical Association Declaration of Geneva' (2005) World Medical Journal Vol 51 No. 2:31.
Lasagna, L (1995) `Modem Hippocratic Oath' Medical Economics June 11, 1995: 197-202.
Robin, ED (1994) `The Hippocratic Oath updated' BMJ 1994; 309:96.
Finfer, S, Theaker, N. Raper, R, Fisher, M (1994) `The Hippocratic Oath Updated' BMJ 1994; 309:953.
Hart, D (1997) `I swear by the music' Observer 1997 July 6.
Philipp, R, Hart, D (1998) `Hippocratic Oath translated into poetry' BMJ 1998; 316:1460.
Sritharan, K, Russell, G, Fritz, Z, Wong, D, Rollin, M, Dunning, J, Morgan, P, Sheenan, C (2001) `Medical oaths and declarations' BMJ 2001; 323:1440.
Louden I (1994) `The Hippocratic oath' BMJ 1994; 319:414
Louden I (1994) `The Hippocratic oath' BMJ 1994; 309:952
Crawshaw, R (1994) `The Hippocratic oath' BMJ 1994; 309:952
On, R (1998) `The Hippocratic Oath: Is it still relevant? Center for Bioethics Update March 14.1.
For example, Department of Health (2005) Government Response to the Report from the House of Commons Science and Technology Committee: Human Reproductive Technologies and the Law: recommendation 4.
Sacred Congregation for the Doctrine of the Faith. 1980. `Jura et Bona' (Declaration on Euthanasia) in Flannery, A (ed) Vatican II Volume 11: More Postconciliar Documents. Northport, New York: Costello Publishing: 510-18.
For example, editorial (1998) Catholic Medical Quarterly May 1998:3.
At Imperial in 2001, see Sritharan et al. (2001) `Medical oaths and declarations' BMJ 2001; 323:1440.
At Norwich (planned for 2007) see Andrew Moscrop (2003) `Is it time to end taking oaths?' student BMJ 2003;11:131-174.
Stanton, J. Angelo, E, Rea-Luthin, M (1996) `Swearing to Life' First Things 59, January 1996:9-15.
Cameron, N (1991) The New Medicine: The Crisis in Medicine and the Hippocratic Oath London: Hodder andSoughton.
Feuchet, KA, Calhoun, B (1997) `The Hippocratic and Other Oaths: Past and Present Proposal for an Oath for Christians' Journal of Biblical Ethics in Medicine Vol. 10 No. 2:16-31; see also Linda Loma University `Physicians' Oath' <http://www.llu.edu>; Christian Medical and Dental Associations (1991) `Christian Physicians' Oath' CMDA 1991, amended 2005 <www.cmdahome.org>
Cornell University News Service, 22 June 2005 <www.news.cornell.edu/stories/June05/Hippocratic_Oath.mh.html>
Dr. D A Jones is senior lecturer in Bioethics at St. Mary's College, Strawberry Hill