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A Historical Approach to the Hippocratic Oath
Li-Chuan Kuo
PhD student, Department of History,
National Cheng Kung University, Tainan, Taiwan
2007/03/19
Father of Western Medicine — Hippocrates
A historian of medical history,
Otto L. Bettman, regards the Oath
in the Hippocratic Corpus can be
seen as “pioneering modern
medical ethics with a universal and
humanitarian appeal beyond any
cultural differences. ”
It is probably because of his
famous Oath, Hippocrates has been
praised as a paragon of physicians
and called the “Father of Medicine”.
Engraving of Hippocrates by Peter Paul
Rubens, 1638
Is this Oath timeless values ?
However, do specific
medical ethics exist
timeless?
What are the ethical
implications of the
Hippocratic Oath to the
contemporaries?
What the Oath says about medical context ?
 It is said that the root of modern medical ethics can be traced back to
Hippocrates, as if the values of the Oath is timeless and humanistic.
 However, the Oath, if based on Ludwig Edelstein’s influential
hypothesis, is imbued with Pythagorean doctrines.
 In my opinion, the first interpretation may ignore the fact that
ancient physicians were restricted to specific historical context
and medical environment.
On the other hand, Edelstein’s attempt to return the Oath to a
possible historical context is praiseworthy but gives an
excessive emphasis on its ideological element. This becomes a
matter of hit or miss.
A historical approach
A historical approach would
take ancient Graeco-Roman
medical art and popular
ethics into account, which
contributed to the creation
of this document.
I hope we could find a
reading different from the
prevailing ones we are used
to.
A twelfth-century Byzantine
manuscript of the Oath in the form
of a cross.
An ancient physician is a craftsman
In ancient medical
profession there was no
consensus on medical
principles and treatments,
no medical organization
that offered systematic
training and no officially
recognized tests that
licensed one to practice.
Heteroglossia – “the other voices” in ancient
medical market
Doctors had to complete for clients
with other kinds of healers, such as
root-cutters (or herbalists),
midwives, trainers in the
gymnasium, cult-priests, sellers of
amulets and so on.
The Hippocratic doctors were only
one kind of them and were not
necessarily privileged in this
business.
Ancient doctor as a craftsman of medical art
(Technê)
Though Plato and Aristotle paid a high tribute
to Hippocrates as a practitioner of medicine,
they thought it lacked a firm epistemological
basis.
What this criticism implies is that medicine is a
matter of apprenticeship and personal
experience as well as tips from good
handbooks
Reputation is the key to the Medical Profession
A doctor in the medical market had to rely largely on his
reputation (doxa) to attract potential clients and he
always looked beyond his customers’ shoulders for more
potential customers with all kinds of mechanism that
facilitate this purpose.
Reputation is the key to the Medical Profession
That is why Greek doctors
paid a great attention to
their personal appearance,
way of speaking, social
decorum and skill in
rhetoric and so on.
Rarely has it been
mentioned that a better
grasp of medical
knowledge should be aimed
at.
Oath as an admission oath of the medical guild
Because doctors were trained as
apprentices and seen as
craftsmen, they were often found
to be members of the religious
cult association called
“Asclepiadai,” children of Greek
healing god Asclepius. The Oath
can therefore be seen as an
admission oath that regulated the
practices of its members.
Oath as an admission oath of the medical guild
This Oath and its related
sacrifices, celebrations,
processions and social
gatherings would provide
a way of identification
for its members and gives
them a social distinction
and solidarity in the
competition with other
healers.
The Oath was embedded in contemporary Society
The practice and morality in the Oath therefore could
not be separated from the social morality at that time.
For example:
 I will remain free of all mischief of sexual relationship
with both women, men and slaves.
 I will not speak about anything that I see or hear whether in the course of the
treatment or not.
These moral are general regulations that governed the
segregation between different sexes as well as social
interactions between citizen-peers, their relatives and
possessions in the ancient Greek society at large.
The physician, an unpunished killer?
“Doctors learn by exposing us to risks,
and conduct experiments at the
expense of our lives. Only a doctor can
kill a man with impunity. ”
(Pliny the Elder, Natural History)
Pliny the Elder on Mandragora
This statement comes from a cynic
Roman senator who suspected anything
Greek.
But it seems that the Oath is very
gingerly about life and so it warns
against the use of abortive medicine and
the use of surgery and cauterization.
Respect for Life Or Risk-Reward ?
 I will neither give a deadly drug to anybody if asked
for it, nor will I make a suggestion to this effect.
 I will not give to a woman an abortive remedy.
 I will not use the knife, not even on sufferers from stone, but will
withdraw in favor of such men as are engaged in this work.
The Oath warns against amputation and abortion because
these practices could cost the patients' life and ruin the
reputation of doctors.
It looks that this recommendation is a kind of professional
safeguard rather than any expression of humanitarianism.
The Oath has an apologetic undertone
The quotation of Pliny the
Elder seems to indicate that
the general public in Greek
and Roman societies
entertained a prejudice
against medical
practitioners and this put
the “medical craftsmen” on
the defense.
Evidence from the rest of the Hippocratic Corpus
The Hippocratic Corpus has very precious
few works like On Fractures, a practical
discussion on how to set bones. Nor is there
much about the effect of treatment on
patients in the corpus.
Few of the theories are put
into practice. It looks there
is a great discrepancy
between theory and
practice.
Evidence from the rest of the Hippocratic Corpus
Surgery was avoided in the Oath:
 It ran the great risk of failure and cost life as a result.
 A medical failure that brought ruin to medical
reputation and a religious pollution, an anathema and
impiety to the healing god.
 This explains why ancient medical writers were so
“rational” and discursive in their writings and used
the most conservative methods in healing such as diet,
bathing and so on.
A Tentative Conclusion
All the regulations in the Hippocratic
Oath, first of all, might be based on
the social morality that prevailed in
ancient classical world. It is also a
kind of apology in answer to possible
criticisms.
The Oath provides a set of regulations
that define the nature and scope of
their profession, with a strong stress
on the mechanism.
The Hippocratic Oath safeguards the
reputation of its members that would
guarantee a competitive edge in the
medical market.
All of these can be understood in a
more realistic spirit. The ascription of
the humanitarianism to the Oath seems
more a projection of modern concern
rather than a historical truth - at least as
far as the Oath is concerned.
Thank you!
When the Hippocratic Oath is
understood as a historical text,
which was based on the GraecoRoman popular morality. Thus it
might not be a norm for modern
medicine.
I think it is up to us to ask whether
standardized ethics do we need for
Bioethics?
The Hippocratic tree

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