clause so that a doctor could not permit considerations of race, sexual orientation, or social standing (among many other factors) to affect the quality of care and their duty to treat.9 This was especially monumental considering the Hippocratic oath’s inclusion in the social context of slavery in ancient Greece. An unwritten tradition in ancient Greece for oath violations would demand no punishment if a dying patient was the slave as opposed to heavy punishments if the patient was “of noble birth.”
Flickr The recital of the Hippocratic Oath is a long-cherished tradition for medical students to this day.
for surgery. As a part of the “do no harm” idea, the Hippocratic oath includes a vow to “not cut, even for [gall] stones.”4 However, the Hippocratic oath does include a clause saying to leave the cutting to the practitioners with a specialty in carrying out such procedures. Another work in the Hippocratic corpus, On the Nature of Child, explains how to conduct one such procedure as well as other concoctions for supposedly terminating a pregnancy. Modern and past critics argue about the exact interpretation: the oath could be advocating for a general ban on abortion or a specific ban on the use of a pessaries in abortion. Still, the oath does again seem to simplify a major debate as a corollary of non-maleficence. That’s not to say that excluding any verse about abortion or euthanasia would be the most beneficial option. Their inclusion in the Hippocratic oath merits discussion and acknowledgement of how these issues apply to modern medicine. However, the Hippocratic oath in its historic version is certainly not the most ideal option for recital. Interestingly enough, the Hippocratic oath did indeed disappear from medical school ceremonies globally for centuries.7 Aside from its use in medical history, the Hippocratic corpus offered explanations such as the humoral theory (the body being composed of four humoral fluids including
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blood and phlegm) that would be declared as pseudoscience in modern times. A greater public consciousness of medical ethics did however resurge after World War II. As the Nuremberg trials witnessed some of the first-ever institutions of international law in dealing with the former Axis powers, one of the most notorious trials included the trial of Nazi doctors stationed at concentration camps. These doctors, including the notorious Josef Mengele, obviously dismissed any idea of patient consent and ruthlessly carried out medical experiments on prisoners and even sickly civilians in the name of eugenics. Nazi eugenics perverted any semblance of “medicine” involved and even called the initiative the “Euthanasia Program” to mask its true purpose.8 The Japanese were also found to have experimented on Chinese captives. The Japanese Imperial Research program sought to develop weapons of biological warfare with agents like cholera and plague with over 200,000 Chinese killed in the process.1 The Japanese even conducted “practice surgeries” on live Chinese prisoners without anesthesia. These atrocities prompted the formation of a World Medical Association (WMA) in Geneva and declarations for the creation of an international physician’s oath. The major addition in the 1948 Geneva WMA Physician’s Oath included a non-discriminatory
Euthanasia strikes at the very ethical core of a physician’s devotion to doing no harm and perseverance in undertaking a medical career, so an oath including an oversimplification of the issue does not seem to be applicable.
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All these advances are not to say that the world magically inherited a universally-abided code of medical ethics. Even with the guise of increased ethical deliberation in medicine, the U.S. actually granted immunity from prosecution to the Japanese experimenters for their data on biological warfare. Aside from that, the Nuremberg trials really only focused on the vices of the Axis side with minimal accountability for war crimes committed by the Allied forces. The atomic bombs most certainly had a devastating effect on the communal health of Hiroshima and Nagasaki for generations afterwards due to the radiation exposure. It’s also noteworthy to consider the medical advances made due to the increased resources allocated to research beneficial for warfare. The discovery and mass production of penicillin was vital to World War II efforts. It may seem antithetical to some that medicine is most advanced in war where “doing harm” abounds. We cannot oversimplify the matter and conclude that wartime medical research is unethical. However, an increased focus on using medical research to gain advantages in combat can facilitate immoral acts, as has been witnessed in the past. World War II highlighted a peak for medical immorality, which justifiably coincided with an overall global trust in medicine, especially for the American public. The trend of specialization in medicine in the 50s also created an increased belief that medicine became a commercial profession.7 Patients believed that they were being thrown from one doctor to the next, without personalized care. Medicine seemed to become synonymous with taking advantage of a patient instead of the selfless care alluded to all those centuries ago in the Hippocratic oath. In response to this public distrust, the recitation of the Hippocratic oath resurfaced in American medical communities in the 1960s. Dr. Louis Lasagna created a revision of the Hippocratic oath to emphasize the compassion of the patient. The “Lasagna oath” addresses the issues of abortion and euthanasia by promising to treat such issues with “humility.” The Lasagna
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