A

s they don their white coats for the first time, a new crop of medical students nationwide is taking an oath — but it may not be the one you think.

The Hippocratic oath has been out of fashion for a while. It doesn’t actually say, “do no harm,” but it does pledge allegiance to mythical goddesses, among other things. In its place are modernized oaths, which combine the idea of “do no harm” with vows to remember both the human beings on the other end of the stethoscope and their social and financial well-being when treating them.

“We see health as a much broader context than just the physical symptoms and diagnoses,” said Steve Smith, associate dean for student affairs at Dell Medical School at the University of Texas at Austin, one of three new medical schools opened in the US this summer.

advertisement

Dell let its inaugural class select and revise their own oath earlier this month. The students decided to modify parts of a more humanistic oath written in 1964 by Dr. Louis Lasagna, a former dean at Tufts University School of Medicine.

“I will remember that I do not treat a fever chart, or a cancerous growth, but a sick human being,” the students vowed at their symbolic white coat ceremony. In these ceremonies, now common nationwide, students accept white coats, recite oaths, and commit to practice ethically as they begin their medical education.

Oath-taking has become nearly universal at US medical schools, and while oaths of all stripes are often called “Hippocratic,” hardly any schools use the original oath that Hippocrates, the Greek “father of medicine,” is said to have written over 2,000 years ago.

That oath has several problems, said Smith. For starters, he pointed to the Greek gods: “I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses,” the oath begins. The original oath also asks doctors never to “give a woman a pessary to procure abortion,” and to abstain from euthanasia (“I will neither give a deadly drug to anybody who asked for it”).

Lasagna’s oath is the most popular one used by medical schools: 33 percent use it, according to a 2009 survey of 135 US and Canadian medical schools. Just 11 percent of the schools use the classical Hippocratic version, researchers found.

“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,” Lasagna’s oath reads in part. Lasagna’s version also calls on doctors to admit when they don’t know the answer; prevent diseases; and to take responsibility not just for the patient’s health, but for the way an illness affects a person’s “family and economic stability.”

How would you change the Hippocratic oath?

  • What oath would you take if you were a doctor-in-training? How would you fill in the blank?

Other values influence a school’s oath. Dr. Robert Orr, a professor at Loma Linda, a Seventh-Day Adventist university outside of Los Angeles, surveyed medical schools in the US and Canada in 1993 about this practice. While oath-taking had become widespread, he and coauthors concluded the content of the Hippocratic oath had been watered down over the years. He joined a panel that rewrote the oath in 1995 at Loma Linda’s medical school, which had been using a secular version.

The school’s new oath doesn’t swear off abortion or euthanasia, as Hippocrates’s version did. But it brings back one thing Orr noted had gone missing — a pledge to God.

“This is not a code of ethics for providers,” Orr told students in a 2012 ceremony before they took the new oath, “but a professional oath sworn to God almighty.”

New York Medical College, Tulane, and the University of California, San Francisco, all have students vow not to discriminate against patients based on gender, race, religion, or sexual orientation.

Most schools stick with one of three main versions of the oath, often for the sake of tradition — Hippocrates’s, Lasagna’s, and the Declaration of Geneva, said Dr. B. Alex Foster, the coauthor of the oath survey and an assistant professor at UT Health Science Center in San Antonio.

But some medical school classes have revised their oaths to reflect their personal values.

Medical students at Creighton University, a Jesuit university in Omaha, Neb., revised their school’s oath last year to keep up with modern times, adding a pledge not to discriminate against patients based on sexual orientation, according to spokeswoman Cindy Workman.

At Harvard Medical School, each class of students now writes its own oaths, one at the white coat ceremony and another at graduation, when they take the oath as a newly minted doctor.

The latest version that incoming students at Harvard recited in August reads in parts like a fiery sermon. It calls on doctors-in-training to “wake up to the realities of the world” and “rise up.”

“We promise to bear witness to historical injustices that continue to unfold for marginalized communities,” the oath reads, in part. “… We must have the courage to act when we witness injustice.”

Leave a Comment

Please enter your name.
Please enter a comment.

  • Unfortunately I have never had an exactly “high” opinion of our “Medical Philosophers”
    Even more unfortunate that this negative view is constantly reinforced.
    Euthanasia is so enlightening and loving.
    Good to see that our Butchers in white are no longer bound any longer by such outdated archaic principles like “Do no harm”

  • Just to counter the baleful influence of identity politics that has infected every facet of academic life these days, why don’t we include “I pledge to uphold the principles of the Declaration of Independence and the United States Constitution”?

    • If they take it or change it. Dose it really matter. When someone that dosen’t know anything about medicine or the humen body. Like the DEA tell Dr’s how to treat they parent’s and the Dr’s do what the DEA wants. When they should say. You should have know way of knowing how i treat my parents. You are looking into so were you shouldn’t and what you are doingvis against the law so please leave. But then again it is the House that is telling the DEA to do this to our Dr’s. So on this oath thing. It dose not matter anymore. Dr’s will no long fight to help their parents

  • This article presents an oath against performing euthanasia as a “problem.” This is extremely disturbing since euthanasia is illegal in most of the US and doctors have for millenia been agents of defending life, not harbingers of death. Let’s hope we keep it that way. Physicians need to continue to keep a unified ethical code, not personalized feel-good substance-less “oath.”

  • So if some progressive student writes his oath to state he/she will not provide extensive medical treatment to anyone over a certain age will he/she still be allowed to practice medicine? What you are professing is ridiculous and dangerous and I believe it is being done for the purpose of creating doctors who will have no problem with death panels in the future. Sorry. The old stand-by oaths worked for decades and they need to stand as they are. Allowing medical students to make up their own stinks of a hidden agenda.

  • We took the Oath of Maimonides in 1977. Not originally gender neutral, but an enduring oath still with significance and merit.

    The eternal providence has appointed me to watch over the life and health of Thy creatures. May the love for my art actuate me at all time; may neither avarice nor miserliness, nor thirst for glory or for a great reputation engage my mind; for the enemies of truth and philanthropy could easily deceive me and make me forgetful of my lofty aim of doing good to Thy children.

    May I never see in the patient anything but a fellow creature in pain.

    Grant me the strength, time and opportunity always to correct what I have acquired, always to extend its domain; for knowledge is immense and the spirit of man can extend indefinitely to enrich itself daily with new requirements. Today he can discover his errors of yesterday and tomorrow he can obtain a new light on what he thinks himself sure of today.

    Oh, God, Thou has appointed me to watch over the life and death of Thy creatures; here am I ready for my vocation and now I turn unto my calling.

    • Thanks for sharing this oath. This is definitely better than any of the Hippocratic versions that I have seen. And I had Dr. Lasagna as a professor at Tufts — he was awesome, but the Hippocratic Oath is terminally out of date.

  • I drafted a modern rewrite of the HO while I was at Yale. It is far better than Lasagna’s or any of the other bowdlerized versions I have seen. I had a friend make it into a work of calligraphic art and it hangs on my wall now. I should probably publish it.

  • The problem with changing the vows is that this is not like a marriage where two people are making vows to one another. The purpose of the Hippocratic oath is that it is a vow that is basically made “with society” toward an expectation of non-biased healthcare. If doctor’s vows vary, then a standard is lost. If their vows vary, they should then post them for people to read. Perhaps we should know better what the Hippocratic oath says: I don’t.

  • “Vows to remember both the human beings on the other end of the stethoscope and their social and financial well-being when treating them…”

    This could translate to different quality of care and choices of care depending upon a person’s financial status. Really? That could mean a great many things, many of which are negative, not positive.

  • Keep in mind that there is no requirement to say an oath or even attend the graduation ceremony. It’s nice if time permits, but duty often calls at inopportune times.

  • ““I will remember that I do not treat a fever chart, or a cancerous growth, but a sick human being,” …

    Probably a good idea to treat humans who aren’t sick as well, since preventive action is a pretty important concept.

Sign up for our Morning Rounds newsletter

Your daily dose of news in health and medicine.

X