by Jane M. Orient, M.D.
Everybody seems to think that doctors swear to the Oath of Hippocrates, and follow a long ethical tradition dating back to the 5th century before Christ.
Not anymore. The new doctors seem to be making it up as they go along. The tradition is not being set by a white beard who sat at many a patient’s bedside, taught a generation or more of disciples, earned the respect of his contemporary colleagues, and wrote a corpus of observations and reflections still esteemed millennia after his death.
For example, the oath taken by the first graduating class of the Phoenix branch of the University of Arizona College of Medicine was written by the students themselves. They were charged with the task as they entered, and had all of 4 years to think about it.
The graduates don’t use the word “swear.” That’s a verb that implies an object (to whom?), and a concept that assumes the existence of a higher authority, such as the Greek gods to whom the original Oath is addressed, or the Creator referred to in the Bible. The new graduates “promise” or “pledge”—perhaps to themselves.
The graduates “appreciate,” are “grateful and humbled,” and they “aspire” and “strive.” They “commit to lives of practice and learning, to living artfully and with passion.” Among the hopes: “Let us always remember the excitement and awe that we feel at this moment.”
But passing from feelings to action, the actual promises—of things “we will” do— are few. First, “we will respect and honor all who are involved in the healing arts.” Those who taught them the art are evidently no more worthy than anybody else who is somehow “involved” in one of the allied professions. Standing on the shoulders of those who came before, “we will support those who follow.” As to dedication, “we will balance our commitment to medicine and our relationships with loved ones.” Finally, “we will stay true to our profession, our values, our morality and our personal ethics.”
Patients, in other words, do not come first: their needs must be balanced against other priorities. This is perhaps a natural consequence of restrictions on working hours. These days, there is no time to dawdle over teaching points; the law requires the young physicians to leave after a certain number of hours, and to “hand off” the patients, however desperately ill, to the incoming shift workers .
The values, the morality, and the ethics are “ours.” There is apparently no universal law, just as there is no higher Lawgiver. Gone are the “thou shalt nots” of the Oath of Hippocrates: abortion, euthanasia, seduction of patients or anyone in their household, and the violation of confidences. Even the injunction to “never do harm to anyone” has vanished, along with the positive injunction to “prescribe regimen for the good of my patients according to my ability and my judgment.” Being true to the profession, after all, might mean subordinating my judgment and my patients to the goals of the accountable care organization, as well as reporting on anything the payers might want to know.
In the Oath of Hippocrates, it is presumed that physicians will be tending the sick, trying to cure disease and postpone death. The new physicians might instead be “enhancing well being” and “serving” as “positive role models to others in our community, inspiring them to live healthy lives.” But while they’re working to create a utopia where disease is all prevented, who will see those who still suffer pain and illness?
Medicine is truly undergoing a revolution, an overturning of traditional ethics, starting in the earliest days of medical school. The institutions are now being run by the 60s generation, who chanted “Western civ has got to go.”
That generation cheered as the Beatles sang: “Roll over Beethoven, and tell Tschaikowsky the news.”
When the classical foundations are torn down, what will replace them? We’ve gone from Beethoven, to the Beatles, to gangster rap. Patients need to ask: after Hippocrates, what?
Jane M. Orient, M.D., On Air contributor speaking on Healthcare Reform. Dr. Orient has appeared on some of the largest TV and Radio Networks in the country and her op-eds have been printed in hundreds of local and national newspapers, magazines, internet, followed on major blogs and covered in the Wall Street Journal and The New York Times.
Doctor Orient is the Executive Director of Association of American Physicians and Surgeons and has been in solo practice of general internal medicine since 1981. She is a clinical lecturer in medicine at the University of Arizona College of Medicine. She received her undergraduate degrees in chemistry and mathematics from the University of Arizona, and her M.D. from Columbia University College of Physicians and Surgeons. She is the author of Sapira’s Art and Science of Bedside Diagnosis; the fourth edition has just been published by Lippincott, Williams & Wilkins. She also authored YOUR Doctor Is Not In: Healthy Skepticism about National Health Care, published by Crown. She is the executive director of the Association of American Physicians and Surgeons, a voice for patients’ and physicians’ independence since 1943.
