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SICOT e-Newsletter

Issue No. 56 - May 2013

History of Orthopaedics

Hippocratic Oath…  A pledge, The journey, Our destiny (Part 2)

Hitendra K. Doshi
SICOT National Delegate of Singapore

(To read part one, please click here.)

One may then seek to know the method of developing the ability to discriminate. The teacher in the oath also gives a solution as the oath advises not to please anyone at the expense of the life of a patient. Hence, it is cautioning the doctor to be mindful that any treatment offered should be for the best interest of the patient without any tinge of self gratification. This is a quality of ‘selflessness’ that we have pledged and with such a virtue, the mind is sanctified. Such purity of thought results in positive discrimination. This is the ‘purity of life’ and ‘art’ that Hippocrates relates to in the oath. More interestingly, it teaches us that such noble values are inherent in man and, hence, Hippocrates correctly uses the word ‘preserve’ with regards to the purity that already exists in every human being including doctors. If a well is polluted with muddy water, the bottom of the well cannot be seen. However, as the mud is cleared, the bottom of the well becomes more visible. This analogy should stimulate the mind of a man to realize the fundamental truth of his own purity that is ever existent. A doctor has to be free from negative imaginings, inferences, emotions and egoistic desires. Having sharpened our intellect in understanding the purity of life and art, Hippocrates goes on to teach us the methodology of keeping impurities at bay.

The spirit of ‘contentment’ and ‘sacrifice’ is unveiled in the following lines that read: “I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art”. If a patient is not diseased and treatment is administered, it is deemed unethical. However, the inference from the oath is that if a patient is diseased, even an appropriate treatment which is justified medically can be unethical too if other more economical treatments are not considered first. This is yet another challenge to the practice of ‘value based medicine’. Hippocrates wisely reminds us that appropriate treatment administered becomes unjust if monetary gain is the ultimate desire. A doctor may give primary importance on the monetary profits and less importance on the procedure of choice for the well being of the patient. However, the oath obliges the doctor to regard earnings as a secondary gain resulting from the work done primarily for the well being of the patient. Therefore, a doctor should treat with the spirit of placing the welfare of the patient on the highest pedestal above one’s own desires. Though money is important, the oath teaches us to exercise discretion when deciding on the treatment and charging a fee. A correct fee may be charged to the wealthy, but a doctor should be kind and considerate to the poor. It should become second nature for a doctor to sacrifice power, position, name, fame, time and money for the welfare of the patient. With such a spirit of satisfaction, contentment and sacrifice, there will be no competition with another doctor in earning huge sums and acquiring more and more possessions. That is the spiritual message of Hippocrates as he guides in the second line of this pledge, to have no hesitation to refer a patient to another doctor who will be of best interest for the well-being of the patient. Nevertheless, the attitude of competition which has its benefits should be constructive in nature and should enable a doctor to realize the nobility of the profession. To be able to discriminate promptly and effectively, the teacher in the oath reveals yet another method.

The value of detachment from the senses and external attractions is expressed in the following part of the oath that reads: “In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.” The vulnerability of man in adhering to the righteous path is eminent as he is exposed to external influences through the senses. As a doctor, such vulnerability can cause ill effects to the patient and the doctor himself. Therefore it is repeatedly emphasized that the intention of the doctor when faced with a patient should be pure in ensuring the well-being of the patient without any personal interest. That should be the sole desire of practice by a doctor. Instead, if a doctor lives a life solely to fulfill his material and sensual desires, then medical practice will be in accordance to the attachments to such temptations. Particular emphasis is given by Hippocrates to be uninvolved with pleasurable emotional bondage when treating a patient. This is to illustrate the vulnerability of emotions. An emotion is indeed a natural instinct of man and it is inherently present in its pure form. However, when emotions are allowed to run unabated, it can be detrimental and result in immoral attachments. Therefore, for a doctor to be able to perform a duty solely for the well being of the patient there should be no room to entertain any personal desires and emotions. It is only with such awareness that a doctor can conduct himself intentionally with professionalism and nobility.

“All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal”, is the final pledge taken before the concluding statement. Having reassured oneself of the dignity and virtues of a doctor, the conscience will be clear that the relationship of the doctor which is established with a patient through the profession is ‘pure’ and ‘trustworthy’. As a doctor, all personal information of the patient is retrievable from the history taken as it is a requirement to be able to diagnose and treat appropriately. That is the trust and faith the patient has on a doctor and hence the doctor must also be true to himself that the information obtained will be utilized solely to restore the well being of the patient and not shared if there is no justified need. The oath here also reveals the value of being ‘respectful’ and ‘truthful’. A doctor must respect the dignity of the patient. It is only by the virtue of being respectful and truthful to the patient that a doctor can receive respect and truthfulness from the patient in return. Therefore, it cannot be overemphasized that the oath here demonstrates the latent values of trust, faith, respect and truth which are the guiding walls in the path of a life of a doctor. Having taken an oath which spells out loud and clear the inherent human values, a doctor is indirectly compelling himself to take the path of nobility. Every word and every line of the oath has a message of deeper significance which should guide a doctor in his practice. If the oath is uttered without reflection on the directives given, a doctor will remain oblivious and hence choose a different path which could lead him astray from his destiny. Therefore, the journey of a doctor is practicing the essence of the ‘Hippocratic Oath’. It promotes the philosophy of ‘value based medicine’ which all doctors should live by in order to realize that doctors are destined to be noble.

However, for the minds which doubt and question as to why such virtues leading to nobility need to be practiced by a doctor, Hippocrates gives a divine answer with affirmation in last breath of the oath which reads: “If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot”. This concluding statement of the oath reassures a doctor, that he will enjoy his life in spite of all sacrifices made. It promises the doctor that happiness and delight will be the grace in return, if virtues of the oath are held faithfully. The sacredness of the oath taken ensures respect from all in the present time and for generations to come. The oath indirectly awakens us to realize the very fact that when the hour of judgments is upon us, we won’t be able to carry with us the wealth we have amassed. Instead, the sacrifice and devotion of a doctor will remain for generations and will be the invisible garland that tells his tale. The oath further affirms that, if a doctor violates human values and deviates from righteousness, he will never be happy as sadness, grief and disrespect will be the punishment he will have to endure in exchange. Hippocrates makes a salient point that man ultimately wants happiness and this can be achieved and experienced only when the flag of human values are kept flying high. Though the journey of medical practice may be fraught with challenges, we should walk the terrain with steadfastness and not give in to momentary delusions of enjoyment at the expense of human values. Instead, Hippocrates guides us to yearn for eternal joy.

In conclusion, the ‘Hippocrates Oath’ is indeed a pledge, guiding us on our journey to reach our destiny. It is indeed an inward ‘awakening’ when we realize the principle of ‘simple living’ and ‘high thinking’, Hippocrates himself had adopted in his life all those years ago and then later out of pure generosity penned it down for the rest of us in the form of an oath. The oath must become a ‘mantra’ in the conscious mind, to enable its significance to echo constantly in the subconscious mind. We should not be hypocrites and instead be ‘Hippocrates’ in thought, word and deed directly manifesting the divine directions of the oath.