European Stars and Stripes (Newspaper) - May 29, 1990, Darmstadt, Hesse                                Ancient oat for doctors endures by Lawrence k. Altman new York times s America s newest physicians receive their degrees Many will swear to the hippocratic oath one of the most enduring documents in history. The oath is attributed to Hippocrates a greek physician in the 5th Century b.c., but no one is certain about its origins and use Over the last 25 centuries. Even today not every medical graduate swears to Hippocrates standards of professional behaviour and the wording of the oath May change from year to year even in the same medical school. Doctors probably did not begin swearing to the hippocratic oath until about 1100. But it is As hard to find a carefully researched history of the oath As it is to find out its current use said or. Albert r. Jonsen who Heads the department of medical history and ethics at the University of Washington in Seattle. There is a lot of mythology about the oath he said. Contrary to widespread impression doctors Are not required to take any oath. Another Surprise is that the hippocratic oath is Seldom studied in medical school even at a time of heightened interest in medical ethics. For Many doctors the graduation ceremony is the first and Only encounter with the hippocratic oath. This single encounter leaves Little lasting impression about its Content among Many physicians according to a Small Survey reported in a recent Issue of academic Medicine published by the association of american medical colleges. The indifference reflects a feeling among Many medical leaders that the oath is inadequate for the enormous scientific economic political and social changes that Medicine has undergone since ancient greeks swore to Pagan gods and goddesses and relied on garlic poultices and other treatments Long discarded. Because ancient physicians could do so Little for patients they did not share the modern physician s problem of differentiating Between what can be done and what ought to be done. Yet Many others yearn for traditional values and say that the hippocratic oath and other ancient codes i swear by Apollo m m Mac Ink Al Archt by t deserve greater emphasis in medical education. Times May have changed but principles should not they say in pointing out that medical leaders Are criticizing their own colleagues for greed fraud cheating and even stealing the books for courses on medical ethics. The oath covers obligations to professional colleagues and patients. Much of it seems sensible like proscribing sex with patients and breaches of confidentiality. But a literal interpretation would also eliminate tuition for students that now can reach $24,300 a year. Many of the oath s principles or moral rules like prohibiting abortions have been modified by Laws judicial decisions professional customs and medical advances. Physicians now Are supposed to report cases of certain communicable diseases to health departments and in some areas must inform sexual partners that a patient is infected with the aids virus. Confidentiality is further eroded by demands from the government and private health insurance carriers. The original version would leave surgery to a once separate Guild now surgeons Are an integral part of the medical profession. And the oath forbids euthanasia something some physicians practice openly and Many More practice in secret. Other Points in the oath conflicts with trends that have developed Over recent years. Paternalism for example is Central to the oath doctors who swear to it Promise Healing according to their judgment and skills but the oath ignores the wishes of the patient. The oath also Fosters professional secrecy today a prevailing belief is that medical knowledge belongs to the Community scholars Are sceptical that Universal adherence to the oath Ever existed. That doctors performed abortions and had sexual relations with patients in ancient Greece is obvious from the proscriptions in the oath. Recent surveys have found that about 5 percent of physicians have admitted to sexual Intercourse with their patients Many graduating classes write their own oaths others use an oath written in 1964 by or. Louis lasagna now a Dean at Tufts University medical school in Boston which oaths Are used at which schools is not known the latest published Survey was conducted in 1977 among 112 medical schools in the United states and 16 in Canda by Walter j. Friedlander of the University of Nebraska College of Medicine. An oath was administered in 94 percent of the . Medical schools and 63 percent of the Canadian institutions. In the United states 6 percent of the schools offered the classic hippocratic oath and 42 percent a modified version. The declaration of Geneva a modernized version of the oath that was written by the world medical association in 1948, was administered in 28 percent of medical schools. Ten percent offered the prayer of Maimonides. An ethical guide to Medicine attributed to the 12th Century rabbi physician and philosopher classical hippocratic oath i swear by Apollo the physician. That according to my ability and judgment i will keep this oath and stipulation to reckon him who taught me this Art equally dear to me As my parents to share my substance with him and relieve his necessities if required to regard his offspring As on the same footing with my own Brothers and to teach them this Art if they should wish to learn it without fee or stipulation and that by Precept lecture and every other Mode of instructions. I will follow that method of treatment which according to my ability and judgment i consider for the Benefit of my patients and abstain from whatever is deleterious and mischievous. I will give no deadly Medicine to anyone if asked nor suggest any such counsel furthermore i will not give to a woman an instrument to produce an abortion. With purity and holiness i will pass my life and practice my Art. I will not Cut a person who is suffering with a Stone but will leave this to be done by practitioners of this work. Into whatever houses i enter i will go unto them for the Benefit of the sick and will abstain from every voluntary act of mischief and corruption and further from the seduction of females or males Bond or free. Whatever in connection with my professional practice or not in connection with it i May see or hear in the lives of men which ought not be spoken abroad i will not divulge oath for new doctors written by or. Louis lasagna in 1964 i swear to fulfil to the Best of my ability and judgement this covenant i will respect the hard won scientific gains of those physicians in whose Steps i walk and gladly share such knowledge As is mine with those who Are to follow. I will apply for the Benefit of the sick All measures which Are required avoiding those twin traps of Over treatment and therapeutic nihilism. 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. I will not be ashamed to say i know not nor will i fail to Call in my colleagues when the skills of another Are needed for a patient s recovery. I will respect the privacy of my patients for their problems Are not disclosed to me that the world May know. Most especially must i tread with care in matters of life and death. If it is Given me to save a life All thanks but it May also be within my Power to take a life this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above All i must not play at god. I will remember that i do not treat a fever Chart or a cancerous growth but a sick human being whose illness May affect his family and his economic stability. My responsibility includes these related problems if i am to care adequately for the sick. I will prevent disease whenever i can for prevention is preferable to cure. I will remember that i remain a member of society with social obligations to All my fellow men those sound of mind and body As Well As the infirm. Not tuesday May 29, 1990 the stars and stripes Page 13