Hypocritical oath

What do you do when you have an ancient, authoritative document that you have committed yourself to follow, and yet it stands in judgment against contemporary values and practices? One alternative is to change your positions so that they accord with what the document teaches-after all, that is what it means to acknowledge an authority. Another alternative is to change the document, so that it fits your current positions.

What the TNIV does to the Bible, the medical profession worldwide has just done to the Hippocratic oath.

For 2,500 years, since medicine was first put on a scientific foundation by the Greek physician Hippocrates, those embarking on the medical profession have sworn to uphold a specific standard of ethics designed for those assuming the life-and-death responsibilities of being a doctor.

The Hippocratic oath eloquently committed physicians to "do no harm." Its principles applied across the centuries, even anticipating problems that would become bigger issues today, such as forbidding the sexual abuse of patients. The problem, though, to today's medical establishment, is that Hippocrates was resolutely pro-life. The oath, to which nearly all med-school graduates solemnly swear, forbids both euthanasia and abortion.

Those doctors who went into the abortion business were perjuring themselves, so the oath became something of an embarrassment. Many medical schools began to leave that part out of it, or to substitute vague platitudes for the specific language of Hippocrates, or to drop the swearing of an oath altogether. (See WORLD, Jan. 22, 2000.)

But now, in a global effort, the medical profession has established a brand new code of ethics designed to replace the Hippocratic oath altogether.

The Medical Professionalism Project, consisting of a panel of physicians from around the world, after many years' study published a set of principles designed to guide the practice of medicine in "the new millennium." The document, published simultaneously in the last month's issues of the major British and American medical journals, The Lancet and The Annals of Internal Medicine, is titled "The Charter on Medical Professionalism."

Whereas the Hippocratic oath is a succinct 364 words, in the English translation, the Charter is 1,445 words that say much less. What Hippocrates asked of physicians is an "oath," a serious promise, a vow made to the gods of medicine, in its original Greek formulation, and to "almighty God" in Christian medical schools. The Charter is more in the form of a corporate mission statement, a series of "professional commitments" in line with doctors' new status as HMO workers, as opposed to following a divinely ordained calling.

The Charter is organized around three "principles." The "principle of primacy of patient welfare" calls for "altruism," saying nothing, of course, about the specifics of not performing euthanasia or abortion, or even "doing no harm." It does say that "market forces" should not be allowed to interfere with "the best interest of the patient."

Much of the document is devoted to the "principle of patient autonomy." Decisions have to be left to the patients. This formally enshrines "pro-choice" as the guiding standard for medical ethics.

Then there is the "principle of social justice." This commits the medical profession to the shibboleths of liberal political rhetoric-"the fair distribution of health care resources," non-discrimination for "race, gender, socioeconomic status, ethnicity, religion, or any other social category."

These principles are then unpacked in a series of 10 "commitments" (not commandments): "to professional competence," "to honesty with patients," "to patient confidentiality," "to maintaining appropriate relations with patients," "to improving quality of care," "to improving access to care," "to a just distribution of finite resources," "to scientific knowledge," "to maintaining trust by managing conflicts of interest," and "to professional responsibilities."

The Charter avoids the language of morality, setting forth a few guidelines for corporate procedure without grounding them, as the Hippocratic oath does, in transcendent moral absolutes.

Today's liberals-and many conservatives-have a way of projecting their morality out into the periphery of their experience, rather than applying it in concrete, personal terms. It is easier to be for "global justice"-or "global freedom"-and to feel a rush of self-righteousness for one's political stance, than to regulate one's own behavior. It is easier for doctors to be ethical by "managing conflicts of interest" and pursuing the "just distribution of finite resources" than by refusing to commit abortions.

The medical profession obviously feels a need for ethical direction, but this is difficult to manufacture apart from belief in absolute moral truths. How different is "The Charter on Medical Professionalism," with its preoccupation with economics and bureaucracy, from the Hippocratic pledge: "With purity and with holiness I will pass my life and practice my Art."