A modern successor to the Hippocratic Oath has been approved by the World Medical Association. This is the first revision in a decade and reflects changes in the climate of medical ethics.
The current declaration is still a noble attempt to affirm that doctors have duties towards their patients and towards society; they are not just profit-maximising entrepreneurs with an expertise in human physiology.
However, it has drifted from the urgency that doctors felt in 1948, just after World War II. Before and during the War a number of eminent German doctors had betrayed their profession by experimenting on unwilling concentration camp inmates, exploiting their helplessness to further scientific knowledge (often it was bogus). Some participated in involuntary euthanasia; others in mass murder. Amongst the trials of Nazis after the War was a trial of 23 doctors. Seven of them were hanged. Japanese doctors also participated in medical atrocities.
So a personal commitment not to harm patients was clearly serious business. In 2017 perhaps the danger of becoming an enemy of mankind instead of its servant seems less pressing. The changes in the 2017 code reflect a more bureacratised, more legalistic view of medicine.
First of all, the “Declaration of Geneva” is to be called, not an “oath”, but a “pledge”. An oath is a solemn promise, often invoking a divinity as a witness. In an increasingly secularised society, the WMA apparently feels that subtly introducing the idea of God and God-given laws is an anachronism.
Or even a natural law. In the 1948 version doctors declared that “even under threat, I will not use my medical knowledge contrary to the laws of humanity”. The “laws of humanity” has been replaced by “human rights and civil liberties”. In other words, the idea of innate right and wrong has been displaced by positive law. In some circumstances, at least, right and wrong may be defined by the government.
The most striking change implicitly allows abortion. In 1948, doctors were to declare that “I will maintain the utmost respect for human life from the time of conception.” In other words, the nigh-universal prohibition of abortion was fully backed by the medical profession. By 2017, this had been watered down to “I will maintain the utmost respect for human life”. In as much as some ethicists maintain that an embryo is life, but not a human life, this is an escape clause for abortion.
There is some pressure on the WMA to alter its position on end-of-life issues, although it seems resolutely opposed at the moment. But at this rate, it could change. Will doctors someday pledge to “maintain the utmost respect for freely chosen autonomous human life”?
Another important amendment is the emphasis on patient autonomy. A clause has been inserted into the 2017 version which says, “I will respect the autonomy and dignity of my patient”. While this sounds noble, the priority given to autonomy is ominous. Does that mean that a doctor must do whatever patients ask – whether it is performing abortions, giving adolescents a sex change, or helping them to commit suicide?
A somewhat unusual new clause requires doctors to look after their own health: “I will attend to my own health, well-being, and abilities in order to provide care of the highest standard”. Perhaps this is meant to exclude doctors whose age has outstripped their medical knowledge. But it also suggests that there is less emphasis on medicine as a confraternity, a guild ready to share knowledge. The 1948 version declared that “my colleagues will be my brothers”. In 2017, is this still true? What are the consequences of doctors abandoning the notion of profession?
The current Declaration of Geneva is used across the world by physicians. In many countries it is actually part of the medical professional code and in some it is legally binding. However, in other countries it is either not used at all or has been adapted. The revised pledge is supposed to be a global ethical code for all physicians. WMA President Dr Yoshitake Yokokura, of Japan, said:
“The life of physicians today is completely different to what it was in 1948 when the original Declaration of Geneva was adopted. Since then, the Declaration has become a core document of medical ethics and a modern version of the 2,500-year old Hippocratic Oath. We hope that the Declaration approved today will be used by all physicians around the world to strengthen the profession’s determination to maintain the highest standard of health care for patients.”
As you can read below, the Declaration of Geneva does not open the floodgates to a utilitarian view of health care. But in some key points – the value of human life, especially – it is far from clear.
Here is the complete text of the 2017 version:
AS A MEMBER OF THE MEDICAL PROFESSION:
I SOLEMNLY PLEDGE to dedicate my life to the service of humanity;
THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration;
I WILL RESPECT the autonomy and dignity of my patient;
I WILL MAINTAIN the utmost respect for human life;
I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing, or any other factor to intervene between my duty and my patient;
I WILL RESPECT the secrets that are confided in me, even after the patient has died;
I WILL PRACTISE my profession with conscience and dignity and in accordance with good medical practice;
I WILL FOSTER the honour and noble traditions of the medical profession;
I WILL GIVE to my teachers, colleagues, and students the respect and gratitude that is their due;
I WILL SHARE my medical knowledge for the benefit of the patient and the advancement of healthcare;
I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard;
I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat;
I MAKE THESE PROMISES solemnly, freely, and upon my honour.
Michael Cook is editor of MercatorNet.