Did you know that the earliest doctors were religious or government employees? It's true. In Babylonian medical practice records dating from eighteen centuries before Christ, doctors were servants of the king. The monarchy trained them, examined them, and paid for their services. In ancient Egypt, medicine was the province of the temple and the priesthood.

It was the influence of Hippocrates, a pagan Greek from the fifth century B.C., that made the physician responsible to the patient and took medicine out of the realm of religion and the occult and set it on a scientific course. Hippocratic medicine was a human skill, not a magical art, and its fundamental principle became respect for the human dignity of the patient, not for any king or other employer.

Hippocrates was born about 460 B.C. on the Greek island of Cos, a medical sanctuary -- rather like a modern health resort. His grandfather was well versed in orthopedics and his father, Heraclidos, was an authority on diet, which played an important role in ancient medicine and is once again coming into its own today. His teacher Herodicus introduced Hippocrates to the benefits of gymnastics, running, and competitive sports.

Far from being a typical Greek physician, Hippocrates was intent on reforming medicine, giving it a new character. Indeed, in Roe v. Wade, the landmark Supreme Court abortion decision of 1973, the Hippocratic Oath was brushed aside on precisely the grounds that he was not representative of ancient medicine. Indeed, he was not: he did not like what he found there.

His reforms were based on a particular concept of God and of human dignity. Although Hippocrates was neither a Christian nor a Jew, medical historian Ludwig Edelstein points out that he had one fundamental conviction in common with both -- namely, the belief that there is one God and that we human beings, male and female, are made in His image. Modern medicine has forgotten this; the standard materialistic evolutionary dogma of our era repudiates the idea of Creation and divine purpose. With the loss of the doctrine that God has made us for such a purpose, and in his image, man loses, as Pitirim Sorokin wrote, "the invisible armor that protected him."

THE HIPPOCRATIC OATH

I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses making them my witnesses, that I will fulfil according to my ability and judgment this oath and this covenant:

To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art -- if they desire to learn it -- without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but to no one else.

I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect. Similarly, I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief, and in particular of sexual relations with both female and male persons, be they free or slaves.

What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself holding such things shameful to be spoken about.

If I fulfil this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.

Hippocrates
5th Century B.C.

THE OATH'S DISAPPEARANCE

The Oath of Hippocrates had usually figured at least ceremonially in medical school graduations, even if his principles were beginning to be forgotten. But even this ceremonial reverence was dropped after 1973, when in Roe v. Wade, the U.S. Supreme Court rejected the Oath as a guide to medical ethics and practice.

Beginning about twenty years ago, a number of physicians and scholars began to look critically at the discarded Oath, some rejecting it, but others seeing it as a potential guide out of a growing ethical chaos. Most readily accessible is the work of my Trinity colleague Nigel M. de S. Cameron, The New Medicine (Crossway), which deals with Hippocrates' significance for medicine today.

Agreeing with Cameron are two west European writers, Professor Charles Lichtenthaeler of the Hamburg University Faculty of Medicine and Professor Giacomo Mottura of the Faculty of Medicine of the University of Turin (Torino). Lichtenthaeler wants us to make Hippocrates' deep religious insights once again our own, not simply in their original form, but as they were preserved and deepened by his Jewish and Christian successors in medicine and theology. Mottura emphasizes the physician's responsibility to the whole of society, as well as to men and to God (or the divine) and wants to see it reaffirmed and accepted again today as in the past.

Yet, others disagree. In his 1981 paper, "Farewell to Hippocrates: Medical Ethics Between Hippocrates and the Geneva Oath," East German physician Dr. Ulrich Wolff expresses respect for Hippocrates but feels that the world of medicine has so changed that it is time to say goodbye to his precepts. Wolff seems to think that the age of genetic research, abortion, and euthanasia requires us to change our Hippocratic ideals. He feels that changes in the law (giving some countries easy abortions), the increasing age of the population, and many other factors have rendered Hippocrates' view of human dignity obsolete.

"The Hippocratic principles have not so much been tried and found wanting as found demanding and not tried."

Who will turn out to be the real prophet (or prophets), and who the voice (or voices) crying in the wilderness? The Old Testament prophet Jeremiah wrote, "Thus says the LORD, 'Stand by the ways and ask for the ancient paths, Where the good way is, and walk in it; and you shall find rest for your souls'" (6:16). This is what both Lichtenthaeler and Mottura would have us do, but today more Americans are following Wolff, as though they are like those the prophet quotes, "But they said, 'We will not walk in it.'"

IS IT A RELIC OR A REMINDER?

Is the Oath merely a relic, a testimony to the medical ideas of the past, of no more relevance than the ancient Egyptian medical view that the soul enters the body through one ear at birth and leaves through the other at death? Or is it a prophetic admonition and warning for the present, a guide to the future?

In order to understand its significance, it is necessary to know that an oath in antiquity involved a sacred obligation. Today, we have a weak concept of both the sacred and obligation. Lichtenthaeler feels the Oath is relevant today for two reasons:

...the value system of the Western Christian era, which was binding on us all, has fallen into pieces after 1945 with the Western Christian era itself. The world around us is coming more and more to resemble a pagan land with a few Christian remnants...

The old taboos have fallen, as people say; every moral frame of reference is placed in doubt; everything has to be allowed, and nothing may be categorically forbidden... We speak glibly of our 'permissive society' although in a strict sense no such thing as 'society' exists any more in our regions. Society has degenerated into an abstraction... Where are the criteria for good and evil now?...

[Also,] the incredibly rapid progress of medical science and technology has thrown us into unanticipated conflicts, for which our predominantly scientific training has left us totally unprepared.... Our newspapers report abortions, artificial insemination, organ transplants, genetic manipulation, living wills, and passive euthanasia,... Involuntarily we are plunging at many points into an ethical No Man's Land, and we look despairingly for unchallengeable norms. Here it is that the Oath of Hippocrates challenges us...

The Oath begins in a way that seems out of place to a Christian, or for that matter to a modern materialist: "I swear by Apollo...and by all the gods and goddesses..." The point of this was to stress the absolutely binding commitment of the oath-taker. As Lichtenthaeler points out, the inclusion of "all the gods and goddesses" was to keep the swearer from wriggling out of his obligation by claiming to honor a different divinity.

Although Hippocrates emphasized the distinction between medicine as an art and a science on the one hand and the older shamanistic and occult practices on the other, he did not make medicine this-worldly. The physician's duty to his patients is expressed in the light of his duty to the gods. The things that the Hippocratic physician promises to shun, among them abortion and physician-assisted suicide, involve the physician in defilement or guilt and will call down the wrath of the gods.

The second segment of the Oath may be called a Contract of Apprenticeship, expressing the physician's responsibility to this teachers. He is to honor them as he would his own parents, and to instruct their sons as he would his own. The practice of medicine thus involves not only a religious but also a kind of family relationship.

From the deities and teachers we turn to the patients. The physician promises to treat all who need his help "according to my ability and judgment." The first principle of Hippocratic medicine is to do nothing to harm. "Never will I give anyone, even at his express request, a deadly remedy, nor counsel him thereto, and likewise I will give to no woman an abortive [device]." With respect to these provisions and the way law and medicine ignore them today, we must say that the Hippocratic principles have not so much been tried and found wanting as found demanding and not tried. Today abortion on demand, even partial birth abortion, is "the law of the land," protected by the president and the federal judiciary against every effort by the legislatures to limit it, even in the slightest. And today the "deadly remedy" is exactly what is being given, increasingly with government approval, in physician-assisted suicide.

The Hippocratic physician was to keep himself and his art holy and upright, principles that might seem almost ludicrous in medical schools today. The physician promises to enter a house only for the benefit of the sufferer, and particularly to refrain from all lasciviousness and impurity towards women and men, free and slave. Here also is the origin of "professional confidentiality:" "Whatsoever I learn in therapy or out of it in the lives of men, to the extent that it may not be spread about, I shall treat as a holy secret." Finally, the oath-taker appeals to the divine witnesses to grant him fame and honor if he keeps the Oath, but the opposite if it is broken.

A CALL TO ACCOUNTABILITY

American medicine leads the world in many respects. Unfortunately, according to Professor Mottura, it has also brought about a dangerous development. The newly-founded American Medical Association began from the start to claim a kind of special immunity for physicians, similar to that claimed by the medieval church for its clergy. "Benefit of clergy" meant that priests could be tried only before a church court even when charged with a civil offense.

Today, we may call it "Benefit of medicine," for the Code formulated by the AMA in 1847 specifies that no tribunal is higher than the physician's own conscience to judge whether he has committed trans-gressions or negligence. Although many, perhaps most, American doctors of the last century were Christians, this explicit claim to autonomy implicitly rejects the concept of medicine as a calling by God and consequently exposes the profession to increasing interference and control by the state. The abandonment of an orientation towards God also paves the way for a utilitarian morality, or, as Malcom Muggeridge put it, "the ethics of the stock farm."

To recover and reaffirm respect for human dignity, to make medicine more than just a hard but lucrative job again, to make it a call-ing, to remind our physicians and ourselves that their first duty is to their patients, not to government or the H.M.O., and to learn once more to shun abortion and euthanasia will require more help than the memory of Hippocrates alone can give us; it will require a widespread awakening of a spiritual nature. The memory of Hippocrates alone cannot take us there, but he can point the way. We do not want the judgment of history, a century or more from now, to say that medicine in the United States, which led the world in church membership and church attendance, had become more pagan than that of the pagan Father of Medicine, Hippocrates.

Dr. Harold O.J. Brown is Professor of Theology and Philosophy at RTS. On the faculty of Trinity Evangelical Divinity School since 1976, he held the Franklin and Dorothy Forman Chair of Ethics from 1987 until becoming Professor Emeritus in 1988. Biomedical ethics has been an interest of Brown's since 1975, when together with former Surgeon General Dr. C. Everett Koop and two others he founded the Christian Action Council.




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