Last time we highlighted that Hippocrates framed his entire oath with the gods as his witnesses. This provided for him an inherent accountability in the profession of medicine, as wrongdoing could be punished by the gods. The question remains, however, why an oath?
The Greek term for oath, horkos, is derived from the term for a bound or a limit. This is telling because it was implied in an oath that what was said in the oath would bind a person and limit him/her from going beyond what was said. This makes sense to us when we think about it a little. Today we are unlikely to make oaths (since it sounds too intense) and instead we make promises. They function in a similar way in that they set out actions to be done and not to be done. For example, if I were to say, “I promise to eat my vegetables and not to eat my dessert first,” I am setting out actions to do and actions not to do. I am bound by these words in this promise.
They differ, however, in that promises tend to be made between people and there is no accountability outside of this. If I eat my dessert first, there are unlikely to be any serious consequences. We have already seen, however, that Hippocrates frames the oath with the gods as his witnesses. As he understands, breaking this oath will bring judgment. He is bound to do no harm, he cannot go beyond this. Furthermore, Hippocrates stipulates conditions that oath-takers must submit to if they break the oath, namely they must submit to having the opposite of the oath’s blessings – disrepute and no enjoyment of life. While most people taking the heavily altered Hippocratic Oath today hardly think of the consequences of breaking the oath, for Hippocrates this was of utmost importance.
That this oath was taken with such seriousness is suggested by Scribonius Largus, who was likely a military physician at some point in his lifetime. He treated the Hippocratic Oath with the same reverence as the sacramentum of the Roman soldier, the oath to defend the emperor and empire even to the cost of life. What sorts of oaths are taken today with such seriousness?
The oath is significant because it means that medicine was not something to be entered into lightly. Medicine was for the finest, for the most dedicated people with fine integrity. It was not for a random group of people, some deciding medicine was a good means to make money and others deciding it could be a cushy job. Medicine was a serious matter, and because of the oath every person that entered into medicine was to be held to a higher standard. While we often say this about medicine today, we do not realize the seriousness of medicine that existed in a prior era. This is certainly a challenge from Hippocrates to us worthy of contemplation.
Are we so committed to medicine that we would put our reputations on the line and live in such a way that is open to the scrutiny of the highest authorities? Some might suggest that the government or colleges serve a similar role. I would agree with this but with some additional thoughts. While colleges can punish negative behaviour, what incentive is there to do positive work instead of just “getting by” without being noticed by regulatory bodies? Or what if someone found a way to play the system without being reprimanded? These are questions we will examine in our next post with Hippocrates and the oath.