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The Hippocratic Oath and the Ethics of Medicine






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The Hippocratic Oath and the Ethics of Medicine. Steven Miles, MD University of Minnesota. Believed to be the only depiction of Hippocrates. Oath -- 400 BC. Hippocractic Medicine Rejected divine explanations for the cause or treatment of disease in favor of empirical, causal observations.
The Hippocratic Oath and the Ethics of Medicine

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Slide 1

The Hippocratic Oath and the Ethics of Medicine

Steven Miles, MD

University of Minnesota

Believed to be the only depiction of Hippocrates.

Slide 2

Oath -- 400 BC

  • Hippocractic Medicine

    • Rejected divine explanations for the cause or treatment of disease in favor of empirical, causal observations.

    • Transformed oral traditions passed in families to recorded observations and clinical experiences shared within a guild.

Slide 3

Time Line

Columbus Voyage

Fall of Athens

1000

BCE

CE

Oldest Oath

Papyrus

Oath

Church

Editing

“Hippocratic”

Medical

Works

Deontological

works

1st Medical

School use

Slide 4

The Cutting Insertion

Fall of Athens

1500

1000

BCE

CE

I will not cut, and certainly not those suffering from stone, but I will cede this to practitioners of this activity.

Oldest Oath

Papyrus

Oath

Surgery separates from Medicine

Bladder stone

surgical innovation

240 BCE

Slide 5

Oaths Ethics‘Questions

  • Who is the physician?

  • What is the physician committed to?

  • Who is the physician accountable to?

Slide 6

Who is the physician?

Slide 7

Opening of Oath: An invocation?...

  • I swear by Apollo the Physician and by Asclepius and by Hygieia and Panacea and by all the gods as well as goddesses, making them judges [witnesses], to bring the following oath … to fulfillment, in accordance with my power and my judgment;

Slide 8

… or does it proclaim geneology?

  • “Is there a man who has not heard of me—Amphitryon of Argos, son of Alcaeus, grandson of Perseus, and father of Heracles. I have lived here in Thebes ever since the crop of Sown Men sprang full grown out of the Earth.”

    • From Heracles by Euripides

If geneology, what does it mean?

Slide 9

The Family of Medicine I(Medicine born of love and grief)

Apollo Coronis

Physician, prophecy

Asclepius

Chiron (a Centaur)

Trainer of Achilles

Medical education

Slide 10

Apollo

God of Reason

God of Prophecy

Oracle at Delphi

Physicians

Reason- Natural Cause and Effect:

Points to cause, diagnosis, and treatment.

Prognosis

Apollo: Prophecy & Prognosis

Slide 11

Prometheus (Foresight)

  • A titan who gave humans fire and creativity to invent medicines and imagine a prognosis.

  • To prevent despair at foreseeing death in a person who was dying.

    Prom: I stopped mortals from foreseeing doom.

    Chorus: What cure did you discover for that sickness?

    Prom: I sowed in them blind hope.

    • Aeschylus. Prometheus Bound

Slide 12

The Family of Medicine II

Epione

(Hercules’ Daughter)

‘Soothing’

Asclepius

‘Unceasingly

Gentle’

Slide 13

Pindar’s Verdict on Asclepius

  • Still, even wisdom yields to hope of profit. And gold induced no less than he [Asclepius] to try to resur-rect a man whom death already had imprisoned…. We must seek from deity the things that fit our mortal hearts, keeping our cond-ition and our destiny in mind. My vital being, do not seek immortal life; exhaust, instead, all possibility. Pindar. Pythian Odes 3-63.

Slide 14

What does the Apollo Genesis Story of Medicine Say?

  • The passion to heal arises from love and grief.

  • Physicians must accept mortality as a boundary for moral work.

  • The names of Asclepius and Epione say that healing is not a war but a gentle rebalancing to path to health.

Slide 15

The Family of Medicine III

Asclepius Epione

Unceasingly Gentle Soothing

Iaso

Healers

Panacea

Medicines

Telesphorus

Convalescence

Hygieia

Health

Aigle

Radiance

Podalirius

Machaon

Slide 16

The Family of Medicine IV

Asclepius Epione

Unceasingly Gentle Soothing

Podalirius

Machaon

“to regard my teachers as equal to my parents” [Oath]

Hippocrates

Each Physician

(Hippocrates dies in Larissa)

Slide 17

What is the physician committed to?

Slide 18

What is the Physician Committed to?

Slide 19

What does the Physician Promise to Society?

I will not give a drug that is deadly to anyone if asked, nor will I suggest the way to such a counsel.

  • Capital punishment?

  • Euthanasia?

  • Homicide?

Slide 20

What does the Physician Promise to Society?

I will not give a woman a destructive pessary.

Antiabortion?

Pro-life?

Anti-trespass in a woman chattel society?

Pessaries are dangerous.

Slide 21

What Does the Physician Promise to the Patient? 1

  • especially from sexual acts both upon women's bodies and upon men's, both of the free and of the slaves.

Slide 22

What Does the Physician Promise to the Patient? 2

About whatever I may see or hear in or without treatment…

-- things that should not ever be blurted out outside –

I will remain silent, holding such things to be [profane to speak of].

Slide 23

Who are Physicians Accountable to?

  • If I render this oath fulfilled, and if I do not blur and confound it may it be to me to enjoy the benefits both of life and of techne (art and science), being held in good repute among all human beingsfor time eternal.

  • If, however, I transgress and perjure myself, the opposite of these.

Slide 24

Oath’s Vision

An empirical science, a moral community

Self sustaining by passing accumulating knowledge

Justice

Benefi-cence

Physician and Society

Personal Integrity

In a pure and holy way,

I will guard my life

and my art and science.

Clinical Ethics

Accountability

to judgment of history.

Slide 25

Summary

  • Oath conforms to the medical practice and rhetoric of Classic Greece.

  • Roles: education, compiling knowledge, and treatment.

  • Ethics: beneficence and on avoiding injustice in public and clinical spheres.

  • Progressive and historically accountable rather than deistically accountable.

Slide 26

Steven Miles MDmiles001@umn.edu


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