Whatever happened to the Hippocratic Oath?
It was a condition of his training that he should sign an oath, in his own blood, that he would use the skills he learned for good and not for ill. He was gaining, after all, skills that would enable him to wound or kill. It was required that he would promise to deploy them virtuously and responsibly.
It is a similar story with medical ethics. In ancient Greece, as doctors first began to learn methods that could mean the difference between life and death, a code of ethics was developed, known as the Hippocratic Oath.
One part of it reads: 'I will use those dietary regimens which will benefit my patients according to my greatest ability and judgment, and I will do no harm or injustice to them'. It also includes a promise to maintain patient confidentiality and not to poison anybody, even when asked to.
Many people assume that trainee doctors still swear the Hippocratic Oath but they don't. Medical schools have their own oaths or declarations. Bristol University, for example, asks its medical students to make a 'promise', the final part of which is: 'I will work for the good of all persons whose health may be placed in my care and for the public wellbeing'.
The medical profession is, or at least used to be, a vocation. It was driven in large measure by a desire to do good in the world rather than for the pursuit of financial gain. In the early 20th century, before the creation of the NHS, general practitioners varied their fees according to the means of their patients. It is estimated that one fifth of the population was given treatment for free.
Surely today, too, most young people who go into medicine also have at least some sense of vocation and a feeling that their training and skills give them a responsibility to others. But how do they now square these ideas with withdrawing their labour – as they have voted to do – between the 25th and 30th of July?
This is not equivalent in any way to industrial action undertaken to delay the collection of bins, or force commuters into the inconvenience of riding a slow rail-replacement bus. Doctors know, better than anyone else, that vast numbers of people are waiting for operations. They know that the delay of an operation or therapy for, say, cancer, means that it is more likely that the patient will die.
Cancer, by its nature, grows. If it spreads too far, it becomes impossible to save the patient. By withdrawing their services, doctors know that more patients will have more delays in the treatment of cancer, heart disease and other potentially deadly diseases. Is this what they went into medicine for? To threaten fatal consequences for patients for the sake of a better pay deal? If so, it is a sad transformation of the ideals that doctors once represented.
On another issue, the attitude of the British Medical Association to puberty blockers suggests a big change in ideology. The very thorough Cass Review asserted that the evidence base and rationale for early puberty suppression was unclear, and that masculinising/feminising hormone therapy should not be provided for people below the age of 16.
The leadership of the BMA is clearly capable of working when it comes to 'critiquing' the Cass Review. It appears to be ideologically opposed to its findings. The Hippocratic priority of doing 'no harm or injustice' appears to have been pushed aside yet again in the service of political expediency.
As for assisted dying (in other words, helping to end someone's life) this is, on the face of it, directly contrary to the Hippocratic Oath. If this becomes law, doctors will – or at least one hopes they will – wrestle with their consciences to be as confident as possible that they are 'working for the good of all persons'.
But the sad truth is, as a young doctor said to me yesterday, that the philanthropic ideal of medicine is not as strong as it once used to be. Those now entering the field of medicine should not be surprised to see their status in the public eye suitably diminished.
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