the hippocratic oath and the ethics of medicine steven miles, md university of minnesota believed to...
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The Hippocratic Oath and the Ethics of
Medicine
Steven Miles, MDUniversity 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.
– Transformed oral traditions passed in families to recorded observations and clinical experiences shared within a guild.
Time Line
1000
Deontological works
Oldest OathPapyrus Church
Editing
1st MedicalSchool use
“Hippocratic”MedicalWorks
Fall of Athens
CEBCE
Oath
Columbus Voyage
The Cutting Insertion
1000
Bladder stonesurgical innovation
240 BCE
Oldest OathPapyrus
Fall of Athens
CEBCE 1500
Oath
Surgery separates from
Medicine
I will not cut, and certainly not those suffering from stone, but I will cede this to practitioners of this activity.
Oaths Ethics‘Questions
•Who is the physician?•What is the physician
committed to?•Who is the physician
accountable to?
Who is the physician?
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;
… 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 EuripidesIf geneology, what does it mean?
The Family of Medicine I(Medicine born of love and grief)
Apollo CoronisPhysician, prophecy
AsclepiusChiron (a Centaur)Trainer of AchillesMedical education
Apollo: Prophecy & Prognosis
Apollo• God of Reason
• God of Prophecy– Oracle at
Delphi
Physicians• Reason-
Natural Cause and Effect:– Points to
cause, diagnosis, and treatment.
• Prognosis
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
The Family of Medicine II
Epione(Hercule
s’ Daughte
r)‘Soothing
’
Asclepius
‘Unceasingly
Gentle’
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.
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.
The Family of Medicine III
Asclepius EpioneUnceasingly Gentle Soothing
Hygieia
Health
AigleRadiance
TelesphorusConvalesce
nce
IasoHealers
PanaceaMedicines
Podalirius Machaon
The Family of Medicine IV
Asclepius EpioneUnceasingly Gentle SoothingPodalirius
Hippocrates
Machaon
Each Physician(Hippocrates dies in Larissa)
“to regard my teachers as equal to my parents” [Oath]
What is the physician
committed to?
MD in Society Clinical Ethics
Principles
I will use regimens for the benefit of the ill in accordance with my ability and my judgment, but from [what is] to their harm or injustice I will keep [them].
Into as many houses as I may enter, I will go for the benefit of the ill, while being far from all voluntary and destructive injustice,
Examples(2)
1. I will not give a drug that is deadly to anyone if asked, nor will I suggest the way to such a counsel. 2. I will not give a woman a destructive pessary.
1. especially from sexual acts both upon women's bodies and upon men's, both of the free and of the slaves. 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].
What is the Physician Committed to?
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?
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.
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.
What Does the Physician Promise to
the Patient? 2About 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].
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 beings for time eternal.
• If, however, I transgress and perjure myself, the opposite of these.
Oath’s Vision
Accountabilityto judgment of history.
An empirical science, a moral community
Self sustaining by passing accumulating knowledge
Personal IntegrityIn a pure and holy way,
I will guard my life and my art and science.
Physician and Society
Clinical Ethics
Justice
Benefi-cence
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.
Steven Miles MD
miles001@umn.edu
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