Do Euthanasia and Physician-Assisted Suicide Violate the Hippocratic Oath?
General Reference (not clearly pro or con)
Hippocrates, Greek philosopher and physician, is credited with writing the "Hippocratic Oath," which has been translated in 2002 by Michael J. North, MS, MSLS, Head of Rare Books & Early Manuscripts in the History and Medicine Division at the US National Library of Medicine, available at www.nlm.gov:
"I swear by Apollo the physician, and Asclepius, and Hygieia and Panacea and all the gods and goddesses as my witnesses, that, according to my ability and judgement, I will keep this Oath and this contract:
To hold him who taught me this art equally dear to me as my parents, to be a partner in life with him, and to fulfill his needs when required; to look upon his offspring as equals to my own siblings, and to teach them this art, if they shall wish to learn it, without fee or contract; and that by the set rules, lectures, and every other mode of instruction, I will impart a knowledge of the art to my own sons, and those of my teachers, and to students bound by this contract and having sworn this Oath to the law of medicine, but to no others.
I will use those dietary regimens which will benefit my patients according to my greatest ability and judgement, and I will do no harm or injustice to them.
I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.
In purity and according to divine law will I carry out my life and my art.
I will not use the knife, even upon those suffering from stones, but I will leave this to those who are trained in this craft.
Into whatever homes I go, I will enter them for the benefit of the sick, avoiding any voluntary act of impropriety or corruption, including the seduction of women or men, whether they are free men or slaves.
Whatever I see or hear in the lives of my patients, whether in connection with my professional practice or not, which ought not to be spoken of outside, I will keep secret, as considering all such things to be private.
So long as I maintain this Oath faithfully and without corruption, may it be granted to me to partake of life fully and the practice of my art, gaining the respect of all men for all time. However, should I transgress this Oath and violate it, may the opposite be my fate."
Howard Markel, Director of the Center for the History of Medicine at the University of Michigan Medical School, wrote in his May 13, 2004 article, "'I Swear by Apollo' - On Taking the Hippocratic Oath" that appeared in The New England Journal of Medicine:
"Although many scholars dispute the exact authorship of the writings ascribed to the ancient physician Hippocrates, who probably lived sometime between 460 and 380 B.C., the oath named for him is simultaneously one of the most revered, protean, and misunderstood documents in the history of medicine…
[N]early every U.S. medical school will administer some type of professional oath to its share of about 16,000 men and women who are eager to take possession of their medical degrees. Yet it is doubtful that Hippocrates would recognize most of the pledges that are anachronistically ascribed to him…"
Peter Tyson, former Editor in Chief for NOVA online, in his Mar. 27, 2001 article "The Hippocratic Oath Today," available at pbs.org, wrote:
"Today, most graduating medical-school students swear to some form of the oath, usually a modernized version. Indeed, oath-taking in recent decades has risen to near uniformity, with just 24 percent of U.S. medical schools administering the oath in 1928 to nearly 100 percent today.
Yet paradoxically, even as the modern oath's use has burgeoned, its content has tacked away from the classical oath's basic tenets. According to a 1993 survey of 150 U.S. and Canadian medical schools, for example, only 14 percent of modern oaths prohibit euthanasia, 11 percent hold convenant with a deity, 8 percent foreswear abortion, and a mere 3 percent forbid sexual contact with patients—all maxims held sacred in the classical version. The original calls for free tuition for medical students and for doctors never to 'use the knife' (that is, conduct surgical procedures)—both obviously out of step with modern-day practice. Perhaps most telling, while the classical oath calls for 'the opposite' of pleasure and fame for those who transgress the oath, fewer than half of oaths taken today insist the taker be held accountable for keeping the pledge...
[Some] physicians...claim that the principles enshrined in the oath never constituted a shared core of moral values, that the oath's pagan origins and moral cast make it antithetical to beliefs held by Christians, Jews, and Muslims. Others note that the classical [Hippocratic] Oath makes no mention of such contemporary issues as the ethics of experimentation, team care, or a doctor's societal or legal responsibilities."
Louis Lasagna, MD, former Dean of the Sackler School of Graduate Biomedical Sciences at Tufts University, wrote the 1964 version of the Hippocratic Oath which appeared in the June 28, 1964 New York Magazine article "Would Hippocrates Rewrite His Oath?", available at pbs.org, which many medical schools currently use:
"I swear to fulfill, to the best of my ability and judgment, this covenant:
I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.
I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.
I will not be ashamed to say 'I know not,' nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.
I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.
I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.
I will prevent disease whenever I can, for prevention is preferable to cure.
I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.
If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help."
Do Euthanasia and Physician-Assisted Suicide Violate the Hippocratic Oath?
Josef Kure, DPhil, Head of the Department of Medical Ethics at Masaryk University (Czech Republic), in his 2011 chapter "Good Death Within Its Historical Context and as a Contemporary Challenge: A Philosophical Clarification of the Concept of Euthanasia" from the book, Euthanasia - The 'Good Death' Controversy in Humans and Animals, wrote:
"The Hippocratic tradition, whose core is the Hippocratic Oath, prohibits the killing of a human being, just as it forbids any aid in suicide (in present-day terminology in 'physician assisted suicide'): 'To please no one will I prescribe a deadly drug nor give advice which may cause his death.' Euthanasia as a direct killing of the patient, regardless if upon his/her request or without any request, is not forbidden by the Hippocratic Oath directly. But such a prohibition can be deduced, a fortiori [with greater reason or more convincing force], from the prohibition of any help in suicide. So euthanasia as the killing of a patient by the physician is not in accordance with either the Hippocratic Oath or the spirit of the Hippocratic tradition."
Patrick G. D. Riley, PhD, Columnist for StAR, in his Nov. 2010 Linacre Quarterly article, "The Import of an Oath," available at www.cathmed.org, wrote:
"A modified oath, taken in recent years by medical students at graduation (if indeed any oath is taken), appears to subsume the Hippocratic Oath’s prohibition of euthanasia and abortion under an undertaking to 'perform no operation, for a criminal purpose, even if solicited, far less suggest it.' Yet this leaves the healing and health-preserving character of the medical profession at the mercy of civil law, for if abortion or euthanasia is legal, then a foresworn physician can plead that he is bound by no oath against it. Civil authorities can make the same argument should they demand that physicians commit legally-sanctioned crimes forbidden by the Hippocratic Oath but not by a modified oath."
Wesley Smith, JD, Consultant to the International Anti-Euthanasia Task Force, in a Mar. 9, 2006 article "Harm Done" that appeared in the National Review Online, available at www.nationalreview.com, wrote:
"You see, real people--that is patients--don't blithely dismiss the Hippocratic Oath as if it were merely akin to a secret handshake. In their commonsense understanding, the Oath protects their welfare by making doctors honor-bound to always 'do no harm' (a catchphrase that succinctly summarizes the moral thrust of the Oath, although it does not appear in the document itself).
Unfortunately, we live in an age when pledges of duty and fidelity of the kind found in the Oath are fast becoming passé...
This is most unfortunate. The author of the Oath... understood that killing is not a medical act."
The Lutheran Church, Missouri Synod, in the 2001 "President's Commission on the Sanctity of Life," titled "That They May Live," available at www.lcms.org, wrote:
"Assisted-suicide/euthanasia violates the Hippocratic Oath, the foundation for medical ethics for more than 2,000 years. The Hippocratic Oath explicitly forbids assistedsuicide/euthanasia by requiring doctors to pledge, 'to give no deadly medicine to anyone if asked, nor will I make a suggestion to this effect.' The Christian ethicist, Gilbert Meilaender, interprets the Oath as creating a positive obligation for physicians to 'be committed to the bodily life of their patients.' Assisted-suicide/euthanasia clearly conflicts with this moral obligation since it is an act intended to end the patient’s bodily life. This is one reason why organized medicine—ranging from the World Medical Association, to the American Medical Association (AMA), to almost all of the state medical associations—overwhelmingly opposes legalizing assisted-suicide/euthanasia."
Richard C. Eyer, DMin, Director Emeritus of the Concordia Bioethics Institute at Concordia University Wisonsin, in an Oct. 1999 Campus Presentation Series, "Ethics and Suffering: From Healing to Relief of Suffering," available at www.mtio.com/articles, stated:
"The aim of medicine is, according to the [Hippocratic] Oath, to heal and not to kill.
The [Hippocratic] Oath made clear what it means to 'do no harm.' The meaning of 'injury or wrongdoing' was named specifically as abortion, euthanasia, sexual abuse, and breach of confidentiality. In contrast,
in postmodern medicine the interpretation of what constitutes 'harm' lies in
the eye of the beholder. The Kevorkian spectacle has illustrated this... The jury accepted Kevorkian’s defense that he was
only aiming at the relief of suffering and he was set free. No one pointed out
the obvious that the means used to relieve suffering was to kill the patient.
This case, along with others that followed, contributed to the deconstruction
of Hippocratic medicine and the subsequent promotion of postmodern medicine;
moving the profession of medicine away from the aim of healing and into the
murky waters of relief of suffering through assisted suicide and euthanasia."
Nigel M. de S. Cameron, PhD, President of the Center for Policy on Emerging Technologies and Research Professor at the Chicago-Kent College of Law in the Illinois Institute of Technology, in his Oct. 23, 1995 article "Doctors Under Oath" that appeared in Christianity Today, available at www.christianitytoday.com, wrote:
"On the twin life issues of abortion and euthanasia, he [Hippocrates] made the definitive statements: No, No…
Most people don't realize that the most important single fact about the Hippocratic Oath is that it is an oath. Almost all of the post-Hippocratic alternatives, from the World Medical Association's Declaration of Geneva and so on, are simply human statements of intent, declarations in two dimensions. The immense moral power of the oath arises from setting human life and the medical practice squarely in the presence of God."
Leon Kass, MD, PhD, former Chairman of the President's Council on Bioethics, wrote in his Winter 1989 article "Neither for Love nor Money: Why Doctors Must Not Kill" that appeared in the journal Public Interest:
"The prohibition against killing patients... stands as the first promise of self-restraint sworn to in the Hippocratic Oath, as medicine's primary taboo: 'I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect'... In forswearing the giving of poison when asked for it, the Hippocratic physician rejects the view that the patient's choice for death can make killing him right. For the physician, at least, human life in living bodies commands respect and reverence--by its very nature. As its respectability does not depend upon human agreement or patient consent, revocation of one's consent to live does not deprive one's living body of respectability. The deepest ethical principle restraining the physician's power is not the autonomy or freedom of the patient; neither is it his own compassion or good intention. Rather, it is the dignity and mysterious power of human life itself, and therefore, also what the Oath calls the purity and holiness of life and art to which he has sworn devotion."
The Christian Medical and Dental Associations' Apr. 29, 1988 "CMDA Ethics Statement: Euthanasia", available at www.cdma.org, included:
"Physician-assisted suicide and euthanasia were explicitly proscribed in the Hippocratic Oath. Although this was a minority opinion when introduced 2500 years ago, the Hippocratic ethic gradually became the dominant influence for practitioners of modern medicine and dentistry. Practitioners have adopted the role of healer with the goals of healing when possible, and relief of suffering. While there have doubtless been individual physicians and dentists over the centuries who have occasionally helped their patients to die, this activity has clearly remained outside the boundaries of acceptable medical treatment."
Kenneth A. Feucht, MD, PhD, Surgical Oncologist at Puyallup Surgical Consultants, and Byron Calhoun, MD, Professor and Vice-Chair in the Department of Obstetrics and Gynecology at West Virginia University-Charleston, in their Journal of Biblical Ethics in Medicine article, "The Hippocratic and Other Oaths: Past and Present Proposal for an Oath for Christians," available at www.bmei.org, wrote:
"The Hippocratic Oath recognizes the immense
value of human life from conception to death.
... [Hippocrates'] declaration negates abortion, infanticide, suicide, and euthanasia, because all seek to abrogate God's solitary prerogative of ordering our days for us. The ultimate sin is the idolatry of 'becoming like God' seeking to overturn His written days commanded for our lives. Hippocrates was right. Godly physicians must not murder their patients.
The Hippocratic Oath established a cultus of physicians
sworn and bound by it. The oath was taken as one entered medical school, not
when one completed it. It impelled the physician-as-teacher to instruct only
those students sworn to uphold the oath. It was restrictive and intolerant of
ethical variance in the medical community."
Ronald A. Lindsay, JD, PhD, President and CEO of the Center for Inquiry, Rebecca P. Dick, JD, Lawyer for the Federal Trade Commission's Mergers Division, and Tom Beauchamp, PhD, Professor of Philosophy and Senior Research Scholar at the Kennedy Institute of Ethics at Georgetown University, in their 2006 Washington University Journal of Law & Policy article, "Hastened Death and the Regulation of the Practice of Medicine," available at www.law.wustl.edu, stated:
"Because the Hippocratic Oath instructs physicians not to provide a 'deadly drug,' some have concluded that physicians, by their training and moral commitment, must necessarily reject assistance in hastening death. This is not so. The provision in the Hippocratic Oath that prohibits providing a deadly drug did not even reflect accepted medical practice in ancient Greek city-states where, upon request, a physician could provide a lethal drug for a suffering patient. In some sense, physicians who provide assistance in hastening death are adhering to a longstanding understanding of the scope of medical practice: to care for and meet the needs and desires of a patient in all stages of the patient’s life. Significantly, the activities a physician undertakes in providing assistance in hastening death are the same as those often carried out by a physician who oversees a withdrawal of treatment. As a purely medical matter, there is little to distinguish a physician’s activities in withdrawing treatment from activities in hastening death through other means."
William E. Morgan, DC, chiropractor, in his July 29, 2004 Journal of Chiropractic Humanities article "Hippocrates on Ethical Practice Management," available at www.journalchirohumanities.com, wrote:
"Hippocrates did not make a moral statement about whether or not euthanasia or abortions were right or wrong. One of his works, Dismembering of the Fetus in the Womb, even explains how to perform an abortion. His message in the Oath was that physicians were in the business of life and… Giving a concoction to induce an abortion can be done without any particular healing knowledge. Likewise, euthanasia is not a complicated process."
Richard E. Thompson, MD, Adjunct Instrutor of Ethics at Drury University, in a Mar./Apr. 2004 article in The Physcian Executive titled, "I Swear by Apollo, the Hippocratic Oath is Obsolete," stated:
"The Hippocratic Oath is not the only time-honored school of ethical and moral thought to be discarded because of inflexibility. Rules stated as always or never are sooner or later discredited by failure to withstand the 'Yes but, what if...?' questions. The oath’s didactic references to abortion and euthanasia are too simplistic to be useful to those seriously debating the professional, political, ethical and religious aspects of these complex topics. Perhaps it is not necessary for a pledge of professionalism to be so specific. If it is necessary, then Hippocrates fails us by omitting mention of stem cell research and genetic engineering."
Steven H. Miles, MD, Professor and Maas Family Endowed Chair in Bioethics for the Center for Bioethics and Professor of Medicine at University of Minnesota Medical School, in his 2004 book The Hippocratic Oath and the Ethics of Medicine, stated:
"...the history of the euthanasia debate and descriptions in the of the care of dying persons in ancient Greece make it unlikely that 'I will not give a drug that is deadly' refers to anything like our concepts of physician-assisted suicide, voluntary or non-voluntary euthanasia, or discontinuing life-sustaining treatment.
...The Greek-derived word euthanasia (literally: 'good death') was not coined until 280 BCE, about a century after the Oath was written. This new word did not refer to assisting death; it referred to a natural death without agony… "
Philip Nitschke, MD, Director and Founder of Exit International, in his June 5, 2001 interview with Kathryn Jean Lopez titled "Euthanasia Sets Sail" that appeared in the National Review Online, available at www.nationalreview.com. commented:
"Over time the Hippocratic Oath has been modified on a number of occasions as some of its tenets became less and less acceptable. References to women not studying medicine and doctors not breaking the skin have been deleted. The much-quoted reference to 'do no harm' is also in need of explanation. Does not doing harm mean that we should prolong a life that the patient sees as a painful burden? Surely, the 'harm' in this instance is done when we prolong the life, and 'doing no harm' means that we should help the patient die. Killing the patient--technically, yes. Is it a good thing--sometimes, yes. Is it consistent with good medical end-of-life care: absolutely yes."
Sherwin Nuland, MD, clinical professor of Surgery at the Yale School of Medicine, wrote in his Feb. 24, 2000 article titled "Physician-Assisted Suicide and Euthanasia in Practice," published in The New England Journal of Medicine, available at www.nejm.org:
"Many opponents of [euthanasia and physician-assisted suicide] point to the Hippocratic Oath and its prohibition on hastening death. But those who turn to the oath in an effort to shape or legitimize their ethical viewpoints must realize that the statement has been embraced over approximately the past 200 years far more as a symbol of professional cohesion than for its content. Its pithy sentences cannot be used as all-encompassing maxims to avoid the personal responsibility inherent in the practice of medicine. Ultimately, a physician's conduct at the bedside is a matter of individual conscience.
The wisdom of past years and moments enters into the deliberation, but decision making in the present bears a burden that is unique to the particular transaction between the doctor and the individual patient who has come for help. To seek refuge in ancient aphorisms is to turn away from the unique needs of each of our patients who have entrusted themselves to our care."
Martin Gold, JD, Counsel of Record, in his Oct. 1996 Amicus Curiae brief "Bioethicists Supporting Respondents" in Vacco v. Quill and Washington v. Glucksberg, wrote:
"At the time of Hippocrates, there was no prohibition against physician-assisted suicide in mainstream Greek medicine... neither the Hippocratic Oath nor classical tradition provides a compelling ethical or professional prohibition of physician-assisted suicide."
Stephen R. Reinhardt, LLB, Judge on the US Court of Appeals for the Ninth Circuit, in the May 28, 1996 majority opinion for Compassion in Dying v. State of Washington, wrote:
"In Roe [v. Wade], the Court cited a scholar's conclusion that the Hippocratic Oath 'originated in a group representing only a small segment of Greek opinion and that it certainly was not accepted by all ancient physicians.' The Court stressed the Oath's 'rigidity' and was not deterred by its prohibitory language regarding abortion. As Roe shows, a literalist reading of the Hippocratic Oath does not represent the best or final word on medical or legal controversies today. Were we to adhere to the rigid language of the oath, not only would doctors be barred from performing abortions or helping terminally ill patients hasten their deaths, but according to a once-accepted interpretation, they would also be prohibited from performing any type of surgery at all, a position that would now be recognized as preposterous by even the most tradition-bound AMA members."
Thomas A. Preston, MD, former Chief of Cardiology at Pacific Medical Center and Professor of Medicine at University of Washington, in his 1995 Seattle Law Review article "Physician Involvement in Life-Ending Practices," stated:
"...In the time of Hippocrates, physicians had no drugs of therapeutic efficacy by present standards, but they did have poisons which were sometimes used on non-dying patients for mischievous purposes. In this context, the Hippocratic injunction against the use of deadly drugs was good public relations for the medical guild, and had nothing to do with terminally-ill patients.
…The context in which physicians might end patients' lives has changed. Hippocrates never had a patient on a ventilator. As recently as about thirty years ago no physician had a patient with recurrence of leukemia after bone marrow transplantation. Modern medicine has changed the context in which patients now die, from one natural death with relative impotence of physicians to change the course of dying, to medical prolongation of life resulting in different and unnatural forms of dying. The injunction against lethal drugs in the old context of dying remains valid, but we rightly should reassess it in the context of modern forms of dying.
…The physician who prolongs her patient’s life, but who then aids in the patient’s request to die, has not violated the Hippocratic injunction, and in fact has fulfilled the physician’s duty to heal so far as is reasonable without producing harm."