Do euthanasia and physician-assisted suicide violate the Hippocratic Oath?
General Reference (not clearly pro or con)
The National Institutes of Health's History of Medicine Division provided a description and the text of the Hippocratic Oath on its website (accessed Sep. 29, 2006):
"The Hippocratic Oath...is perhaps the most widely known of Greek medical texts. It requires a new physician to swear upon a number of healing gods that he will uphold a number of professional ethical standards...
Over the centuries, it has been rewritten often in order to suit the values of different cultures influenced by Greek medicine...
Hippocratic Oath:
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:
...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 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…
There are two highly controversial vows in the original Hippocratic Oath that we continue to ponder and struggle with as a profession: the pledges never to participate in euthanasia and abortion."
Do euthanasia and physician-assisted suicide violate the Hippocratic Oath?
PRO (yes)
CON (no)
Leon Kass, MD, PhD, former Chairman of the President's Council on Bioethics, wrote in his Winter 1989 article "Neither for Love nor Money" 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."
Wesley Smith, JD, Consultant to the International Anti-Euthanasia Task Force, wrote in a Mar. 9, 2006 article "Harm Done" that appeared in the National Review Online:
"Dr. Sherwin Nuland...a supporter of euthanasia in limited cases, proposed...that doctors be provided 'thorough training in [euthanasia] techniques'...
Such 'how to kill your patients' classes would clearly violate the famous Hippocratic Oath under which doctors have for some 2,500 years pledged, 'I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect.'
Nuland knew that, of course. But he dismissed the relevance of the Oath...
For most people, this is a very radical idea... 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..."
Nigel M. de S. Cameron, PhD, wrote in his Oct. 23, 1995 article "Doctors Under Oath" that appeared in Christianity Today:
"…Hippocrates, the famous physician of antiquity, is in the news once again. Although almost nothing is known of his life and work, he gave birth to centuries of medical tradition in Western civilization.
Among recent developments, a group of distinguished doctors and ethicists, including some Christian leaders, have signed a modernized version of the famous oath. That may not be too much of a surprise, since Hippocrates was the father of all prolifers. On the twin life issues of abortion and euthanasia, he made the definitive statements: No, No…
Try though we may, we cannot entirely escape the notion that medicine is indelibly inscribed with human values. The genius of Hippocrates, with his pagan vision of human dignity that so remarkably anticipated the Judeo-Christian vision of care for those who are made in the image of God, was to bind medical practice and moral commitments in a covenant of indissoluble marriage…
Hippocratic medicine treats human life as a gift from beyond human life, a covenant stewardship to be kept by patient and physician alike."
Philip Nitschke, MD, Director and Founder of Exit International, commented in his June 5, 2001 interview with Kathryn Jean Lopez titled "Euthanasia Sets Sail" that appeared in the National Review Online:
"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, wrote in his Feb. 24, 2000 article titled "Physician-Assisted Suicide and Euthanasia in Practice," published in The New England Journal of Medicine:
"If the prevention and relief of suffering are the aims of medical interventions--and not only the preservation or prolongation of life--it seems imperative to rethink our profession's reluctance to participate in euthanasia or even be present during an assisted suicide without legal guarantees of protection.
Many opponents of these practices 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, wrote in his Oct. 1996 Amicus Curiae brief "Bioethicists Supporting Respondents" in Vacco v. Quill and Washington v. Glucksberg:
"The Hippocratic Oath can only be understood in its historical context. At the time of Hippocrates, there was no prohibition against physician-assisted suicide in mainstream Greek medicine; the practice was subject to consultation and informed consent similar in intent to the protocols urged by medical professionals and bioethicists today…
Adherents of the Hippocratic school of medicine were strongly influenced by Pythagoras. Not unlike contemporary adherents of natural cures for disease, he eschewed many then-mainstream, accepted medical practices. The original Greek version of the Oath, quoted by the Quill petitioners, required the followers of Hippocrates:
'to teach them this art--if they desire to learn it -- without fee and covenant;
[to] apply dietetic measures for the benefit of the sick according to my ability and judgment;
not [to] give to a woman an abortive remedy
not [to] use the knife'…
The text of the Hippocratic Oath has been modified many times through the ages. Contemporary versions, routinely adopted in medical-school graduation exercises and similar contexts…do not contain the prohibitions against surgery, abortion, or accepting fees for teaching medicine, and also omit the prohibition against physician-assisted suicide. In short, neither the Hippocratic Oath nor classical tradition provides a compelling ethical or professional prohibition of physician-assisted suicide."
