When I started this column over three years ago, Eugene D Robin, MD, Professor Emeritus of Medicine and Physiology at Stanford gave me some insight concerning the Hippocratic Oath. I had known Dr Robin as one of the foremost investigators after reading some of his hundreds of research articles over the years. As I met more of is pulmonary fellows he had trained, I became aware that he also excelled in all three legs of medicine–clinical practice, and teaching in addition to research. His books have had a high moral perspective long before the discipline of ethics was as well developed as today. In 1984, he challenged the consciousness of physicians with the idea that some procedures may not only be unnecessary, but actually do harm. His book that year was titled MATTERS OF LIFE & DEATH: Risks vs. Benefits of Medical Care. In the NEJM the same year an article appeared stating that the physicians’ “need to know” more about the patient’s illness than is necessary for treatment, would eventually exhaust medicine’s economics resources. In April 1985 Dr Robin wrote an article for California Physician with the subtitle of “At least try to do more good than harm.” In 1986, Dr Robin’s book was reissued in a popular format by Harper & Roe as MEDICAL CARE CAN BE DANGEROUS TO YOUR HEALTH. If at that time we had listened to him we may not have needed managed care today to conserve resources. It was then that I first became aware of Dr Robin’s research into the history of the Hippocratic Oath. In an article in THE LANCET on June 3, 1995 he summarized the background of the Hippocratic Oath. He recently sent me the latest revision of that oath which may have out lived it’s usefulness after 24 centuries. We publish this latest revision as a “Code of Conduct” for physicians to live by as we enter the 21st century.
The New Oath for Physicians
In the name of suffering humanity, with humility, compassion, and dedication to the welfare of the sick according to the best of my ability and judgment, I will keep this oath and stipulations:
I will be honest with my patients in all medical matters. When this honesty reveals bad news, I will deliver it with understanding and sympathy and tact.
I will provide my patients with acceptable alternatives for various forms of diagnosis and medical and surgical treatment, explaining the risks and benefits as best I know them.
I will allow my patients make the ultimate decision about their own care. In circumstances where my patients are incapable of making decisions, I will accept the decision of family members or loved ones, encouraging them to decide as they believe the patient would have decided.
I will not sit in moral judgment on any patient, but will treat their illness to the best of my ability whatever the circumstances.
I will be empathetic to patients with illnesses caused by substances such as alcohol or drugs, or other forms of self-abuse usually believed to be under voluntary control.
Knowing my own inadequacies and those of medicine generally, I will strive to cure when possible but to comfort always.
I shall perform medical tests only if I believe there Is a reasonable chance that the results will improve the outcome.
I will not perform any tests or procedures or surgery solely to make money. I will freely refer my patients to other physicians If I am convinced that they are better able than I to provide treatment.
I will freely furnish copies of medical records to patients or their families upon request.
I will do unto patients and their families only what I would want done unto me or my family. I will not experiment on patients unless the patients give truly informed consent. I will strive to instruct patients fully so their informed consent is possible.
I will remain a student all my professional life, attempting to learn not only from formal medical sources but from my patients as well.
I will attempt to function as a teacher for my patients so that I can care for them more effectively and can apply the lessons they provide to the care of other patients.
I will provide care to all patients seeking it, regardless of sex, race, colour, creed, sexual preference, lifestyle, or economic status. In particular, I will volunteer some of my time to providing free care to the poor, the homeless, the disadvantaged, the dispossessed, and the helpless.
I will turn away no patient, even though with dreaded contagious diseases.
I will encourage my patients to seek medical opinions other than my own before agreeing to accept my opinion.
I will treat my professional colleagues with respect and honour, but I will not hesitate to testify openly about physicians and medical institutions that are guilty of malpractice, malfeasance, cupidity, or fraud.
I will defend with equal fervour colleagues who are unjustly accused of malpractice, malfeasance, cupidity, or fraud.