The Hippocratic oath and good medical practice

What is the Hippocratic Oath?

Hippocrates was a Greek philosopher and physician who lived from 460 to 377 BC. He is known as the "father of modern medicine"¹ . His work included the Hippocratic Oath which described the basic ethics of medical practice and laid down a moral code of conduct for doctors. The classical Hippocratic Oath has been translated and interpreted² . However, modern versions have also been proposed, using many of the basic principles of the original. Many people think that doctors still swear the Hippocratic Oath. It is not compulsory but in fact many medical schools now hold a ceremony where graduating doctors do swear an updated version. The British Medical Association (BMA) drafted a new Hippocratic Oath for consideration by the World Medical Association in 1997 but it was not accepted and there is still no one single modern accepted version³ . In some medical schools the Declaration of Geneva physician's oath is used⁴ . In others an oath individualised by the institution is used.

In 1997 only 50% of UK medical schools used a form of the Hippocratic Oath whereas in 2017 this study found that 19/27 (70%) of schools required an Oath, indicating an increase in the use of the Oath over the preceding 20 years⁵ .

A separate article discusses Medical Ethics.

Summary of principles from the Hippocratic Oath³

The classical Hippocratic Oath has been summarised as:

"A solemn promise:

• Of solidarity with teachers and other physicians.

• Of beneficence (to do good or avoid evil) and non-maleficence (from the Latin 'primum non nocere', or 'do no harm') towards patients. (In fact the well-known "first do no harm" phrase does not feature in the classical Hippocratic Oath.)

• Not to assist suicide or abortion.

• To leave surgery to surgeons.

• Not to harm, especially not to seduce patients.

• To maintain confidentiality and never to gossip."

General Medical Council: Good Medical Practice⁶

The GMC is charged with the supervision of the conduct of the medical profession. This includes educational standards, ethics and behaviour. The extent to which the GMC should question personal ethics and behaviour if they do not impinge on medical practice may be debated.

The GMC publishes advice to doctors on the standards expected of them in the form of the document 'Good Medical Practice'. It discusses the duties of a doctor registered with the GMC. This covers many of the principles of the original Hippocratic Oath.

Patients must be able to trust doctors with their lives and health. To justify that trust you must show respect for human life and you must fulfil certain duties which the GMC categorises into four domains:

Domain 1. Knowledge, skills and performance

• Make the care of your patients your first concern.

• Provide a good standard of practice and care:

  • Develop and maintain your professional performance.

  • Apply knowledge and experience to practice.

  • Recognise and work within the limits of your competence.

  • Record your work clearly, accurately and legibly.

Domain 2. Safety and quality

• Contribute to and comply with systems to protect patients.

• Respond to risks to safety.

• Protect patients and colleagues from any risk posed by your health.

Domain 3. Communication, partnership and teamwork

• Communicate effectively.

• Work collaboratively with colleagues to maintain or improve patient care.

• Teaching, training, supporting and assessing.

• Continuity and co-ordination of care.

• Establish and maintain partnerships with patients:

  • Listen to and respond to their concerns and preferences.

  • Give patients the information they want or need in a way they can understand.

  • Respect patients' right to reach decisions with you about their treatment and care.

  • Support patients in caring for themselves to improve and maintain their health.

Domain 4. Maintaining trust

• Show respect for patients:

  • Treat patients as individuals and respect their dignity.

  • Treat patients politely and considerately.

  • Respect patients' right to confidentiality.

• Treat patients and colleagues fairly and without discrimination.

• Act with honesty and integrity.

• Never abuse your patients' trust in you or the public's trust in the profession.

You are personally accountable for your professional practice and must always be prepared to justify your decisions and actions.

For full details and elaboration, refer to the GMC's Good Medical Practice advice⁶ .

The GMC also has further guidance on the duty of confidentiality, and on acting on concerns about patient safety (for example, due to a colleague's ill health or performance or due to inadequate premises, equipment, systems or policies)^{7 8} .

Resources

Ethics can be a very difficult issue and it often helps to discuss dilemmas with others. Partners or trainers may be the first point of call but others are also available to offer advice. Difficult decisions are often best shared. Your indemnity insurer will be happy to offer advice. You can also call the GMC and ask them for advice. The BMA also has a number of publications which may be of help⁹ .

When you make an ethical decision, remember that you may be called upon to justify it. Complex matters of ethics often do not have a simple right or wrong but all aspects of the argument need to have been explored. Consider the implications of your actions.

There are ethical problems with the use of new methods and technologies in medicine and all of these are affected by economic and political influences¹⁰ .