First, do no harm

The words “First, do no harm,” are not in the Hippocratic oath. Too often, lately, we’ve seen journalists reporting that medical personnel involved in the interrogation of prisoners are violating “their Hippocratic oath,” which says “First, do no harm.” These journalists are showing their ignorance of medical education, modern medical practice, and history, and at the same time they are perpetuating the myth that doctors must commit to a higher moral standard than the rest of us.

The words “First, do no harm,” or Primum non nocere in the original Latin, are from Galen, a Roman physician. Not from Hippocrates, the Greek father of medicine, and certainly not from the Hippocratic oath. Hippocrates actually did say something similar, something that probably should have been in the oath, and perhaps the inspiration for Galen, but that’s as close as it gets. In Epidemics, Bk. I, Sect. XI. he writes:

“Declare the past, diagnose the present, foretell the future; practice these acts. As to diseases, make a habit of two things— to help, or at least to do no harm.”

The simple fact of the matter is that for many graduating doctors, taking an oath is optional. If they do take one it can be (rarely) the original, or any of several variations that have been updated to reflect the nature of modern medicine, and the beliefs of the particular medical school.

But for some reason, we are still taught that doctors take the Hippocratic Oath, or at least we respond angrily when told that a doctor has violated it. Journalists are doing the public a disservice when they perpetuate the myth. Perhaps we should insist that journalists take an oath that begins “First, tell no lies.”

Here, for your edification, are three medical oaths:

  • The classical Hippocratic Oath, according to a 1943 translation from the Greek.
  • The Lasagna Oath, written in 1964 by Dr. Louis Lasagna, academic dean of the medical school at Tufts, and
  • A somewhat more generic oath endorsed by the American Medical Association.
  • The Classical Hippocratic Oath

    I swear by Apollo the physician and Aesculapius, and Hygieia and Panaceia, and all the gods and goddesses, that, according to my ability and judgement, I will keep this Oath and this stipulation.

    To reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, 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 disciples bound by a stipulation and oath according to the law of medicine, but to none others.

    I will follow that system of regimen which, according to my ability and judgement, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion.

    With purity and with holiness I will pass my life and practice my Art. I will not cut persons labouring under the stone, but will leave this to be done by men who are practitioners of this work. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further, from the seduction of females or males, of freemen and slaves.

    Whatever, in connection with my professional service, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret.

    While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times. But should I trespass and violate this Oath, may the reverse be my lot.

    The Lasagna Oath

    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 which 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.

    Oath endorsed by the American Medical Association

    You do solemnly swear, each by whatever he or she holds most sacred: That you will be loyal to the Profession of Medicine and just and generous to its members. That you will lead your lives and practice your art in uprightness and honor.

    That into whatsoever house you shall enter, it shall be for the good of the sick to the utmost of your power, your holding yourselves far aloof from wrong, from corruption, from the tempting of others to vice.

    That you will exercise your art solely for the cure of your patients, and will give no drug, perform no operation, for a criminal purpose, even if solicited, far less suggest it.

    That whatsoever you shall see or hear of the lives of men or women which is not fitting to be spoken, you will keep inviolably secret.

    These things do you swear. Let each bow the head in sign of acquiescence. And now, if you will be true to this, your oath, may prosperity and good repute be ever yours; the opposite, if you shall prove yourselves forsworn.

    –SG

    What do you think? Please enter a comment below.

    4 Responses to “First, do no harm”

    1. LL Says:

      PLEASE see also ‘Confessions of a Medical Heretic’ by Robert Mendelsohn.

    2. SG Says:

      Mendelsohn is often quoted as a leading critic of the Medical Industry and is a good reference for further reading on our topic. He gets enough criticism from the medical establishment that you start to think the gentlemen do protest too much. For example: “A Few Notes on Robert Mendelsohn, M.D.” Quackwatch is a front for the Medical Industry, essentially a one man-band who, like Karl Rove, will say just about anything to discredit anyone who dares to criticise the Medical Establishment. Ironically, protectionism, solidarity, and demarcation are firmly entrenched in the Hippocratic Oath.

      You might also, enjoy “Dr. Tom Cruise, M.D.” — Tom Cruise on the Universal Efficacy of Vitamins in Treating Every Medical Problem Known to Man, by Bachem Macuno. We don’t know what sort of Oath they administer when they jump you into Scientology, but evidently it allows them to practice medicine.

    3. LL Says:

      Without a doubt, the medical profession would sure love to discredit this fine man. Too bad they rely on the “quackbuster,” Stephen Barrett, as their hatchet-man. Among other things, Barrett’s made a career out of being the medico’s point-man in the battle to minimalize chiropractic, and absolutely any other alternative to allopathy, yet his own credentials and motives might bear a little scrutiny:

      http://www.iahf.com/antiquackbusters/20020105a.html

      http://www.quackpotwatch.org/opinionpieces/obfuscator.htm

      http://www.rvi.net/~fluoride/000222.htm

      http://www.healthfreedomlaw.com/Welcome%20Clark%20Fights%20Back%20-%20Figueroa%20Dismissed.htm

      http://www.toolsforhealing.com/CD/Articles/Q/QuackBusters-AJudgesView.html

      etc.

    4. Acrobat Says:

      Hey, I’m so glad I came across your blog. You have tons of great information here, I’ll be sure to come back and keep on reading, keep up the good work!

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