The Hypocritical Hippocratic Oath

Since the time of Ancient Greece, doctors, physicians, healers, and surgeons have sworn the Hippocratic Oath- a solemn vow to “To hold him who has taught me this art as equal… if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art—if they desire to learn it—without fee and covenant… I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice…”.

Or at least, this was the oath that was taken in the time of Hippocrates- to whom the authorship of the oath is attributed. Of course, the modern Hippocratic Oath has changed greatly over the past two and a half millennia. The contemporary text, adapted in 1964, focuses primarily on treating patients not as “a fever chart, [or] a cancerous growth” but as actual people, while also promising respect the privacy of patients and to not “play God”.

So what’s the issue? While the modern version of the Hippocratic Oath makes good points, it lacks certain fundamental elements found in the original oath. While the original oath made doctors obligated to teach each other’s children (if willing to learn) free of charge. Today, learning to become a doctor takes eight years (minimum) and costs a small fortune (medical university is far from cheap). The original oath also ordered doctors to protect their patients from “injustice”. Not disease, not infection, but injustice. This part of the oath is nowhere to be found in later versions.

Now the first section discussed- the section concerning the mutual instruction of the medically aspiring children of fellow doctors- is perhaps understandable. With today’s advances in the fields of medicine, surgery, and pharmaceuticals, it is understandable that this part of the original oath is no longer applicable- after all, there’s only so much any one doctor can know. Nevertheless, one can’t help but imagine what society would be like if doctors- all doctors- were obligated to teach. If anyone willing and diligent enough to learn medicine could study medicine regardless of how rich or poor he was, what would our world look like? Would we have eliminated cancer by now? Would we have the cure for the common cold?

One can really only guess. This is, after all, the great, good, and glorious Capitalist system where a person’s quality of education (or very existence thereof) is determined by the size of his wallet (though the issue of Capitalist/Communist education has been covered in previous posts).

And what of the section concerning a doctor’s duty to protect his patients from injustice? One can easily see why this part would be taken out of newer versions. This is a Capitalist society where medical treatment, like almost everything else, is merely a commodity to be bought and sold. If a patient is dying but cannot afford the treatment that would save him, the doctor is left with an irresolvable quandary. On one hand the doctor has a patient who cannot afford the treatment he needs to live, on the other hand, the laws of Capitalism state that anything is worth what its purchaser will pay for it. So the doctor is presented with a single, impossible option. If he goes along with the “purchase-worth-price-paid” logic, he’d be forced to conclude that since the dying man will not (because he cannot) pay for the treatment, he would rather not live and is therefore suicidal and best committed to a mental institution. Since the man clearly isn’t suicidal, the doctor must either (1) state that the Hippocratic Oath is fundamentally flawed or (2) state that Capitalism is fundamentally flawed. Fortunately, the doctor will not decision. Since, as the advocates of Capitalism would have us believe, Capitalism is completely compatible (perhaps the only system compatible) with justice, the entire situation is a logical paradox and therefore this situation can never exist.

Yeah, right.

Despite [deeply flawed] logic, these situations exist all across the globe, not only for life-or-death situations but almost any medical issue, from cough medicine to prosthetic limbs to brain surgery. The Hippocratic oath, so long as it is practiced in a Capitalist society, will always be a sad hypocrisy. The ugly truth is that Hippocratic oath- even the contemporary Hippocratic oath- will never be able to mesh with Capitalism. There will always be a conflict between ethics and economics, and frankly, if there’s a choice between the two I think it’s pretty obvious which option I’ll take.

And for this reason I submit that we do away with the Capitalist system and replace it with something better. A system where anyone who chooses to be a doctor can be a doctor and have the best medical education available. A system where any person sick, injured, or dying has the opportunity to be treated, and by doctors who are doing so out of the love of their profession and sense of justice and humanity- not self-interest and greed. A system where doctors are never forced to choose between economic feasibility and the Hippocratic oath.

The Capitalist health system is terminally ill, and I believe that this is a physician unable to health itself. Yes, the Capitalist system is in place and has been for a long time, however, as time goes on and the line between justice and injustice becomes more distinct, more pronounced, it is only a matter of time before the people revolt against a system based on flawed-logic and hypocrisy.


15 Responses to “The Hypocritical Hippocratic Oath”

  1. 1 hogcatch
    July 13, 2009 at 11:33 pm

    Fact of the business is medical science revolves around trial and error! As long as the “error” part can cost a physician their career, the cost of delivering the service will be high! Insurance is only a curtain between them and the pile of $ allocated from our economy to pay for it, and none of the providers are willing to walk away from the curtain with the thought they left something behind!

    • 2 Kelly
      April 15, 2012 at 7:03 am

      Error should not cost a doctor her career! It doesn’t in Scandinavia. Patients don’t sue- it’s unheard of. Doctors are people and mistakes happen.

  2. 3 trotskyite
    July 14, 2009 at 12:05 am

    So your point is?

  3. July 16, 2009 at 12:28 am

    Trotskyiye, how do you define justice?

  4. 5 trotskyite
    July 16, 2009 at 12:52 am

    People getting exactly what they deserve.

  5. July 16, 2009 at 4:08 pm

    Okay, that’s pretty close to how I define it as well. But I can’t make any sense of the paragraph that begins, “And what of the section concerning a doctor’s duty…” How is this a matter of justice?

  6. 7 trotskyite
    July 16, 2009 at 6:18 pm

    Yeah, I never got around to developing that section- I was considering suggesting that doctors have, due to their Hippocratic oaths, an obligation to propagate justice even when it means going against the Capitalist system. For example, if a patient was dying and couldn’t afford a specific drug, wouldn’t the doctor be obligated to obtain that drug and save his patient, even if it means breaking into a pharmacy?

  7. July 17, 2009 at 3:28 am

    I see. Under a capitalist system, that’s a dilemma because nobody wants the person to die for lack of ablity to pay; we receive things under capitalism according to ability and willingness to pay. Under communism there would be no dilemma because he would receive the medicine for free, according to his needs. Got it.

    This brings the question of need into sharp focus, which I have been thinking about lately and wanted to ask you anyway. For the man to receive medicine, society will have to have produced the medicine. Under capitalism, society knows how much to produce by means of the price mechanism. Under communism, how do we measure need and how do we determine production?

    Also, about need– back home, I drive a big Dodge 1500 conversion van. (I picked it up used for pretty cheap). I’ve made good use of it. I took it with me to New Orleans when I did some post-Katrina work there. It served as a bedroom, a mobile office, a shelter, and a personnel transport. I’ve taken it with me on a lot of road trips, and I’ve got it stocked with emergency equipment that I’ve used to help people out. Personally, I’d try to make the case that I need this van, and I can point to all the good that has come from my having it, though I would not have been able to formulate that argument back when I bought the thing. I didn’t know it would become such a good investment.

    Meanwhile, my friend the college professor will tell you quite bluntly and in all seriousness that he needs a Cadillac. He also requires air conditioning and a good parking space. And he means it; he doesn’t stop fighting until he gets these things, I’ve seen it. He’ll park in the college president’s space if he has to, but he will have his good parking space.

    So, away from obvious things like medicine and food and so on, how does communism measure a person’s needs? Under communism, would I have received a van and my friend his Cadillac? Or would we both be required to drive Volkswagens? Maybe you could write a post about how commuism measures need.

  8. 9 trotskyite
    July 17, 2009 at 5:40 am

    In all honesty, I’d have to tell this professor that I’m confident he’ll survive with his car or parking space.

    As far as cars go, I’d generally imagine that there’d be a push for an efficient public transport system, which would save money, make streets less crowded, and leave a smaller impact on the environment. “Private” cars would be lent to those who don’t have the option of public transport. Since we have different cars for different purposes, the public would be by no means limited to a single model (though we’d probably avoid creating flashy, expensive, and inefficient models like that Hummer-limo cross). Obviously I don’t know every aspect of the proposed Communist world, I can only estimate and postulate.

    As far as other necessities go, such as food and medicine, I believe that the public ministries of agriculture and health would be fully capable of meeting the people’s needs. After all, corporations are able to supply the public with the essentials- there’s no reason a public ministry can’t do the same job. Just because money is eliminated doesn’t mean demand goes away. The public ministries need to merely supply the minimum amount needed and if there’s any resources left over (as there hopefully would be- the ministries should err on the side of caution), then these can be either stored up as emergency supplies or traded off or donated to less fortunate countries.

  9. July 17, 2009 at 4:59 pm

    “In all honesty, I’d have to tell this professor that I’m confident he’ll survive with his car or parking space.”

    Well, I’m glad you are confident. This is not a man who will condescend to taking public transportation, and he will be no end of trouble for all of us until he has his parking space. It will cost society more to withhold a Cadillac and good parking from him than it would to provide him with these things. Using the price mechanism, the professor can demonstrate just how important these things are to him by paying for them, thereby averting the trouble he would otherwise cause. How in communism do we spot such peculiar individuals before they cause expensive problems?

    I don’t understand how the ministries you describe will decide how much of things to produce. If they consistently err on the side of excess, then considerable resources will go to stores, emergency supplies, and donations that could have been productively employed elsewhere. This is exactly what happened in the U.S. housing market, actually. People dumped way too much money into houses and built more than society needed. The resulting repercussions have been very painful. That pain is what it feels like when you produce too much of something. It is the poverty that comes when resources are squandered on things we don’t need. Without the price mechanism I suppose we wouldn’t feel the pain, but that doesn’t mean we wouldn’t be wasting our efforts. What mechanisms in communism exist to ensure we produce the right amounts of things?

  10. 11 trotskyite
    July 17, 2009 at 9:32 pm

    I just now realized that I have a typo in my previous comment. What I meant to write was “I’m confident he’ll survive without his car or parking space.”

    I’m not quite sure of what you mean when you say that your friend will be “no end of trouble” without his parking space. I’m quite sure what that he can do much of anything to attain something (in my own opinion) quite so trivial as a parking space. Unless he somehow manages to get fifty-one percent of the population to vote that he should have a parking space and a Cadillac, I’m afraid that he’ll probably have to do without.

    As far as creating extra resources, I think that we can’t use the current economic situation as an example. Yes, investing far too heavily in the housing market resulted in a financial fiasco, but one must keep in mind that there are some serious differences between the proposed Communist system of resource allocation and the system we live in. The houses that were invested in, for example, cost money. In this Capitalist system, people will buy and sell houses according to how much profit they hope to make- too many people buying too many houses and not being able to sell them results in a crash. In the Communist system, however, the purpose of creating houses isn’t profit- it’s to ensure that the public receives adequate and safe housing. If there are suddenly a massive number of empty houses, then no one loses anything- the houses can always be given to new families or to immigrants. The same goes for medicine, food, building materials, etc.

  11. July 19, 2009 at 7:13 am

    Fifty-one percent. I guess if I wanted an addition to my home I’d need fifty-one percent of the vote.

    In thinking this policy through, I was reminded of the Wright brothers. As we all know, they invented the airplane. What is not so widely known is that by the time they got around to it, the concept of an airplane had been widely discredited. Rather like cold fusion today, heavier-than-air flight was the pursuit of crackpots. All the serious minds had moved on to something else.

    The Wright brothers weren’t crackpots, they had some insightful ideas about using differential lift to steer an aircraft, rather than trying to steer by means of a rudder. They also invented the wind tunnel, and experimented with it. They understood what they were doing, even if nobody else did.

    Because they had some personal money from their bicycle business, they could afford this odd pursuit. And of course, they eventually succeeded. Now, they needed materials to work with, and time to construct models and perform experiments. Because they held personal property, they were free to devote some resources to the project– the resources they owned.

    If they’d needed 51% of the vote in order to consume the resources needed for wind tunnels, models, and experiments, would they ever have gotten it? Almost certainly not– as I say, flight was the domain of hare-brained crackpots. No rational voter would waste public assets on such a silly thing.

    What allowances does communism make for the sort of individuality exhibited by the Wright brothers? Clearly, all of society has benefitted from the invention of the airplane, but without some private property, how will genius find room to do what it does? Under communism, where does creativity fit in?

  12. 13 trotskyite
    July 19, 2009 at 11:26 pm

    If you don’t mind, I’ll address this issue in a later post.

  13. July 20, 2009 at 3:15 am

    I look forward to it.

  14. 15 Kelly
    April 15, 2012 at 7:01 am

    Thanks for this post! I am an American, born and raised who moved to Scandinavia in my late 20s. I am now in medical school here. I could never imagine practicing in a capitalist healthcare system. Here it is a socialist (NOT communist, NOT red) system and while i see the good and bads with it, I am so thankful that I won’t have the ethics dilemma you describe. All get life-saving treatment, period.

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