Wednesday, September 03, 2003

The Hippocratic Oath and the Presidency

I recently heard an apt comment about Howard Dean: wouldn't it be nice to have a President who has already sworn to "do no harm"? This is a reference to Dean being a doctor and the Hippocratic oath. I decided to do some research on this and I discovered that there is no single standard for the oath and that not all medical schools require their graduates to swear it. Therefore, I do not know for a fact that Dean has taken this oath. Furthermore, the "do no harm" does not actually appear in the versions of the oath that I have found. It is, at best, a compression of the ideas present in the oath.

I did find what is probably the most commonly accepted version of the oath. It was written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University. I think it might be useful to annotate this oath and see how it might apply to the Presidency:

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.

This is essentially a restatement of the scientific method. Science teaches us above all else that knowledge, in order to advance, cannot be the exclusive pervue of a select few. In fact, egotism is contrary to the scientific method since the individual accomplishments of a single scientist cannot be more important then the advancement of science as a whole. A President who followed this principle would openly acknowledge the debt he has to other leaders and would actively seek out their input. He would also share with the world what he knows, where possible, rather than adopt the principle that everything should be a secret unless it is absolutely necessary to release that information.

I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

This is a call to do neither to little or to much to fix any particular problem. It is, I would suggest, an essential element of pragmatism. A President who followed this principle would not ignore problems until they got out of control nor assume that he has an exclusive view on the TRUTH and that everyone must do what he says.

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.

Problems cannot always be solved by the simple application of ideological theory or the latest technological doo-dad. Sometimes solving a problem requires the simple application of a sympathetic ear. A President who followed this rule would care about the less tangible qualities of leadership, not just the raw application of power.

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.

Humility is an essential quality. Few things are worse than someone who refuses to admit they are in over their head. They will just make the problem worse. A President who followed this rule would consult with others and be willing to admit that he does not have the solution to all the worlds problems.

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.

It chills me to think how applicable this is to our present situation in the War on Terrorism. A President who followed this rule would not strut around on aircraft carriers while people are dying due to the direct actions he had taken. He might still take those actions if they were necessary to protect the security of the nation. But he would not glory in the role of warrior-in-chief.

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.

The problems of the world are not problems on charts. They are not problems of theory. They are problems of human beings. A President who followed this rule would never lose focus on the fact that every single action he takes has real impact on real human beings.

I will prevent disease whenever I can, for prevention is preferable to cure.

The magic bullet doesn't exist. Not all problems can be solved with the proper application of force. Sometimes the best solution to a mess is to not get into the mess in the first place. Do I really need to explain how this one applies today?

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.

You are not above the rest of society because of your special abilities or your special role. Indeed, those abilities and your high place in society places obligations on you to put others before yourself. A President who follows this rule would understand that he is the servant of the people, not the other way around.

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.

The greatest pleasure comes from helping others. Praise and fortune are not the rewards for a job well done. The best reward is to be remembered fondly for the things you have done to improve the world around you.

Wouldn't it be nice to have a President who has already sworn to all these things?

Update: The AMA has a registry of oaths on their web page (thanks to 'space' for the link). Here is the oath for the Albert Einstein College of Medicine of Yeshiva University where Dr. Dean went to school (it may have changed since Dean graduated):

Declaration of Geneva

I solemnly pledge myself to consecrate my life to the service of humanity; I will give to my teachers the respect and gratitude which is their due; I will practice my profession with conscience and dignity; the health of my patient will be my fist consideration; I will respect the secrets which are confided in me, even after the patient has died; I will maintain by all the means in my power, the honor and the noble traditions of the medical profession; my colleagues will be my sisters and brothers, I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation or social standing to intervene between my duty and my patient; I will maintain the utmost respect for human life from its beginning even under threat and I will not use my medical knowledge contrary to the laws of humanity; I make these promises solemnly, freely, and upon my honor.

Still a pretty good model for a President eh?


Post a Comment

Links to this post:

Create a Link

<< Home