Клятва Гиппократа: История и Современное Значение

Oath of ethics taken by physicians

The Hippocratic Oath is an oath of ethics historically taken by physicians. It is one of the most widely known of Greek medical texts. In its original form, it requires a new physician to swear, by a number of healing gods, to uphold specific ethical standards. The oath is the earliest expression of medical ethics in the Western world, establishing several principles of medical ethics which remain of paramount significance today. These include the principles of medical confidentiality and non maleficence. As the seminal articulation of certain principles that continue to guide and inform medical practice, the ancient text is of more than historic and symbolic value. It is enshrined in the legal statutes of various jurisdictions, such that violations of the oath may carry criminal or other liability beyond the oath's symbolic nature. The original oath was written in Ionic Greek, between the fifth and third centuries BC. Although it is traditionally attributed to the Greek doctor Hippocrates and it is usually included in the Hippocratic Corpus, some modern scholars do not regard it as having been written by Hippocrates himself.

The oath is arguably the best known text of the Hippocratic Corpus, although most modern scholars do not attribute it to Hippocrates himself, estimating it to have been written in the fourth or fifth century BC. Alternatively, classical scholar Ludwig Edelstein proposed that the oath was written by the Pythagoreans, an idea that others questioned for lack of evidence for a school of Pythagorean medicine. While Pythagorean philosophy displays a correlation to the Oath's values, the proposal of a direct relationship has been mostly discredited in more recent studies. Its general ethical principles are also found in other works of the Corpus: the Physician mentions the obligation to keep the 'holy things' of medicine within the medical community (i. e. not to divulge secrets); it also mentions the special position of the doctor with regard to his patients, especially women and girls. However, several aspects of the oath contradict patterns of practice established elsewhere in the Corpus. Most notable is its ban on the use of the knife, even for small procedures such as lithotomy, even though other works in the Corpus provide guidance on performing surgical procedures. Providing poisonous drugs would certainly have been viewed as immoral by contemporary physicians if it resulted in murder. However, the absolute ban described in the oath also forbids euthanasia. Several accounts of ancient physicians willingly assisting suicides have survived. Multiple explanations for the prohibition of euthanasia in the oath have been proposed: it is possible that not all physicians swore the oath, or that the oath was seeking to prevent widely held concerns that physicians could be employed as political assassins. The interpreted AD 275 fragment of the oath contains a prohibition of abortion that is in contradiction to original Hippocratic text On the Nature of the Child, which contains a description of an abortion, without any implication that it was morally wrong, and descriptions of abortifacient medications are numerous in the ancient medical literature. The oath's stance on abortion was unclear even in the ancient world where physicians debated whether the specification of pessaries was a ban on simply pessaries, or a blanket ban on all abortion methods. Scribonius Largus was adamant in AD 43 (the earliest surviving reference to the oath) that it precluded abortion. William Henry Samuel Jones states that "abortion though doctors are forbidden to cause it, was possibly not condemned in all cases". He believed that the oath prohibited abortions, though not under all circumstances. The oath stands out among comparable ancient texts on medical ethics and professionalism through its heavily religious tone, a factor which makes attributing its authorship to Hippocrates particularly difficult. Phrases such as 'but I will keep pure and holy both my life and my art' suggest a deep, almost monastic devotion to the art of medicine. He who keeps to the oath is promised 'reputation among all men for my life and for my art'. This contrasts heavily with Galenic writings on professional ethics, which employ a far more pragmatic approach, where good practice is defined as effective practice, without reference to deities. The oath's importance among the medical community is nonetheless attested by its appearance on the tombstones of physicians, and by the fourth century AD it had come to stand for the medical profession. The oath continued to be in use in the Byzantine Christian world with its references to pagan deities replaced by a Christian preamble, as in the 12th century manuscript pictured in the shape of a cross.

There is no direct punishment for breaking the Hippocratic Oath, although an arguable equivalent in modern times is medical malpractice, which carries a wide range of punishments, from legal action to civil penalties. In the United States, several major judicial decisions have made reference to the classical Hippocratic Oath, either upholding or dismissing its bounds for medical ethics: Roe v. Wade, Washington v. Harper, Compassion in Dying v. State of Washington (1996), and Thorburn v. Department of Corrections (1998). In antiquity, the punishment for breaking the Hippocratic oath could range from a penalty to losing the right to practice medicine. In 2022, a college in the Indian state of Tamil Nadu saw a batch of medical students undertaking the Charaka shapath, a Sanskrit Oath by the name of ancient sage physician Maharishi Charak instead of the Hippocratic oath. The state government subsequently dismissed the Dean of the Madurai medical college for this act.