First, Do No Harm, Part III – Primum Non Nocere.
Welcome to this final treatment on the topic of Primum No Nocere. What a journey it is and it is not over. The basic tenent of First, Do No Harm has survived the millennia. Our world has become smaller and more inter-connected because of technology. Because of this lines have blurred between cultures, societies, male and female as to what we are capable of and what is expected. This has caused a transfer of information at unprecedented rates. We are finding out that we truly are much more alike than different, despite differences. As this transfer of information has grown our understanding of ourselves and of the workings of anatomy has grown many-fold. These progressions of the human, mind, body and spirit has also caused a change to the what we write. They are reflected in the progression of these medical oathes.
It is apparent that deities no longer influence many of these thought processes as they did in Hammurabi’s,
Vaidya’s, Hippocrates’, Sun Simiao’s Asaph’s, Maimodes’ and Enjuin’s time with their polytheistic and monotheistic overlays. (Though I believe that theism still plays an underlying role). What once was taboo is now passeé or on its way to be. The oaths have taken on a more humanistic form. You will see this change in the more current revised version of the Hippocratic oath and the AMA Code of Medical Ethics. And, surprisingly for me at least, these oathes are no longer a requirement of graduating physicians.(1) In some cases these oathes are now being called “declarations”.
– The code of HAMMURABI 1792–1750 BCE;
– VAIDYA’S oath, somewhere in the 1600s BCE;
– HIPPOCRATIC Oath, somewhere around 4 BCE;
– SUN SIMIAO OATH (581–682 CE), also known as the “Chinese Hippocrates”;
– ASAPH OATH – somewhere around 600 CE;
– THE OATH OF MAIMONIDES – somewhere around the 1500s CE;
• The 17 rules of ENJUIN – somewhere around the 1500s CE, Japan;
• HIPPOCRATIC Oath, CONTEMPORARY 1964 & 2010
• AMA Code of Medical Ethics, 2001 American Medical Association code of ethics;
• American Board Of Internal Medicine. (Summary)
The 17 rules of Enjuin 1500s CE, Japan (2)
The Seventeen Rules of Enjuin are a code of conduct developed for students of the Japanese Ri-shu school of medicine in the 16th century CE. These rules require physicians to work together with others of their trade as a brotherhood. The guidelines regarded conduct not only in action but also in mind, prohibiting immoral feelings when examining a woman.
1. Each person should follow the path designated by Heaven (Buddha, the Gods).
2. You should always be kind to people. You should always be devoted to loving people.
3. The teaching of Medicine should be restricted to selected persons.
4. You should not tell others what you are taught, regarding treatments without permission.
5. You should not establish association with doctors who do not belong to this school.
6. All the successors and descendants of the disciples of this school shall follow the teachers’ ways.
7. If any disciples cease the practice of Medicine, or, if successors are not found at the death of the disciple, all the medical books of this school should be returned to the School of Enjuin.
8. You should not kill living creatures, nor should you admire hunting or fishing.
9. In our school, teaching about poisons is prohibited, nor should you receive instructions about poisons from other physicians. Moreover, you should not give abortives to the people.
10. You should rescue even such patients as you dislike or hate. You should do virtuous acts, but in such a way that they do not become known to people. To do good deeds secretly is a mark of virtue.
11. You should not exhibit avarice and you must not strain to become famous. You should not rebuke or reprove a patient, even if he does not present you with money or goods in gratitude.
12. You should be delighted if, after treating a patient without success, the patient receives medicine from another physician, and is cured.
13. You should not speak ill of other physicians.
14. You should not tell what you have learned from the time you enter a woman’s room, and, moreover, you should not have obscene or immoral feelings when examining a woman.
15. Proper or not, you should not tell others what you have learned in lectures, or what you have learned about prescribing medicine.
16. You should not like undue extravagance. If you like such living, your avarice will increase, and you will lose the ability to be kind to others.
17. If you do not keep the rules and regulations of this school, then you will be cancelled as a disciple. In more severe cases, the punishment will be greater.
HIPPOCRATIC OATH, CONTEMPORARY(3)
Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University
• 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 [that] are required, avoiding those twin trap of over treatment 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.
HIPPOCRATIC OATH, CONTEMPORARY 2010(4)
“I do solemnly swear, by whatever each of us hold most sacred:
• That I will be loyal to the Profession of Medicine and just to its members.
• That I will lead my life and practice my art in uprightness and honor.
• That into whatsoever house I shall enter it shall be for the good of the sick to the utmost of my power, my holding myself far aloof from wrong, from corruption, from the tempting of others to vice.
• That I will exercise my art solely for the cure of my patients, and will give no drug nor perform an operation for a criminal purpose, even if solicited, far less suggest it.
• That whatsoever I shall see or hear of the lives of my patients which is not fitting to be spoken, I will keep inviolably secret.
• These things I do swear. Let each of us bow the head in sign of acquiescence.
American Medical Association 2001. (AMA)
Principles of Medical Ethics – Physician’s Charter. (5)
I. A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.
II. A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities.
III. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.
IV. A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law.
V. A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated.
VI. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.
VII. A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.
VIII. A physician shall, while caring for a patient, regard responsibility to the patient as paramount.
IX. A physician shall support access to medical care for all people.
ABIM – American Board Of Internal Medicine Summary
The practice of medicine in the modern era is beset with unprecedented challenges in virtually all cultures and societies. These challenges center on increasing disparities among the legitimate needs of patients, the available resources to meet those needs, the increasing dependence on market forces to transform health care systems, and the temptation for physicians to forsake their traditional commitment to the primacy of patients’ interests. To maintain the fidelity of medicine’s social contract during this turbulent time, we believe that physicians must reaffirm their active dedication to the principles of professionalism, which entails not only their personal commitment to the welfare of their patients but also collective efforts to improve the health care system for the welfare of society. This Charter on Medical Professionalism is intended to encourage such dedication and to promote an action agenda for the profession of medicine that is universal in scope and purpose.
HOW DOES THIS ALL TIE INTO CIEAURA AND MYSELF?
HERE IS HOW…
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I truly hope that you have enjoyed this series along with improved understanding of how far we have come, the progress being made and the contributions Cieaura is making in energy wellness. I know it is for me. What possibilities the future holds!
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Chipsterhealth, March 16, 2013
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(1) In a 1989 survey of 126 US medical schools, only three reported usage of the original oath, while thirty-three used the Declaration of Geneva, sixty-seven used a modified Hippocratic oath, four used the Oath of Maimonides, one used a covenant, eight used another oath, one used an unknown oath, and two did not use any kind of oath. Seven medical schools did not reply to the survey. In France, it is common for new medical graduates to sign a written oath.
“Hippocratic Oath.” (June 1, 2011) http://en.wikipedia.org/wiki/Hippocratic_Oath (accessed June 1, 2011).
(2) The 17 rules of Enjuin
(3) HIPPOCRATIC OATH, CONTEMPORARY 1964
(4) HIPPOCRATIC OATH, CONTEMPORARY 2010
(5) American College of Allergy, Asthma & Immunology. “American Medical Association Code of Ethics.” (June 17, 2001) http://www.acaai.org/about/Pages/code-of-ethics.aspx (accessed June 1, 2011).
Halsall, Paul. “Hammurabi’s Code of Laws.”Internet Ancient History Sourcebook. (1998) http://www.fordham.edu/halsall/ancient/hamcode.html (accessed June 1, 2011).