Journal of Medicine and Philosophy, 30:107–128, 2005
Copyright © Taylor & Francis, Inc.
ISSN: 0360-5310 print
Journal of Medicine and Philosophy301Taylor & FrancisTaylor and Francis 325 Chestnut StreetPhiladelphiaPA191060360-5310XXXX-XXXX NJMPTaylor & Francis, Inc.4665510.1080/0360531059090708420051 32F. Jotterand The Hippocratic Oath and Contemporary Medicine
The Hippocratic Oath and Contemporary
Medicine: Dialectic Between Past Ideals
and Present Reality?
Rice University, Houston, TX, USA
The Hippocratic Oath, the Hippocratic tradition, and Hippocratic
ethics are widely invoked in the popular medical culture as con-
veying a direction to medical practice and the medical profession.
This study critically addresses these invocations of Hippocratic
guideposts, noting that reliance on the Hippocratic ethos and the
Oath requires establishing
1.what the Oath meant to its author, its original community of recep-
tion, and generally for ancient medicine,
what relationships contemporary invocations of the Oath and the
tradition have to the original meaning of the Oath and its original
what continuity exists and under what circumstances over the last
two-and-a-half millenniums of medical-moral reflections,
what continuity there is in the meaning of professionalism from the
time of Hippocrates to the 21st century, and
what social factors in particular have transformed the medical
profession in particular countries.
This article argues that the resources for a better understanding of
medical professionalism lie not in the Hippocratic Oath, tradition, or
ethos in and of themselves. Rather, it must be found in a philosophy
of medicine that explores the values internal to medicine, thus
providing a medical-moral philosophy so as to be able to resist the
deformation of medical professionalism by bioethics, biopolitics, and
governmental regulation. The Oath, as well as Stephen H. Miles’
Address correspondence to: Fabrice Jotterand, MA, PhD(c) Senior Managing Editor, The
Journal of Medicine and Philosophy, Rice University, 6100 Main Street, Houston, TX, 77005,
USA. Email: email@example.com
108 F. Jotterand
recent monograph, The Hippocratic Oath and the Ethics of Medicine,
are employed as heuristics, so as to throw into better light the extent
to which the Hippocratic Oath, tradition, and ethics can provide
guidance and direction, as well as to show the necessity of taking
seriously the need for a substantive philosophy of medicine.
Keywords: Hippocratic Oath, Hippocratic tradition, philosophy
of medicine, professional ethics
The Hippocratic Oath, the Hippocratic tradition, and Hippocratic ethics1 are
widely invoked in the popular medical culture as conveying a direction to
medical practice and the medical profession. In particular, they have been
invoked as a source of medical professional identity. However, closer exam-
ination shows more confusion than clarity. At best, one can say that the
Hippocratic Oath, tradition, and mores have played a symbolic force as a
moral rallying point at different times in the history of medicine.2
This study critically addresses these invocations of Hippocratic guide-
posts, noting that reliance on the Hippocratic ethos and the Oath requires
1. what the Oath meant to its author, its original community of reception,
and generally for ancient medicine,
what relationships contemporary invocations of the Oath and the tradi-
tion have to the original meaning of the Oath and its original reception,
what continuity exists and under what circumstances over the last two-
and-a-half millenniums of medical-moral reflections,
what continuity there is in the meaning of professionalism from the time
of Hippocrates to the 21st century, and
what social factors in particular have transformed the medical profes-
sion in particular countries (after all, it is far from clear whether there is
one sense of medical professionalism shared by medical professionals
across the world).
There is a challenge at the very outset: it is unclear what is meant by
medical professionalism. Reflections in this area are at best unsystematic
and underdeveloped. Many have argued that American medicine was in
important ways deprofessionalized in the 20th century (Engelhardt, 2002a).
This essay argues that the resources for a better understanding of medical
professionalism lie not in the Hippocratic Oath, tradition, or ethos in and of
themselves. Rather, it must be found in a philosophy of medicine that
explores the values internal to medicine, thus providing a medical-moral
The Hippocratic Oath and Contemporary Medicine109
philosophy so as to be able to resist the deformation of medical profession-
alism by bioethics, biopolitics, and governmental regulation. The Oath, as
well as Stephen H. Miles’ recent monograph, The Hippocratic Oath and the
Ethics of Medicine (2004), are employed as heuristics, so as to throw into
better light the extent to which the Hippocratic Oath, tradition, and ethics
can provide guidance and direction, as well as to show the necessity of tak-
ing seriously the need for a substantive philosophy of medicine.
II. HIPPOCRATIC MEDICINE
The extent to which the Oath has been, or still is, a basis for medical ethics
is rather controversial and unclear. Some scholars, such R. M. Veatch (1988)
or H. T. Engelhardt, Jr. (1986) for instance, either simply contend that the
Hippocratic corpus as a sources of traditional morality for medicine is dead
(Veatch) or point out that the Hippocratic ethic was limited to a particular
group of neo-Pythagoreans and that to reconstruct a tradition relevant to
contemporary medicine is rather problematic due to the lack moral agree-
ment in society (Engelhardt). On the other hand, E. D. Pellegrino, (Pellegrino
& Thomasma, 1981), maybe one of strongest proponents of the Hippocratic
ethic, argues that the Hippocratic Oath is the foundation of Western medical
ethics, which was, in his view, universalized in the early Middle Ages but
needs, in contemporary culture, constant reevaluation.3 Miles, as will see,
proposes a mid-way solution (what he calls a “blended position”) that
appears to be attractive since it attempts to make strong connections
between the Oath with current medical practice while recognizing that we
live “in a world of contending and diverse moral systems” (Miles, 2004, p.
172). However, his interpretation of the Oath and its relevance to current
medical practice remain at best symbolic (that is, in so far as one is willing
to “accept” its ethical principles as ideals) which means that he is not able to
provide strong arguments for a recognition of the Oath as normative for the
medical profession as a whole.
Any appreciation of the place and influence of the Oath must be
developed against a recognition that medical ethics and its ethos have
been reshaped and transformed over the centuries. It is not simply the
case that this ethics and ethos were recast by the Hellenistic age, Roman
civilization, and Christianity,4 as Miles acknowledges (Miles, 2004, p. 41).
The contemporary appreciation of the ethics and ethos appears to as in
the light of the Renaissance, the Enlightenment, and the emergence of
post-modern reflections. It is very difficult to reach back and appreciate
what that ethics and ethos meant to the Hippocratic community. It is as
well necessary to recognize that there is not one ethics or ethos, but the
meanings are plural over the centuries. The cardinal task of a philosophy
of medicine is critically to locate the Hippocratic Oath and ethics within a
110 F. Jotterand
much more general appreciation of the nature of medicine and medical
The tradition of Western medicine is often related to the person of
Hippocrates (or the Hippocratic corpus), considered by some scholars as
the founder of medicine as a discipline (Temkin, 1991, p. 42), and the
“father of medicine” (Ackerknecht, 1982, p. 55). Furthermore, it is argued
that Hippocratic writings, and especially the Hippocratic Oath,5 have been
the sources from which medical practice derives its principles of ethical
conduct. Since the 1960s, however, medical practice has undergone a radi-
cal shift6 from its original ideals (i.e., Hippocratic ethic, Percival, etc.) that
appears in discontinuity with the old paradigm of medical practice, that is,
what used to be called the “healing relationship” between the physician and
the patient (Pellegrino & Thomasma, 1993, p. 104). In what follows, I
consider the outcome of this radical shift in light of Miles exploration of the
Oath in terms of the identity of the physicians, the commitments of the
physicians, and medicine as a profession.
A. The Identity of the Physicians
Contemporary oaths taken by medical students will completely omit nearly
two-thirds of the Hippocratic Oath.7 The Oath or covenant begins by a
lengthy invocation of the gods and goddesses. The next and most substan-
tial section outlines the duties of the student to the teacher and the teacher’s
family, as well as the obligation to maintain the continuity of the transmittal
of medical knowledge. Only then does the Oath turn to an outline of moral
obligations. Even here, it must be noticed that the categories employed by
the author of the Oath are not those of good and bad, moral and immoral.
They focus indeed on but a sense of purity or holiness before the gods. The
contemporary, moral reading of the Oath requires then a step away from an
Oath that invokes categories of purity and rectitude before the gods in favor
of an account better comprehensible in purely secular terms.
Last but not least, the Oath focuses on fashioning an esoteric esprit-
de-corps. Nothing is to be divulged to the uninitiate. Here the Oath cre-
ates a professional identity that is not like that of the guilds of the Middle
Ages authorized by a government in order to offer a sanctioned set of
restraints on trade so as to maintain the quality of certain highly-valued
services. The freestanding character of the medical profession in Hippocratic
terms is underscored as well in “The Art,” which says that “medicine is the
only art which [the] states have made subject to no penalty save that of
dishonour ...” (Hippocrates, 1923c, p. 263).
Miles, it should be noted, anachronistically read the Hippocratic medical
profession rather uncritically, as if it were straightforwardly a guild that pro-
vided the basis for an embryonic medical science that would eventually “form
the foundation for the science and ethics of medicine” (Miles, 2004, p. 37).
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