CMDA | CP Oath

Christian Physician's Oath

With gratitude to God, faith in Christ Jesus, and dependence on the Holy Spirit, I publicly profess my intent to practice medicine for the glory of God.

With humility, I will seek to increase my skills. I will respect those who teach me and who broaden my knowledge. In turn, I will freely impart my knowledge and wisdom to others.

With God's help, I will love those who come to me for healing and comfort. I will honor and care for each patient as a person made in the image of God, putting aside selfish interests, remaining pure and chaste at all times.

With God's guidance, I will endeavor to be a good steward of my skills and of society's resources. I will convey God's love in my relationships with family, friends, and community. I will aspire to reflect God's mercy in caring for the lonely, the poor, the suffering, and the dying.

With God’s direction, I will respect the sanctity of human life. I will care for all my patients, rejecting those interventions that either intentionally destroy or actively end human life, including the unborn, the weak and vulnerable, and the terminally ill.

With God's grace, I will live according to this profession.

Passed by the CMDA House of Delegates
May 3, 1991. Chicago, Illinois.

Amended by the CMDA House of Representatives
June 10, 2005. Denver, Colorado.

Explanation

In antiquity, a man who wanted to learn the art of medicine was often required to swear an oath containing important principles and precepts before beginning his study, usually as an apprentice. The Oath of Hippocrates is one such ancient vow. It may have been composed by a group of Pythagorean physicians rather than by Hippocrates of Cos. While the history of the Hippocratic Oath is still the subject of scholarly debate, it is clear that the precepts of the Oath gradually became the guiding principles of the majority of educated physicians, and this ethos was accepted as the standard for centuries, because it is consistent with monotheistic religion and the dignity of people made in the image of God.

In this century, it became increasingly common for the faculties of medical schools to administer an oath to their graduates. While several modifications and adaptations of the classical Hippocratic Oath are still in use, very few graduating physicians swear the actual words or precepts of that ancient standard. Some maintain that the Hippocratic Oath is out of date and no longer applies. Much medical practice, in fact, ignores it. A limited number of physicians maintain that the ancient precepts are still valid, although some of the specific proscriptions or prescriptions may not make sense today. Because of these differing perceptions of the importance and/or validity of the classical Hippocratic Oath, many new oaths have been written and used in modern times. A recent analysis of oath usage and content showed an increasing rate of the use of oaths throughout this century, but a steady decrease in the content items which were present in the classical Hippocratic Oath.

Some Christians are uncomfortable swearing an oath by the ancient Greek gods. Others believe the precepts of the classical Hippocratic Oath are still valid and the swearing of this traditional vow is very important, so they are willing to swear this oath because of its clear declaration of the transcendent nature of the healing relationship, understanding that the object of their vow is the one true God.

The Ethics Commission of the Christian Medical and Dental Society proposed a Christian Physician's Oath in 1990, which was subsequently adopted by the house of Delegates in 1991. The goal was to retain the valid principles and precepts of medical tradition, and to re-frame them in a Christian context. It was the hope that this oath would be adopted and sworn by practicing physicians and would also be administered by CMDS chapters at medical schools to Christian students as they graduate.

Abstracts

"Restoring the Covenant" Tom Elkins and Douglas Brown. CMDS Journal Spring 1987; XVIII(2):16-20

The authors begin by quoting the Hippocratic Oath and they describe it as portraying a "covenant image of the medical professional" with commitment to integrity, mercy, justice, sensitivity and trust. They give examples of unequal treatment of pregnant patients based on their insurance or economic status and express concern about physicians who are motivated by self-interest. They also describe the self-interest of patients and lawyers and the consequent malpractice crisis. Using quotes from Paul Tournier and William May, they lament the fact that the growth of these self-interests has changed the altruistic covenant relationship into a legalistic contractual one which focuses on rights and obligations. They define covenant as "two parties bound to a common agreement" and they demonstrate the use of this concept in scripture as a way to provide security between those parties, even unequal parties.

They then apply this scriptural picture of covenant to the practice of medicine saying it includes "the trust and patience of friendship. Each party of the covenant shares respect and mutual need. Each party is committed for better or worse. Each party acts for the other's interests. Each party has latitude to express disappointment with their own or the other party's performance. Each party can be admonished and even constructively disciplined. Each party maintains a sense of gratitude, even in unfavorable or confusing circumstances." They close with a call to "help deepen the character of health care by nourishing the covenant roles of friend and servant."

"The Moral Basis for Medical Science" D. Elton Trueblood. CMDS Journal Winter/Spring 1988; XIX(1):5-7

The author refers back to Socrates and Hippocrates (and quotes a large portion of the Hippocratic Oath) as he maintains that truth is timeless. Science is important in our culture, but science depends on ethical integrity. The moral basis of medical science is the recognition of a "real right and a real wrong" which is wholly consistent with theism. Hippocrates recognized this as he dealt with questions of medical practice such as abortion. Such ethical realism leads to a humility and a reverence for life which ultimately leads to a reverence for persons. For these reasons, the spiritual life of the medical scientist is more important than his technical ability.

Orr RD, Pang N, Pellegrino ED, Siegler M. Use of the Hippocratic Oath: A review of twentieth century practice and a content analysis of oaths administered in medical schools in the U.S. and Canada in 1993. Journal of Clinical Ethics 1997;8(4):377-88

Background: Oaths have been administered to medical students for a long time, but the oaths used and the content of those oaths have changed with time.

Methods: We surveyed the deans of all 157 allopathic and osteopathic schools of medicine in the U.S. and Canada to assess current practices regarding oath administration, and compared this data to results from similar surveys done in 1928, 1958, 1978, and 1989. We did a content analysis of oaths currently used and compared the results with content items of the original Hippocratic Oath.

Results: There has been a progressive and marked increase in percentage of schools administering an oath over the past 65 years. The graduates of 98% of the 150 responding schools took an oath in 1993 while only 26% of schools administered an oath in 1928. We determined that only one school used the text of the classical Hippocratic Oath, but 68 reported they used other "versions" of the traditional oath. When we examined the contents of all oaths in current use, we discovered that although 100% and 86% respectively still pledge a commitment to patients and to teaching, only 43% vow to be accountable for their actions, only 14% include a prohibition against euthanasia, only 11% invoke a deity, only 8% foreswear abortion, and only 3% retain a proscription against sexual contact with patients.

Conclusions: There has been a steady increase in the use of professional oaths at the time of graduation from medical school during this century. At the same time, there has been a decrease in the number of content items found in the original Hippocratic Oath.

Bibliography

Edelstein L. The Hippocratic Oath: text, translation and interpretation. In Ancient Medicine: Selected Papers of Ludwig Edelstein, Oswei Temkin and C. Lillian Temkin, eds; Baltimore: the Johns Hopkins Press, originally published 1967; paperback edition 1987 pp 3-63

Of the several translations of the classical Hippocratic Oath available, Edelstein s is considered by many to be the most scholarly and accurate. He was the most authoritative historian to posit that the Oath was not written by Hippocrates of Cos, but by a group of Pythagoreans, some of whom may have been physicians.

Kass LR. Is there a medical ethic: the Hippocratic Oath and the sources of ethical medicine. Chapter 9 in Toward a More Natural Science. New York: The Free Press, 1985 pp224-246

Kass, a conservative Jewish scholar, has written this thorough analysis of the Oath (as translated by Edelstein). He believes the Oath expresses the core values of medicine which have been accepted for centuries, and only recently questioned. He recognizes and reinforces the transcendent nature of the professional relationship. He divides the Oath for the sake of analysis into the following sections: the oath itself, conduct regarding teachers and students, treatment (ends and means; limits on ends and means), decorum, and closing prayer.

Bird LP, Barlow J, eds. Codes of Medical Ethics, Oaths & Prayers: An Anthology. Richardson, TX: the Christian Medical and Dental Society, 1989

This compilation by two CMDS staff members provides in one source the wording of and a brief historical note about 31 professional codes, oaths, and prayers used by various groups at various times over the centuries from antiquity to modern times.

Cameron NMdeS. The New Medicine: Life and Death after Hippocrates. Wheaton, IL: Crossway Books, 1991

From the preface: "...the very identity of medicine is under threat - it is, in fact, already in flux. A framework of values once universally accepted within the western medical tradition has begun to slide into disuse. The twilight of the Hippocratic tradition is seen as a small matter, as if the medical enterprise could very well survive with any set of values it chose... ...it is a fundamental misreading of the history and nature of medicine to regard it as capable of surviving the revolutionary value-changes which are now in progress. Only if medicine were narrowly conceived in terms of technique - a set of skills, a matter of expertise - could this be so. If, by contrast, medicine is actually constituted by its commitment to a set of values, then the dropping of those values marks the beginning of the end of medicine itself."

May, William F. The Physician s Covenant, in The Physician s Covenant. Philadelphia: The Westminster Press, 1983.

The author asserts that the dictates of the Hippocratic Oath often result in markedly different consequences for those who instruct future physicians and those who are their patients. He points out (as historian Ludwig Edelstein has) that the Oath "characterizes those duties which a physician undertakes toward patients as an ethical code and those assumed toward the professional guild (one s teachers) as a covenant....Physicians undertake duties to their patients, but they owe something to their teachers. They have received goods and services for which they owe their filial services. Toward their patients, they function as benefactors, but toward their teachers, they relate as beneficiaries. [It is]...responsiveness to gift [that] characterizes a covenant." Contrary to this view, the author argues that all of a physician s engagements within the context of medicine should be characterized by a covenental relationship. Physician's do owe their patients, and they also stand as a primary benefactor of God's grace and mercy. It is the proper perception of this latter relationship--the covenant between God and all of humanity--which is integral to a philosophy of medicine consistent with Christian ministry.

Verhey, Allen. The Doctor s Oath--and a Christian Swearing It, in On Moral Medicine. Ed. Lammers, Stephen E. and Allen Verhey. Grand Rapids, Mich.: Eerdmans, 1987.

Instead of focusing primarily on the content of the Hippocratic Oath, the author turns his attention to the fact that the Oath originated as a minority position intended to reform a medicine which prescribed poison to patients and approved of abortions. It is consideration of this fact which the author believes would be salutary to the contemporary practice of medicine. He incites Christian physicians to develop and defend a medical ethics which is based on their Christian convictions, instead of legal or philosophical tenets. He states, "...Christian medical ethics cannot proceed with integrity if it always restricts itself to articulating and defending standards of the practice or certain applications of impartial principles of philosophy or law to medical dilemmas. It is lamentable that so little of the work in medical ethics by Christian theologians candidly and explicitly attends to the Christian story and its bearing on medicine."

Crawshaw R, Rogers DE, Pellegrino ED, Bulger RJ, Lundberg GD, Bristow LR, Cassel CK, Barondess JA. Patient-physician covenant. JAMA 1995;273(19):1553

This group of medical leaders has proposed a new oath based on a covenant of trust.