Hippocratic Oath – The Answer to the COVID-19 Pandemic
In this time of the pandemic, the medical community has been under significant scrutiny. At times, it seems that our community continues to become more divided when it is pertinent that we come together. Policies surrounding masking and vaccine mandates have been particularly inflammatory during this time of scrutiny. For some individuals, these public health efforts have led to distrust of the medical establishment. To add to what is already a recipe for conflict, there are growing concerns about the negative consequences of the COVID-19 vaccine at the center of the distrust.
“First do no harm” – a saying that echoes far past young impressionable medical students partaking in their white coat ceremony. Even as an adolescent I had become familiar with the mantra of healthcare “first do no harm,” and like many, created strong beliefs of agreement to this mantra. However, today I was watching an episode of Chicago Med, a medical drama tv series.
At the end of this episode, Dr. Choi (emergency medicine physician) turns towards Dr. Charle’s (psychiatrist) and says, “how do we ever know what we are doing is right?” This question, however esoteric, is one that I’ve found myself contemplating as an aspiring physician.
I am reminded of a particular day in the operating room. It was my job to assist the surgeon in monitoring this patient’s nervous system throughout the surgery. At a critical point during the operation, I was asked to run a diagnostic test. I ran it and something wasn’t quite right. Well meaning, the surgeon looked over at me and asked “did you run it?!?” At the moment I was sweating bullets. Feel as if I am at a crossroad, I felt like a deer in headlights. You see, I had ran the test but the result was right on the line of differentiation between “this might be a bad sign” or “you’re good to proceed doc.” In these instances, people in my position are tasked with communicating the unclear results with a physician online to gain better evaluation that can then be communicated to the surgeon. As you might suspect, time is of the essence. Unfortunately for me, the physician online had not responded in some time. I had a few seconds to rely on my previous training, however little, to make a determination and communicate to the surgeon.
I am reminded of this moment because like the fictional characters in Chicago Med and real healthcare providers around the world – we often aren’t certain what we are doing is right. Decisions are made to the best of one’s ability, training, and intentions. This might seem obvious but I would argue this conflicts with the ironclad mantra of medicine, “first do no harm.”
After Dr. Choi conveys this morally difficult question, Dr. Charles replies by saying “the first part of the oath is clear right? Do no harm.” Well this isn’t quite accurate. “First do no harm” is not a part of the original or modern versions of the Hippocratic Oath, at least not in its clear unwavering form.
Harvard medical school published an article discussing this perplexing aspect of healthcare history/culture and writes that the “first do no harm” mantra is more likely from another work of Hippocrates titled “of the Epidemics.” I highly recommend reading this article because Dr. Robert Schmerling, author of the article, goes on to discuss if “first do no harm” is even possible/practical when it comes to real world situations.
With that said, what does the Hippocratic Oath actually say?
Hippocratic Oath (Modern Version)
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 which are required, avoiding those twin traps of overtreatment 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.