1. The Hippocratic Oath and the Ethics of Medicine Steven Miles, MD University of Minnesota Believed to be the only depiction of Hippocrates.

2. Oath -- 400 BC Hippocractic Medicine –Rejected divine explanations for the cause or treatment of disease in favor of empirical, causal observations. –Transformed oral traditions passed in families to recorded observations and clinical experiences shared within a guild.

3. Time Line 1000 Deontological works Oldest Oath Papyrus Church Editing 1 st Medical School use “Hippocratic” Medical Works Fall of Athens CE BCE Oath Columbus Voyage

4. The Cutting Insertion 1000 Bladder stone surgical innovation 240 BCE Oldest Oath Papyrus Fall of Athens CE BCE 1500 Oath Surgery separates from Medicine I will not cut, and certainly not those suffering from stone, but I will cede this to practitioners of this activity.

5. Oaths Ethics‘Questions Who is the physician? What is the physician committed to? Who is the physician accountable to?

6. Who is the physician?

7. Opening of Oath: An invocation?... I swear by Apollo the Physician and by Asclepius and by Hygieia and Panacea and by all the gods as well as goddesses, making them judges [witnesses], to bring the following oath … to fulfillment, in accordance with my power and my judgment;

8. … or does it proclaim geneology? “Is there a man who has not heard of me—Amphitryon of Argos, son of Alcaeus, grandson of Perseus, and father of Heracles. I have lived here in Thebes ever since the crop of Sown Men sprang full grown out of the Earth.” From Heracles by Euripides If geneology, what does it mean?

9. The Family of Medicine I (Medicine born of love and grief) Apollo Coronis Physician, prophecy Asclepius Chiron (a Centaur) Trainer of Achilles Medical education

10. Apollo: Prophecy & Prognosis Apollo God of Reason God of Prophecy –Oracle at Delphi Physicians Reason- Natural Cause and Effect: –Points to cause, diagnosis, and treatment. Prognosis

11. Prometheus (Foresight) A titan who gave humans fire and creativity to invent medicines and imagine a prognosis. To prevent despair at foreseeing death in a person who was dying. Prom: I stopped mortals from foreseeing doom. Chorus: What cure did you discover for that sickness? Prom: I sowed in them blind hope. –Aeschylus. Prometheus Bound

12. The Family of Medicine II Epione (Hercules’ Daughter) ‘Soothing’ Asclepius ‘ Unceasingly Gentle’

13. Pindar’s Verdict on Asclepius Still, even wisdom yields to hope of profit. And gold induced no less than he [Asclepius] to try to resur- rect a man whom death already had imprisoned…. We must seek from deity the things that fit our mortal hearts, keeping our cond- ition and our destiny in mind. My vital being, do not seek immortal life; exhaust, instead, all possibility. Pindar. Pythian Odes 3-63.

14. What does the Apollo Genesis Story of Medicine Say? The passion to heal arises from love and grief. Physicians must accept mortality as a boundary for moral work. The names of Asclepius and Epione say that healing is not a war but a gentle rebalancing to path to health.

15. The Family of Medicine III Asclepius Epione Unceasingly Gentle Soothing Hygieia Health Aigle Radiance Telesphorus Convalescenc e Iaso Healers Panacea Medicines PodaliriusMachaon

16. The Family of Medicine IV Asclepius Epione Unceasingly Gentle Soothing Podalirius Hippocrates Machaon Each Physician (Hippocrates dies in Larissa) “to regard my teachers as equal to my parents” [Oath]

17. What is the physician committed to?

18. MD in SocietyClinical Ethics Principles I will use regimens for the benefit of the ill in accordance with my ability and my judgment, but from [what is] to their harm or injustice I will keep [them]. Into as many houses as I may enter, I will go for the benefit of the ill, while being far from all voluntary and destructive injustice, Examples (2) 1. I will not give a drug that is deadly to anyone if asked, nor will I suggest the way to such a counsel. 2. I will not give a woman a destructive pessary. 1. especially from sexual acts both upon women's bodies and upon men's, both of the free and of the slaves. 2. About whatever I may see or hear in or without treatment…-- things that should not ever be blurted out outside --I will remain silent, holding such things to be [profane to speak of]. What is the Physician Committed to?

19. What does the Physician Promise to Society? I will not give a drug that is deadly to anyone if asked, nor will I suggest the way to such a counsel. – Capital punishment? – Euthanasia? – Homicide?

20. What does the Physician Promise to Society? I will not give a woman a destructive pessary. Antiabortion? Pro-life? Anti-trespass in a woman chattel society? Pessaries are dangerous.

21. What Does the Physician Promise to the Patient? 1 – especially from sexual acts both upon women's bodies and upon men's, both of the free and of the slaves.

22. What Does the Physician Promise to the Patient? 2 About whatever I may see or hear in or without treatment… -- things that should not ever be blurted out outside – I will remain silent, holding such things to be [profane to speak of].

23. Who are Physicians Accountable to? If I render this oath fulfilled, and if I do not blur and confound it may it be to me to enjoy the benefits both of life and of techne (art and science), being held in good repute among all human beings for time eternal. If, however, I transgress and perjure myself, the opposite of these.

24. Oath’s Vision Accountability to judgment of history. An empirical science, a moral community Self sustaining by passing accumulating knowledge Personal Integrity In a pure and holy way, I will guard my life and my art and science. Physician and Society Clinical Ethics Justice Benefi- cence

25. Summary Oath conforms to the medical practice and rhetoric of Classic Greece. Roles: education, compiling knowledge, and treatment. Ethics: beneficence and on avoiding injustice in public and clinical spheres. Progressive and historically accountable rather than deistically accountable.

26. Steven Miles MD miles001@umn.edu