An Upgraded Hippocratic Oath Is Needed In The Digital And A.I. Era

The Hippocratic Oath is the most famous text in Western medicine. It constitutes the ethical basis of the medical profession. For centuries, it has provided an overview of the principles of this noble mission and doctors’ professional behaviour. At the dawn of a new era in medicine, it is high time to rewrite the Oath so that it would reflect the state of technological development, changes in social structures and in general, the requirements of the 21st century.

These are our suggestions.

What is the Hippocratic Oath?

Used by many medical schools at graduation ceremonies, the medical profession adopted the Oath of Hippocrates as its ethical code of conduct centuries ago. That’s not a mere chance. The text articulates perfectly what the noble profession of being a doctor entails and in a compact overview takes a side in every major ethical issue a physician might encounter during their career.

Only a few know that although the oath bears the name of Hippocrates, the well-known Greek physician, there is no evidence that he wrote it . It is claimed that the document was created 100 years after his death ; still some 2500 years ago.

Source: https://brianpagan.net/2010/first-do-no-harm-towards-a-hippocratic-oath-for-designers/

What does the Hippocratic Oath mean today?

The majority of physicians believe the Oath still has relevance today, although opinions are extremely divided. In 2016, Medscape had a poll to measure opinions about the relevance of Hippocrates’ pledge. Total responses to the survey numbered 2674 physicians plus 134 medical students. Reactions were deeply polarized, and age was a decisive factor. Of those under age 34, 39% said it was significant, compared with 70% of those 65 and older.

Still, statistics show that the majority of medical schools incorporate some kind of oath , giving ethical guidelines to future doctors.

Treating the ill to the best of one's ability, preserving a patient's privacy or teaching medicine to the next generation are all increasingly important matters in medicine.

Therefore we suggest some changes to the original Hippocratic Oath to better reflect the 21st century.

The principles of the Hippocratic Oath – renewed

1) Patient inclusion

The scientific community does not only consist of physicians: medical researchers, nurses and patients must be included – also symbolically. Doctors are not the sole repositories of medical knowledge, and the ivory tower of medicine is crumbling under the weight of the digital sphere, social media, empowered patients or the DIY movement. The Hippocratic Oath should reflect that.

“I will respect the hard-won scientific gains of those physicians, patients and researchers in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.”

2) Healthcare must shift from treatment to prevention

With the recent advances in precision medicine as well as the appearance of preventive and lifestyle health, healthcare should have responses for the ill and the healthy alike. Advising on how to stay fit and well for the healthy is just as important as recommending treatments for the sick. The appearance of health sensors, wearables, and health apps results in new ways of prevention.

It also results in a massive chunk of data medical professionals should be able to use. This data will help analyse as well as predict trends in the health of individuals and populations, so the Oath should change accordingly.

?“I will apply, for the benefit of the healthy and the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.”

3) Acknowledgment for technologies

Technologies also need to be reflected in such a pledge. Physicians need to acknowledge the raison d’etre of technologies in healing, and one of the means to assume its rightful place in medicine starts with its inclusion into the Hippocratic Oath. It has to acknowledge the transformative impact that medical technologies have on healthcare – traditional as well as digital solutions. However, as artificial intelligence, robotics, AR/VR, health apps, wearables, sensors, portable diagnostic devices transform healthcare, that will be even more essential.?

So, what if the oath said,

?“I will remember that there is an art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife, the programmer’s algorithm or the chemist’s drug.

I will help prevent disease whenever I can with my knowledge and available technologies, for prevention is preferable to cure. ”

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4) Recognition of life-long learning

Besides mentioning technologies, it’s also critical to use the latest innovations. That requires openness towards new concepts, ideas or medical devices, which seems to be evident for many physicians, but is not practised in the medical community as often as it should be. Maybe a kind reminder in the oath could give at least a symbolic boost to life-long learning.

“I will embrace life-long learning to continually improve my knowledge and skills to be able to use any technologies with scientific evidence for the benefit of my patients.”

5) The inclusion of equal-level partnership

Access to information and technologies is not a privilege of physicians sitting in the ivory tower anymore. Patients also have access to information about drugs, cures, methods online, and with a pinch of digital literacy, anyone can find curated and credible medical data online. This started to shift the hierarchical patient-doctor relationship into a collaborative partnership in the future. The oath has to address the changing social relations within the structure of the medical system, and therefore The Medical Futurist suggests the inclusion of the following:

“I will treat my patients in an equal-level partnership, and 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.”

6) Addressing privacy concerns

Respecting patients’ privacy is a primary passage in the Oath. However, there is no indication of data privacy anywhere. Sure, there was no need for it 2,000 years ago as Odysseus did not check in to Facebook day after day when heading home to Ithaca, but that’s not the case today.

According to Statista, in 2018, about 2,314 exabytes of new data could be generated worldwide in 2020. The need for safeguarding that amount of information is paramount, so we need to include it in the Oath. How about the following solution?

“I will respect the privacy of my patients and their data, for their problems are not disclosed to me that the world may know.“

Will regulators and policymakers step up for our privacy or are we expected to give away our data to companies?

7) Artificial Intelligence In Medicine

A.I. has a vast potential to automate processes in healthcare. We can expect dramatic changes in care, with A.I. systems to excel at a specific task and healthcare professionals to increasingly interact with them. But what we always highlight is that A.I. will never replace medical professionals. But those physicians who use and embrace A.I. will replace those that do not.

“I will remember that I do not treat a fever chart, a cancerous growth, or an algorithm's suggestion but a sick human being."

The Medical Futurist strongly believes that it is high time to adjust the Hippocratic Oath to the winds of change, so younger physicians could better relate to its overall principles, and older physicians could take more inspiration to work from it.

So here’s the revised Hippocratic Oath, as recommended by The Medical Futurist:

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, patients and researchers 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 healthy and sick, all measures [that] 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 treat my patients in an equal-level partnership, and 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 embrace life-long learning to constantly improve my knowledge and skills to be able to use any technologies with scientific evidence for the benefit of my patients.

I will respect the privacy of my patients and their data, 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 help prevent disease whenever I can with my knowledge and available technologies 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.