Why An Upgraded Hippocratic Oath Is Needed In The Digital Era

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The Hippocratic Oath is the most famous text in Western medicine and 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 behavior. 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.

The Hippocratic Oath in historical perspective

The medical profession adopted the Oath of Hippocrates as its ethical code of conduct centuries ago, but it’s still being used today by many medical schools at graduation ceremonies. That’s not 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. Some 2500 years ago.

Rachel Hajar in her study on the historical perspectives of medical oaths says that in 1500, a German medical school (University of Wittenberg) incorporated taking the oath for its graduating medical students. However, it was not until the 1700s, when the document was translated into English that Western medical schools began regularly incorporating it in convocations. In 1948, it was adopted by the World Medical Association (WMA) based in Geneva, and in 1964, what’s called the Declaration of Geneva. Numerous medical schools use this version of the Oath every since. Later, the text was rewritten by Louis Lasagna (the then Dean of the Tufts University School of Medicine in Boston, Massachusetts, USA) and this version was adopted by many medical schools in the USA.

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

Does the Oath have any significance today?

It seems it still does. Although not every medical student is required to take the Hippocratic Oath or any kind of oath for that matter, and no one is legally bound by the text, the majority of physicians believe the Oath still has relevance today – although it cannot reflect on many contemporary issues and possesses ambiguous, troubling passages.

In 2016, Medscape created a poll to measure opinions about the relevance of Hippocrates’ famous pledge. Total responses to the survey numbered 2674 physicians plus 134 medical students. Reactions were deeply polarized, and age was a decisive factor. 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, in numerous cases the Hippocratic Oath into a ceremonial event. Thus it is essential for schools to give ethical guidance to medical students. But the Hippocratic Oath is in many cases changed to something else as it cannot offer young people the pieces of advice they need in the modern world.

Source: https://med.nyu.edu/our-community/about-us

Here, 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

A passage of the Oath reads as follows, 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.

However, where are the medical researchers, the nurses or the patients? The scientific community does not only consist of physicians. Thus it would be great to include more players in the field, also symbolically. By now, 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.

Source: https://patientengagementhit.com

2) Healthcare must shift from treatment to prevention

Another section says that I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

However, with the recent advances in precision medicine as well as the appearance of preventive health, physicians should not only tend to those who already have symptoms and need treatment but advise the healthy how to stay fit and well. The appearance of health sensors, wearables, and health apps result in a massive chunk of data, which will help analyze as well as predict trends in the health of individuals and populations. This should be included in the Oath, too so medical professionals could act for the benefit of the healthy and the sick.

Source: www.urban.org

3) Acknowledgment for technologies

The Hippocratic Oath should not get by without the inclusion of technologies anymore. It has to acknowledge the transformative impact that medical technologies have on healthcare – traditional as well as digital solutions. However, like 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 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? What if we include “available technologies” into the following passage, so it will read this way: I will help prevent disease whenever I can with my knowledge and available technologies, for prevention is preferable to cure.

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.

Source: www.resources.cactix.com 

4) Recognition of life-long learning

Not only is it necessary to mention technologies in the Hippocratic Oath, but it’s also critical to be able to use the latest innovations. That also requires openness towards new concepts, ideas or medical devices, which seems to be evident for many physicians, but is not practiced 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.

Thus, The Medical Futurist would add the following passage to the oath: 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.

Source: www.bmoforwomen.bmo.com

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. It 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 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.

Source: www.ans-solutions.com

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 Ithaka, but that’s not the case today.

According to a Stanford Medicine White Paper, 153 exabytes (one exabyte = one billion gigabytes) of healthcare data were produced in 2013, and an estimated 2,314 exabytes will be generated in 2020, translating to an overall rate of increase at least 48 percent annually. 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.

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.

The revision of the Hippocratic Oath is part of our From Chance To Choice campaign, which gives information, provide context and design solutions on how to bring down the role of luck in healthcare. We aim to bring it the revised oath to as many medical schools around the world as possible, so reach out to The Medical Futurist on any of our social media channels or at [email protected] for more details. We can’t wait to hear from you!

Dr. Bertalan Mesko, PhD is The Medical Futurist and Director of The Medical Futurist Institute analyzing how science fiction technologies can become reality in medicine and healthcare. As a geek physician with a PhD in genomics, he is a keynote speaker and an Amazon Top 100 author.

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