As many of my readers already know, I tend to do a lot of misconception-busting in these articles. Today I am going to be busting some popular misconceptions about the Hippocratic Oath. I must admit that I am genuinely surprised there are so many, since the Hippocratic Oath is not exactly the sort of flashy, exciting subject that lends itself towards mythologizing. Nonetheless, the misconceptions are rife.
Contrary to popular belief, the Hippocratic Oath was probably not actually written by Hippocrates; it does not contain the words “First, do no harm”; doctors today are rarely ever required to swear the original Hippocratic Oath; and, finally, although there punishments in place for physicians who engage in various forms of malpractice, there are no serious punishments specifically in place for doctors who violate their oaths.
Misconception #1: The Hippocratic Oath was written by the Greek doctor Hippocrates of Kos.
It is widely assumed, both among doctors and among members of the general public, that the Hippocratic Oath was written by the ancient Greek doctor Hippokrates of Kos (lived c. 460 – c. 370 BC), whose name is usually Latinized as Hippocrates. Unfortunately, this widely-held assumption is unlikely to be correct; although the Hippocratic Oath is traditionally attributed to Hippokrates, it was probably not actually written by Hippokrates himself.
You can never trust names. Just because something is named after someone does not mean they really wrote or discovered it. For instance, you can read in this article I published in March 2018 about how the Greek philosopher Pythagoras of Samos (lived c. 570 – c. 495 BC) did not really discover the Pythagorean theorem. The Pythagorean theorem was, in fact, already known to the Babylonians over a century before Pythagoras was even born and the legend about Pythagoras having supposedly discovered the Pythagorean theorem is not attested in any sources until centuries after Pythagoras died. No one knows who really discovered the Pythagorean theorem, but it sure was not Pythagoras.
The same statement is probably also true about the Hippocratic Oath. No one really knows who wrote the Hippocratic Oath, but evidence suggests that it probably was not Hippokrates. It is true that the oath is usually included as part of the Hippocratic Corpus, a collection of around sixty different ancient Greek medical works written in the Ionic dialect of the ancient Greek language that are traditionally attributed to Hippokrates, but that does not mean he really wrote it.
The writings of the Hippocratic Corpus were not all published together as a complete set; instead, they originally circulated independently as individual works. These works were eventually collected at some point by scholars, who labeled them “Hippocratic writings.”
Most classicists now generally agree that most of the writings included in the Hippocratic Corpus were not actually written by Hippokrates himself, but rather by his students, followers, associates, or even later admirers. Scholars have identified at least a score of different authors whose works have become incorporated into the Hippocratic Corpus. It is entirely possible that none of the writings that are now included in the Hippocratic Corpus were really written by Hippokrates at all.
ABOVE: Modern illustration of an ancient bust identified as a bust of the Greek doctor Hippokrates of Kos from an 1881 edition of the book Young Persons’ Cyclopedia of Persons and Places
Aside from the dubious authorship of the entire collection, there is some evidence to indicate that the Hippocratic Oath in particular was not written by Hippocrates. The first piece of evidence that leads us to this conclusion is the fact that the oath was apparently not even universally known among members of Hippokrates’s own school. If Hippokrates had written the oath himself, then we would expect the writings of the Hippocratic Corpus to never describe activities that violate the oath without at least making some mention that these activities were forbidden.
Many of the other writings of the Hippocratic Corpus, however, contain detailed descriptions of activities that violate the oath without making any mention whatsoever of the oath’s prohibitions against these activities. This is far from what we would expect to see if the oath had really been written by the revered founder of the school himself.
For instance, the Hippocratic Oath specifically prohibits any doctor from providing a woman with an abortion, but there are descriptions of abortifacients in other writings of the Hippocratic Corpus that do not make any mention of abortion being considered immoral or forbidden.
Similarly, the Hippocratic Oath also clearly prohibits doctors from performing any kind of surgery, but there are descriptions of how to perform various surgeries in other writings of the Hippocratic Corpus, which do not mention that such surgeries were seen as immoral or that they were banned. All this evidence clearly suggests that Hippokrates came first and the oath came later.
ABOVE: Engraving from 1638 by the Flemish Baroque painter Peter Paul Rubens of an ancient bust presumed to represent Hippokrates of Kos
Another piece of evidence that seems to indicate that Hippokrates probably did not write the Hippocratic Oath himself is the oath’s very religious—almost monastic—tone. Hippokrates is said to have taken a rational, pragmatic approach to medicine and most ancient Greek medical texts from his time onwards usually take a similar approach as well.
The Hippocratic Oath, by contrast, has a markedly religious tone. It begins with an invocation to various deities and includes multiple references to the physician’s relationship with the gods, including a line about how the physician must live “in purity and according to divine law.”
It is generally thought that the Hippocratic Oath was probably written in either the late fifth century BC or the fourth century BC. While it is still possible that Hippokrates of Kos could have written the Hippocratic Oath, it is unlikely that he did and it is much more likely that the Oath was really written by an anonymous student or admirer of Hippokrates.
ABOVE: Ancient Greek marble statue of Asklepios, the patron god of healing and medicine, from the Museum of Epidauros Theater. Asklepios is one of the deities invoked by name at the beginning of the Hippocratic Oath.
Misconception #2: The Hippocratic Oath includes the phrase “First, do no harm.”
Although the idea of not harming patients is central to the Hippocratic Oath, the exact phrase “First, do no harm” never appears anywhere in the oath at all. The closest the oath ever comes to saying “First, do no harm” is in this line:
“…ἐπὶ δηλήσει δὲ καὶ ἀδικίῃ εἴρξειν.”
Here is the line again, as translated into English by Michael North:
“…and I will do no harm or injustice to them [i.e. the patients].”
This line certainly says something very similar to the phrase “First, do not harm,” but it does not actually use those exact words. At another point later in the oath, the idea of not harming comes up again:
“ἐς οἰκίας δὲ ὁκόσας ἂν ἐσίω, ἐσελεύσομαι ἐπ᾽ ὠφελείῃ καμνόντων, ἐκτὸς ἐὼν πάσης ἀδικίης ἑκουσίης καὶ φθορίης, τῆς τε ἄλλης καὶ ἀφροδισίων ἔργων ἐπί τε γυναικείων σωμάτων καὶ ἀνδρῴων, ἐλευθέρων τε καὶ δούλων.”
Here is the same passage, once again, as translated into English by Michael North:
“Into whatever homes I go, I will enter them for the benefit of the sick, avoiding any voluntary act of impropriety or corruption, including the seduction of women or men, whether they are free men or slaves.”
Both of these passages say something very similar to “First, do no harm,” but, as you can see, the oath never uses those exact words. Furthermore, the idea in both cases is slightly different. The phrase “First, do no harm” includes the word “first” at the beginning to indicate that not harming is a physician’s first and foremost responsibility. Although the Hippocratic Oath does forbid the physician from harming, there is no explicit statement that not harming should be the physician’s first priority.
The idea behind the phrase “First, do no harm” was first introduced into the Anglophone medical lingo through the 1847 book Physician and Patient, written by the American physician Worthington Hooker. Hooker, however, was merely quoting the earlier work “An Essay on the Philosophy of Medical Science,” which was first published in 1844. This essay was written by the American physician Elisha Bartlett, who credited the idea that not harming should be a physician’s first responsibility to the French pathologist Auguste François Chomel (lived 1788 – 1858). Barlett writes in the essay:
“The golden axiom of Chomel, that it is only the second law of therapeutics to do good, its first law being this—not to do harm—is gradually finding its way into the medical mind, preventing an incalculable amount of positive ill.”
Chomel, then, appears to be the true originator of the idea that not harming must be a physician’s first priority—not the author of the Hippocratic Oath. The expression “First, do no harm” is, unfortunately, far from the only quotation you are probably used to hearing that is misattributed to an ancient source. For more information on this subject, I recommend reading this article I published in July 2019 that is solely devoted to debunking misattributed ancient quotes.
ABOVE: Engraving of the French pathologist Auguste François Chomel, who is credited with having coined the phrase “First, do not harm.”
Misconception #3: All doctors today are still required to take the Hippocratic Oath.
Virtually no doctors today are ever required to take the original version of the Hippocratic Oath. Instead, doctors may take a modern version of the oath, a completely different oath, or—quite often—no oath at all. This is because most medical professional who are alive today agree that the original version of the Hippocratic Oath is outdated. Here is the full text of the original Hippocratic Oath in Ancient Greek:
“ὄμνυμι Ἀπόλλωνα ἰητρὸν καὶ Ἀσκληπιὸν καὶ Ὑγείαν καὶ Πανάκειαν καὶ θεοὺς πάντας τε καὶ πάσας, ἵστορας ποιεύμενος, ἐπιτελέα ποιήσειν κατὰ δύναμιν καὶ κρίσιν ἐμὴν ὅρκον τόνδε καὶ συγγραφὴν τήνδε:
ἡγήσεσθαι μὲν τὸν διδάξαντά με τὴν τέχνην ταύτην ἴσα γενέτῃσιν ἐμοῖς, καὶ βίου κοινώσεσθαι, καὶ χρεῶν χρηΐζοντι μετάδοσιν ποιήσεσθαι, καὶ γένος τὸ ἐξ αὐτοῦ ἀδελφοῖς ἴσον ἐπικρινεῖν ἄρρεσι, καὶ διδάξειν τὴν τέχνην ταύτην, ἢν χρηΐζωσι μανθάνειν, ἄνευ μισθοῦ καὶ συγγραφῆς, παραγγελίης τε καὶ ἀκροήσιος καὶ τῆς λοίπης ἁπάσης μαθήσιος μετάδοσιν ποιήσεσθαι υἱοῖς τε ἐμοῖς καὶ τοῖς τοῦ ἐμὲ διδάξαντος, καὶ μαθητῇσι συγγεγραμμένοις τε καὶ ὡρκισμένοις νόμῳ ἰητρικῷ, ἄλλῳ δὲ οὐδενί.
διαιτήμασί τε χρήσομαι ἐπ᾽ ὠφελείῃ καμνόντων κατὰ δύναμιν καὶ κρίσιν ἐμήν, ἐπὶ δηλήσει δὲ καὶ ἀδικίῃ εἴρξειν.
οὐ δώσω δὲ οὐδὲ φάρμακον οὐδενὶ αἰτηθεὶς θανάσιμον, οὐδὲ ὑφηγήσομαι συμβουλίην τοιήνδε: ὁμοίως δὲ οὐδὲ γυναικὶ πεσσὸν φθόριον δώσω.
ἁγνῶς δὲ καὶ ὁσίως διατηρήσω βίον τὸν ἐμὸν καὶ τέχνην τὴν ἐμήν.
οὐ τεμέω δὲ οὐδὲ μὴν λιθιῶντας, ἐκχωρήσω δὲ ἐργάτῃσιν ἀνδράσι πρήξιος τῆσδε.
ἐς οἰκίας δὲ ὁκόσας ἂν ἐσίω, ἐσελεύσομαι ἐπ᾽ ὠφελείῃ καμνόντων, ἐκτὸς ἐὼν πάσης ἀδικίης ἑκουσίης καὶ φθορίης, τῆς τε ἄλλης καὶ ἀφροδισίων ἔργων ἐπί τε γυναικείων σωμάτων καὶ ἀνδρῴων, ἐλευθέρων τε καὶ δούλων.
ἃ δ᾽ ἂν ἐνθεραπείῃ ἴδω ἢ ἀκούσω, ἢ καὶ ἄνευ θεραπείης κατὰ βίον ἀνθρώπων, ἃ μὴ χρή ποτε ἐκλαλεῖσθαι ἔξω, σιγήσομαι, ἄρρητα ἡγεύμενος εἶναι τὰ τοιαῦτα.
ὅρκον μὲν οὖν μοι τόνδε ἐπιτελέα ποιέοντι, καὶ μὴ συγχέοντι, εἴη ἐπαύρασθαι καὶ βίου καὶ τέχνης δοξαζομένῳ παρὰ πᾶσιν ἀνθρώποις ἐς τὸν αἰεὶ χρόνον: παραβαίνοντι δὲ καὶ ἐπιορκέοντι, τἀναντία τούτων.
Here is Michael North’s complete English translation of the oath (although I have taken the liberty of restoring the original Greek names of the deities the oath is sworn to, rather than North’s Latinized forms):
“I swear by Apollon the physician, and Asklepios, and Hygieia and Panakeia and all the gods and goddesses as my witnesses, that, according to my ability and judgement, I will keep this Oath and this contract:
To hold him who taught me this art equally dear to me as my parents, to be a partner in life with him, and to fulfill his needs when required; to look upon his offspring as equals to my own siblings, and to teach them this art, if they shall wish to learn it, without fee or contract; and that by the set rules, lectures, and every other mode of instruction, I will impart a knowledge of the art to my own sons, and those of my teachers, and to students bound by this contract and having sworn this Oath to the law of medicine, but to no others.
I will use those dietary regimens which will benefit my patients according to my greatest ability and judgement, and I will do no harm or injustice to them.
I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.
In purity and according to divine law will I carry out my life and my art.
I will not use the knife, even upon those suffering from stones, but I will leave this to those who are trained in this craft.
Into whatever homes I go, I will enter them for the benefit of the sick, avoiding any voluntary act of impropriety or corruption, including the seduction of women or men, whether they are free men or slaves.
Whatever I see or hear in the lives of my patients, whether in connection with my professional practice or not, which ought not to be spoken of outside, I will keep secret, as considering all such things to be private.
So long as I maintain this Oath faithfully and without corruption, may it be granted to me to partake of life fully and the practice of my art, gaining the respect of all men for all time. However, should I transgress this Oath and violate it, may the opposite be my fate.”
Pretty much everyone, including both liberals and conservatives, agrees that this oath is outdated. To start out with, the Hippocratic Oath is sworn by “Apollon the physician, and Asklepios, and Hygieia and Panakeia and all the gods and goddesses.” Last time I checked, there were not very many physicians out there who still worshipped these deities.
Most doctors in western, industrialized countries are either believers in one of the Abrahamic religions or irreligious. Doctors who adhere to one of the Abrahamic monotheistic religions do not believe in the Greek gods and consider it idolatrous to worship them. Doctors who are atheists or agnostics usually consider belief in deities to be a form of superstition. There are very few doctors today who are Hellenic Reconstructionists.
The original version of the Hippocratic Oath also prohibits doctors from administering “lethal drugs” to any patient for any reason, even if the patient asks for them. This means that, under the Hippocratic Oath, assisted suicide for the terminally ill is strictly prohibited. The question of whether or not assisted suicide for the terminally ill is ethical, though, is still debated among physicians. Assisted suicide is currently legal in nine jurisdictions within the United States, as well as in a number of foreign countries.
ABOVE: Map borrowed from Wikimedia Commons. Assisted suicide is legal by legislation in states shown in dark blue, legal by court order in states shown in light blue, and illegal in states shown in red
The oath prohibits doctors from giving any woman “a pessary to induce abortion.” Today, abortions are not usually performed using pessaries. Furthermore, the modern medical community does not generally consider a doctor performing an abortion to be forbidden. It is legal in most western countries for a woman to choose to have an abortion, at least under some circumstances, and many doctors today do, in fact, perform abortions.
The line “In purity and according to divine law will I carry out my life and my art” has very little concrete meaning for most contemporary physicians, since there is no consensus on what exactly counts as pure and in accordance with divine law. After all, doctors come from many different religious backgrounds and different religions have different definitions of “purity” and “divine law.” Many doctors today are not even religious. It would be very difficult for a doctor who is an atheist to live their life “according to divine law.”
The Hippocratic Oath prohibits any doctor from ever performing any kind of surgery. It even specifically prohibits doctors from performing minor surgeries, such as lithotomies. In ancient times, this prohibition against surgery made sense because there was a clear distinction between “doctors” and “surgeons” and it was widely agreed that performing surgery was a task for a surgeon, not a doctor. Today, though, surgeons are doctors. Dictionary.com literally defines the word surgeon as “a physician who specializes in surgery.” In the modern age, it makes no sense to prohibit doctors from performing surgery.
ABOVE: Photograph from Wikimedia Commons showing surgeons engaging in surgery. The original version of the Hippocratic Oath strictly forbids doctors from performing surgery for any reason, since this was a job for surgeons, not doctors. Today, though, surgeons are doctors.
The original version of the Hippocratic Oath mentions that the doctor should not seduce other people’s slaves, but slavery is now officially illegal in every country on Earth, so there is hardly a pressing need for physicians today to swear that they will not seduce other people’s slaves. (It is worth noting, though, that, as I discuss in this other article I published in March 2019, Mauritania—the last country to formally abolish slavery—only did so in 2007, so slavery was still officially legal in at least one country on earth within the lifetimes of most people reading this. Think about that for a moment.)
Finally, the original Hippocratic Oath prohibits doctors from ever sharing patients’ secrets with anyone under any circumstances, but there are some circumstances today under which doctors may be morally and legally obligated to share their patients’ secrets. For instance, a doctor may need to share information about a patient with law enforcement officials if, say, the doctor has learned that the patient is a dangerous serial killer who will probably strike again. Evidently, these sorts of scenarios did not occur to the original author of the oath.
Misconception #4: Doctors today can be severely punished for breaking the Hippocratic Oath.
Nope! As I noted previously, most doctors today never even have to swear the original version of the Hippocratic Oath to begin with. Although some physicians do take oaths as part of their graduation ceremonies from medical school, these oaths are usually regarded as mostly ceremonial and are not seen as a particularly big deal.
There are currently no organizations set up to track down physicians who break their oaths and punish them. Likewise, violating one of these oaths is not officially illegal in and of itself, although certain acts that violate a physician’s oath may be illegal because the acts themselves are inherently illegal and would be illegal regardless of whether the physician doing them had taken an oath or not.
For instance, it is illegal for a doctor to murder a patient by giving them poison, regardless of whether the doctor had sworn an oath not to poison anyone. Doctors rarely get into any kind of legal trouble for oath breaking, but they can and do get in trouble for engaging in malpractice.
Even in ancient times, there was never any enforced punishment specifically for breaking the Hippocratic Oath. If you swore the Hippocratic Oath and then broke it, no one was going to come around, arrest you, and throw you in a prison cell somewhere to rot for the rest of your days for breaking the oath. That being said, people in antiquity generally took any kind of oath very seriously because it was believed that the gods would punish anyone who violated their oaths.
In the ancient Greek world, there were very few things a person could do that people thought the gods were bound to punish, but one of them was oath-breaking. The ancients believed that a person’s word was absolutely sacrosanct and that it needed to be kept at all costs. Breaking one’s oath was regarded as a form of treachery, which was seen as the worst sort of crime.
Many people in ancient times therefore would have certainly believed that the gods would punish anyone who violated the Hippocratic Oath. Nevertheless, there was still never any human organization dedicated to making sure doctors kept their vows. Many unscrupulous doctors probably did end up breaking their vows sometimes. For instance, we have ancient accounts of doctors performing surgery and providing women with abortifacients. In all of these cases, though, we have no record if the doctors in question had taken the Hippocratic Oath.
Conclusion
The Hippocratic Oath is truly a historic text and it has been tremendously influential on the field of medical ethics. Nonetheless, the primary importance of the Hippocratic Oath lies not in its applicability to the contemporary field of medicine, but rather in its historical significance.
The Hippocratic Oath was possibly the very first attempt to lay out a set of rules based on contemporary ethical thinking for how a physician should behave and turn these rules into an oath that was meant for all physicians to swear. The Hippocratic Oath is not a set of eternal, immutable rules that all physicians must obey for all time; instead, it represents the first step on the long road towards a more modern way of thinking about medical ethics.
In this way, the Hippocratic Oath is actually a lot like Athenian democracy. As I plan to discuss in a future article, Athenian democracy is important because of its historical significance and the influence it has had on later forms of government, including our own. That being said, ancient Athenian democracy was horribly flawed in a number of fundamental ways and our modern system of governance, which has drawn inspiration from the ancient Athenian model, is frankly much better.
We should not idealize Athenian democracy as the paragon that all modern democracies should strive to emulate; instead, we should borrow from it what is good and leave the parts of it that did not work to history. Likewise, we should not continue to hold up the original version of the Hippocratic Oath as the set of rules that all physicians must always follow today and for all time. Instead, we should use the ideas from it that work—such as the principle that doctors should never deliberately harm their patients—and abandon the parts that do not work—such as the prohibition against doctors performing surgery.
