The Hippocratic Oath and the Ethics of Medicine
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《新英格兰医药杂志》
The Hippocratic Oath, like Handel's Messiah, is heard once a year. At medical school graduation ceremonies around the nation, 20,000 voices intone modernized, bowdlerized versions of the ancient pledge. For the rest of the year, it goes silent, except for an occasional invocation of one or another of its phrases to make a point about a contentious issue, such as assisted suicide or abortion. Many contemporary medical ethicists dismiss it as antiquated and irrelevant or condemn it as an insidious endorsement of medical paternalism.
Steven Miles wishes to pluck the oath out of its ritualistic niche, refurbish its meaning, and show its relevance for modern medical ethics. Miles is neither a classical scholar nor a historian of medicine. He is a practicing internist, a leader in the field of medical ethics, and a voice in health policy. (He also ran a creditable primary campaign for a Senate seat.) He has immersed himself in the literature about the origins and exegesis of the oath and works through its phrases with admirable skill.
Although a proper historian might criticize an occasional interpretation of the author's, Miles's reading of the oath is illuminating. He attempts to place this mysterious document, written 2400 years ago by unknown hands, in the cultural context of Greek medicine and morality. However, his chief concern is to reveal the oath's relevance for the practice of medicine and for health policy in the modern world. Using the familiar format of grand rounds, he posits a clinical case or health policy issue for each phrase of the oath and asks the Hippocratic physician to comment. This literary device works well enough, although one might wish for more cogent cases in several instances (as happens, of course, in actual grand rounds).
Miles examines the oft-cited phrases about "use of deadly drugs" and "abortifacients," demonstrating that they are unlikely maxims against euthanasia and abortion but offering plausible explanations of the terms' original meaning and relevance to modern medical ethics. He finds, as few commentators have, a dimension of social justice in the oath by distinguishing between the public and private activities of the Greek physician, both of which were governed by concepts of beneficence and justice. He concludes with a pertinent insight: noting that the oath, unlike modern codes and principles, was composed to be proclaimed in the first person, he writes that "its authors spoke explicitly of the necessity for each physician to reveal his professional moral commitments. The first-person voice may be part of the energy behind the Oath's endurance." Finally, teachers of medical ethics may appreciate Miles's outline of a course designed around the phrases of the oath.
Albert R. Jonsen, Ph.D.
California Pacific Medical Center
San Francisco, CA 94120(By Steven H. Miles. 208 p)
Steven Miles wishes to pluck the oath out of its ritualistic niche, refurbish its meaning, and show its relevance for modern medical ethics. Miles is neither a classical scholar nor a historian of medicine. He is a practicing internist, a leader in the field of medical ethics, and a voice in health policy. (He also ran a creditable primary campaign for a Senate seat.) He has immersed himself in the literature about the origins and exegesis of the oath and works through its phrases with admirable skill.
Although a proper historian might criticize an occasional interpretation of the author's, Miles's reading of the oath is illuminating. He attempts to place this mysterious document, written 2400 years ago by unknown hands, in the cultural context of Greek medicine and morality. However, his chief concern is to reveal the oath's relevance for the practice of medicine and for health policy in the modern world. Using the familiar format of grand rounds, he posits a clinical case or health policy issue for each phrase of the oath and asks the Hippocratic physician to comment. This literary device works well enough, although one might wish for more cogent cases in several instances (as happens, of course, in actual grand rounds).
Miles examines the oft-cited phrases about "use of deadly drugs" and "abortifacients," demonstrating that they are unlikely maxims against euthanasia and abortion but offering plausible explanations of the terms' original meaning and relevance to modern medical ethics. He finds, as few commentators have, a dimension of social justice in the oath by distinguishing between the public and private activities of the Greek physician, both of which were governed by concepts of beneficence and justice. He concludes with a pertinent insight: noting that the oath, unlike modern codes and principles, was composed to be proclaimed in the first person, he writes that "its authors spoke explicitly of the necessity for each physician to reveal his professional moral commitments. The first-person voice may be part of the energy behind the Oath's endurance." Finally, teachers of medical ethics may appreciate Miles's outline of a course designed around the phrases of the oath.
Albert R. Jonsen, Ph.D.
California Pacific Medical Center
San Francisco, CA 94120(By Steven H. Miles. 208 p)