http://bmj.com/cgi/content/full/323/7327/1440
BMJ 2001;323:1440-1441 ( 22-29 December )
Editorials
Medical oaths and declarations
A declaration marks an explicit commitment
to ethical behaviour
Some 98% of American 1
3 and
nearly 50% of British medical students 1 4 swear some
kind of oath, either on entry to medical school5 or at
graduation.4
One reason why oaths are more common in America may be that American
children are brought up to swear their allegiance to the flag, so
the concept of affirming their beliefs is less alien than to British
students.
Oaths are neither a universal endeavour 3 4 nor a
legal obligation, and they cannot guarantee morality. So why should doctors
take an oath at all? In 1992 a BMA working party found that affirmation
may strengthen a doctor's resolve to behave with integrity in
extreme circumstances. This group recommended that "medical
schools incorporate medical ethics into the core curriculum, and
that all medical graduates make a commitment, by means of affirmation,
to observe an ethical code."6 The
increasing complexity of healthcare arrangements and interagency
collaboration, and the need to look at rationing resources, has
forced the medical profession to re-examine its core values. In view
of this, and with public confidence in doctors diminishing and
morale at an all time low, it is perhaps unsurprising that the
concept of an entire year of newly qualified doctors freely
declaring their intentions to act ethically and professionally
proved popular with both staff and students at Imperial College.
Oath taking does, however, have its critics. Some think it only encourages
self importance and fuels paternalism. Others see it as a bid for respectability
the
church, the bar, and the armed forces all swear oaths.
We devised the declaration with support and guidance from Raanon Gillon,
emeritus professor of medical ethics. The final version (box) was
approved by the whole year group. We decided early on that oaths
were anachronistic and settled on creating a declaration instead. Of
all the institutes that swear oaths, only three use the classic
Hippocratic oath.3
The remainder use modified alternatives, covenants, and prayers. 1 3 4 Making a
declaration, rather than swearing an oath, is important. We are not
swearing allegiance to an introverted, self serving club but
declaring our intentions to help those who place themselves in our
care and the community at large.
|
Declaration of a
new doctor Now, as a new doctor, I solemnly promise that I will to the best of my
ability serve humanity I recognise that the practice of medicine is a privilege with which comes
considerable responsibility and I will not abuse my position. I will practise medicine with integrity, humility, honesty, and compassion I shall never intentionally do or administer anything to the overall harm
of my patients. I will not permit considerations of gender, race, religion, political
affiliation, sexual orientation, nationality, or social standing to influence
my duty of care. I will oppose policies in breach of human rights and will not participate
in them. I will strive to change laws that are contrary to my profession's
ethics and will work towards a fairer distribution of health resources. I will assist my patients to make informed decisions that coincide with
their own values and beliefs and will uphold patient confidentiality. I will recognise the limits of my knowledge and seek to maintain and
increase my understanding and skills throughout my professional life. I will
acknowledge and try to remedy my own mistakes and honestly assess and respond
to those of others. I will seek to promote the advancement of medical knowledge through
teaching and research. I make this declaration solemnly, freely, and upon my honour. |
The task of composing the declaration was long and more
difficult than we expected. We started by consulting existing oaths including
the original Hippocratic oath, the World Health Organization revised
Hippocratic oath, the prayer of Maimonides, the Geneva declaration,
the University of Naples declaration, and the General Medical
Council's Duties of a Doctor. Although all contained many relevant
principles, we wanted to compose a succinct declaration that the
year group would feel at ease with.
The declaration encompasses the principles of respect for patient autonomy,
non-maleficence, beneficence, and justice. We also included some of
the virtues (humility, honesty, compassion) and core working values
and principles (confidentiality, informed consent, non-prejudice)
that guide modern medical practice. The declaration highlights the
importance of continued medical education and professional
development and encourages openness and accountability in dealing
with adverse clinical events. The place of research and public
health in medicine is also recognised.
The "affirmation of a new doctor" ceremony took place on
27 July 2001. With friends and family looking on, all the newly
qualified doctors stood to confirm their commitment. The ceremony
was designed to be unifying and celebratory as well as offering an
ethical framework to guide new doctors as they embark on their
medical careers. It was timed to immediately precede the start of
our house jobs. We hope that the proximity between accepting
responsibility for patient safety and promising to act
professionally will etch the association indelibly into our minds.
Kaji Sritharan
on behalf of the Imperial College School of
Medicine graduating year of 2001 (k.sritharan@ic.ac.uk);
impmedcer@hotmail.com
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1. |
Hurwitz B, Richardson R. Swearing to care: the resurgence
in medical oaths. BMJ 1997; 315: 1671-1674 |
|
2. |
Louden I. The Hippocratic oath. BMJ 1994; 309: 414 |
|
3. |
Crawshaw R. The Hippocratic oath. BMJ 1994; 309: 952 |
|
4. |
Bende BC. The Hippocratic oath. BMJ 1994; 309: 953 |
|
5. |
Gillon R. White coat ceremonies for new medical students. J
Med Ethics 2000; 26: 83-84 |
|
6. |
BMA. Medicine betrayed. London: Zed Books, 1992. |
© BMJ 2001
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