Codes/Oaths
Background
Codes, oaths and prayers guiding health practitioners in caring for patients have been extant for centuries. Codes of ethics have been expressed in the form of prayers, oaths, creeds, institutional directives, and statements. "Prayers state a very personal commitment of duty; oaths publically pledge the oath taker to uphold specified responsibilities; and codes provide more comprehensive standards to guide the practicing health practitioner, patient, or other decision maker. Each form of ethical statement implies a moral imperative, either to be accepted by the individual personally or to be enforced by a practitioner organization, religious community, or governmental body." (Veatch, Robert. 1995. "Medical Codes and Oaths" in vol. 1,pp. 1419-1435,Encyclopedia of Bioethics. 2nd ed. New York: Macmillan : Simon & Schuster Macmillan ; Prentice Hall International.
One of the earliest oaths is one for medical students taken from the Charaka Samhita manuscript of ancient India. This oath called upon the student to follow a path of personal sacrifice and commitment to duty. In western Medicine, the Hippocratic Oath has had great influence. The Oath of Asaf, from a seventh-century Hebrew medical manuscript, reveals Hippocratic influences in its injunctions against administering poisons or abortifacient drugs, performing surgery, committing adultery, and betraying practitioner confidences. In China, medical ethics appear in the Taoist writer Sun Szu-miao, whose writing stresses the importance of preserving life and serving the interests of the patient. The most widely known Jewish text is the Daily Prayer of a Physician, once ascribed to the Jewish philosopher and phyisician Moses Maimonides (1135-1204).
A select list of oaths, codes and statements is a dropdown on this tab, above.. For more information on the history and background of codes and oaths see the entry "Medical Codes and Oaths" in the Encyclopedia of Bioethics referenced above.
Major & Historical Codes
Charaka Samhita - one of the main texts of Ayurveda ("science of life") - For a discussion see: Menon, I.A., and Haberman, H.F. 1970 "The Medical Students' Oath of Ancient India." Medical History 14, no.3: 295-299
Thomas Percival. Medical Ethics. (1803)
The English physician, Thomas Percival (1740-1804) in 1803 published hisMedical Ethics; or, a Code of Institutes and Precepts Adapted to the Professional Conduct of Physicians and Surgeons. This code, following in the tradition of the Hippocratic Oath was to influence the development of later codes of medical ethics. Indeed, the American Medical Association (AMA) adapted and adopted Percival's code for use by American physicians in 1847. The Percivalian code asserted the moral authority and independence of physicians in service to others, affirmed the profession's responsibility to care for the sick, and emphasized individual honor.
American Medical Association (AMA) Code of Ethics (1846) (full text - pdf)
The AMA Code of Ethics was adapted from the ethical code of conduct published in 1794 by Thomas Percival. This was the first code to be adopted by a national professional organization. The current AMA code of ethics (2001) has nine articles which is two more than the previous version (1980). These additions stress the responsibility the doctor has to the patient and the support of universal access to medical care. Provisions are also added to the revised Oath regarding a commitment to medical education and a responsibility for the betterment of public health. Other features of the Code are:
Nuremberg Code (1947) (full text)
The product of international law, this code deals with medical research on human subjects and arose out of the post-WWII trial of Nazi doctors for crimes against humanity committed in the name of research. The Nuremberg Code sets out 10 principles outlining the ethics of medical research and ensuring the rights of human subjects::
Declaration of Geneva (1948 - rev. 2002) (full text)
This oath for physicians was adopted by the newly established (1948) World Medical Association largely in response the atrocities committed in the name of research in WWII Nazi concentration camps. It was also meant to update the Hippocratic Oath to make it more applicable to the modern era.
World Medical Association International Code of Medical Ethics (1949)(full text)
This was an attempt to develop international standards of medical ethics and sought to summarize the most important principles of medical ethics.
Declaration of Helsinki (Adopted 1964; latest amendment 2000)(full text)
This document has been revised several times since its publication in 1964 as a response to unethical medical experiments of the Nazis during WWII. The latest revision of the declaration (2000) states that "the well-being of the human subject should take precedence over the interest of science and society." Other of the Helsinki principles are that the doctor should only act in the patients best interest and that the health of the patient is the first concern. Many of the principles are incorporated in national research regulations.
The revised declaration also discusses the use of placebo, recommends that ethics committees have the obligation to monitor ongoing trials, and requires that researchers disclose to subjects details of funding and possible conflicts of interest. Finally, there is a recommendation that publishers decline studies not carried out in accordance with the declaration.
In addition to professional associations and governmental bodies, other organizations such as the Catholic Church have issued codes concerning matters of human health.
Ethical & Religious Directives for Catholic Health Facilities (5th ed. 2009) (full text)
This document is written by the United States Conference of Catholic Bishops and is considered binding on not only Catholics but also non-Catholics who are associated with Catholic health facilities.
Instruction on Respect for Human Life (1987) (full text)
The Vatican's Congregation for the Doctrine of the Faith makes known its stance concerning "biomedical techniques which make it possible to intervene in the initial phase of the life of a human being and in the very processes of procreation and their conformity with the principles of Catholic morality".
Patient's Bill of Rights (1973, rev. 1992) (full text)
The Patient's Bill of Rights was first adopted by the American Hospital Association with the expectation that hospitals and health care institutions would support these rights in the interest of delivering effective patient care. It was also written partly as a response to the growing consumer health movement.
Oath and Prayer of Maimonides
Moses Maimonides (1135/38-1204) (in Hebrew: Rav or Rabbi Moshe Ben Maimon, or "RaMBaM" -- the acronym of his name), was the most important Jewish philosopher of the Middle Ages. Maimonides was born in the Spanish city of Cordoba at a time when about one-fifth of the people in southern Spain were Jews. However, Maimonides and his family fled to Fustat (now Cairo) because of rising anti-Semitism in Spain. There Maimonides worked as a physician, but also became a scholar of Jewish law and a philosopher.
The "Daily Prayer Of A Physician" is attributed to Maimonides, but was probably written by Marcus Herz, a German physician, pupil of Immanual Kant, and physician to Moses Mendelssohn. It first appeared in print in about 1793.
The eternal providence has appointed me to watch over the life and health of Thy creatures. May the love for my art actuate me at all time; may neither avarice nor miserliness, nor thirst for glory or for a great reputation engage my mind; for the enemies of truth and philanthropy could easily deceive me and make me forgetful of my lofty aim of doing good to Thy children.
May I never see in the patient anything but a fellow creature in pain.
Grant me the strength, time and opportunity always to correct what I have acquired, always to extend its domain; for knowledge is immense and the spirit of man can extend indefinitely to enrich itself daily with new requirements.
Today he can discover his errors of yesterday and tomorrow he can obtain a new light on what he thinks himself sure of today. Oh, God, Thou has appointed me to watch over the life and death of Thy creatures; here am I ready for my vocation and now I turn unto my calling.
Almighty God, Thou has created the human body with infinite wisdom. Ten thousand times ten thousand organs hast Thou combined in it that act unceasingly and harmoniously to preserve the whole in all its beauty the body which is the envelope of the immortal soul. They are ever acting in perfect order, agreement and accord. Yet, when the frailty of matter or the unbridling of passions deranges this order or interrupts this accord, then forces clash and the body crumbles into the primal dust from which it came. Thou sendest to man diseases as beneficent messengers to foretell approaching danger and to urge him to avert it.
Thou has blest Thine earth, Thy rivers and Thy mountains with healing substances; they enable Thy creatures to alleviate their sufferings and to heal their illnesses. Thou hast endowed man with the wisdom to relieve the suffering of his brother, to recognize his disorders, to extract the healing substances, to discover their powers and to prepare and to apply them to suit every ill. In Thine Eternal Providence Thou hast chosen me to watch over the life and health of Thy creatures. I am now about to apply myself to the duties of my profession. Support me, Almighty God, in these great labors that they may benefit mankind, for without Thy help not even the least thing will succeed.
Inspire me with love for my art and for Thy creatures. Do not allow thirst for profit, ambition for renown and admiration, to interfere with my profession, for these are the enemies of truth and of love for mankind and they can lead astray in the great task of attending to the welfare of Thy creatures. Preserve the strength of my body and of my soul that they ever be ready to cheerfully help and support rich and poor, good and bad, enemy as well as friend. In the sufferer let me see only the human being. Illumine my mind that it recognize what presents itself and that it may comprehend what is absent or hidden. Let it not fail to see what is visible, but do not permit it to arrogate to itself the power to see what cannot be seen, for delicate and indefinite are the bounds of the great art of caring for the lives and health of Thy creatures. Let me never be absent- minded. May no strange thoughts divert my attention at the bedside of the sick, or disturb my mind in its silent labors, for great and sacred are the thoughtful deliberations required to preserve the lives and health of Thy creatures.
Grant that my patients have confidence in me and my art and follow my directions and my counsel. Remove from their midst all charlatans and the whole host of of ficious relatives and know-all nurses, cruel people who arrogantly frustrate the wisest purposes of our art and often lead Thy creatures to their death.
Should those who are wiser than I wish to improve and instruct me, let my soul gratefully follow their guidance; for vast is the extent of our art. Should conceited fools, however, censure me, then let love for my profession steel me against them, so that I remain steadfast without regard for age, for reputation, or for honor, because surrender would bring to Thy creatures sickness and death.
Imbue my soul with gentleness and calmness when older colleagues, proud of their age, wish to displace me or to scorn me or disdainfully to teach me. May even this be of advantage to me, for they know many things of which I am ignorant, but let not their arrogance give me pain. For they are old and old age is not master of the passions. I also hope to attain old age upon this earth, before Thee, Almighty God!
Let me be contented in everything except in the great science of my profession. Never allow the thought to arise in me that I have attained to sufficient knowledge, but vouchsafe to me the strength, the leisure and the ambition ever to extend my knowledge. For art is great, but the mind of man is ever expanding.
Almighty God! Thou hast chosen me in Thy mercy to watch over the life and death of Thy creatures. I now apply myself to my profession. Support me in this great task so that it may benefit mankind, for without Thy help not even the least thing will succeed.
~ Translated by Harry Friedenwald, Bulletin of the Johns Hopkins Hospital 28: 260-261, (1917)
Hippocratic Oath
Classical version ~ Modern version ~
Classical version
I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfil according to my ability and judgment this oath and this covenant:
To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art - if they desire to learn it - without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else.
I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.
I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.
I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.
Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.
What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.
If I fulfil this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.
Translation from the Greek by Ludwig Edelstein. From The Hippocratic Oath: Text, Translation, and Interpretation, by Ludwig Edelstein. Baltimore: Johns Hopkins Press, 1943.
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 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 sick, all measures which 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 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 respect the privacy of my patients, 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 prevent disease whenever I can, 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.
Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, and used in many medical schools today.
Nuremburg Code
This means that the person involved should have legal capacity to give consent; should be so situated as to be able to exercise free power of choice, without the intervention of any element of force, fraud, deceit, duress, over-reaching, or other ulterior form of constraint or coercion; and should have sufficient knowledge and comprehension of the elements of the subject matter involved, as to enable him to make an understanding and enlightened decision. This latter element requires that, before the acceptance of an affirmative decision by the experimental subject, there should be made known to him the nature, duration, and purpose of the experiment; the method and means by which it is to be conducted; all inconveniences and hazards reasonably to be expected; and the effects upon his health or person, which may possibly come from his participation in the experiment.
The duty and responsibility for ascertaining the quality of the consent rests upon each individual who initiates, directs or engages in the experiment. It is a personal duty and responsibility which may not be delegated to another with impunity.
"Trials of War Criminals before the Nuremberg Military Tribunals under Control Council Law No. 10", Vol. 2, pp. 181-182. Washington, D.C.: U.S. Government Printing Office, 1949.]
Patient's Bill of Rights
Patient's Bill of Rights (American Hospital Association)
See other versions of patients rights documents in the U.S.
The Patient's Bill of Rights was first adopted by the American Hospital Association in 1973 and revised in October 1992. Patient rights were developed with the expectation that hospitals and health care institutions would support these rights in the interest of delivering effective patient care. The American Hospital Association encourages institutions to translate and/or simplify the bill of rights to meet the needs of their specific patient populations and to make patient rights and responsibilities understandable to patients and their families.
According to the American Hospital Association, a patient's rights can be exercised on this or her behalf by a designated surrogate or proxy decision-maker if the patient lacks decision-making capacity, is legally incompetent, or is a minor.
Bill of Rights
