Tishchenko P. D. Resurrection of the Hippocratic Oath in Russia
I graduated from medical school in 1972. According to orders signed at the Kremlin by the Chairman of the Supreme Soviet of the USSR, I was obliged, along with every graduating medical student, to swear to a new professional code, "The Oath of the Soviet Physicians." This was the second year the oath was used. Incorporated in the oath were promises to "conduct all my actions according to the principles of the Communist morality, to always keep in mind . . . the high responsibility I have to my people and to the Soviet government." I felt no discomfort joining with my friends in repeating words about the communist morality which by that time had already become a ritualized and meaningless official decoration of our life. The text of this oath fit into the political and medical ideology of that time. Not surprisingly, "The Oath of the Soviet Physicians" died along with the Soviet Union.
Certainly, a rethinking of the aspirations and obligations of physicians in Russia was in order and carried with it the opportunity to set a new direction for medicine in a society struggling to define itself and its values. In June 1992, a new medical oath, "The Promise of Russian Physicians" was published by joint decree of the Minister of Health Care and the Minister of Science, Education and Technology Policy. The preamble declares the new oath to be a combination of the Hippocratic Oath and the prerevolutionary university "Faculty Promise" minus, according to official statement, "evident anachronisms." The preamble also states that the new oath contains "a code of compulsory conditions of medical practice in the Russian Federation" that will promote "the restoration of the priority of universal moral principles" and will "return to medicine its humane role of protector of health for all people and revises the moral foundations of Russian physicians." In the summer of 1992, all graduating medical students in Russia swore to uphold the tenets of "The Promise" as follows:
In the presence of my teachers and brothers in the great science of healing, I assume with deep gratitude the rights of physicians granted to me and solemnly swear:
- to hold him who has taught me this art as equal to my parents, to help him in his deeds and needs;
- to give a share of precepts and oral instruction and all the other learning to pupils with obligatory ties to the medical law, but to no one else;
- in purity and holiness I will guard my life and my art, acting with beneficence and doing no harm to people;
- never to refuse medical service to anyone and to promote it carefully and with patience to patients regardless of different prosperity, race, religion, and conviction;
- whatever house I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice and of all mischief, particularly of sexual relations;
- to direct a regimen and treatment of the sick according to my ability and judgment, abstaining from doing any harm or injustice;
- never to use my knowledge and skill against the health of a man, even an enemy;
- never give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect;
- 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 it in silence holding such things as secret;
- to continue the study of medical science and to contribute to it prosperity, informing the scientific community about all that would be discovered;
- not to produce nor to sell illicit drugs;
- to be just to my comrade physicians and not to insult them personally; but if there will be benefit for a patient, to speak the truth directly without restraint;
- to obtain consultations in demanding cases from those who are more knowledgeable and skilled. When asked for consultation by others, I will acknowledge their merits and efforts.
If I fulfill this Promise and do not violate it, may it be granted to me to enjoy life and art. If I transgress it and swear falsely, may the opposite of all this be my lot.
In terms both of its commissions and omissions, this new oath falls woefully short as a useful guide for moral actions in contemporary medicine. Some of the recommended practices are starkly objectionable. The oath begins with a loyalty pledge to medical teachers as "parents" to be supported in "deeds and needs." Medicine as a club reserved for the initiated is continued by the promise to keep medical knowledge secret from all those outside the profession. Paternalism is rampant throughout the oath, belying the declaration that "evident anachronisms" have been eliminated. For example, the new code begins with male dominated language, ignoring the reality that the vast majority of Russian physicians are women; and extends to the assertion that medical treatment will be directed from the physician's "ability and judgment" thus failing to acknowledge completely what may be the patients own wishes or desires. This latter "compulsory condition" is particularly puzzling because it directly contradicts a broad index of patient's rights, part of a Bill of Legal Regulations of Medical Practice, prepared by the Supreme Soviet.
As glaring for their exclusion as the above errors are for their inclusion are any traditional Russian emphases on preventive medicine or to the physician's relationship to society. It is as if after total allegiance to the State in the earlier "Oath of the Soviet Physicians" now the obligations between the medical profession and society are completely ignored. In general, I presume the authors intended to create a ritual document rather than a regulation of medical practice. I urge Russian physicians to rethink this Code and to create a new one in its place that would include those issues currently overlooked but that are so important to the new environment for medical practice in our country. Specifically, commitments to individual patient rights as well as the responsibility of medicine to the larger society should play a major role in the code to be developed. Also the antiquated, paternalistic, and sexist emphasis that characterizes the Hippocratic Oath should be deleted. New values are needed for our new society.
This article was first publish in Cambridge Quarterly of Healthcare Ethics. Vol 3, Number 1, Winter 1994.