hippocritical oath?

Reading  Subrata Chattopadhyay's paper "Bioethical concerns are global, bioethics is Western" I found familiar mention about the very Euro-North American bias in medical ethics.  Individualism, medicine as business, yeah, yeah, yeah... that's my day job.  But Chattopadhyay spoke specifically about the Hippocratic oath part way through, and my Med I ears perked up.  He commented about how bioethicists quote Kant and Locke and Socrates, but not Buddha, Confucius or Ghandi.  We pledge the oath that came from the Greeks when other disciplines have equally relevant contributions to make. 

He mentioned the Sollemn Oath pledged in Ayurvedic Medicine in Ancient India.  And after a little poking around I found it.  Not only is a physician expected to be a Good Doctor, but a Good Person.  As though the two were inextricably linked...

“ Day and night however thou mayest be engaged, thou shalt endeavour for the relief of the patient with all thy heart and soul. Thou shalt not desert or injure the patient even for the sake of thy life or thy living. Thou shalt not commit adultery even in thought. Thou shall not covert others possessions. Thou shalt be modest in thy attire and appearance. Thou should not be a drunkard or a sinful man, nor should thou associate with abettors of crime.

Thou should speak words that are gentle, pure and righteous, pleasing, worthy, true, wholesome and modest. Thy behaviour must be in consideration of time and place and heedful of past experience. Thou shalt act always with a view to the acquisition of knowledge.

Though possessed of knowledge, one should not boast very much of his knowledge. Most people are offended by the boastfulness of even those who are otherwise good and well informed.

There is no limit at all which the knowledge of Ayurveda can be acquired, so thou should apply thyself to it with diligence. This is how thou should act. Again, thou should learn the skill of practice from one another without carping. The entire world is a teacher to the intelligent and the foe to the unintelligent. Hence, knowing this well, thou should listen and act according to the words of instruction of even an unfriendly person, when they are worthy and such as bring fame to you and long life, and are capable of giving you strength and prosperity.”

This is given in Charaka Samhita, a compedium on Ayurveda authored by Charaka-a renowned authority on Ayurvedic Medicine who lived sometime between the 2nd Century B.C. and 2nd Century A.D.

Code Of Ethics :

• We shall always maintain the Highest Standard of Professional Conduct.
• We shall not be influenced merely by Motives of Profit.
• We shall endeavor to maintain Dignity of Manner.
• We will not do anything that will Weaken, Physically or Mentally, a client.
• We take Patient's Welfare as the first consideration.
• We shall always do our best to provide the most Appropriate Treatment.
• We shall Treat a client / Patient in Complete Confidence.
• We shall always be abiding to the Principles and Practices of Ayurveda.
• We shall provide the Related Services for which we are duly Qualified.

I have to say that the line "Thou should speak words that are gentle, pure and righteous, pleasing, worthy, true, wholesome and modest" is truly remarkable.   Can you imagine?  Doctors in a row, lining up in their sharp coats, promising to speak gently.  Words that are gentle and modest.  <sound of the script of Grey's Anatomy going up in flames>  I find it hard to imagine.  Equally stunning, the phrase "thou should listen and act according to the words of instruction of even an unfriendly person" is totally foreign to a Western physician.  Yet doctor-patient relationships, doctor-nurse relationships, doctor-administration relationships would be totally altered by such an approach!

Quakers teach a kind of intentional listening that is part of their faith experience; to hear that which is divine in the words of others.  The assumption is that each person has equal access to Truth and to the Divine, and that there are fragments of both in everything we say.  Now, I'm not going to get into the metaphysics of divinity here, but there is something deeply instructive about Quaker listening that is attuned to the Ayurvedic code. 

I am a student.

I have been a student of the human experience since the day of my birth and I won't survive my graduation from that discipline.  It's up to me to learn and deepen that study, or to coast, copy or cheat my way through.  And as the oath above suggests, life is the classroom, right?  Compassion = education.  This code of conduct should not be exclusive to physicians, but should be asked of all of us. 

Emergency wards are a classroom...

Patients frequently present at the E.R. with non-emergent maladies - they feel sorry for themselves, have an overdeveloped sense of their own urgency, create drama and resent waiting.  Beneath that, however, is evidence of their life story.  These individuals likely had to clamour to see their needs met when they were young; they have been overlooked and under-appreciated; they have encountered an unsympathetic world and if they don't feel sorry for themselves, maybe no one will care.  They are afraid and isolated, perhaps distrustful of their own bodies, but certainly distrustful of their community to protect their interests... perhaps to even take interest in their interests.  Each one of these patients is a keen lesson in sharp focus that compassion, engagement and protective relationships are essential to human confidence.  When we diminish the experiences of our children (oh, don't be silly), our friends (get over it), and our partners (you think you've had a bad day!) we diminish their humanity, and those injuries add up.  Even the most obnoxious patients are instructors if we listen closely enough.

They tell a truth.

Even if someone is a self-pitying, pouty poopy pants, that doesn't mean their pain doesn't hurt.  The fact that their threashhold may be low might be a result of their need for endurance - people who live in emotional pain suffer physical pain far more acutely.  Are they wimps or are they suffering in ways we just can't see?  Obnoxious patients can teach physicians to remember that context is everything and that illness does not exist in a vacuum.  Pain is subjective and is experienced in layers.  Instead of learning from one another, however, we insert ourselves in the stories we hear:  "that wouldn't bother me" we think, forgetting that is totally irrelevant.  It bothers someone, so that must mean it's bothersome!

Speak words that are gentle, pure and righteous, pleasing, worthy, true, wholesome and modest. Thy behaviour must be in consideration of time and place and heedful of past experience. Thou shalt act always with a view to the acquisition of knowledge... The entire world is a teacher.

I think I may try my own hand at writing an oath... something that will guide my own physicianhood, beyond the formulas of a promise that may be rather incomplete.



Chattopadhyay S, DevRies R (2008) Bioethical concerns are global, bioethics is Western, Eubios Journal of Asian and International Bioethics, 18(4): 106–109