IN SEARCH FOR THE ROOTS OF A DOCTOR’S ETHOS
Facing new challenges which appeared together with the development of bio-medical sciences in the contemporary medicine, there is a good professional and moral formation of doctors, based on the most valuable examples
Whereas, not only today do we know that the tradition of Hippocrates’ medicine, being formed for nearly 2.5 thousand years, enriched and strengthened with an experience of Christian mercifulness, is collapsing in our eyes. The beginnings of deconstruction of the Christian culture of Europe, in which medicine has always had an important place, reach back to the Enlightenment period, but it appeared fully after the reform of August Comte, who reformed not only sciences but he inscribed his reform into a kind of a religious plan, whose purpose was the salvation of the man without God.
A troublesome document
People of the Enlightenment epoch referred to the nature, raised to the rank of deity. In the post-positivism times there was no place or respect for either God, or nature. So, no wonder, that the terms of both the natural law and God’s law stopped being understandable and were eliminated from culture. The Hippocrates’ Vow, together with overvaluations, clearly describing the basic duties of a doctor, which is serving to the human health and life from conception to natural death, became a troublesome document. As a result, it disappeared from medical universities and academies. Well, maintaining tradition, students of medicine take a medical vow, often mistaken as the Hippocrates’ Vow, but nearly always omitting the basic rule of the Hippocrates’ medicine saying about the protection of the human health and life, regardless of his stadium of development, quality and usefulness.
In order to stop actions demoralizing medical groups through enforcing moral relativism, or any kinds of pragmatisms treating the man, for example, as an element of economical structure, we must return to sources. We must remind about them, so that we could find permanent – because strengthened with experiences of hundreds of generations of excellent doctors – basis for building full medicine, of the human value, treating a patient as a subject carrying the dignity of the human being, who cannot be reduced to the biological level or even psychological level, because he is an intelligent being, free and realizing his vocation in the eschatological space of spiritual life.
Calling for people of conscience
High moral standards, based on the values of Hippocrates’ medicine, which is science and also faithful service to the man needing help, were and still are the basis for medicine without social and individual trustfulness to a doctor. Therefore, speaking a different language, a doctor should always be a man of conscience. The statutory law changes according to the current policy, and rules described in Hippocrates’ Vow and on pages of the Bible in the form of Ten commandments do not change, because they are compatible not with the current tendencies, ideologies, but they are faithful to the man, the truth about the human being and what is entailed here – compatible with the good of the man.
Although Hippocrates’ Vow appeared a few thousand years ago, it is a document astonishingly universal. Despite attempts of falsifying this unusual document, which was read with respect in classical Greek schools, in famous schools of the early-Middle Age Arabian medicine and at the most serious European universities, we must know that it includes a clear awareness of what is today called the ethos of the job of public trustfulness. It is mentioned by the beginning of this horouable declaration of decent proceeding in doing job. ‘I will respect my Master in the job on the same level as my parents (…) and I will psas right things, lectures and the whole science to my sons, the sons of my Master and their students…’.
Another group of norms included in the Vow refers directly to the relation with patients. ‘I will use healing treatments according to my abilities and knowledge for the benefit of patients, defending them against any harm’. The text of the vow does not leave any doubts that the purpose of a doctor and every representative of the medical job is life protection, beginning from the prenatal phase till the natural death. ‘I will not give lethal poison to anybody, nor even to anybody’s demand, nor I will advice it, similarly, I will never give an abortifacient to a woman’. This explicit radical Hippocrates’ attitude opting for definite life protection became the cause of the text as a vow today, making it allegedly not universal after a few dozen ages. On this occasion it is often argued with a sentence concerning patients suffering from cholelithiasis: ‘I will not operate on patients suffering from cholelithiasis, leaving the job to people applying this surgery’. This sentence expresses a rule of following specified competences in medicine, not prohibition of treating cholelithiasis.
Calling for discretion
Hippocrates’ Vow also defines the rule of discretion – decent respecting the intimacy of the man who, looking for help, says about his deepest secrets. He expects effective actions saving his health and sometimes, even life, and also claims respecting his subjectivity. A patient cannot be the object of medical surgeries but he is always their subject. Even when he is unconscious, he does not lose his human dignity which should be respected. Facing the developing genetics which allows for discovering the deepest mysteries of the human body through genetic examinations, the rule of discretion becomes more and more demanded in the work of laboratory diagnosticians.
What is characteristic for the ethical code is the sanction for not following specified norms. It has a moral dimension. If I do not follow rules specified in a code of a professional group, I place myself outside this group and exclude myself from it. It is well expressed by Hippocrates: ‘If I keep this vow and I do not breach it, I will achieve success in life and fulfilling this job, and I will be respected by people all the time; if I breach it, I will have troubles’.
The Oath has marked a beautiful and rich tradition of moral reflection in ancient Greece, later enriched with the Christian thought. This trend also includes the tradition of medicine of the Arab world, whose symbol is Awicenna.
The first famous Polish text of the medical vow (from XV century), which was taken by graduates of medicine of the Academy in Cracow, was reflected by the prototype of Hippocrates. Only invocation was changed with the reference to the Holy Trinity: ‘Having witnesses in God Father, Son and the Holy Spirit I take a vow that I will follow everything which is included in this vow – as much as I can, in such an extent in which my abilities will allow me to…’(A. Tulczynski, ‘History and evolution of ethical codes’, ‘Ethics and medical deontology’, edited by T. Kielanowski, no. 195 Warsaw 1985). This invocation disappeared in XIX century. In the place of the reference to God in the Holy Trinity, there appeared the reference to the very significance of the job, which was to be a sufficient guarantee of following the norms of the taken vow. In the XX century, following the ideologies of the Enlightenment and Positivism, the man started trusting himself more than God. Only law was to be sufficient but it is changing with the tendencies existing in our culture, and the man is always the same, has the same unchangeable needs and a right for being respected, even when he is disabled, or is short of strength, for being treated as a person aware of his presence in the world, who is intelligent and free in his choices. In medicine, which wants to be loyal to its vocation and the man, there is no escape from Hippocrates.