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Human rights within the Hippocratic Oath (2002)
  • 1. The Hippocratic Oath

  • 2. Comparison - each paragraph of the Oath compared to relevant international law

  • The Hippocratic Oath

    - As translated by Ludwig Edelstein

    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 judgement this oath and this covenant:

    a) 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 to no one else.

    b) I will apply dietetic measures for the benefit of the sick according to my ability and judgement; I will keep them from harm and injustice.

    c) I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect.

    d) Similarly I will not give to a woman an abortive remedy.

    e) In purity and holiness I will guard my life and my art.

    f) I will not use the knife, not even on sufferers from stone, but will withdraw in favour of such men as are engaged in this work.

    g) 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.

    h) 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.

    i) If I fulfil this oath and do not violate it, may it be granted to me to enjoy life and art, being honoured with fame among all men for all time to come;

    j) if I transgress it and swear falsely, may the opposite of all this be my lot.

    The comparison

    a) 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 to no one else.

    This exuberant solidarity with medical teachers can be interpreted as a respect for knowledge and experience, which to a great extent would have been passed on orally in those days ...

    General Comment 14*:

    Para 36. ... states have to ensure the appropriate training of doctors and other medical personnel, ... [and] ... have to promote medical research ...

    b) I will apply dietetic measures for the benefit of the sick according to my ability and judgment;

    This can be interpreted, given the limited treatments available then, as referring to conscientious practice based upon non discrimination and carefully honed medical skills ...

    General Comment 14*:

    Para 12 (b) Accessibility - health facilities, goods and services have to be accessible to everyone without discrimination,

    [...]

    Non-discrimination - health facilities, goods and services must be accessible to all, especially the most vulnerable or marginalised sections of the population, in law and fact, without discrimination on any of the prohibited grounds.

    Para 35 Obligations to protect include, inter alia, to ensure that medical practitioners and other health professionals meet appropriate standards of education, skill, and ethical codes of conduct.

    c) I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect.

    This can be interpreted as meaning no treatment or procedure will be used that is not appropriate in terms of risk of iatrogenic (treatment induced) harm balanced against potential benefit, in the circumstances pertaining ...

    General Comment 14*:

    Para 12 c All health facilities, goods and services must be [...] designed to [...] improve the health status of those concerned.

    Para 12 d [...] health facilities, goods and services must also be scientifically and medically appropriate and of good quality. This requires, inter alia, skilled medical personnel, scientifically approved and unexpired drugs and hospital equipment, safe and potable water, and adequate sanitation.

    Para 35 Obligations to protect include, [...] to ensure that medical practitioners [...] meet appropriate standards of education, skill, and ethical codes of conduct.

    d) Similarly I will not give to a woman an abortive remedy.

    This can be interpreted as, given historically recent developments in mainstream thinking on abortion, meaning that no abortion will be carried out in the absence of approved and legal indications, and women should have access to reproductive medicine and contraception ...

    General Comment 14*:

    Article 12 (2) a The right to maternal, child and reproductive health

    Para 14 The provision for the reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child" (Art. 12 (2) a) may be understood as requiring measures to improve child and maternal health, sexual and reproductive health services, including access to family planning, pre- and post-natal care, emergency obstetric services and access to information, as well as to resources necessary to act on that information.

    Para 21 ... there is a need to develop and implement a comprehensive national strategy for promoting women's right to health throughout their life span. Such a strategy should include [...] sexual and reproductive services. A major goal should be reducing women's health risks, particularly lowering rates of maternal mortality [...]

    Para 34 In addition, States should refrain from limiting access to contraceptives and other means of maintaining sexual and reproductive health, from censoring, withholding or intentionally misrepresenting health-related information, including sexual education and information, as well as from preventing people's participation in health-related matters.

    e) In purity and holiness I will guide my life and my art.

    This can be interpreted as referring to respecting human rights and adherence to ethical medical practice ...

    General Comment 14*:

    Para 35 [...] the duties of States to adopt legislation or to take other measures to ensure that medical practitioners ....] meet appropriate standards of [...] ethical codes of conduct

    Para 44 e [states] .... obligations .... to provide appropriate training for health personnel, including education on health and human rights.

    f) I will not use the knife, not even on sufferers from stone, but will withdraw in favour of such men as are engaged in this work.

    This can be interpreted as anticipating regulations requiring that doctors undergo speciality training under the auspices of the Medical Royal Colleges and the necessary facilities ...

    General Comment 14*:

    Para 36 [...] States have to ensure the appropriate training of doctors and other medical personnel, the provision of a sufficient number of hospitals, clinics and other health-related facilities, and the promotion and support of the establishment of institutions providing counselling and mental health services, with due regard to equitable distribution throughout the country.

    g) 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.

    This can be interpreted as not abusing the professional intimacy inherent in the patient-doctor relationship, and respecting cultural traditions and customs ...

    General Comment 14*:

    Para 12 (c) of the General Comment specifies that Acceptability - All health facilities, goods and services must be respectful of medical ethics and culturally appropriate, i.e. respectful of the culture of individuals, minorities, peoples and communities, sensitive to gender and life-cycle requirements, as well as being designed to respect confidentiality and improve the health status of those concerned.

    Para 37 (ii) ensuring that health services are culturally appropriate and that health care staff are trained to recognize and respond to the specific needs of vulnerable or marginalised groups;

    Article 10 of Covenant on Economic, Social and Cultural Rights**:

    1. The widest possible protection and assistance should be accorded to the family, which is the natural and fundamental group unit of society, particularly for its establishment and while it is responsible for the care and education of children.

    h) 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.

    This can be interpreted as respecting confidentiality ...

    General Comment 14*:

    Para 12 c All health facilities, goods and services must be [...] designed to respect confidentiality

    Universal Declaration of Human Rights***:

    Article 12 – No one shall be subjected to arbitrary interference with his privacy, family, home, or correspondence, nor to attacks upon his honour and reputation. Everyone has the right to the protection of the law against such interference or attacks.

    i)If I fulfil this oath and do not violate it, may it be granted to me to enjoy life and art, being honoured with fame among all men for all time to come;

    There is nothing that says the good are happy or necessarily even honoured, but ...

    the preamble to the Covenant on Economic, Social and Cultural Rights comments**:

    Realizing that the individual, having duties to other individuals and to the community to which he belongs, is under a responsibility to strive for the promotion and observance of the rights recognized in the present Covenant.

    j) if I transgress it and swear falsely, may the opposite of all this be my lot

    This can be interpreted as analagous to measures to gain redress or compensation for violations of the right to health ...

    General Comment 14*:

    Para 48 Violations of the right to health can occur through the direct action of States or other entities insufficiently regulated by States. The adoption of any retrogressive measures incompatible with the core obligations under the right to health, as outlined in paragraph 43 above, constitutes a violation of the right to health.

    Para 60 The incorporation in the domestic legal order of international instruments recognizing the right to health can significantly enhance the scope and effectiveness of remedial measures and should be encouraged in all cases.

    Incorporation enables courts to adjudicate violations of the right to health, or at least its core obligations, by direct reference to the Covenant.



    * To promote better understanding of the International Covenant on Economic, Social and Cultural Rights (ICESCR) , and therefore implementation by member States, the Committee on Economic Social Cultural Rights (CESCR) from time to time publishes amplifications of individual Articles, known as General Comments. These elaborate on the text of the treaty and serve to define the nature of rights and obligations under the Covenant. This is particularly important because, unlike other core human rights treaties, the ICESCR has no procedure by which CESCR can comment on individual complaints of violations, the normal way in which a treaty’s meaning is defined.

    General Comment 14 is a 65 paragraph explication that defines what the right to the highest attainable standard of health is in practice.

    General Comment 14 can be found at URL:
    http://www.unhchr.ch/tbs/doc.nsf/(symbol)/E.C.12.2000.4.En?OpenDocument (accessed 16/7/04).

    ** The foremost legal source for the international human right to the highest attainable standard of health is Article 12 of the 1966 International Covenant on Economic, Social and Cultural Rights

    www.ohchr.org/english/law/cescr.htm

    *** Universal Declaration of Human Rights
    http://www.udhr.org/UDHR/default.htm



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