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Paternalism in the Hippocratic Oath

Jules van Schaijik of the Personalist Project writes about the Hippocratic Oath (excerpted)

I swear by Apollo, the healer, Asclepius, Hygieia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath and agreement: To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art. I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone. I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion. But I will preserve the purity of my life and my arts. I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art. In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves. All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal. If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot.

Toward a Reconstruction of Medical Morality”, by Edmund D. Pellegrino, provides a good example.  The Hippocratic ethic, Pellegrino thinks, is paternalistic to a degree that is simply no longer acceptable. It views the physician as “an authoritative and competent practicioner, devoted to his patients well-being. He is a benevolent and sole arbiter who knows what is best for the patient and makes all decisions for him.” He cites a Hippocratic source in which the doctor is adviced to “Perform all things calmly and adroitly, concealing most things from the patient while you are attending to him.” A little later the doctor is told to treat the patient with solicitude, “revealing nothing of the patient’s present and future condition.”

This the-doctor-knows-best view …. is no longer valid. The modern principle of “patient autonomy” must be allowed to qualify and interpret the older principle of beneficence.

Incorporating this modern value into the Hippocratic ethic represents, it seems to me, a genuine and positive development of the latter, not a corruption. ….Patient autonomy should not only be understood negatively, as something with which the doctor may not interfere, but also positively, as something he should try to encourage and make possible to the best of his abilities.

 


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  1. 1

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  2. theaveeditor #
    2

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