The Hippocratic Oath is often cited as containing the phrase “first, do no harm”. This idea in medicine has been used for promoting health but has also been used as a cudgel against those who will not follow the current orthodoxy. People of all viewpoints will cite the Hippocratic Oath as a reason that physicians should do what they say. But what does the Hippocratic Oath actually say and why has this idea of “first, do no harm” become so interconnected with it? Let’s go to the text.
Disclaimer: The translation from Greek is in italics. I do not speak Greek and thus did not independently confirm this translation. If any Ancient Greek scholars want to correct the translation, let me know.
The Oath (with commentary)
“I swear by Apollo Healer, by Asclepius, by Hygieia, by Panacea, and by all the gods and goddesses, making them my witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture.”
Coming in hot with a bunch of Greek gods that I can guarantee most physicians don’t believe in. I can look past this, though, given how many oaths are made using ancient language out of tradition more than actual current belief.
“To hold my teacher in this art equal to my own parents; to make him partner in my livelihood; when he is in need of money to share mine with him; to consider his family as my own brothers, and to teach them this art, if they want to learn it, without fee or indenture; to impart precept, oral instruction, and all other instruction to my own sons, the sons of my teacher, and to indentured pupils who have taken the Healer’s oath, but to nobody else.”
After the initial ritual language, we get into a section that modern medicine has completely thrown out. Medicine is still viewed as an apprenticeship, but this is in no way provided without a fee. Furthermore, students don’t support their former teachers or their teacher’s families. Finally, it seems that the Hippocratic Oath specifies teaching sons, not daughters. Many, I’m sure, would not be pleased if this part of the oath were adhered to.
“I will use those dietary regimens which will benefit my patients according to my greatest ability and judgment, and I will do no harm or injustice to them. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly, I will not give to a woman a pessary to cause abortion. But I will keep pure and holy both my life and my art. I will not use the knife, not even, verily, on sufferers from stone, but I will give place to such as are craftsmen therein.”
Here is where we can see the origins of “first, do no harm”. I hope that most would agree that diet can have a huge impact on health, so the first part makes sense. This is followed by a statement that the taker of the oath will do no harm or injustice to patients. This is not the first entreaty on the physician, though. The “first, do no harm” seems to be a modern contrivance (or possibly pulled from other writings of Hippocrates). The second half of this paragraph is where those that use the Hippocratic Oath as a cudgel prove that they have never read it. In the second sentence, you see a statement that you will not administer poison or suggest such a course. Depending on your definition this could include treatments such as certain chemotherapy agents and would definitely include physician-assisted suicide. Next, it says you will not give a woman a pessary to cause abortion. Finally, it implies that those taking the oath aren’t surgeons (a difference between older medical practice and modern medicine).
“Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bond or free. And whatsoever I shall see or hear in the course of my profession, as well as outside my profession in my intercourse with men, if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets.”
After a bit of controversy, there is a passage that I think has a direct connection to modern medicine. In this, you can see the origins of the ideas of HIPAA laws and the confidentiality of medical records.
“Now if I carry out this oath, and break it not, may I gain for ever reputation among all men for my life and for my art; but if I break it and forswear myself, may the opposite befall me.” – Translation by W.H.S. Jones.
Not much to add here. There has always been a prestige to medicine which has at times been based on reality and at others been based on myth. Modern societies have always viewed doctors that cause intentional harm with disdain.
The Modern Myth
Having read the actual text, we can see the origins of an idea but where does the conflation of “first, do no harm” with the Hippocratic oath come from? I have a theory.
As medicine moved from an age of superstition to a more scientific field, it needed to distinguish itself from the barbaric past. However, this step needed to be taken while not completely abandoning the prestige that physicians held in their communities. As medical science progressed, it became clear that many of the methods used to “heal” patients actually caused harm and often hastened death (see bleeding and mercury treatments). The problem was that you didn’t want to completely sever the connection with the past because that could result in a loss of community prestige and trust.
The desire to continue this community position is not without reason. If you are asking a person to trust you to help them through an injury or illness, there is a need for trust. This trust, by necessity, will not always be based on direct knowledge of a person’s experience or a pre-existing relationship. Connecting an old past, with a modern process needs a bridge. I think that is where the Hippocratic oath comes in. By rephrasing this archaic oath into a simple statement of “first, do no harm”, you immediately connect modern medicine with history while clearly stating an axiom that engenders trust. Never mind that it’s a paraphrase at best.
I can’t say for sure where the statement originated from. I have seen claims it comes from the 17th century or possibly a 19th-century surgeon. I do think that modern medicine has glommed onto it as a way of claiming its actions are in the best interests of the patient. It is a form of medical propaganda that can be thrown around at will. “Remember your Hippocratic Oath” can be thrown at a person and will immediately put the target on defense. The only problem is that no one who actually reads it believes it.