Unless you’ve been under a rock or on a boat in the middle of the ocean, you’re aware that the United States is in the middle of a measles outbreak that has, so far, infected over 100 people, and was traced back to December Disneyland visits.
There’s been a lot of chatter lately over encouraging adherence to vaccines, lawsuits, and so on-and in the ways of the world, in the last 24 hours, people have suddenly shifted to what the Hippocratic Oath says and whether primum non nocere (“do no harm”) is part of the Oath, and what that means for doctors who peddle anti-vaccine beliefs (and in particular, charming Arizona cardiologist and vaccine refuser Jack Wolfson).
As I mentioned on Twitter this morning, this would be a really convenient time to have someone with a piece of paper saying they have a degree in medical history around. (Hi.) So, a quick summary and expansion of this morning’s question and answer:
Is “primum non nocere” part of the Hippocratic Oath?
No, not in the original versions of the Oath that we have. This isn’t to say that the idea of what we would now call the principle of non-maleficence isn’t written in to even the earliest examples of the Oath, merely that the particular phrasing doesn’t show up. What does occur in the early versions of the Oath are phrases like “abstain from harm” – which is pretty close. The phrase “do good and do no harm” does occur in another part of the Hippocratic Collection, the Epidemics.
So what’s the origin of the phrase primum non nocere?
Good question–one that many people have made dissertations and other research projects out of. The last I was reading about this (which admittedly was a few years ago), the general consensus seemed to be that the specific phrase first enters American medical lexicon in the mid-1800s in reference to an earlier medical textbook.
What’s important here, though, at least in terms of talking about contemporary non-maleficence and beneficence, is that the concept behind “do no harm” (regardless of phrasing) has been a part of medicine for a very long time. This is one of the reasons the concept of “not cutting for stone” is in the Hippocratic Oath: removal of kidney stones (the stone being cut) in men used to be a rather brutal, bloody, and deadly procedure, and thus was left to the barber-surgeons, rather than the more refined doctors.
That said, I’d also say it’s equally important to not place a lot of emphasis on the Hippocratic Oath. While it is an incredibly important piece of medical history, it also banned surgery (not just removing kidney stones), providing abortions, and providing deadly medications. Those trained in medicine were expected to train their own sons in medicine, as well as the sons of their teacher – and tuition? Not a thing. Oh, and don’t forget swearing fealty to Apollo. (I wouldn’t want anyone who is anti-choice or anti-euthanasia for religious reasons to get too excited here.)
And of course, all of this ties in to the last, and common, question about the Oath: is the Hippocratic Oath actually a legally binding oath? At least in America, no.
What the Hippocratic Oath is, in many ways, is another living document that is frequently revised to reflect contemporary views–which is why the bits about leaving surgery to the professionals has been taken out–and still contains elements that have been considered essential to the art/techne of medicine for roughly 2500 years. It is a wonderful part of the history and lineage of medicine, connecting what was to what is. What it is not is a place to look for legalistic or even moral answers for contemporary medico-social issues.