Cornell Medical School Rewrites Hippocratic Oath

Weill Medical College at Cornell University has rewritten the Hippocratic Oath - the vow for newly trained doctors that's been around for more than 2,500 years.

The oath has been rewritten before, and not just by Hollywood, which convinced most Americans that it contains the phrase: "First, do no harm." (It turns out that "do no harm" comes from another of Hippocrates' writings, "Epidemics.")

The dean of the medical school at Cornell, Dr. Antonio Gotto, said Cornell's new version of the classic vow is the first time a medical college has attempted a revision in recent memory as a schoolwide effort rather than as a project generated by a group of students or an individual faculty member.

As a result, Dr. Gotto said, the oath is "more meaningful. It's something that is more understandable. It's something that's more relevant to the way medicine is practiced in society."

The chief of the division of medical ethics at Cornell and a professor of medicine, Dr. Joseph Fins, who led the revision committee, said he's pleased with the final product and thinks its original author would be, too.

"I think if Hippocrates were alive today, he would have revised it," he said. "I think he was a modernist."

Cornell's version of the oath does not address the issues of abortion or physician-assisted suicide, which were both frowned upon in the original and edited out of most modern versions.

It removes references to the Greek gods, which were featured prominently in the original, and it secularizes some of the language. It also deletes a note of warning at the conclusion.

The final words of the original were: "If I render this oath fulfilled, and if I do not blur and confound it [making it to no effect] may it be [granted] to me to enjoy the benefits both of life and of techne, being held in good repute among all human beings for time eternal. If, however, I transgress and perjure myself, the opposite of these."

Cornell's version now reads: "I now turn to my calling, promising to preserve its finest traditions, with the reward of a long experience in the joy of healing."

Dr. Gotto said Cornell wanted it to "end on a positive note."

More broadly, the new Cornell version - which Dr. Fins wants to incorporate into the curriculum so that students have a deeper sense of its meaning and context in the history of medicine - emphasizes the relationship between physicians and patients, even in the age of HMOs, and plays up the role of doctors as advocates.

The author of "The Hippocratic Oath and the Ethics of Medicine," Steven Miles, who is a professor of medicine and bioethics at the University of Minnesota, said there have been hundreds of revisions of the Hippocratic Oath since it was written.

Of the Cornell version, he said: "I think it's a wonderful oath, but it's not the Hippocratic oath."

He said about 80% or 90% of medical school administer some version of the original. He said the Cornell oath is so different he would not consider it a version of the classic.

Dr. Miles said Cornell's oath lacks the original's richness. For example, he said the original referred to the Greek gods not as a tribute to religion but as a swearing to the "lineage" of medicine because the god referenced was Apollo, who in myth created medicine.

The co-author of a recent report on medical oaths, Kayhan Parsi, a professor of bioethics and health policy at Loyola University, said the specifics of the oath are less important than whether the new doctors understand the significance of what they are vowing as they graduate.

"The ritual of oath-taking is very important, but I think both students and faculty should invest more time in thinking about what it is they're swearing to - making it more of a useful event rather than a symbolic event."

He did say it might be time for schools to come together to craft one, definitive oath for all graduating students to "create solidarity between all physicians."