The e-mail has been pouring in on my article in today's NRO on the deconstruction of the Hippocratic Oath. They are so interesting and varied, I thought I'd share some of them with the readers of Secondhand Smoke. I intend to keep posting some of the newer communications as I receive them.A medical school professor writes that idealistic med. students embrace the Oath!
"Thank you! I have felt like a lone voice in the wilderness. For six years, I taught medical ethics at the University of Kentucky, the only practicing MD in the course. The first day of each year, I would hand my students a copy of the original Hippocratic Oath, and tell them that all they needed to know about medical ethics was contained therein; everything else was fluff and details. The students actually loved it. They loved the noble vision of the virtuous professional that the oath projects. No student every complained about my teaching of bright lines that must not be crossed, and respect for human life. Young physicians will embrace the good, if someone will only present it to them."One wag suggests outsourcing executions to the Netherlands:
"Your article gave me a great idea. Wasn't there some problem with a state which insisted that capital punishment be carried out in the presence of a qualified anesthesiologist, versus the Hippocratic pretensions of anesthesiologists that they weren't going into the execution business? [That would be California.] Hey, let's outsource. There should be plenty of Dutch anesthesiologists we can hire."Here's one correspondent that believes the LLU "steward resources" clause is about triage. I disagree:
"The decline of civilization can always be intriguing subject matter. We need to hold high individual dignity, as the Pope has recently said. My struggle with your article is the lack of resource measurement you allowed LLU in their triage. Shall a doctor stay with the first soldier he sees? Shall he risk the life or the mission of other soldiers as he focuses on the first soldier he touches?
LLU knows more than any other institution the excesses that can be expensed in the search for the best care. They gained world renown using a chimp's heart to further the life of an infant. Noble effort but recognized as not worthy of future development.
A few years ago, I adopted that exact clause in my practice mission statement. Otherwise, we would be denying affordable treatment to the masses, while waiting for a few wealthy patrons to garnish enough resources for the best treatments. Two extreme examples, the intense battle scene and the dull dental office both must utilize the triage principal. Acting as a good steward of the resources of society and of the talents granted me."This writer laments the loss of traditional Hippocrtic values at a famous Catholic medical school:
"My school, "Catholic" Georgetown, changed our oath within 15 months of Roe. No other profession has (had ) such an innate trust by the public that allows them to share their most private behavoirs and allows such intimate exams on their first meeting with a physician with perfect confidence and trust. Mothers turn their children's care over to them. Patients allow themselves to be rendered unconscious and helpless knowing that a surgeon is going to cut them. Until HMOs, they knew doctors would do what was best for them and not their pocketbooks. Our profession went downhill when we became killers for hire. Then patients knew we would use our skills for violence for monetary gain."This from Bradford Short, who takes me to task for not better rebutting Dr. Nuland: Bradford is a pal and he blogs at The Thing Is (www.thefactis.org/thethingis), and has a series of articles on these issues in Issues in Law and Medicine:
"First, Nuland is wrong on the history. The Oath has been an important ethical cannon (and respected for its content) in America and Britain for at least 450 years. Recent historiography on the subject has shown that prominent English physicians translated the Oath, with its strong prohibitions on all euthanasia and nearly all abortion, repeatedly throughout the 16th century and that 17th century English physicians known for being respected ethicists, like the physician/political theorist John Locke, opposed most abortion and condemned suicide and euthanasia just as the Oath told them to."From a medical student:
"...I am a graduating medical student at the University of Pennsylvania, and am sad to say that here, too, we are encouraged to recite a watery-swill rendition of the classic oath. I have long been of the opinion that this is totally ridiculous and that the current versions of the oath border on lacking any real meaning and are an insult to the profession, to our patients, and to the rich and honorable tradition of Western medicine; as such it has, for some time, been my intention to recite the historic oath (albeit in English, not Ancient Greek). I'm encouraged to see that I am not alone in these sentiments, and I hope that your article receives the wide audience it, and its message, deserves."From a non fan, although I am not exactly certain what his point is:
"You must have a really big problem with the Confederate flag. Once upon a time, it was a symbol of slavery. Some say its message is different today. I gather you don't." This anecdote shows what can happen when doctors and patients have sex:
"A few years ago I asked a friend, a prominent spine surgeon in his mid-50s, if he had taken the Hippocratic Oath when he became a physician. He said he had not. (Oh, and he is currently divorcing his wife and just bought a $25K engagement ring for a former patient.)"I have also heard from readers who believe that giving children vaccines violates the Oath, which I don't agree with at all, and others offering praise or condemnation. I think the reaction demonstrates the continuing importance of the Oath and people's emotional attachment to its "do no harm" precepts.