Medical Ethics: Bedrock Oaths Versus Zeitgeist Barometers
December 16, 2017
by Jonathan Imbody
This excerpt is the third in a series of essays on conscience in healthcare, by Jonathan Imbody, Vice President for Government Relations of the Christian Medical Association and Director of Freedom2Care. The essays respond to "Physicians, Not Conscripts — Conscientious Objection in Health Care," Ronit Y. Stahl, Ph.D. and Ezekiel J. Emanuel, MD, PhD, New England Journal of Medicine 376;14, April 6, 2017.
On the heels of World War II, with medical ethics in the spotlight following unconscionable Nazi atrocities, the World Medical Association (WMA) decided the Hippocratic Oath, which had guided medicine since around 500 BC, needed to be replaced. So the WMA developed a new oath that contained some of the principles of the ancient oath but opened the door to continual modernizing.
The WMA's Declaration of Geneva, introduced in 1948, followed the general pattern of the Hippocratic Oath, which promotes patient protections by highlighting the physician's discretion in the use of power.
The Declaration of Geneva followed the Hippocratic Oath's assumption that the physician is not a pawn of the patient but a professional who exercises ethical judgment. The Declaration stated conscience freedom in healthcare simply: "I will practice my profession with conscience and dignity."
Shifting ideology is replacing timeless oaths and bedrock principles
By contrast to the fixed bedrock principles enshrined in the millennia-old Hippocratic Oath, however, the WMA’s Declaration of Geneva undergoes revision every decade. After half a dozen windward revisions in the direction of liberal social positions, the evidence of the Declaration's ever-shifting form belies its claim to "safeguard the ethical principles of the medical profession, relatively uninfluenced by zeitgeist and modernism."
In fact, the Declaration serves as a veritable zeitgeist barometer, tracking with the current era's cultural climate.
Exhibit A: Physicians using the original Declaration of Geneva promised, "I will not permit consideration of religion, nationality, race, party politics or social standing to intervene between my duty and my patient." Five considerations.
By 2017, the list had expanded with more than a dozen new items or phrasings to read, "I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing, or any other factor to intervene between my duty and my patient" (changes noted in added italics). Apparently exhausted by compiling the extra items, the Declaration editing committee decided to cover their bases for all time: "or any other factor."
The Declaration of Geneva has quickly become a "fill-in-the-blank" blackboard of social and political agendas.
Exhibit B: The original Declaration unequivocally asserted, "I will maintain the utmost respect for human life from the time of conception."
That apparent pro-life commitment survived just one revision.
By 1983, activist editors had watered it down to, "I will maintain the utmost respect for human life from its beginning" (emphasis added). Divorced from science and subjected to the ideological whim of the interpreter, "beginning" could mean any time from conception to birth to verbal ability to, what the heck, graduation with an advanced degree.
Fill in the blank with your own whim.
Apparently, by 1983, practitioners of modern medicine had lost the ability to acknowledge what biological science right up until that point had clearly demonstrated as an inarguable reality: that human life begins at conception. So the new medical oath reflected the loss of scientific knowledge, resorting to fuzzy, flexible ambiguity.
By the fourth revision, oath editors apparently had lost all interest in when life begins. The newly revised statement simply said, "I will maintain the utmost respect for human life."
Perhaps the next revision will delete human and simply refer to "life," followed by a subsequent revision that will pledge, "I will maintain the utmost respect." The final revision will be simply, "I," which appears to be the only remaining ethic. Whatever I want, whatever I think, whatever I choose.