The Hippocratic Oath and the Ethics of Medicine [Paperback]

Steven H. Miles (Author)

Book Description

ISBN-10: 0195188209 | ISBN-13: 978-0195188202 | Publication Date: June 2, 2005 | Edition: 1

This engaging book examines what the Hippocratic Oath meant to Greek physicians 2400 years ago and reflects on its relevance to medical ethics today. Drawing on the writings of ancient physicians, Greek playwrights, and modern scholars, each chapter explores one of its passages and concludes with a modern case discussion. The Oath proposes principles governing the relationship between the physician and society and patients. It rules out the use of poison and a hazardous abortive technique. It defines integrity and discretion in physicians' speech. The ancient Greek medical works written during the same period as the Oath reveal that Greek physicians understood that they had a duty to avoid medical errors and learn from bad outcomes. These works showed how and why to tell patients about their diseases and dire prognoses in order to develop a partnership for healing and to build the credibility of the profession. Miles uses these writings to illuminate the meaning of the Oath in its day and in so doing shows how and why it remains a valuable guide to the ethical practice of medicine. This is a book for anyone who loves medicine and is concerned about the ethics and history of this profession.

Editorial Reviews

From The New England Journal of Medicine

The Hippocratic Oath, like Handel's Messiah, is heard once a year. At medical school graduation ceremonies around the nation, 20,000 voices intone modernized, bowdlerized versions of the ancient pledge. For the rest of the year, it goes silent, except for an occasional invocation of one or another of its phrases to make a point about a contentious issue, such as assisted suicide or abortion. Many contemporary medical ethicists dismiss it as antiquated and irrelevant or condemn it as an insidious endorsement of medical paternalism. Steven Miles wishes to pluck the oath out of its ritualistic niche, refurbish its meaning, and show its relevance for modern medical ethics. Miles is neither a classical scholar nor a historian of medicine. He is a practicing internist, a leader in the field of medical ethics, and a voice in health policy. (He also ran a creditable primary campaign for a Senate seat.) He has immersed himself in the literature about the origins and exegesis of the oath and works through its phrases with admirable skill. Although a proper historian might criticize an occasional interpretation of the author's, Miles's reading of the oath is illuminating. He attempts to place this mysterious document, written 2400 years ago by unknown hands, in the cultural context of Greek medicine and morality. However, his chief concern is to reveal the oath's relevance for the practice of medicine and for health policy in the modern world. Using the familiar format of grand rounds, he posits a clinical case or health policy issue for each phrase of the oath and asks the Hippocratic physician to comment. This literary device works well enough, although one might wish for more cogent cases in several instances (as happens, of course, in actual grand rounds). Miles examines the oft-cited phrases about "use of deadly drugs" and "abortifacients," demonstrating that they are unlikely maxims against euthanasia and abortion but offering plausible explanations of the terms' original meaning and relevance to modern medical ethics. He finds, as few commentators have, a dimension of social justice in the oath by distinguishing between the public and private activities of the Greek physician, both of which were governed by concepts of beneficence and justice. He concludes with a pertinent insight: noting that the oath, unlike modern codes and principles, was composed to be proclaimed in the first person, he writes that "its authors spoke explicitly of the necessity for each physician to reveal his professional moral commitments. The first-person voice may be part of the energy behind the Oath's endurance." Finally, teachers of medical ethics may appreciate Miles's outline of a course designed around the phrases of the oath. Albert R. Jonsen, Ph.D.
Copyright © 2004 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS. --This text refers to an out of print or unavailable edition of this title.

Review

" The Hippocratic Oath and the Ethics of Medicine contains a wealth of background material. It is concise, well written, and intellectually nourishing, a road map for exploration into antiquity. It is a must for scholars and an interesting read for anyone concerned with medical ethics. --JAMA

"Despite the influence of the Hippocratic Oath on Western medicine, few comprehensive analyses of the Oath have been performed. As a result, this text is an important contribution to the medical ethics literature. It is easy to read, comprehensive, and well referenced." --Mayo Clinical Proceedings

"Miles's reading of the oath is illuminating." -New England Journal of Medicine

"...works through its phrases with admirable skill. . . . Miles's reading of the oath is illuminating. . . . He finds, as few commentators have, a dimension of social justice in the oath by distinguishing between the public and private activities of the Greek physician, both of which were governed by concepts of beneficence and justice. He concludes with a pertinent insight: noting that the oath, unlike modern codes and principles was composed to be proclaimed in the first person, he writes that its "authors spoke explicitly of the necessity for each physician to reveal his professional moral commitments. The first person voice may be part of the energy behind the Oaths endurance." Finally, teachers of medical ethics may appreciate Miles's outline of a course designed around the phrases of the oath." --New England Journal of Medicine

See all Editorial Reviews

Product Details

• Paperback: 232 pages
• Publisher: Oxford University Press, USA; 1 edition (June 2, 2005)
• Language: English
• ISBN-10: 0195188209
• ISBN-13: 978-0195188202
• Product Dimensions: 8.1 x 5.4 x 0.7 inches
• Shipping Weight: 14.4 ounces (View shipping rates and policies)
• Average Customer Review: 5.0 out of 5 stars  See all reviews (2 customer reviews)
• Amazon Best Sellers Rank: #600,857 in Books (See Top 100 in Books)
  • #88 in Books > Medical Books > Basic Sciences > Histology

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Customer Reviews

Most Helpful Customer Reviews

2 of 2 people found the following review helpful:

5.0 out of 5 stars Tough read worth the effort, January 18, 2007

By 

Dr. G. Caldwell (Worthing, UK) - See all my reviews
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This review is from: The Hippocratic Oath and the Ethics of Medicine (Hardcover)

You will be rewarded for hard work. A tour de force through Greek and Egyptian medical history, proving that yesterday's stories are today's truths. Look for a Hippocratic Doctor when you are ill, even if he won't treat you if you just feel ugly!

4 of 5 people found the following review helpful:

5.0 out of 5 stars The relevance of Hippocrates today, January 17, 2005

By 

Erich H. Loewy (Gold River, CA. USA) - See all my reviews
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This review is from: The Hippocratic Oath and the Ethics of Medicine (Hardcover)

This most readable book should be read by all aspiring physicians. There is no doubt that codes from Hippocrates to the JAMA, the Yale and a variety of "home-made" codes have a self serving aspect but one that has become less so (or less obvious) over the years. Dr. Miles emphasis on the social obligations of physicians is more than timely--the many problems in medicine today (from the shameful lack of access to rampant poverty which plays a role in health and disease)are often passed over as "system errors" as though they were acts of nature. That, however, is the point: Cyclones and earthquakes are things with which we have to deal and which (for now, at least) we cannot prevent. The lack of access to medical care, the fact that many elderly are unable to afford their medication and those without part B cannot see a physician until they are deathly sick, the growing disparity between the grindingly poor and the immensely wealthy are that way because it is the way we have structured our society. They can be changed and physicians have a responsibility to be leaders in that field. Dr. Miles emphasizes this fact--and one hopes that it is taken to heart.

This is a book that every medical student should read cover to cover as should any physician or allied health care worker. Indeed, it is a book that the layman would find profitable, informative and in places amusing. It would, by the way, make a wonderful graduation gift to the fledgling physician. If one has any interest in medicine this book is a must.