Whatever happened to the Hippocratic Oath?
It was a condition of his training that he should sign an oath, in his own blood, that he would use the skills he learned for good and not for ill. He was gaining, after all, skills that would enable him to wound or kill. It was required that he would promise to deploy them virtuously and responsibly.
It is a similar story with medical ethics. In ancient Greece, as doctors first began to learn methods that could mean the difference between life and death, a code of ethics was developed, known as the Hippocratic Oath.
One part of it reads: 'I will use those dietary regimens which will benefit my patients according to my greatest ability and judgment, and I will do no harm or injustice to them'. It also includes a promise to maintain patient confidentiality and not to poison anybody, even when asked to.
Many people assume that trainee doctors still swear the Hippocratic Oath but they don't. Medical schools have their own oaths or declarations. Bristol University, for example, asks its medical students to make a 'promise', the final part of which is: 'I will work for the good of all persons whose health may be placed in my care and for the public wellbeing'.
The medical profession is, or at least used to be, a vocation. It was driven in large measure by a desire to do good in the world rather than for the pursuit of financial gain. In the early 20th century, before the creation of the NHS, general practitioners varied their fees according to the means of their patients. It is estimated that one fifth of the population was given treatment for free.
Surely today, too, most young people who go into medicine also have at least some sense of vocation and a feeling that their training and skills give them a responsibility to others. But how do they now square these ideas with withdrawing their labour – as they have voted to do – between the 25th and 30th of July?
This is not equivalent in any way to industrial action undertaken to delay the collection of bins, or force commuters into the inconvenience of riding a slow rail-replacement bus. Doctors know, better than anyone else, that vast numbers of people are waiting for operations. They know that the delay of an operation or therapy for, say, cancer, means that it is more likely that the patient will die.
Cancer, by its nature, grows. If it spreads too far, it becomes impossible to save the patient. By withdrawing their services, doctors know that more patients will have more delays in the treatment of cancer, heart disease and other potentially deadly diseases. Is this what they went into medicine for? To threaten fatal consequences for patients for the sake of a better pay deal? If so, it is a sad transformation of the ideals that doctors once represented.
On another issue, the attitude of the British Medical Association to puberty blockers suggests a big change in ideology. The very thorough Cass Review asserted that the evidence base and rationale for early puberty suppression was unclear, and that masculinising/feminising hormone therapy should not be provided for people below the age of 16.
The leadership of the BMA is clearly capable of working when it comes to 'critiquing' the Cass Review. It appears to be ideologically opposed to its findings. The Hippocratic priority of doing 'no harm or injustice' appears to have been pushed aside yet again in the service of political expediency.
As for assisted dying (in other words, helping to end someone's life) this is, on the face of it, directly contrary to the Hippocratic Oath. If this becomes law, doctors will – or at least one hopes they will – wrestle with their consciences to be as confident as possible that they are 'working for the good of all persons'.
But the sad truth is, as a young doctor said to me yesterday, that the philanthropic ideal of medicine is not as strong as it once used to be. Those now entering the field of medicine should not be surprised to see their status in the public eye suitably diminished.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
The Guardian
16 hours ago
- The Guardian
The right wants to kill off the NHS. Striking doctors are playing into their hands
There were no pickets when I set out at the weekend to talk to striking doctors. Not even at St Thomas' hospital, a prime site opposite the Houses of Parliament, or at Guy's at London Bridge. 'It's a bit sparse,' said the duty officer from the British Medical Association, the doctors' union. The British Medical Journal (owned by the BMA but with editorial freedom) ran the headline: 'Striking resident doctors face heckling and support on picket line, amid mixed public response.' Public support has fallen, with 52% of people 'somewhat' or 'strongly' opposing the strikes and only 34% backing them. Alastair McLellan, the editor of the Health Service Journal, after ringing around hospitals told me fewer doctors were striking than last time, which isn't surprising given that only 55% voted in the BMA ballot. Managers told him these strikes were less disruptive than the last ones. But even a weaker strike harms patients and pains a government relying on falling waiting lists. 'When you're operating on the margins, it takes very little disruption to send waiting lists up again,' McLellan said. Strikes are costly, since consultants have to be paid to fill shifts, which is typically more expensive. One hospital manager asked me wryly: 'Have you tried paying for an out-of-hours emergency plumber or electrician?' This time Jim Mackey, the head of NHS England, is playing it tough. He told medical directors on Monday to warn doctors that anyone striking on one of their 12 compulsory training days would forfeit their qualification – and not to let strikers take up locum shifts on non-strike days to make up for the money they've lost. No more Mr Nice Guy. Everyone employed by the NHS will get an above-inflation pay rise this year, which is less than the 5.4% (comprising a 4% rise and a consolidated £750 payment) that resident doctors will receive. Nurses and ambulance crews have just voted overwhelmingly against a pay award of 3.6%. That was only a consultative ballot, leaving plenty of time for negotiations that might avoid holding a full strike ballot. Consultants are now balloting too. These looming demands make it vanishingly unlikely that Wes Streeting will give even more money to striking resident doctors, who have already received the top NHS offer. Mackey plays the hard man, but Streeting's emollience is over. He seems indignant and offended by the BMA. His first act as health secretary was to end the resident doctors' 44 days of strikes between March 2023 and July 2024 with a generous 22% pay rise, even while the rightwing press accused him of bowing to 'union paymasters'. Making peace was his welcome political signal that the party of the NHS was setting about repairing Tory damage. There was hope for goodwill and patience from healthcare workers. So the BMA coming back for more within a year was a shock, and a slap in the face for Streeting. The BMA is kicking a government that had been well-disposed towards it. With Tory and Liberal Democrat peers attempting to block the government's radical employment rights bill, Labour's enemies will relish this timely assistance from the strike. A piece on CapX, a comment site owned and produced by the Centre for Policy Studies, called the striking doctors 'Scargills in white coats' with 'blood on their hands', which is of course the literal truth, given what they do at work (Tom Dolphin, the new BMA chair, is a consultant anaesthetist who works in trauma surgery; his job involves 'a fair amount of stabbings, occasional shootings, assaults [and] falls from height'). Keir Starmer has warned that the strikes 'play into the hands' of those who do not want the NHS to 'succeed in its current form'. Vultures are circling: Nigel Farage talks of private insurance; the International Monetary Fund, in its great unwisdom, recently suggested the better-off should pay for NHS services; while the piece on CapX echoed the right's glee at the strike: 'The problem here isn't just that the BMA is populated by socialist thugs, it's that the NHS is a socialist system.' The NHS is ever ready to rescue us all, regardless of status – that is why doctors and nurses top public respect charts, and why they have much to lose as the public turns against them. 'When the BMA asks, 'What's the difference between a Labour government and a Conservative government?', I would say a 28.9% pay rise and a willingness to work together to improve the working conditions and lives of doctors,' Streeting said in vain last week. In a timely contrast, Kemi Badenoch has declared that the Tories would ban doctors' strikes, putting them under the same restrictions that apply to police officers and soldiers. Both sides in this strike are obdurate. 'This could be a marathon. We could be doing this until Christmas or maybe beyond,' the deputy chief executive of NHS England has glumly warned. Streeting says the negotiation door is always open, but the BMA says there's no point without cash on the table. Bad blood between them springs from the negotiations: talks were going well until the BMA resident doctors' committee told its co-chairs that it could not approve the government's deal because it did not address the BMA's demand that resident doctors receive a 29% pay rise over the next few years. Yet Streeting's offer tackled serious grievances: years of bad planning left 20,000 resident doctors without specialist training places, stuck in a bottleneck that he promised to resolve. The BMA damaged people's sympathy for the doctors by absurdly comparing their pay to that of a coffee barista. Resident doctors can expect to be on a steep annual trajectory, averaging £43,400 in year one and £51,600 in year two; as new consultants they will get £105,000, while GP partners earn as much as £160,000. The word in the corridors is that the BMA is losing support across the NHS and among its own members, Nick Hulme, the CEO of the East Suffolk and North Essex NHS foundation trust, told me. He said some of his consultants had this week resigned from the BMA. So has the fertility pioneer Robert Winston. History may reassure the BMA that the public will always trust doctors over politicians. This time, the public backs those trying to cut waiting lists more than the strikers who are adding to them. Polly Toynbee is a Guardian columnist
The Guardian
17 hours ago
- The Guardian
The right wants to kill off the NHS. Striking doctors are playing into their hands
There were no pickets when I set out at the weekend to talk to striking doctors. Not even at St Thomas' hospital, a prime site opposite the Houses of Parliament, or at Guy's at London Bridge. 'It's a bit sparse,' said the duty officer from the British Medical Association, the doctors' union. The British Medical Journal (owned by the BMA but with editorial freedom) ran the headline: 'Striking resident doctors face heckling and support on picket line, amid mixed public response.' Public support has fallen, with 52% of people 'somewhat' or 'strongly' opposing the strikes and only 34% backing them. Alastair McLellan, the editor of the Health Service Journal, after ringing around hospitals told me fewer doctors were striking than last time, which isn't surprising given that only 55% voted in the BMA ballot. Managers told him strikes were less disruptive than the last ones. But even a weaker strike harms patients and pains a government relying on falling waiting lists. 'When you're operating on the margins, it takes very little disruption to send waiting lists up again,' McLellan said. Strikes are costly, since consultants have to be paid to fill shifts, which is typically more expensive. One hospital manager asked me wryly: 'Have you tried paying for an out-of-hours emergency plumber or electrician?' This time Jim Mackey, the head of NHS England, is playing it tough. He told medical directors on Monday to warn doctors that anyone striking on one of their 12 compulsory training days would forfeit their qualification, and not to let strikers take up locum shifts on non-strike days to make up for the money they've lost. No more Mr Nice Guy. Everyone employed by the NHS will get an above-inflation pay rise this year, which is less than the 5.4% (comprising a 4% rise and a consolidated £750 payment) that resident doctors will receive. Nurses and ambulance crews have just voted overwhelmingly against a pay award of 3.6%. That was just a consultative ballot, leaving plenty of time for negotiations that might avoid holding a full strike ballot. Consultants are now balloting too. These looming demands make it vanishingly unlikely Wes Streeting will give even more money to striking resident doctors, who have already received the top NHS offer. Mackey plays the hard man, but Streeting's emollience is over. He seems indignant and offended by the BMA. His first act as health secretary was to end the resident doctors' 44 days of strikes between March 2023 and July 2024 with a generous 22% pay rise, even while the rightwing press accused him of bowing to 'union paymasters'. Making peace was his welcome political signal that the party of the NHS was setting about repairing Tory damage. There was hope for goodwill and patience from healthcare workers. So the BMA coming back for more within a year was a shock, and a slap in the face for Streeting. The BMA is kicking a government that had been well-disposed towards it. With Tory and Liberal Democrat peers attempting to block the government's radical employment rights bill, Labour's enemies will relish this timely assistance from the strike. A piece on CapX, a comment site owned and produced by the Centre for Policy Studies, called the striking doctors 'Scargills in white coats' with 'blood on their hands', which is of course the literal truth, given what they do at work (Tom Dolphin, the new BMA chair, is a consultant anaesthetist who works in trauma surgery; his job involves 'a fair amount of stabbings, occasional shootings, assaults [and] falls from height'). Keir Starmer has warned that the strikes 'play into the hands' of those who do not want the NHS to 'succeed in its current form'. Vultures are circling: Nigel Farage talks of private insurance; the International Monetary Fund, in its great unwisdom, recently suggested the better-off should pay for NHS services; while the piece on CapX echoed the right's glee at the strike: 'The problem here isn't just that the BMA is populated by socialist thugs, it's that the NHS is a socialist system.' The NHS is ever ready to rescue us all, regardless of status – that is why doctors and nurses top public respect charts, and why they have much to lose as the public turns against them. 'When the BMA asks, 'What's the difference between a Labour government and a Conservative government?', I would say a 28.9% pay rise and a willingness to work together to improve the working conditions and lives of doctors,' Streeting said in vain last week. In a timely contrast, Kemi Badenoch has declared that the Tories would ban doctors' strikes, putting them under the same restrictions that apply to police officers and soldiers. Both sides in this strike are obdurate. 'This could be a marathon. We could be doing this until Christmas or maybe beyond,' the deputy chief executive of NHS England has glumly warned. Streeting says the negotiation door is always open, but the BMA says there's no point without cash on the table. Bad blood between them springs from the negotiations: talks were going well until the BMA resident doctors' committee told its co-chairs that it could not approve the government's deal because it did not address the BMA's demand that resident doctors receive a 29% pay rise over the next few years. Yet Streeting's offer tackled serious grievances: years of bad planning left 20,000 resident doctors without specialist training places, stuck in a bottleneck that he promised to resolve. The BMA damaged people's sympathy for the doctors by absurdly comparing their pay to that of a coffee barista. Resident doctors can expect to be on a steep annual trajectory, averaging £43,400 in year one and £51,600 in year two; as new consultants they will get £105,000, while GP partners earn as much as £160,000. The word in the corridors is that the BMA is losing support across the NHS, as well as among its own members, Nick Hulme, the CEO of the East Suffolk and North Essex NHS foundation trust, told me. He said some of his consultants had this week resigned from the BMA. So has the fertility pioneer Robert Winston. History may reassure the BMA that the public will always trust doctors over politicians. This time, the public backs those trying to cut waiting lists more than the strikers who are adding to them. Polly Toynbee is a Guardian columnist
Telegraph
17 hours ago
- Telegraph
Obesity fuels surge in liver cancer
Obesity is helping to fuel a surge in liver cancer cases around the world, academics have warned. The number of new cases of liver cancer globally is set to double from 0.87 million in 2022 to 1.52 million in 2050, according to projections published as part of a new Lancet Commission on Liver Cancer paper. A team of experts, led by academics in Hong Kong, said the proportion of liver cancers caused by the disease's most common cause – the Hepatitis B virus – is set to reduce over the coming years. Cases caused by the Hepatitis C virus are also expected to decline proportionately. However, liver cancer cases caused by alcohol and obesity are set to increase. Experts predicted that by 2050, some 21 per cent of liver cancers will be caused by alcohol. And 11 per cent will be caused by a severe form of metabolic dysfunction-associated steatotic liver disease (MASLD) – known as fatty liver disease, where excessive fat builds up in a person's liver. The severe form of this condition is called metabolic dysfunction-associated steatohepatitis. The research team points out that 60 per cent of liver cancers are preventable. The researchers also said that global deaths from liver cancer are expected to rise from 760,000 in 2022 to 1.37 million in 2050. 'These data suggest that preventive measures targeting a comprehensive number of risk factors for hepatocellular carcinoma are sorely needed,' the team of experts wrote. The main treatment for MASLD is a balanced diet, being physically active and potentially losing weight. Prof Jian Zhou, chairman of the commission from Fudan University in China, said: 'Liver cancer is a growing health issue around the world. 'It is one of the most challenging cancers to treat, with five-year survival rates ranging from approximately five per cent to 30 per cent. 'We risk seeing close to a doubling of cases and deaths from liver cancer over the next quarter of a century without urgent action to reverse this trend.' Professor Stephen Chan, of the Chinese University of Hong Kong, who was the first author of the study, added: 'As three in five cases of liver cancer are linked to preventable risk factors, mostly viral hepatitis, alcohol and obesity, there is a huge opportunity for countries to target these risk factors, prevent cases of liver cancer and save lives.' Commenting on the study, Pamela Healy, chief executive of the British Liver Trust, said: 'Liver cancer is the fastest-rising cause of cancer death in the UK, and just 13 per cent of people diagnosed will survive for five years or more. 'We know that the biggest risk factors are having pre-existing liver cirrhosis or viral hepatitis, and this new analysis highlights that MASLD, also known as fatty liver disease, is expected to be linked to an increasing number of cases. 'As well as improving early detection through surveillance of people with cirrhosis, it is essential that we tackle these underlying causes and prioritise public health. 'By supporting people to maintain a healthy weight, cut down on alcohol and get tested and treated for hepatitis, we can prevent many cases of liver cancer and save lives.' In 2022, some 64 per cent of adults in England were estimated to be overweight or obese.
