4 min read

The expectations of an oath: lessons from Hippocrates

M. Çiftçi explores the evolution of a historic and contemporary commitment to protect the vulnerable.

M. Ciftci has a PhD in political theology from the University of Oxford. He is currently writing a book about church-state relations that will be published by Palgrave Macmillan. 

While surgeons operate in the background a digital display shows numbers in the foreground
Natanael Melchor on Unsplash.

A ‘casual acceptance of infanticide seems to have been not the exception but the rule among both Greeks and Romans in the centuries immediately preceding the birth of Christ.’ That shocking fact about the pagan world’s attitudes towards children, mentioned in David Albert Jones’ The Soul of the Embryo, has been brought to our attention again recently by Tom Holland’s Dominion. Since his book was published, much has been written, even in Seen & Unseen, about the radical alteration of our attitudes towards the weak and vulnerable, especially children, women, and slaves, by the Christian faith’s love for the weak over the strong. The depictions of Christ’s suffering humanity in crucifixes over centuries slowly worked to change the attitudes of even the strong and powerful.  

But to think that the Greco-Roman world was entirely callous towards the vulnerable is not true. There is a minority of voices revealing that, even then, there were some opposed to the killing of children in the womb or after birth. There were some who anticipated the revolution of values that the Judaeo-Christian tradition was about to inaugurate. Within that minority of pagan authors, the writings attributed to Hippocrates (who was roughly a contemporary of Socrates) and to his school, in particular, stand out. Translations of his writings from Greek into Syriac, Arabic, and Latin ensured their influence for centuries over Muslim and Christian physicians. The most well-known one, of course, is the Hippocratic Oath, which explicitly forbids causing an abortion using a pessary.  

Its description of the moral rules and humane ideals that physicians swear to obey, is partly responsible for the honour and prestige that is still, even today, attached to the medical profession. Medical schools around the world, including 70 percent of them in the UK, still use some version of the Oath in their graduation ceremonies, so that the new medics can make their promise to obey a short summary of the ethical ideal that should guide their practice. The revival of interest in the Oath more recently dates from the post-war period, when the appalling example of medical experimentation in the Nazi regime led the then newly founded World Medical Association to draft the Declaration of Geneva in 1948, since revised multiple times, which have in turn inspired many other versions of the Oath to be written. Some of them are banal and frankly silly, such as one version by the poet David Hart: ‘I will not knowingly do harm to those in my care, I will smile at them and encourage them to attend to their dreams and so hear the voices of their inner strangers’.  

Doctors today, in their day-to-day work, rely more often on complex documents detailing their professional obligations. So, what can we and they learn from the Oath? 

The Oath includes general promises to use treatments for the benefit of patients and to protect them from harm and injustice, but more specifically it also promises to not give a deadly drug to anyone if asked, nor to suggest giving one to a patient, including a pessary to cause an abortion as I’ve already mentioned. Later the Oath states:  

‘Into whichever houses I enter, I will go for the benefit of patients, keeping myself free of any intentional injustice or corruption, particularly in sexual matters, involving both female and male bodies, both of the free and of slaves.’  

Already, this tells us, there was an awareness that patients are vulnerable when in the care of another. The physician must not take advantage of their vulnerability, either sexually, or by euthanising them, or by enabling those in despair to commit suicide. A renewed commitment to these rules should be urged, since some doctors continue to abuse their power over patients in these ways, sometimes even with legal permission in countries that permit assisted suicide

That the Oath was written by a pagan points to the possibility of us all finding our way, without appeal to any holy book or revelation, to an agreement about some basic moral rules that should guide doctors. However, Christianity put its own spin on the Hippocratic Oath, as we can see from a Christian version of it dating from the early Middle Ages. Gone is the reference to swearing by Apollo and Asclepius, whose serpent-entwined rod remains a symbol of medicine today. But, more importantly, the Christian oath forbids causing an abortion by any means, making the promise more definite and explicit. This provides further evidence of the argument mentioned at the beginning of Christianity’s preoccupation with defending the most vulnerable from harm.   

Whereas the original Oath envisages belonging to a closely-knit circle of physicians, led by a teacher, from which outsiders are to be excluded, those sections are completely missing from the Christian version. According to W.H.S. Jones, this could be because creating ‘an inner circle of practitioners shows an aristocratic exclusiveness, which is in sharp contrast with the universal brotherhood of Christianity. The relief of pain and suffering … should be tied by no fetters and hindered by no trade-union rules. Christian benevolence should be universal.’ For that reason, Jones thought that the Christian Oath might have been originally written during the earliest centuries of Christianity, when Jesus’ healing missions and the Apostles’ practice of holding all possessions in common had not yet been ‘forgotten or neglected.’  

In Westminster Abbey, last year, we saw at the Coronation that the heart of our political system is an exchange of vows between monarch and his people, vows sworn in the belief that to remain faithful to what was promised are gifts given by something above us and beyond our ability to control. Similarly, the weighty responsibilities of marriage have inspired societies across generations to begin married life by pledging solemn promises. Why should we expect anything less from those who take us into their care when we are struck by disease, or facing death?  

Weekend essay
8 min read

The Post Office scandal: why truth matters

Lawyer Alex Stewart analyses the Post Office scandal for the lessons it teaches on our missing morals.

Alex Stewart is a lawyer, trustee and photographer.  

A man, dressed in a suit and anarak, stands in front of a law court.
Toby Jones plays the eponymous Mr Bates in ITV Studios dramatisation.

The reaction to ITV's 4-part dramatisation of the The Post Office Horizon story has been profound. It managed to stir up huge public sympathy for the sub postmasters and has galvanised the Government into action. The story has also tapped into deep wells of moral outrage at a time when trust in our institutions and corporations is the lowest in living memory. It’s a tale of failure to take responsibility. It’s a tale that shows the truth matters. 

A failure to take responsibility 

What seems to have enraged us most is the collective moral failure over many years of those in positions of power. They either deliberately covered up the problems with the Post Office’s Horizon IT system, by withholding information about known faults, or simply ignored them.  The sense of disbelief has been compounded by the apparent inability, so far, to pin the blame on any one person or group of people. The Post Office’s ex CEO, Paula Vennells, has handed back her CBE but it seems she was only the tip of an iceberg of obfuscation and prevarication.   

What emerges is a pattern of behaviour that moral philosophers call moral diffusion. It is also called the ‘bystander effect’, so-called after a case in which a woman was attacked in New York in the presence of a large number of people who knew that she was being assaulted but failed to come to her rescue as they all saw it as someone else’s problem. 

I witnessed an example of this the other day in London at a busy pedestrian crossing. A man with an angle grinder was cutting through a bicycle lock.  As the sparks flew, pedestrians looked at each other for reassurance, as if to ask - is this ok?  Was he shamelessly stealing the bicycle, or had he been sent by the council to remove a long-abandoned bicycle?  No one knew and no one intervened. 

The instinct to shirk responsibility seems to be hardwired into us, part of our fallen nature.  It all started with Adam and Eve. Embarrassed and ashamed they hide, only to discover you cannot hide from God. And when they are discovered, both deny personal responsibility, saying in effect “it wasn’t me”.  

Later we have the story of Cain killing his brother Abel. Cain doesn't deny he has done something wrong, he simply denies he had any responsibility for his brother at all.  He asks why he should have any concern for anyone beyond himself. ‘Look after Number One’ Is the voice of Cain throughout the ages. 

Why is this failure of leadership such an effrontery to us? Because we instinctively recognise that leadership is not about lording it over others. 

The Government has promised to hold to account those responsible for the scandal.  Perhaps the roving searchlight of the inquiry will succeed in identifying the human culprits? In the meantime, executives and politicians are scrambling over themselves to deny responsibility, typified by the response of Sir Ed Davey who has taken the art of the non-apology to a new level. The honourable exception, among the political class, is Lord Arbuthnot who as an MP was both tireless and fearless in campaigning for justice for the sub-postmasters.     

Why is this failure of leadership such an effrontery to us? Because we instinctively recognise that leadership is not about lording it over others, hiding behind other people’s decisions or passing the buck, it is about taking responsibility.  In practice we do not live by the philosophy presented by Glaucon in Plato’s Republic, that justice is whatever is in the interest of the stronger party.  Nor are we willing to live in a Darwinian world where in the struggle for supremacy there is no need for the powerful to look out for the weak simply because they are powerful.    

There is a fascinating moment in the story of Moses in the book of Exodus when he notices an Egyptian official beating one of the Israelite slaves. He sees that no one else is willing to intervene and he gets involved, at some personal risk, and in so doing marks himself out as a leader.   

Leadership is born when we become active not passive, when we decide that something is wrong and we need to take steps to put it right. These are the people who make the world a better place because doing nothing, though it may not be illegal, is not morally neutral. Failing to act to prevent a wrong does not simply leave a vacuum, it gives permission for evil to flourish. Or as Burke put it “The only thing necessary for the triumph of evil is for good people to do nothing.”   

Alan Bates could have resigned himself to his fate, but instead has doggedly pursued justice for 20 years.  

We all long for leaders who will lead responsibly and not out of self-interest, who will not turn a blind eye to the suffering of the powerless or blame others when asked to explain why they did nothing.   

This is especially so in the church which holds itself to a higher standard and should know better. The ITV series quite deliberately dwells on the fact that Paula Vennells was, as well as being CEO of the Post Office, ordained in the Church of England.  

The truth matters 

Key to the success of the sub-postmasters case was the ability to get to the truth, a task made very difficult by the fact that the Post Office held all the records needed to prove that it was the Horizon system, not the sub-postmasters, that was at fault.   

Being able to determine the truth of a matter is essential to how we lead our lives, and especially in matters of justice.  The version of events presented by the Post Office turned out to be false, but once this false version was on record, the reputations of otherwise upstanding pillars of local communities were destroyed overnight.  The public shame and the human cost of being cruelly and wrongly labelled a liar and thief is powerfully brought home by the TV series, as is the relief of vindication. 

We do not in reality live our lives in a postmodern universe where truth is seen as relative (Oprah’s infamous “What is your truth?” moment), or nothing more than a claim to power.  We know on a daily basis the power of the truth to set us free, from false accusations or a guilty conscience, and how much it stinks when we are deceived - especially when it is by the powerful.  

A lack of integrity 

During the Cold War, there was a running joke that the best indicator of whether a country operated as a one-party state was whether it had the word “Democratic” in its name.    

We have become used to the same kind of dissonance between image and reality, whether it is the smiley telegenic people in a company’s glossy videos (actors? library footage?) or an impossibly worthy values statement.

I was once part of group of employees invited to revamp our employer’s declared values. We were presented with a set of aspirational statements that described a culture that was akin to the Garden of Eden and a working environment that bore no relation to the reality.  When I pointed this out, I was not invited back.   

In public Paula Vennells was insistent that the Post Office cared about its people while out of the spotlight those people were being horribly mistreated.   

It isn’t always so, but how can so many organisations live with such glaring contradictions?  Or is it that boards become so disconnected, by geography or otherwise, from the organisations they run and the cultures they preside over that they actually believe the image over the reality?  

"Computer says no"

One of the more terrifying issues raised by the Post Office scandal is how the principle of the presumption of innocence was abandoned.  How come the testimony of hundreds of innocent people was rejected in favour of a faulty computer system’s data?  

Part of the problem is that the English courts regard computer records as reliable unless the defendant can show otherwise. Since 1999, the burden of proof - and with it the presumption of innocence – has effectively been reversed: the defendant is guilty unless he can show that the computer records implicating him are wrong.   

The notion that we cannot challenge a computer that “Says No” is a real problem. As the Post Office scandal shows, computer software is often riddled with bugs. After all, it is written by fallible human programmers. It also became clear that the Horizon system’s data could be manipulated remotely - and without the knowledge of the sub postmasters.  

To assume that computer generated evidence is infallible is a very dangerous assumption in a world increasingly dominated by machines and, more recently, artificial intelligence.   

A very human story 

The sub-postmasters in the Post Office case were not machines or assets.  The ITV drama succeeded in doing what no legal or investigative process can adequately do, it humanised the victims. Despite all the PR talk about caring for its people, the Post Office only cared about its own reputation, and in the process of trying to save itself lost its humanity and its reputation.   

The drama successfully stripped away all the lifeless procedural, technical and legal terminology to reveal a very simple, devastatingly human story that needed to be told. In Alan Bates’ words: “the Post Office stole my livelihood, my shop, my job, my home, my life savings and my good name”.   

This Post Office story has struck a chord because it reminds us of is what is increasingly missing in public life - leadership, accountability, respect for the truth, integrity and humanity. 

Watching the ITV drama, I was frequently moved to tears and cheered at the end. We root for the victims out of solidarity, as if we ourselves had been wronged.  

The Christian understanding of sin identifies it as a public not a private matter, as it infects the whole body politic.  This is why the case name given to a crime is “R (that is, the state) v X”. There are certain wrongs which are so serious they are considered to be offences against the whole community, not just the individual victim.  

The Post Office saga is a parable of our times.  It tells a story of a society whose elites have become dangerously detached from principle and deaf to the concerns of ordinary people. It will not go away any time soon. The moment of true catharsis, if it comes, will be when our institutions and leaders have earned back our trust. 

The last word goes to the book of Proverbs: 

When good people run things, everyone is glad, but when the ruler is bad, everyone groans.