Article
Ethics
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?  

Article
Character
Ethics
General Election 24
Politics
Trust
7 min read

The problems Keir Starmer faces are not just political - they are spiritual

His greatest battle may be the fight for our trust.

Graham is the Director of the Centre for Cultural Witness and a former Bishop of Kensington.

Downing Street

The beginning of a new government is a bit like the beginning of a new football season.  Nothing yet has gone wrong. The future seems full of promise. The grim memory of last season is in the past. Hope is in the air.

Keir Starmer, in his early speeches as Prime Minister, sound some familiar notes. He speaks of “a weariness in the heart of a nation, a draining away of the hope, the spirit, the belief in a better future that we need to move forward together.” While not quite Margaret Thatcher’s invoking the spirit of St Francis in 1979, Sir Keir was reaching for something deeper than the practicalities of politics, for bigger themes, more resonant ideas. Yet there was one note that caught my eye, not just in these speeches but also before that in the election campaign – a theme that cropped up often – the need for trust.

On the day after the election, when the confirmation came through that Labour had won, in an early morning speech to supporters delivered at the Tate Modern, he said this: “Make no mistake, this is the greatest test for politics in this era – the fight for trust is the battle that defines our age.”

Keir Starmer has put his finger on something. As Martin Kettle in the Guardian put it, “Whether you approve of Keir Starmer’s election strategy or not, it is a matter of observable fact that he has centred it upon the regaining of trust.” The Labour manifesto claimed that “over the last 14 years, trust in politics has been shattered.” It went on: “sleaze and scandal have eroded trust. Just as corrosive has been the inability of politicians to keep promises made to the British people.” Among the main reasons the Conservatives were roundly rejected were the actions of Boris Johnson’s inner circle, who partied in Downing Street while families were avoiding each other and staying away from their parents’ funerals (I know – I was one of them). I'm not sure that he and his party realised how corrosive and damaging that was to public trust in government and the Conservatives in particular. Perhaps now they know.

Trust is built when politicians keep their promises and deliver what they say they will over the months and years. It wilts in the presence of political in-fighting, bets placed by election candidates, or unfulfilled boasts to save the NHS.

Hope and trust are vital things for human life. We cannot live without them. And it’s not just in politics. The Church of England has had its own troubles with trust in recent times. A report, debated at General Synod, lamented the lack of trust in the Church, setting it in the context of a general lack of trust in institutions in our society.

Starmer understands that trust has to be earned. “This lack of trust,” he said outside No 10 Downing Street, “can only be healed by actions not words.” And trust takes time. Trust is built when politicians keep their promises and deliver what they say they will over the months and years. It wilts in the presence of political in-fighting, bets placed by election candidates, or unfulfilled boasts to save the NHS.

However, to be fair to politicians, trust has not only to be earned, it also has to be given. And we have become less trusting as a nation. The IPSOS Trust Index reveals that politicians, the media, bankers and advertising executives are our least trusted institutions. An ONS survey in 2023 revealed that trust in political parties, the media, local government, and international organisations was at its lowest level for years. A survey of over 36,000 interviews across 28 countries revealed “a world ensnared in a vicious cycle of distrust, fuelled by a growing lack of faith in media and government. Through disinformation and division, these two institutions are feeding the cycle and exploiting it for commercial and political gain.”

To break what it called the ‘cycle of distrust’, it recommended demonstrating tangible progress, focussing on long-term thinking and providing credible information. Yet I wonder if the problem lies deeper than that.

Trust is a habit. It is like a muscle. The more you exercise it, the more it tends to grow. Yet the paradox of trust is that without trustworthy objects in our lives, it becomes hard to exercise that muscle. A child growing up with parents who regularly deceive and lie to him, promising but not showing up to sports events, hinting at presents that never actually turn up, quickly learns that trust doesn't work. The disappointment is too great to bear. Cynicism works better. He learns to take everything with a pinch of salt, to be wary of promises, and that a guarded attitude where the default position is not to believe is a safer option. 

In a broken and fallen world, trust is a fragile thing. Some people and institutions will be more trustworthy than others, but even the best will get things wrong...

The problem politicians face is that politics, as they say, is the art of the possible, and along the way, whether due to financial constraints, or the need to do deals with allies, political opponents, or (more likely for Starmer, given the size of his majority) within your own party, compromises have to be made, promises ‘re-aligned’ if not actually broken, which is where distrust starts to creep in. Nick Clegg famously made a promise that his party would never increase student fees, yet in the cut and thrust of actually having to govern, he had to break that promise, and his version of the Liberal Democrat party never recovered.

A little while ago, I interviewed Esau McCaulley, an African-American theologian and New York Times columnist with a fascinating backstory. His childhood in the backstreets of Alabama was complicated by an intermittently absent and unreliable father, whose promises were broken again and again. Esau learnt to approach the world with wariness, burned by broken promises. Yet somehow, through the determination of a good mother and the steady influence of a local church, he learnt to trust again. As he put it: “others must own their scepticism, and I my trust, both of which arise out of deeply held convictions about the nature of reality.”

Like Starmer, McCaulley has put his finger on something. The question of whether or not we believe ultimate reality can be trusted lies beneath our cultural tendencies towards trust or mistrust. Ultimately, trust needs a transcendent object. In a broken and fallen world, trust is a fragile thing. Some people and institutions will be more trustworthy than others, but even the best will get things wrong and when those people and institutions that we have trusted implicitly let us down, it is the hardest fall of all.

Judaism and Christianity, in particular the latter, have made a big deal about faith and trust. The Bible is not a list of pithy, timeless aphorisms, but consists of a story across time – and as we saw, trust takes time. One of the central characteristics of the God of the Christian Bible is faithfulness across time. It tells the story of a God who makes a world with a regularity that can be trusted, where the sun rises and sets, light follows darkness, where the fluctuations of a dynamic planet are contained - hence the symbol of the rainbow as a sign that God will not ultimately destroy his creation. When the creation is disrupted by a primeval act of rebellion by the very species that was intended to care for the creation, God promises to send a rescuer from out of that very species to redeem it, a promise fulfilled in Jesus Christ. It then promises the as-yet-unfulfilled hope that the world will one day be healed and brought to its fullness. We do not yet see that, but on the basis of promises previously kept, we are invited to trust. The narrative arc of the Bible is a story that is designed to inculcate trust.

Contemporary spirituality does not have such a focus on faithfulness in time. An appeal to ‘find our spiritual centre’, to ‘accept the present moment’ may bring a temporary sense of peace and serenity. It doesn’t rebuild trust. Because trust, as Keir Starmer has recognised, is built slowly over time by trusting in someone who proves themselves trustworthy.

Having such a transcendent horizon of faith tends to build the muscle of trust. It turns the dial from the default of distrust to that of trust. It becomes just a little easier to handle the disappointments of broken promises in this world because ultimate reality can be trusted.

All this tells us that the deepest problems we face as the new government begins its work are not just political - they are spiritual. I for one hope and pray that Keir Starmer's government will be as trustworthy as he hopes it will be. It would be wonderful if they can rebuild a sense of trust in politics. But there are limits to what politics and politicians can do. They cannot ultimately heal our hearts from the damage done to our ability to trust. Only a faithful God can do that.

Starmer is, well known as an atheist. In seeking to build trust, he has hit the right note. In identifying trust as the key issue of the day, he is perhaps unknowingly reaching out for the God he doesn’t believe in, but who builds trust in those who do.