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.

Mehmet Ciftci has a PhD in political theology from the University of Oxford. His research focuses on bioethics, faith and politics.

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
Assisted dying
Care
Comment
Ethics
6 min read

It's a dreadful thing when we regard the disabled, the dependent, and the different as disposable

A MND sufferer reflects on the historic vote to legalise assisted dying
A crowded House of Commons awaits a vote.
MPs await the result.
Parliament TV.

I can’t say I’m surprised, but I am disappointed. The euthanasia juggernaut has been gathering momentum throughout the western world. In this country it appeared as the Voluntary Euthanasia Society, to be later rebranded as the richly endowed Dignity in Dying. It’s been beavering away for decades, with well publicised personal stories and legal cases which have been very effective in persuading general opinion that dying is frequently nasty and that we should have the right to choose when and how to die. That organisation resisted using the term ‘suicide’, which is what they advocate, realising that it opens up the accusation of devaluing life. So, I’m not surprised that MPs have, after an impassioned debate, by a narrow majority, eventually given way to the pressure.

A fortnight ago, I had my annual check-up at the motor neurone disorder clinic and subsequently received the GP letter.

“Date seen 02/06/2025…  Diagnosis (this visit) Primary Lateral Sclerosis…  Symptom onset 2000”.

I well remember the year 2000, my voice deteriorating, my balance starting to fail me, resulting finally a year later in the consultant’s verdict, “You have a motor neurone disorder.”

I knew what that meant as at the time Diane Pretty, backed and publicised by the Voluntary Euthanasia Society, was fighting through the courts as far as the European Court of Human Rights for the right for her husband to take her to commit suicide in Switzerland in the Dignitas “clinic”. It was a frightening time to receive an MND diagnosis, and it still is today. The normal progression is both swift and relentless. However, the Motor Neurone Disease Association does say “in the majority of cases, death with MND is peaceful and dignified”.

At that time I could have been depressed; I could have known how much care I would need, how much it might eat into our savings; I could have feared the physical and emotional toll it would take on my wife; I could have been desperate about the future. Certainly I was vulnerable. Fortunately, I was of an optimistic nature and had plenty of reasons for living.

But it could easily have been otherwise. I might well have panicked and opted for a doctor to help me die, if the law debated in the Commons today was in effect. Then I wouldn’t have seen two sons getting married nor grandchildren being born and growing up. I would have missed out on twenty years of an increasingly restricted but paradoxically fulfilled life.

Of course you might argue that I’m ‘lucky’ to have, as became clear over the years, my exceptionally rare and slow form of MND, but I wasn’t to know that, as indeed none of us do despite our doctors’ best predictions. Indeed I am lucky to be alive.

However it was my experience that brought me face to face with the fact of my own mortality and the issue of assisted dying. There seemed to me to be four main drivers. First, the desire for autonomy; second, the insistence of independence; third, a sort of compassion, and fourth, finance. There were two further factors: fear of death and fear of being “a burden”.

Autonomy

It’s a modern western concept that humans are by nature autonomous beings, meaning that choice is an inalienable right. I once co-wrote a book with the title, I Choose Everything, based on a quote of Therèse of Lisieux. It was from a childhood incident, but it did not mean she reserved the right for total autonomy, but rather the opposite. As she later wrote, “I fear only one thing: to keep my own will; so take it, for ‘I choose all!’ that you (God) will!”

Absolute choice is not a virtue. Choosing where to drive your car is not a virtue as it can endanger other road users. There are many limitations on freedom or taboos that protect others in a society. Taking someone’s life directly or indirectly is a universal one. Individuals submitting to a higher authority holds a community and a nation together.  

Independence

Another related modern heresy is the ideal of independence. How utterly fatuous this is! None of us is born independent. We’re born relational. All of our lives we are interdependent. Being cared for is not to be lacking in dignity. Being 100% dependent does not deprive someone of their human dignity. Even the most disabled person is a human being made in the image of God. It is a dreadful thing when a society regards the disabled, the dependent, the different, the mentally deficient and the declining as inferior and potentially disposable. Of course the advocates of the Bill would vehemently deny that they or it implied any such thing. Yet the history of the twentieth century bears witness to how subtly a society can be seduced by the pernicious philosophy of eugenics.

Compassion

It is a modern paradox that medical advances have contributed to the illusion that death is to be feared. Yes, death has always been the last enemy and, yes, we hope it will be peaceful. But we shall all die. Contrary to received wisdom, the compassionate response to that fact of life is not to “put someone out of their misery”; compassion (literally suffering with) means to be with them in their suffering. This is what good palliative care provides, making the end of life dignified, worth living and even pain free.

As former Prime Minister Gordon Brown pertinently asked, “When only a small fraction of the population are expected to choose assisted dying, would it not be better to focus all our energies on improving all-round hospice care to reach everyone in need of end-of-life support?”

Finance

Of course palliative care costs more than facilitating patients to take their own lives. According to the Daily Mail “Legalising assisted dying would save the taxpayer £10million in NHS costs in its first year, rising to £60million after a decade, according to grim new estimates published by the government.” The estimates are indeed grim, but also attractive to politicians straining to balance the national budget. Yet they raise the fundamental question: do we want to live in a society which values money over life?

Which is the most fundamental of all the issues: the sanctity of life has been a core principle central to all the Abrahamic faiths, which undergird our culture and way of life. In the words of Job on hearing of the death of all his children, “The Lord gave and the Lord has taken away.” The start and end of life are not ours to determine. We lack the wisdom of God.

Apparently the majority of our parliamentarians have decided to place that prerogative into the hands of suggestible and distinctly fallible humans beings. We or our children shall, I fear, reap the whirlwind.

As an afterthought I have a number of friends who disagree with me, often after personal experience of watching a loved one die. I sympathise and I suppose that I must be glad for them that the MPs have represented their wishes. And I would never condemn them if they decided to choose the route of assisted dying for themselves. I hope they won’t have to.

Meanwhile I trust that, when the Bill comes to the upper house, their Lordships will fulfil their function of revising it wisely and effectively. They certainly have relevant expertise, for example in the field of palliative care - which is in danger of being squeezed following this bill.

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