‘First do no harm’ is not in the Hippocratic Oath

(I first wrote and published this article in 1997 on my now defunct Everwild website.)

It is a widely held misconception that the familiar dictum “First, do no harm” comes from the Hippocratic Oath, an oath many physicians take when they enter medical practice.

However, the Hippocratic Oath does not and never did contain those words (nor was it actually written by Hippocrates, according to many sources). It expresses a similar idea, but never employs the words “First, do no harm.”

Today there is no single oath that all physicians take upon entering practice.

It is the opinion of many scholars that Hippocrates did, in fact, originate the phrase, but did so in his Epidemics, Bk. I, Sect. XI. One translation reads: “Declare the past, diagnose the present, foretell the future; practice these acts. As to diseases, make a habit of two things — to help, or at least to do no harm.”

The Greek “First, do no harm” becomes “Primum non nocere” in Latin. A translation of the original perhaps, but some sources attribute “Primum non nocere” to the Roman physician, Galen.

Today there is no single oath that all physicians take upon entering practice. Depending on where they earn their medical degrees, they may take any one of many pledges, but all embody the ethics and ideals of Hippocrates, the acknowledged father of modern medicine.

The exact wording of the original oath has been subject to dispute, as translations and interpretations of the original Greek have varied. Complicating the picture are the many modernizations of the oath which take into account changes in language, social mores, and medicine itself over the centuries.

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The Hippocratic Oath

(An Early Version)

I swear by Apollo the physician and Aesculapius, and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgement, I will keep this Oath and this stipulation.

To reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others.

I will follow that system of regimen which, according to my ability and judgement, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion.

With purity and with holiness I will pass my life and practice my Art. I will not cut persons labouring under the stone, but will leave this to be done by men who are practitioners of this work. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further, from the seduction of females or males, of freemen and slaves.

Whatever, in connection with my professional service, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret.

While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times. But should I trespass and violate this Oath, may the reverse be my lot.

The Hippocratic Oath

(A Modern Version)

I swear in the presence of the Almighty and before my family, my teachers and my peers that according to my ability and judgment I will keep this Oath and Stipulation.

To reckon all who have taught me this art equally dear to me as my parents and in the same spirit and dedication to impart a knowledge of the art of medicine to others. I will continue with diligence to keep abreast of advances in medicine. I will treat without exception all who seek my ministrations, so long as the treatment of others is not compromised thereby, and I will seek the counsel of particularly skilled physicians where indicated for the benefit of my patient.

I will follow that method of treatment which according to my ability and judgment, I consider for the benefit of my patient and abstain from whatever is harmful or mischievous. I will neither prescribe nor administer a lethal dose of medicine to any patient even if asked nor counsel any such thing nor perform the utmost respect for every human life from fertilization to natural death and reject abortion that deliberately takes a unique human life.

With purity, holiness and beneficence I will pass my life and practice my art. Except for the prudent correction of an imminent danger, I will neither treat any patient nor carry out any research on any human being without the valid informed consent of the subject or the appropriate legal protector thereof, understanding that research must have as its purpose the furtherance of the health of that individual. Into whatever patient setting I enter, I will go for the benefit of the sick and will abstain from every voluntary act of mischief or corruption and further from the seduction of any patient.

Whatever in connection with my professional practice or not in connection with it I may see or hear in the lives of my patients which ought not be spoken abroad, I will not divulge, reckoning that all such should be kept secret.

While I continue to keep this Oath unviolated may it be granted to me to enjoy life and the practice of the art and science of medicine with the blessing of the Almighty and respected by my peers and society, but should I trespass and violate this Oath, may the reverse be my lot.

.

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Another Modern Oath

Another version, approved by the American Medical Association, is as follows:

You do solemnly swear, each by whatever he or she holds most sacred: That you will be loyal to the Profession of Medicine and just and generous to its members. That you will lead your lives and practice your art in uprightness and honor.

That into whatsoever house you shall enter, it shall be for the good of the sick to the utmost of your power, your holding yourselves far aloof from wrong, from corruption, from the tempting of others to vice.

That you will exercise your art solely for the cure of your patients, and will give no drug, perform no operation, for a criminal purpose, even if solicited, far less suggest it.

That whatsoever you shall see or hear of the lives of men or women which is not fitting to be spoken, you will keep inviolably secret.

These things do you swear. Let each bow the head in sign of acquiescence. And now, if you will be true to this, your oath, may prosperity and good repute be ever yours; the opposite, if you shall prove yourselves forsworn.

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Oath and Law of Hippocrates

From “Harvard Classics Volume 38”
Copyright 1910 by P.F. Collier and Son.
This text is placed in the Public Domain, June 1993.

Introductory Note

Hippocrates, the celebrated Greek physician, was a contemporary of the historian Herodotus. He was born in the island of Cos between 470 and 460 BC, and belonged to the family that claimed descent from the mythical Aesculapius, son of Apollo. There was already a long medical tradition in Greece before his day, and this he is supposed to have inherited chiefly through his predecessor Herodicus; and he enlarged his education by extensive travel. He is said, though the evidence is unsatisfactory, to have taken part in the efforts to check the great plague which devastated Athens at the beginning of the Peloponnesian war.

He died at Larissa between 380 and 360 BC The works attributed to Hippocrates are the earliest extant Greek medical writings, but very many of them are certainly not his. Some five or six, however, are generally granted to be genuine, and among these is the famous “Oath.” This interesting document shows that in his time physicians were already organized into a corporation or guild, with regulations for the training of disciples, and with an esprit de corps and a professional ideal which, with slight exceptions, can hardly yet be regarded as out of date.

One saying occurring in the words of Hippocrates has achieved universal currency, though few who quote it today are aware that it originally referred to the art of the physician. It is the first of his “Aphorisms”: “Life is short, and the Art long; the occasion fleeting; experience fallacious, and judgment difficult. The physician must not only be prepared to do what is right himself, but also to make the patient, the attendants, and externals cooperate.”

The Law of Hippocrates

Medicine is of all the arts the most noble; but, owing to the ignorance of those who practice it, and of those who, inconsiderately, form a judgment of them, it is at present far behind all the other arts.

Their mistake appears to me to arise principally from this, that in the cities there is no punishment connected with the practice of medicine (and with it alone) except disgrace, and that does not hurt those who are familiar with it. Such persons are the figures which are introduced in tragedies, for as they have the shape, and dress, and personal appearance of an actor, but are not actors, so also physicians are many in title but very few in reality.

Inexperience is a bad treasure, and a bad fund to those who possess it.

Whoever is to acquire a competent knowledge of medicine, ought to be possessed of the following advantages: a natural disposition; instruction; a favorable position for the study; early tuition; love of labour; leisure. First of all, a natural talent is required; for, when Nature leads the way to what is most excellent, instruction in the art takes place, which the student must try to appropriate to himself by reflection, becoming an early pupil in a place well adapted for instruction. He must also bring to the task a love of labour and perseverance, so that the instruction taking root may bring forth proper and abundant fruits.

Instruction in medicine is like the culture of the productions of the earth. For our natural disposition, is, as it were, the soil; the tenets of our teacher are, as it were, the seed; instruction in youth is like the planting of the seed in the ground at the proper season; the place where the instruction is communicated is like the food imparted to vegetables by the atmosphere; diligent study is like the cultivation of the fields; and it is time which imparts strength to all things and brings them to maturity. Having brought all these requisites to the study of medicine, and having acquired a true knowledge of it, we shall thus, in travelling through the cities, be esteemed physicians not only in name but in reality.

But inexperience is a bad treasure, and a bad fund to those who possess it, whether in opinion or reality, being devoid of self-reliance and contentedness, and the nurse both of timidity and audacity. For timidity betrays a want of powers, and audacity a lack of skill. They are, indeed, two things, knowledge and opinion, of which the one makes its possessor really to know, the other to be ignorant. Those things which are sacred, are to be imparted only to sacred persons; and it is not lawful to impart them to the profane until they have been initiated into the mysteries of the science.

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One snake or two?

I have long intended to address another misconception about medicine — the idea that the caduceus (with two snakes) is the symbol of medicine. It is not. The true, original symbol of medicine is the staff of Aesculapius (one snake). This topic has been discussed elsewhere in great depth and I encourage you to read further if I have piqued your interest. One suggestion:

http://drblayney.com/Asclepius.html

–SFR

© 1997 Everwild.com



Categories: Health, History

Tags: , , , ,

4 replies

  1. An interesting and worthy subject, your post here. I note a strong religious thread in the first “modern version” of the oath, not unexpected since religion has dominated the theme of human life and death throughout history. Noteworthy is the injunction against abortion and assisted suicide, something not common to the other two. The extent to which physicians observe such oaths is of course a voluntary exercise, but it is some comfort that guidance is formalized.

    A rather strange thought occurs to me. I wonder if doctors’ respect for patients has diminished in the modern era because so many modern ailments are brought about as a consequence of self indulgence and sedentary lifestyles? If so, how might this affect how they view their oath and how they practice?

    My own maternal gggrandfather, Arthur Asher Baker was a self-taught country doctor in the early days of Berryville, Arkansas, and he too, I have read, paid home visits and often took payment in the form of produce, chickens, and the like. He must have had something on the ball because everything written about him was good.

    Jim

    • If doctors’ respect for patients has diminished because of the patients’ self-indulgence and sedentary lifestyles, I’m in a world of hurt. But if my doctor feels that way, she’s hiding it extraordinarily well.

      I wonder how much new doctors really think about the meaning of the oath as they recite it. Exhausted, possibly disillusioned, relieved to be finishing that stage of their education, they may throw off those words like we would a swearing in, in a courtroom. But it is always there as a reminder to contemplate in quiet moments, and it reminds us all of how noble the aspirations are, even if they aren’t always reached.

      I always thought of my dad as Marcus Welby personified. And as far as I ever heard from anyone, everyone else thought of him that way too. I used to go with my dad when he made house calls, and wait in the car when he went inside. Medicine sure has changed since those days. And despite all the modern advances, I think I’d rather have back the doctor-patient relationships we used to have.

    • I love that question! “I wonder if doctors’ respect for patients has diminished in the modern era because so many modern ailments are brought about as a consequence of self indulgence and sedentary lifestyles? If so, how might this affect how they view their oath and how they practice?” As a nurse leader that is a most compelling question. I am off to pursue that answer today.

      • It might depend a lot on what doctors expect when they go into medicine in the first place, and their individual attitudes. Most younger practitioners were probably well aware of what they’d be dealing with when they became doctors and chose their specialties. I would hope if there’s too little respect there, they would not have become doctors in the first place.

"I never considered a difference of opinion in politics, in religion, in philosophy, as cause for withdrawing from a friend." ~ Thomas Jefferson

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