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Hippocrates Redux

2,500-year-old doctors' oath gets updated

THURSDAY, Feb. 14, 2002 (HealthDayNews) -- American and European doctors, hoping to strengthen an eroding public trust in a greatly changed world of medicine, have renewed their commitment to the 2,500-year-old Hippocratic Oath with a new professional code of conduct.

The code, called the "Charter on Medical Professionalism," consists of three fundamental principles -- primacy of patients' welfare, of patients' autonomy, and of social justice, including fair distribution of health care resources -- and 10 professional responsibilities. It appears jointly in the Feb. 5 issue of the Annals of Internal Medicine and the Feb. 9 issue of The Lancet.

"We envision the charter as a conduit to strengthen public trust by reaffirming professional values," says Harry Kimball, president of the American Board of Internal Medicine (ABIM) Foundation in Philadelphia. The charter was written by members of the Medical Professionalism Project, sponsored by the ABIM Foundation, the American College of Physicians-American Society of Internal Medicine (ACP-ASIM), and the European Federation of Internal Medicine (EFIMI).

Although the Hippocratic Oath -- which directs doctors to "exercise your art solely for the cure of your patients, and will give no drug, perform no operation, for a criminal purpose" -- is still relevant today, physicians and patients alike face a health care environment vastly different -- and perhaps more troubled -- than that of Hippocrates' day.

"In the last 15 years, we have seen an incredible expansion of knowledge," says Tareg Bey, associate clinical professor at the University of California at Irvine, who is also certified by the European Academy of Anesthesiology. That includes DNA analysis, cloning, genetic therapy, in vitro fertilization, laser technology and MRIs, to name just a few innovations. Advances in genomics alone pose substantial challenges not just in the medical realm, but also in the legal, ethical and political arenas.

The explosion in technological innovations is compounded by changes in market forces, including an emphasis on the profit motive, problems in health care delivery, and increased globalization.

There are also increasing disparities in the needs of patients and the ability of health care systems to address these needs, as well as more sophisticated and knowledgeable patients who expect to be treated as partners by their physicians.

""Forces that are largely beyond our control have brought us to circumstances that require a restatement of professional responsibilities," Harold Sox, editor of the Annals of Internal Medicine, says in a prepared statement.

Some members of the medical community view the charter as a bittersweet development.

""I agree with all the points of the charter," says Bey. "It is just sad that it has to be written down as a new charter because all of what the charter requests is common sense."

He adds, "The mere fact that this charter was created is, for me, a sign that things did not go right in the past. This is definitely a beginning of a new era in medicine."

What To Do

The full-text version of the new charter can be viewed at Annals of Internal Medicine.

More information about the Medical Professionalism Project is available at MPP 2001.

If you'd like to read the entire Hippocratic Oath and its effect on medicine, go to this NOVA site from public TV station WGBH.

SOURCES: Interviews with Linda Blank, senior vice president, American Board of Internal Medicine Foundation, Philadelphia; Tareg Bey, M.D., F.A.C.E.P., associate clinical professor, University of California, Irvine, Orange, Calif.; Feb. 9, 2002, The Lancet; Feb. 5, 2002, Annals of Internal Medicine
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