I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant.

The classical Hippocratic oath taken by new medical students may or may not seem familiar – particularly since most medical schools, including Georgetown, give some modified version of the code of ethics that doesn’t include Greek deities.

“All students have to subscribe to some kind of code of ethics. For most, it’s a modified version of the Hippocratic oath. For some it’s an oath that is based on religious beliefs,” said Robert Veatch, professor of medical ethics, describing how the oath varies by medical school. “In the early 1990s there was only one institution that took the classic Hippocratic oath.”

Though he’s not quite sure if that one school still uses the classic oath, his May 8 Gifford Lecture at the University of Edinburgh in Scotland explored why physicians are often steered from a code of ethics based on spiritual and cultural beliefs rather than those of a professional group such as the American Medical Association (AMA).

“Most of the time people think that ethics can be found through religion or a philosophical group,” he said prior to his overseas lecture. “You think of your religion, not your professional group, as being able to give you a code of ethics.”

On May 8 Veatch joined a select group of scholars -- dating back 120 years – when he delivered the Gifford Lecture at the University of Edinburgh.

“Medical ethics has been the focus of my whole career and being invited to give this lecture is the highlight of a career,” said the scholar who became the first professor to deliver the lecture while at Georgetown.

Gifford Lectures are given every year at one of the four historic Scottish universities -- Edinburgh, University of Glasgow, University of St. Andrews and University of Aberdeen. They mostly focus on ways to promote and diffuse the study of natural theology, or the knowledge of God. “It’s theology using reason, not revelation,” Veatch said.

Since the first lecture in 1888, Gifford lecturers have been recognized as pre-eminent scholars in the fields of theology, psychology, anthropology, history and philosophy, among others, to talk about theology supported by science instead of theology dependent on the miraculous. Past lecturers include astronomer and astrophysicist Carl Sagan, psychologist and educational reformer John Dewey and Swiss reformed theologian Karl Barth.

Other Gifford lecturers with relations to Georgetown include Arthur Peacocke, who served as Royden B. Davis Professor of Interdisciplinary Studies at Georgetown from 1994-1995; John Haldane, who served as a Royden B. Davis Professor of Humanities from 2001-2002; and Jean Bethke Elshtain, who currently serves as Leavey Chair Professor in the government department.

As a bioethicist and former director of the Kennedy Institute of Ethics at Georgetown, Veatch has long questioned the codes within religion and the secular society as they relate to health and science. In his Gifford presentation, “Hippocratic, Religious and Secular Medical Ethics: The Points of Conflict,” Veatch not only took aim at the Hippocratic oath and other codes of ethics, he looked at the conflicts that arise because of them.

“Oftentimes religious and professional ethics may clash,” he said.

Many debates continue to spark over spiritual beliefs and science when it comes to issues such as stem cell research, abortion and methods of birth control. However, Veatch said it’s the more subtle questions that can cause the most conflict.

Should a doctor tell a patient they are ill with something if the information will cause further stress and harm to them? Should doctors be present during executions even if it is to ensure that the procedure is carried out in a way that doesn’t cause unnecessary pain or torture? These are questions Veatch poses, and the answers aren’t easy.

“The AMA has found itself changing its stances because of a changing society,” Veatch said.

He referenced a 1976 case, Tarasoff v. Regents of the University of California, in which a mentally ill man told his psychologist during a session that he was going to kill his former girlfriend once she returned from a trip out of the country.

“At the time the professional code said that as a physician your duty was to your patient and no one else,” Veatch said.

Even though the psychologist had the man civilly committed, he was released shortly thereafter. With no warnings given to the ex-girlfriend or her family, the man carried out his confession to the psychologist and killed his ex-girlfriend.

“That case wound up changing California’s code, and physicians now have a duty to warn individuals if there is a threat to their safety,” Veatch said.

The professor says changes in codes of ethics are not uncommon. “In this case the code changed immediately for physicians in California,” he said.

But another problem Veatch sees is that physicians' professional codes vary on the local, state, national and international levels.

“It winds up that a layperson has no idea what oath his or her physician has taken,” he said.

When the next crop of medical students come to Georgetown this fall to don their white coats and take a modified version of the Hippocratic oath, Veatch said they should think about what their oaths mean and how they affect their patients.

“That’s important because it’s the [patient] often that can wind up with no say,” he said.

Source: Blue & Gray (May 12, 2008)