Can a Doctor take the Hippocratic Oath of Ethics yet adhere to the Catholic Health Care Directive?

Here is one for you.

Physicians often take the Hippocratic Oath, a pledge to abide by a set of ethical principles while practicing medicine (modern version from http://en.wikipedia.org/wiki/Hippocratic_Oath):

  • I swear to fulfill, to the best of my ability and judgment, this covenant:
  • I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.
  • I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
  • I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.
  • I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.
  • I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.
  • I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.
  • I will prevent disease whenever I can, for prevention is preferable to cure.
  • I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.
  • If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.
  • —Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University

Now, Catholic Health Systems, which employ physicians, are bound by a set of religious morals in the direction of their health care. These morals are clearly laid out in "Ethical and Religious Directives for Catholic Health Care Services, Fifth Edition, United States Conference of Catholic Bishops 2009".

http://www.usccb.org/issues-and-action/human-life-and-dignity/healt...

Doctors who are employed at Catholic Hospitals and other facilities must abide by these religious directives, as clearly laid out on page 3:

"Throughout the centuries, with the aid of other sciences, a body of moral principles has
emerged that expresses the Church’s teaching on medical and moral matters and has proven to be
pertinent and applicable to the ever-changing circumstances of health care and its delivery. In
response to today’s challenges, these same moral principles of Catholic teaching provide the
rationale and direction for this revision of the Ethical and Religious Directives for Catholic
Health Care Services."

These Directives, based upon moral principles (less on science), contain explicit instructions on what services will be provided or restricted. The Directives place restrictions on End-of-Life care, stem cell research, infertility treatments, family planning, and treatment for rape victims, among other areas, in order to stay consistent with the moral principles of Catholic teaching.

My question is this: 

Can a Doctor take the Hippocratic Oath and practice at a Catholic Hospital, without being in violation of the ethics he/she has sworn to uphold in the Oath?

Tags: Catholicism, ethics, hospitals, morals

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Liz,

It's a complicated question.

Some medical schools use, instead of the Hippocratic oath, "The Declaration of Geneva".  It is a more modernized declaration of principles for doctors.

At the time of being admitted as a member of the medical profession:

I solemnly pledge to consecrate my life to the service of humanity;
I will give to my teachers the respect and gratitude that is their due;
I will practice my profession with conscience and dignity;
The health of my patient will be my first consideration;
I will respect the secrets that are confided in me, even after the patient has died;
I will maintain by all the means in my power, the honour and the noble traditions of the medical profession;
My colleagues will be my sisters and brothers;
I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;
I will maintain the utmost respect for human life;
I will not use my medical knowledge to violate human rights and civil liberties, even under threat;
I make these promises solemnly, freely and upon my honour.

That declaration has undergone editing and fine tuning over the years.  Especially, I don't think sexual orientation was included until recently.  Similar for the human rights and civil liberties line.

The original versions of the Hippocratic oath are interesting to consider.  Of course, I can't translate from the ancient Greek.  Some parts of it are closer to catholic doctrine than one might think.

From that Nova link and copied here.  Bold font change is mine, for points below.

Hippocratic Oath: Classical Version

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:

To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art—if they desire to learn it—without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else.

I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.

What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.

If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot

So, of course, we no longer swear by Apollo, Aesclepias, Hygeia, or Panaceia.  Although some doctors have a aesclepias rod on their signage, and we promote hygeine, and some folks still look for panaceas.

And, of course, the gender is more inclusive now.

That "original" version forbids giving of poisons.  Depending on your definition, a lot of medications are highly poisonous.  That's the entire basis for chemotherapy, some heart medications, antibiotics.

And the "original" also forbids abortions.

And not ""using the knife" - I guess that distinguishes physicians from surgeons, but in the modern era, the knife is essential to many aspects of medicine.

Then, the issue of confidentiality.  True, we have Health Information Privacy Protection Act (HIPPA) to protect us, but in this era, the health information is shared widely with insurance companies and the government.

Almost all that remains is no sexual relations with patients or their slaves, male or female.  I'm glad that is still forbidden.

===================================================================

Apollo razi grotami pomoru.jpg

(Image of Apollo from commons.wikimedia.org)

This is just my overly verbose way of saying, it's more complicated than first meets the eye.  And more interesting.  In those places that use the oath, it's edited for local and current cultural preferences. 

The catholic hospitals and catholic insurance groups can edit it to their preference too.

All that said, I'm still very concerned about the burgeoning catholic hegemony of health care in some regions of the US.  It worries me a lot.  I think we need means for informing people so they can make decisions about where they go for care, and what to do if they don't have a choice.

As it comes to a practicing physician vs. the RC church, I debate the church's adherence to the Hippocratic oath, particularly as regards the issue of abortion.  I posted this article a couple years back, and it has many fellows as regards the church's absolute position on abortion, regardless of the circumstances.  The woman in Ireland, the child in Brazil, both pregnant, neither in proper condition to bring their pregnancies to term.  One died because the facility she was at would not do the needed procedure.  The other had an abortion and she, her father, and the attending physician were excommunicated for their trouble.  The hospital in the article I cited was removed from good standing in the church, a fact that facility has apparently shrugged off, as they are more concerned with those under their care than they are with some artificial precepts that some fool in a cassock wants to superimpose.

The church can KEEP it's "directives."  I would only use them were there no other choice.

Both of you may be interested in this report, just released by MergerWatch and the ACLU 

MISCARRIAGE OF MEDICINE: The Growth of Catholic Hospitals and the Threat to Reproductive Health Care (attached). 

It documents the growing threat of Catholic-affiliated facilities, which are increasing at a rate second to for-profit facilities, while all other types of health care facilities decline. These facilities operate under the Catholic Health Care Directives attached above, which are administered by a local Bishop. Doctors are indirectly or directly impacted. For example, in our state we have a Death by Dignity act, allowing for personal choices to be made about how one dies. Certain facilities in our state have gag orders placed upon their doctors - they are not allowed to discuss suicide as an option for end of of life care - even though it is a state law, simply because it is against their "religious directives."

Is this ethical? 

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