The World Medical Association recently released a contemporary successor to the 2500-year-old Hippocratic Oath. It was published late last year in the Journal of the American Medical Association. The original Hippocratic Oath has undergone several modifications since 1948 when it was first revamped and presented as The Physician’s Pledge under the World Medical Association Declaration of Geneva.
The 2017 version no doubt is re-energising. It gave me goosebumps when I first read it, though there is nothing in it that I had not heard of previously.
The declaration exhorts physicians to pledge to dedicate their lives to the service of humanity, to consider the well-being of patients as their first priority, and to maintain the utmost respect for human life. It asks physicians to do their job with dignity and conscientiously while honouring the noble traditions of the profession. The pledge talks about the importance of maintaining patient confidentiality, respecting colleagues and honouring civil liberties. It asks doctors to pledge solemnly, freely and with honour.
However, there are two obvious deficiencies in the document.
First, the sentence “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” leaves out the all important discriminatory element of economic status. “Social standing” is not equivalent of socioeconomic status, class or economic status. “Any other factor” only reinforces the suspicion that the World Medical Association has perhaps chosen to skirt this very key issue.
Very few countries in the world have egalitarian government-funded single-payer systems which cater to the population at large without consideration of the ability to pay. In some developed countries like the United States, organisations and individual practitioners are even allowed to choose the insurance policies that they would like to work with or the class of patients that they would like to cater to. The development of cutting-edge patented therapies only adds to the undesirable situation. One may argue that physicians are merely part of the system and are not expected to bring organisational changes or influence the evolution thereof. But since they are the central figures in the health-care industry, shouldn’t they be the ones to lead?
By not taking a categorical stance in this matter, the World Medical Association has only ended up undermining physicians and their importance within the system. It has also accepted the discomforting global reality of personalised medicine for some and a lack of basic care for many others.
Second, the sentence “I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard” is perhaps a bit naïve when dismal data of widespread physician burnout – characterised by emotional exhaustion, lack of a sense of accomplishment and depersonalisation – are accumulating around the globe. Moreover, physician burnout is now felt to be an institutional failure rather than that of the individual.
Yes, I will pledge to attend to my well-being so that I can take good care of my patients. But should I also not pledge that I will work to help overhaul the system so that it is friendlier to physicians? Perhaps, the World Medical Association should pledge to help us do so.
Jay Desai is a neurologist.