"You can’t legislate morality. But you can give incentives for people to act in a moral fashion, regardless of what their beliefs are," Miriam Joseph says. She is a Registered Nurse in the critical care unit of North Shore Evanston Hospital. I spoke to her about her thoughts on the Hippocratic Oath and how it affects her work. "I think it plays into everybody’s practice, the morality of what we’re doing," she said, sipping a cup of green tea. Hard decisions always have to be made in medicine. These decisions include things as simple as whether or not to give a patient a minimally invasive surgery, and as complex as what to do in the case of a young girl becoming pregnant and wanting an ...view middle of the document...
In times of confusion and moral quandary, doctors have looked to the Oath for guidelines. However, medical ethics is a changing field. Atul Gawande, a surgeon and journalist well known for his work optimizing modern healthcare, wrote in his book, Complications,
We look for medicine to be an orderly field of knowledge and procedure. But it is not. It is an imperfect science, an enterprise of constantly changing knowledge, uncertain information, fallible individuals, and at the same time, lives on the line. There is science in what we do, yes, but also habit, intuition, and sometimes plain old guessing. (7)
It seems to me that in this “enterprise of constantly changing knowledge”, there could be much less “plain old guessing” if a new code of basic ethics were to be implemented into our medical system. The doctors of today are entering Emergency Rooms and Operating Rooms with a misty understanding of what the ethically correct path is. They are facing situations that are new to them, and they need a guiding hand. The ethics of medical situations are mutating with the advances in technology that mankind ceaselessly pours out. As our abilities change, we have to change the way we approach the ethics of these technologies and capabilities. The Oath has its strengths and weaknesses, but, more and more, it doesn't provide clear guidance in many situations. Some parts, however, remain strongly relevant.
One particular line in the Hippocratic Oath has stood the test of time. "I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone," often paraphrased colloquially as 'first, do no harm'. Joseph agrees that she thinks about that sentence daily at her nursing job.
Not a day goes by at work that someone doesn’t say ‘Yeah but remember, first do no harm.' There’s always that thought to minimize whatever kind of discomfort that you have to inflict by your therapy. And the concept of therapies being difficult and painful and life threatening themselves comes up all the time.
Medical practice is an equation of cost versus benefit, the effects of treatment always weighed against the possible outcomes. Each regimen prescribed to a patient is chosen because it will do the least harm possible, and the most good. However, when the options are clear, but the morally correct path is not, new problems arise. This often occurs in technologies that have been invented in recent years, when they are still unknown and seldom used.
When two scientists, Watson and Crick, discovered the double-helix structure of DNA in 1953, science and medicine changed forever. 24 years later, in 1977, the complete genome of Bacteriophage fX174 was sequenced, every single adenine, guanine, cytosine, and thymine listed in order (Pillsbury). Since then, we have made incredible progress in genome sequencing, having completed the first complete human genome in 2003 (Human Genome Project). Along with entire genomes, individual...