Hippocrates' oath and Asclepius' snake : the birth of the medical profession

T. A. Cavanaugh's__Hippocrates' Oath and Asclepius' Snake: The Birth of the Medical Profession__articulates the__Oath__as establishing the medical profession's unique internal medical ethic - in its most basic and least controvertible form, this ethic mandates that physicians help and not harm the sick. Relying on Greek myth, drama, and medical experience (e.g., homeopathy), the book shows how this medical ethic arose from reflection on the most vexing medical-ethical problem -- injury caused by a physician -- and argues that deliberate iatrogenic harm, especially the harm of a doctor choosing to kill (physician assisted suicide, euthanasia, abortion, and involvement in capital punishment), amounts to an abandonment of medicine as an exclusively therapeutic profession. The book argues that medicine as a profession necessarily involves stating before others what one stands for: the good one seeks and the bad one seeks to avoid on behalf of the sick, and rejects the view that medicine is purely a technique lacking its own unique internal ethic. It concludes noting that medical promising (as found in the White Coat Ceremony through which U. S. medical students matriculate) implicates medical autonomy which in turn merits respect, including honoring professional conscientious objections. Cover 1 Hippocrates’ Oath and Asclepius’ Snake 4 Copyright 5 Dedication 6 Contents 8 Acknowledgments 12 Introduction 16 1 Snake? 22 1.1 Asclepius’ Snake 22 1.2 Iatrogenic Harm 33 1.3 The Medical-​Ethical Problem: Role-​Conflation 37 2 Hippocrates’ Oath 46 2.1 Hippocrates’? 46 2.2 Oath: Gods, Goddesses, Contract, and Oath-​Proper 58 2.2.1 Gods and Goddesses 60 2.2.2 Contract 64 2.2.3.1 Oath-​Proper: Regimens, Harm, and Injustice 71 2.2.3.2 Oath-​Proper: The Rejection of Killing 73 2.2.3.3 Oath-​Proper: Cutting 79 2.2.3.4 Oath-​Proper: Entering Houses Free of Injustice (Sexual Acts) 81 2.2.3.5 Oath-​Proper: Entering Houses and Not Gossiping 83 2.2.4 The Oath Concludes: Blessing and Self-​curse 84 3 Wounding 88 3.1 A Distinction Within the Apollonian/​Asclepian Account 89 3.2 Coming to Terms: Distinguishing Wounds from Injuries 92 3.3 Hippocratic Medicine Distinguished from Apollonian and Asclepian Skill 94 3.3.1 The Asclepian Account Disputed 98 3.3.2 Apollonian Killing Considered: Dr. Guillotin and his “Simple Mechanism” 102 3.3.3 Attempts to Make Physicians Apollonian 110 3.4 Further Reasons Why Physicians Ought not Kill 114 3.5 If Thou Shalt not Kill Must One Strive Officiously to Keep Alive? 121 3.6 Is the Problem of Iatrogenic Harm Most Basic? 123 3.7 Forswearing Other Injuries and Injustices: Sexual Relations and Gossip 131 4 Oath, profession, and autonomy 136 4.1 Oath and Profession 136 4.2 Further Reasons for a Medical Oath 139 4.3 Professional Autonomy 145 4.3.1 Professional Autonomy: The Internal Therapeutic Ethic as Law 148 4.3.2 Professional Autonomy: The Basic Internal Medical Norm 149 4.3.3 Professional Autonomy: Medicine not Solely a Technique 156 4.3.4 Professional Autonomy: Salient Claims 158 4.4 Conclusion: One or Many Medical Professions? 162 Appendix: Hippocrates’ Oath—​Greek text and literal English translation 166 Notes 172 References 182 Index 186 CONTENTS ACKNOWLEDGMENTS xi INTRODUCTION 1 1 SNAKE? 7 1.1 Asclepius’ Snake 7 1.2 Iatrogenic Harm 18 1.3 The Medical-​Ethical Problem: Role-​Conflation 22 2 HIPPOCRATES’OATH 31 2.1 Hippocrates’? 31 2.2 Oath: Gods, Goddesses, Contract, and Oath-​Proper 43 2.2.1 Gods and Goddesses 45 2.2.2 Contract 49 2.2.3.1 Oath-​Proper: Regimens, Harm, and Injustice 56 2.2.3.2 Oath-​Proper: The Rejection of Killing 58 2.2.3.3 Oath-​Proper: Cutting 64 2.2.3.4 Oath-​Proper: Entering Houses Free of Injustice (Sexual Acts) 66 2.2.3.5 Oath-​Proper: Entering Houses and Not Gossiping 68 2.2.4 The Oath Concludes: Blessing and Self-​curse 69 3 WOUNDING 73 3.1 A Distinction Within the Apollonian/​Asclepian Account 74 3.2 Coming to Terms: Distinguishing Wounds from Injuries 77 3.3 Hippocratic Medicine Distinguished from Apollonian and Asclepian Skill 79 3.3.1 The Asclepian Account Disputed 83 3.3.2 Apollonian Killing Considered: Dr. Guillotin and his “Simple Mechanism” 87 3.3.3 Attempts to Make Physicians Apollonian 95 3.4 Further Reasons Why Physicians Ought not Kill 99 3.5 If Thou Shalt not Kill Must One Strive Officiously to Keep Alive? 106 3.6 Is the Problem of Iatrogenic Harm Most Basic? 108 3.7 Forswearing Other Injuries and Injustices: Sexual Relations and Gossip 116 4 OATH, PROFESSION, AND AUTONOMY 121 4.1 Oath and Profession 121 4.2 Further Reasons for a Medical Oath 124 4.3 Professional Autonomy 130 4.3.1 Professional Autonomy: The Internal Therapeutic Ethic as Law 133 4.3.2 Professional Autonomy: The Basic Internal Medical Norm 134 4.3.3 Professional Autonomy: Medicine not Solely a Technique 141 4.3.4 Professional Autonomy: Salient Claims 143 4.4 Conclusion: One or Many Medical Professions? 147 viii · C ontentsA P P E N D I X : H I P P O C R AT E S ’ O AT H —​G R E E K T E X T AND LITERAL ENGLISH TRANSLATION 151 NOTES 157 REFERENCES 167 INDEX 171 T. A. Cavanaugh's Hippocrates' Oath and Asclepius' Snake: The Birth of the Medical Profession articulates the Oath as establishing the medical profession's unique internal medical ethic - in its most basic and least controvertible form, this ethic mandates that physicians help and not harm the sick. Relying on Greek myth, drama, and medical experience (e.g., homeopathy), the book shows how this medical ethic arose from reflection on the most vexing medical-ethical problem -- injury caused by a physician -- and argues that deliberate iatrogenic harm, especially the harm of a doctor choosing to kill (physician assisted suicide, euthanasia, abortion, and involvement in capital punishment), amounts to an abandonment of medicine as an exclusively therapeutic profession. The book argues that medicine as a profession necessarily involves stating before others what one stands for: the good one seeks and the bad one seeks to avoid on behalf of the sick, and rejects the view that medicine is purely a technique lacking its own unique internal ethic. It concludes noting that medical promising (as found in the White Coat Ceremony through which U. S. medical students matriculate) implicates medical autonomy which in turn merits respect, including honoring professional conscientious objections. "T. A. Cavanaugh's Hippocrates' Oath and Asclepius' Snake: The Birth of the Medical Profession articulates the Oath as establishing the medical profession's unique internal medical ethic--in its most basic and least controvertible form, this ethic mandates that physicians help and not harm the sick. Relying on Greek myth, drama, and medical experience (e.g., homeopathy), the book shows how this medical ethic arose from reflection on the most vexing medical-ethical problem--injury caused by a physician--and argues that deliberate iatrogenic harm, especially the harm of a doctor choosing to kill (physician assisted suicide, euthanasia, abortion, and involvement in capital punishment), amounts to an abandonment of medicine as an exclusively therapeutic profession. The book argues that medicine as a profession necessarily involves stating before others what one stands for: the good one seeks and the bad one seeks to avoid on behalf of the sick, and rejects the view that medicine is purely a technique lacking its own unique internal ethic. It concludes noting that medical promising (as found in the White Coat Ceremony through which U.S. medical students matriculate) implicates medical autonomy which in turn merits respect, including honoring professional conscientious objections"--Jacket. Hippocrates' Oath and Asclepius' Snake: The Birth of the Medical Profession articulates the Oath as establishing the medical profession--a practice incorporating an internal, uniquely medical ethic that particularly prohibits doctors from killing. In its most basic and least controvertible form, this ethic mandates that physicians try to help while not trying to harm the sick T.A. Cavanaugh's 'Hippocrates' Oath and Asclepius' Snake' articulates the Hippocratic Oath as establishing the medical profession by a promise to uphold an internal medical ethic that particularly prohibits doctors from killing. In its most basic and least controvertible form, this ethic mandates that physicians help and not harm the sick This book articulates the Hippocratic Oath as establishing the medical profession by a promise to uphold an internal medical ethic that particularly prohibits doctors from killing. In its most basic and least controvertible form, this ethic mandates that physicians help and not harm the sick.