The Hippocratic Oath

I have weirdly strong feelings about the Hippocratic Oath as an ethical frame around the medical profession. I think it is the most noble commitment which any professional community makes.

Over on Twitter I have accumulated a little thread of commentaries on the friction between physicians’ obligations versus our politics & society. In it I repeatedly reference “the shade of Hippocrates”, not just because I am pagan in that sense, but because referencing him underlines that the commitment is sacred in every sense of the word, the material equivalent of bodhicitta.

Two of my favorite evocations of the profundity of the commitment come from pop culture.

The first is a little scene from the TV series The West Wing in which President Jed Bartlet talks to his wife Abbey, who is a physician.

Jed
Eisenmenger’s Syndrome.

Abbey
It’s a cyanotic heart condition. There’s something called ventricular-septal defect …

Jed
The Ayatollah’s son has it.
[⋯]

Abbey
What’s the problem, Jed? Don’t tell me there’s a problem with State …

Jed
The only doctor available won’t do it.

Abbey
He’s Jewish?

Jed
Persian.

Abbey
He doesn’t have a choice.

Jed
Abbey …

Abbey
He doesn’t. Doctors aren’t instruments of the state, and they’re not allowed to choose patients on spec.

Jed
I can’t order him to do it.

Abbey
Yes, you can.

Jed
Through the power vested in me by you?

Abbey
Samuel Mudd set Booth’s leg after he shot Lincoln. Doctors are liable in this country if they don’t treat the patient in front of them.

Jed
Just for the record, this is why we don’t talk about foreign policy — which we do, but you don’t think we do enough.

Abbey
Why?

Jed
Because Samuel Mudd was tried and convicted of treason for setting that leg.

Abbey
So?

Jed
What “so”?

Abbey
So that’s the way it goes. You set the leg.

The second is from the TV series Firefly. Jayne wakes up in the dispensary after having betrayed not just their doctor, but their doctor’s sister, whom we have seen him sacrifice a great deal to protect. The doctor says to him:

You’re in a dangerous line of work, Jayne. Odds are you’ll be under my knife again. Often.

I want you to understand one thing very clearly.

No matter what you do, or say, or plot — no matter how you come down on us — I will never, ever harm you. When you’re on this table, you’re safe, because I’m your medic.

And however little we may like or trust each other, we’re on the same crew. Got the same troubles, same enemies, and more than enough of both.

Now, we could circle each other and growl. Sleep with one eye open. But that thought wearies me. I don’t care what you’ve done. I don’t know what you’re planning on doing. But I’m trusting you. I think you should do the same.

Because I don’t see this working any other way.

This is on my mind because we are entering a time of profound conflict.

I am bitter. I am scared. I am angry.

And I am determined to remember that my object is and will remain to save everybody. Including my enemies. Especially my enemies.