The modern Physcian's Pledge to replace Hippocratic Oath?

One of the oldest professional oaths is the Hippocratic Oath, which is now as old as 2400 years old.

The practice pledging this oath begans at the University of Wittenberg in Germany in 1508.

The contents of the oath are still relevant, although pledging in the name of long forgotten medieval Greek gods is probably what makes it out-dated.

A new modern version of the oath, known as ‘The Physician’s Pledge’, encapsulates the essence of the Oath while removing the peripheries has been published in JAMA (click here).

The full text of the 2017 pledge now reads as:

AS A MEMBER OF THE MEDICAL PROFESSION:

I SOLEMNLY PLEDGE to dedicate my life to the service of humanity;

THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration;

I WILL RESPECT the autonomy and dignity of my patient;

I WILL MAINTAIN the utmost respect for human life;

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 RESPECT the secrets that are confided in me, even after the patient has died;

I WILL PRACTISE my profession with conscience and dignity and in accordance with good medical practice;

I WILL FOSTER the honour and noble traditions of the medical profession;

I WILL GIVE to my teachers, colleagues, and students the respect and gratitude that is their due;

I WILL SHARE my medical knowledge for the benefit of the patient and the advancement of healthcare;

I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard;

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.

A very interesting addition to the oath compared to Hippocratic Oath is this:

I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard”

This addition has been lobbied by Dr. Sam Hazledine.

To quote MIMS.com,

Dr Sam Hazledine from Queenstown, New Zealand made history by petitioning for the amendment last year, where he obtained 4,500 signatures to include a clause for doctors to focus on their own health as well as of their patients.

I guess it is a solemn reminder that physicians should do what they preach.

Discussion on the dilemma in bioethics using the various ethical theories

We often discuss bioethical principles using Beauchamp and Childress (2008)'s four bioethical principles (some people would say that there are more than four) but seldom do we teach or guide students through some of these bioethical dilemma (which we often face in real clinical practice) using the various ethical or moral theories in philosophy.

This short video starts with a case discussion follows by a short description of three common ethical theories. It's not meant to be a didactic tutorial but rather to trigger discussion among students.

Case scenario:
You are a house officer on duty. At 3.15 pm, you take some blood sample from a rather aggressive patient for some routine blood investigations that are due at 3 pm. Unfortunately, after you have taken the sample, you forget to label the sample bottles immediately. Worse still, one of the bottles drop on the floor and spill the sample. You would need to take a new 20-ml blood sample from this patient. You know that if you were to admit your blunder, he would ask you lots more questions than you can answer and furthermore, he is a hot-tempered man. You anticipate you will waste a lot of time with him and would result in delay in attending to other patients. Or you could lie to him and say that you need to do some additional blood tests that have just been ordered by your specialist (knowing that he would not question that). What would you do?

My First Lesson In Med School

Credit: Picture from stock.xchng

One of the first lessons that I was taught when I entered medical school is this:

"To be a good doctor, you need to have the eyes of an eagle, the hands of a maiden (or woman) and the heart of a lion"

This lesson, which I still remember vividly, was taught by Prof Mafauzy Mohamed who is now the campus director of the medical school of Universiti Sains Malaysia.

Although I have found variants of this quote in the internet here and here, that statement made a tremendous impact in my medical career, and 16 years later as I look back, I realize how true it is not only for surgeons, but for all doctors as well (and is very true for an emergency physician too).

We need to be sharp, like an eagle's eye - to pick up warning early signs and symptoms that the patient is deteriorating.

We need to be gentle, like the hands of the maiden (although most versions in internet, use the word "lady" or "woman"), I particularly like the word "maiden" to depict the gentleness and kindness of our touch.

We need to be courageous, like the heart of a lion - when the emergency situation calls for such action to be taken swiftly and boldly to save the life of the patient.

As the saying goes,
"A teacher affects eternity, no one can tell where his influence stops" - Henry Adams

That's the rewarding part of being a lecturer.

Revised Powerpoint Slides on Ethics of Resuscitation 2010

I have just uploaded my revised version of Ethics of Resuscitation slides. The lecture was given during the Master of Medicine Intensive Course on Bioethics & Communication 2010.

Go the the original source where this file is hosted and click on the download link for FREE download. I allow for FREE download for non-commercial use ONLY as long as I am acknowledged as the author of this work, and that no alteration whatsoever is to be done on the slide without the permission of the author.

Ethics In Resuscitation (Revised for 2010)

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Ethics of Resuscitation (Revised 2010) by Dr. Chew Keng Sheng is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 2.5 Malaysia License.
Based on a work at www.slideshare.net.

Ethics in Resuscitation

Ethics in Resuscitation

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Other Important Points Not Covered in the Lecture:

The Concept of Patient Autonomy

“Every human being of adult years and sound mind has the right to determine what shall be done with his own body, and a surgeon who performs an operation without his patient’s consent commits an assault, for which he is liable”

- Justice Cardozo in Schloendorff v Society of New York Hospital, 105 NE 92 (NY1914)


Bolam Test and Bolitho Test

Under the Bolam test, a doctor is not negligent if he is acting in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art, merely because there is a body of such opinion that takes a contrary view.

In this case, a patient, Mr Bolam, sued the hospital and its doctors for damages, claiming negligence on the part of the doctors in performing electroconvulsive therapy on him which resulted in fractures. The patient also claimed that he did not give informed consent to the hospital doctors.


“. . . (a doctor) is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art . . . a man is not negligent, if he is acting in accordance with such practice merely because there is a body of opinion who would take a contrary view. At the same time that does not mean that a medical man can obstinately and pigheadedly carry on with some old technique if it has been proved to be contrary to what is really substantially the whole of informed medical opinion . . .”

- Judge McNair


Bolitho case - the court must be satisfied that the exponents of a body of professional opinion have a logical basis and had directed their minds to the comparative risks and benefits in reaching a defensible conclusion. The opinion of the expert witnesses must be founded on logic and good sense. It is now a matter for court & not medical opinion to decide standard of professional care

The ability and willingness of the courts in Bolitho case to consider the correctness of a professional view has been extended beyond information disclosure and into treatment. This case arose out of a failure of a hospital doctor to examine and intubate a child experiencing respiratory distress, leading to brain damage through asphyxia. The plaintiff patient had expert evidence that a reasonably competent doctor would have intubated in those circumstances. The defendant doctor had her own expert witnesses saying that non-intubation was a clinically justifiable response.


Reference:
1. A set of power point slides by Assoc Prof Catherine Tay can be downloaded here.

2. Medico-legal articles by Assoc Prof Catherine Tay:

- Informed Consent To Medical Treatment: What Needs To Be Disclosed? Click here
- Recent developments in informed consent: the basis of modern medical ethics. Click here
- Informed Consent in Obstetrics and Gynecology. Click here
- Recent Developments of Informed Consent in Eye Research. Click here

3. Elements of Informed Consent — A Survey of Medical Professionals
Click here

4. sBMJ series
- Biomedical ethics: The basic principles. Click here
- Biomedical ethics: Patients' right. Click here
- Biomedical ethics: Organ transplantation. Click here
- Biomedical ethics: Genetics. Click here