January 27, 2023

Promises to keep: medical graduates and their oaths

A survey of oaths taken by medical students in the United States and Canada in 2014 and 2015 suggests that doctors are beginning their career with vague, confusing, and inconsistent notions of medical ethics.

In an article in The New Bioethics, three doctors analysed oaths from 150 of all 153 US and Canadian medical schools and compared them to oaths taken in 2000.

Most (54.7%) of them are variants of the ancient Hippocratic Oath, although a growing number (14.9%) administer only oaths which have been written by the students themselves. In 1989 no medical school administered a student-written oath.

There were some interesting changes over the last 15 years:

  • Oaths to a deity have decreased from 17.7% to 7.7%, but oaths to oneself have increased to more than 40%.
  • Commitment to observe positive law has remained unchanged (34.0% of schools) but promises to adhere to the “laws of humanity” declined steeply, from 39.7% to 16.7% of schools.
  • Pledges to abstain from sexual misconduct with patients and their family were low in 2000 and have actually declined to 2%.
  • Prohibitions of intentional killing have fallen dramatically, and are recited at only 2% of schools – although the proportion where students promise to respect the value of human life remain unchanged at 30.7%
  • Abortion prohibitions are almost non-existent at 1.3%.
  • Pledges to subject one’s conscience to the rules of governments and institutions or patient preference were included by 24.7% of schools. But an equally large proportion committed themselves to always obey one’s conscience (28.7%) and to practice according to judgement by 35.3%.

The inconsistencies and differences in the oaths point to larger divisions and uncertainties in Western culture, the authors say. “It should perhaps not be surprising that the bioethical discourse is dominated by controversial debates which essentially revolve around the question, ‘What does the physician profess to do and not do for her patient?’ It is quite clear from our study that modern oaths do not coherently or consistently answer this question.” A common moral framework for medicine is in danger of disappearing.