The first healthcare laws were not laws as we understand them today, but oaths – the most famous being the Hippocratic Oath. Physicians taking the oath vow to uphold principles of good patient care, as a duty that affords them the right to practice clinical medicine.
For as much as we reference the oath today, we know little about Hippocrates himself. We rely heavily on his writings to understand his medical philosophies. We know he practiced medicine on the Greek island of Kos, an intellectual center of Hellenistic culture. He challenged many of his contemporary physicians, who advocated for rational and logical approaches to patient care. Hippocrates in contrast emphasized intuition and considered direct patient experience the most important factor in curing illness.
Interestingly, the oath itself was not even written by Hippocrates, but by his students after his death, ostensibly to formalize his philosophy, but in reality to distinguish physicians trained under his methods, in order to create a competitive advantage for his pupils – transforming a hallowed oath that balanced duty with rights into a series of phrases that restricted competition among schools of medicine.
This transformation continues to the present, as we take select phrases from medical oaths and paraphrase them into contrived interpretations.
This is exemplified in the phrase “Do no harm,” which ironically never appeared in the original oath. Though it appears in legal courts today, when lawyers decry the actions of healthcare providers who have purportedly violated their duties to their patients. But we cannot discern individual responsibilities through individual actions alone. The clinical context and the underlying medical condition define the importance of all the clinical actions and obligations.
As the physician-philosopher Maimonides said, “The greater the contradiction, the deeper the wisdom.” The deep wisdom contained within physician oaths describes the nature of rights in healthcare as a relationship between healthcare responsibilities or duties, and rights afforded, which may appear as contradictions, but merely serve two sides in a deep rooted balance.
The relationship, linked by the lines defined in the oaths, must be understood as a balance, to be experienced as much as learned, felt as much as deduced. It comes from principles of humanism, which serves as the roots of modern medicine and explains why we characterize health through our experiences.
The physicians who form the pantheon of medicine all emphasized an experience-based approach to healthcare. Hippocrates characterized medicine as an art to be practiced, and said that it consists not of treating a disease but of healing a person.
Famed Roman surgeon Galen began his medical career as a surgeon treating dying gladiators. Soon he became renowned for his experimental approach to medicine, eventually serving as the private physician to the Caesars. His career trajectory was emulated centuries later by Maimonides, who became the personal physician to Saladin, the legendary Muslim Crusader. Maimonides also took an experimental approach to medicine, but emphasized civic responsibility as well.
These traits would later inspire Canadian physician William Osler’s humanistic approach to medicine at the turn of the twentieth century. Dr. Osler, who is best known for turning John Hopkins Medical Center into a research juggernaut, also designed a clinical curriculum that became the model for modern medical education in the United States. He prioritized the clinic as much as the textbook, and believed direct patient contact is the bedrock of good medicine.
When we look at medicine through its humanistic origins, we better understand the balance between healthcare and law. Henry David Thoreau emphasized moral behavior in broad terms, more than any individual civic action, as a person’s civic duty to society. Thoreau’s views on civic duty stem from his perspective on individual rights, which he held sacred above all, including above government intervention. Thoreau encouraged individuals whose rights were compromised inappropriately to serve as a “counter-friction to a fundamental immorality.” He believed laws should be in balance with an individual’s fundamental rights, and that a law’s validity should be measured by its morality.
Healthcare rights are similarly defined through distinct qualities and manifest in different ways, but the fundamental concept of health pervades beyond any clinical distinction. If physicians do not believe they can give medical advice to a patient or perform a procedure for fear of backlash or litigation, then physicians lose the inclination to share advice or perform procedures, reverting to more defensive tendencies of self-protection that affects patient care.
They have violated their oath. It’s that simple and that complex. In healthcare, an action is never just an action, like a law is never just a law. Individual actions or decisions matter far less than the overall behavior and its intent. That’s why the first healthcare laws were oaths.