The legacy and lessons of the Hippocratic Oath
By Liam Gibson | 19 October 2022
Before abortion was decriminalised in Northern Ireland in 2019, abortion activists consistently attacked the province’s protection of unborn children as based on outdated legislation that they derided as being passed before the invention of the lightbulb. The Offences Against the Person Act is certainly old — it became law in 1861 — but the values it expressed were not Victorian; they were in fact far, far older, stretching back to the fifth century before Christ and the emergence of the Hippocratic Oath. These were the values that provided the foundation of Western medical ethics and a legacy that transformed the world.
For its opponents, then as now, its most countercultural passage states:
“I will neither give a deadly drug to anybody if asked for it nor will I make a suggestion to this effect. Similarly, I will not give to a woman an abortive remedy.”1
In recent times, academics have claimed that the Oath merely prohibited certain methods of abortion and not the practice of abortion itself. But when examined in the context of the ancient world, it is clear that the Oath reflected a profound belief in what we would recognise as the sanctity of human life from the moment of conception until its natural end.
Both abortion and euthanasia (now politely referred to as physician-assisted suicide) were commonplace in the ancient world and widely practised in the medical profession. Among philosophers, Plato and the stoics approved of both practices, and while Aristotle frowned on suicide, he approved of abortion, at least before the stage of “animation”.2 The Hippocratic approach to medicine was just one of many schools of thought, and the ethics it espoused were rejected by the majority of ancient doctors and philosophers. Nevertheless, despite its lack of acceptance, the ideals it embodied ultimately became dominant precisely because of the obligations the Oath placed on doctors.
In its opening lines, it calls upon Apollo, Aesclepius, Hygeia, Panacea and “all the gods and goddesses” to witness the swearing of the covenant. This makes the physician accountable to divine judgement. Its outright rejection of killing and guarantee of confidentiality won the trust of patients who understood that their interests were better served by the followers of Hippocrates than by their pragmatic counterparts.
While Christians could not swear by false gods, the principles within the Oath were gradually accepted as part of Christianity’s Greek inheritance. By the eleventh century, its pagan elements had been dispensed with and doctors across Christendom were happy to consider themselves as following in the Hippocratic tradition. This remained the situation until the late nineteenth century, when the ideas of Malthus and Darwin slowly began to sever the cords of Christian morality that held in check negative tendencies in the medical profession.
The result, however, was not a repudiation of the Hippocratic tradition but its reinterpretation. In what one witness at the Nuremberg Medical Trial described as an “ironic joke of world history”,3 medicine under the Nazis sought to return to the ethics and “solid philosophical ground” of the Hippocratic Oath. In an introduction to Eternal Doctors, a series of books for members of the SS in the medical profession, Heinrich Himmler held up Hippocrates, whose life and accomplishments, he argued, “proclaims a morality, the strengths of which are still undiminished today and shall continue to determine medical action and thought in the future.”4 But this perversion of the Hippocratic tradition was to be stripped of the alleged detrimental effects of Christianity’s exaggerated compassion for the individual that took care of the weak instead of the health of the group. As one high-ranking Nazi health official put it, “…the ill-conceived ‘love of thy neighbour’ has to disappear … It is the supreme duty of the … state to grant life and livelihood only to the healthy and hereditarily sound portion of the population …”5
Yet while doctors were urged to act with “ice-cold logic”, euthanasia was presented to the German people as more merciful than Christian morality. The 1941 film Ich kluge an, (I Accuse) tells the fictional story of a young doctor put on trial for giving a lethal injection to his incurably ill wife after she pleads with him to end her suffering. The accusation of the title is directed at those who would condemn the terminally ill to a slow and painful death.
The film was made at the behest of Dr Karl Brandt, architect of the Aktion Tiergarten 4 euthanasia programme, and was based on a novel by Helmut Unger, a consultant in the selection of the children for Gnadentod — literally, “mercy death”. It was, of course, intended to change the perceptions of its audience, but it was also aimed at assessing the level of public support for the euthanasia programme. Although the initial response was positive, the backlash against the systematic killing of the disabled was already more determined than anything the Nazis had faced.
On 3 August 1941, Clemens von Galen, bishop of Münster, preached a furious sermon in which he invoked the wrath of God on those who murdered the innocent. He warned that the killing of “invalids” would eventually claim the healthy, once they were no longer productive. On learning of the sermon, Hans Scholl, a founding member of the White Rose group of Munich students, is said to have responded, “At last somebody has had the courage to speak out.” The White Rose, as well as other groups, made copies of the text and secretly began to distribute them. The RAF even dropped copies to Wehrmacht troops. Werner Mölders, a Catholic Luftwaffe pilot, who received Nazi Germany’s highest military honour from Hitler personally, threatened to return the decoration.
Outraged by the sermon, leading Nazi officials called for the execution of the Bishop. Martin Bormann, Hitler’s secretary, agreed that he deserved the death penalty but knew that it could not be done. Joseph Goebbels concluded that such measures would turn the Bishop into a martyr, spread hostility among the laity and provoke other priests and bishops to take up the cause.
On 24 August 1941, Hitler ordered Brandt to halt the T4 programme. According to internal calculations, since its commencement in January 1940, it had claimed the lives of 70,273 individuals. The killing of the disabled would continue in secret and, therefore, without the possibility of restraint.6 But with the invasion of the USSR the previous June, the attention of the regime was already turning towards genocide on a much larger scale.
After the war, Brandt was indicted, not for his role in the T4 programme, but for authorising lethal experiments on concentration camp inmates. At his trial, he was unapologetic and made no attempt to distance himself from the policies of the Nazi regime. Before he was hanged in June 1948, he said, “I have always fought in good conscience for my personal convictions and done so uprightly, frankly and openly.”
In the immediate aftermath of the war, the crime of “encouraging abortions” was also widely condemned by the international community.7 Several health officials were tried for the legalisation of abortion for Polish and Russian women and a few were executed.
The corruption of the medical profession was essential to the Nazi regime. Doctors legitimised, facilitated and perpetrated its crimes. Doctors starved and gassed the disabled. Doctors separated the fit from the unfit among the new arrivals at the concentration camps. It was doctors who were tasked with euthanising any troublemakers among U-boat crews.
The Geneva Declaration 1948
In September 1948, the World Medical Association’s Geneva Declaration was intended to ensure that the practice of medicine would never again depart from the Hippocratic tradition. In its updated oath, doctors were called upon to affirm:
“I will maintain the utmost respect for human life from the time of conception, even under threat; I will not use my medical knowledge contrary to the laws of humanity.”8
By October 1983, however, ambiguity was introduced to this passage when the 35th World Medical Assembly changed it to: “I will maintain the utmost respect for human life from its beginning…”
Similar semantic compromises by the medical profession have created the impression that legal protection for unborn children is a relic of the past. While the World Medical Association still condemns as unethical all forms of euthanasia, the language of “death with dignity” has helped assisted suicide spread across the Western world like a wildfire fuelled by false compassion. It was fear of disability and horror of suffering that corrupted German medicine before the Nazis came to power. As early as 1922, the popular writer Ernst Mann argued that: “misery can only be removed from the world by painless extermination of the miserable!”9
In a society that increasingly shares this point of view, only by returning to the values of the Hippocratic Oath and Christian compassion can we hope to avoid the fate that befell the German people.
- Ludwig Edelstein, Ancient Medicine: Selected Papers of Ludwig Edelstein, O Temkin and C Lilian Temkin, (eds) (trans from German) C Lilian Temkin (John Hopkins Press, 1967) p 6.
- Edelstein, p 9-20.
- Werner Liebbrandt, 27 January 1947, Nuremberg Medical Case vol II, p 81.
- Robert Jay Lifton, The Nazi Doctors (Macmillan, 1986) p 32. Subsequent quotes come from the same source unless otherwise stated.
- Dr Arthur Guett, cited Nuremberg Medical Case vol I, p 58.
- It is estimated that by the end of the Nazi regime, the deaths of approximately 250,000 people were caused by euthanasia. Further information is available online at the Holocaust Encyclopaedia.
- James McHaney, the prosecutor of the RuSHA/Greifelt Case, called abortion an “inhumane act” and an “act of extermination” and stated that even if a woman’s request for abortion was “voluntary’, abortion was still “a crime against humanity”. See Rita Joseph, Human Rights and the Unborn Child (Martinus Nijhoff, 2009) p 10.
- Adopted by the 2nd General Assembly of the World Medical Association, Geneva, Switzerland, September 1948.
- Lifton p 44.