What Happened to the Hippocratic Oath?

Every year, students entering Harvard medical and dental schools write their own oaths about how they pledge to interact with each other and care for themselves, their patients, and the larger community based on submissions from their classmates.

“We pledge to ourselves to commit to integrity, humility, and wonder in both our learning and in our service of patients, to have the courage to be vulnerable and acknowledge our innate privileges, and to continuously address our implicit biases,” the Class of 2028 began their oath among their medical and dental peers last year. They wore their new white coats presented days earlier in a ceremony with family and friends.

The medical school pledge, recited at the end of a weeklong Introduction to the Profession course, might address contemporary societal issues such as inclusion, diversity, equity, anti-racism, implicit biases, and the need for increased advocacy. The class discusses similar subjects.

The students’ oath was recorded. Previous classes live streamed their presentation.

“We try to encourage introspection,” said Kathe Miller, MD, an assistant professor and the family medicine adviser at the medical school who directs the Introduction to the Profession course. “This is an opportunity to take a pause and consider who they want to be as a professional and how they want to be as a professional, to write it down and say it out loud,” Miller said.

For new med student Shreyas Rajesh, the oath he helped create several months ago represented a specific set of principles the medical school class wanted to keep in mind through 4 years of med school. “We are taking seriously our pledge and commitment to the profession…,” said Rajesh, who led the oath-writing committee for his class.

Harvard’s oath is just one example of how today’s medical schools and students update and personalize a historical tradition while making their vows as doctors in training more relevant to current medical concerns.

What Happened to the Hippocratic Oath?

Modern interpretations of the Hippocratic Oath, which dates back over 2000 years, have replaced the original in which students swore to the physician Apollo and healing “gods and goddesses.” Hippocrates, an ancient Greek doctor and philosopher, is considered the father of modern medicine.

The ethical oath that medical students across the world recite today, typically at white coat and graduation ceremonies bookending their medical training, is often far different than the ancient doctors who have gone before them or even those a few decades ago.

Difference of Opinion

However, the changes are not universally accepted. Doctors and groups representing medical professionals have criticized the revised oaths, claiming they water down medical ethics, violate free speech, and have become too political.

“Hippocrates would not recognize what Harvard is promising,” said Daniel Sulmasy, MD, PhD, a general internist, professor of biomedical ethics, and director of the Kennedy Institute of Ethics at Georgetown University, Washington, DC.

A professional oath is “not something classmates make up,” Sulmasy said. “It binds them to physicians around the world and a practice of thousands of years. It’s more than a medical school or a particular class that does not even connect to the class before them. I think it’s a terrible trend. They think they are in pursuit of relevance, but they are missing the connection.”

Whether students create their own oaths or medical school administrators update them with student input, modern vows tend to address current societal issues while removing mentions of implied and potentially controversial subjects such as abortion, assisted suicide, gender-specific language, and religious undertones that may have been included in the original.

The new renditions tend to preserve the original intent of the Hippocratic Oath: “To benefit my patients according to my greatest ability and judgment” and to “do no harm or injustice to them.” Additionally, modified oaths remain an affirmation to uphold professional and ethical standards in medical practice, including patient confidentiality, respecting educators, and passing on medical knowledge.

“I’ve been to many white coat ceremonies, and if the Hippocratic Oath is used, it is always a modern version,” said Kathleen Reeves, MD, president and CEO of The Arnold P. Gold Foundation. The nonprofit organization created the ceremony more than 30 years ago so students could say the oath at the start of their medical training instead of just at graduation.

Similar to Harvard, each incoming class at the University of Arizona College of Medicine — Phoenix writes an oath as part of an Introduction to Medicine course. Students recite the oath at a white coat ceremony and graduation, reflecting on their commitment to caring for patients and serving as doctors, according to a college spokesperson.

Timely and Timeless

The rise in updated oaths in recent years may be the result of medical schools rethinking professional rituals following the pandemic, when classes were primarily online, and many doctors were thought to be retiring, according to Tom Bledsoe, MD, an internal medicine doctor and bioethics professor at The Warren Alpert Medical School of Brown University, Providence, Rhode Island. “Maybe it was a time for innovations,” said Bledsoe, who teaches students about medical ethics, including the role of oaths.

Students may better understand their role and be more accountable for their actions if they create a new oath and recite it publicly, he said. “They are more likely to uphold the oath “if they say it to their future self: this is my promise to do with the knowledge and training given to me.”

He believes updated student oaths can balance a student’s personal and professional ethics, but they “must acknowledge the promises the profession makes to the society in which it functions.”

Oaths should also be broad enough to remain relevant, Bledsoe said. He understands arguments against students updating their oaths. “When you join a club or a team, you don’t get to rewrite the rules of the game just by joining it.”

Lost in Translation

Jeffrey Singer, MD, a longtime general surgeon and senior fellow in Health Policy Studies at the Cato Institute, Washington, DC, doesn’t believe the newer physician oaths focus enough on patient care.

“A lot of the schools have let their students or faculty compose oaths that are politically charged,” said Singer. “The cultural and social justice issues addressed by students and faculty in many cases have very little to do with the practice of medicine and the treatment of patients, or respect for their autonomy.”

Sulmasy shares similar concerns. “People accuse me of being old-fashioned. I think medicine is a community of history and tradition we need to be respectful of. Others may say being connected to tradition is old-fashioned. It’s like saying the Ten Commandments is old-fashioned.”

He argues that Harvard’s pledges, in particular, are vague, lack personal altruism, and are idiosyncratic. “I think some of it is rather inward-looking. People don’t generally swear oaths to take good care of themselves. And when they look outward, the ethical themes are historically and culturally limited. I’m not saying it’s not important at this time to be concerned with social justice issues and racism in medicine; it just shouldn’t be part of an oath.”

Harvard’s student pledge is more of a promise, which can be broken, rather than a swear, such as required in a court or in a marriage vow, Sulmasy said. An oath should indicate: “I’m changing myself. I commit myself to be a different kind of person. I’m going to be this type of person from now on.”

He also opposes oaths at the start of medical training. “An oath shouldn’t be said as you enter the profession but at the end after you’ve met all the requirements.” You can’t swear and act like a doctor if you haven’t gone through the training yet, he stressed.

White Coat Ceremony

Oaths have limited use in medical education; initially, only recited during graduation and more recently, during orientation for first-year students as part of white coat ceremonies.

Gold, a pediatric neurologist and founder of The Arnold P. Gold Foundation, started the white coat ceremony at Columbia University, New York City, in 1993 to emphasize the importance of compassionate patient care at the start of medical training. He believed that reciting such an oath at graduation was too late.

Harvard students also write a new oath to recite at graduation.

The most important element of the white coat ceremony, however, is that the oath is taken in front of family, faculty, and peers, and students accept their obligation to care for their future patients, Reeves said.

Creating a personalized oath helps students think deeply about the words they are reciting, she said. “It’s an important educational moment.”

She believes that reciting the oath at the beginning of medical training reinforces that students are going to see people at their most vulnerable, should take their commitment to patients seriously, gain patient consent, be truthful and fair, and recognize biases.

Still, creating and reciting the oath is only part of the equation; ensuring students follow the ethical principles contained in the document is the point. Reeves is pleased that more schools are adding curricula to discuss the messages behind the new oaths, such as what it means to be inclusive and address bias.

“It’s not a one-and-done,” she said. “The more you can make the oath central and not just something that is read and never revisited, the better we are all going to be.”

Meanwhile, Sulmasy sees the updated oaths as a social and political fad, a break from a tradition and a history that the students view as out of date.

He worries how the new oaths, which emphasize a doctor’s lifestyle and work-life balance, will affect patients. “I hope in the end it doesn’t reflect a lack of commitment to patients.”

As a new Harvard student, Rajesh contends that his class oath makes a strong pledge to show compassion and empathy to patients. “We wanted to recognize patients in our oath even though we are still students…It’s important to keep the care of people in mind even though we are viewed as separate from the patient care team.”

He also believes the oath he helped create offers students “room to grow” into doctors and “influences our thinking for the next 4 years and also the rest of our lives.”

Roni Robbins is a freelance journalist and former editor for Medscape Business of Medicine. She’s also a freelance health reporter for The Atlanta Journal-Constitution. Her writing has appeared in WebMD, HuffPost, Forbes, New York Daily News, BioPharma Dive, MNN, Adweek, Healthline, and others. She’s also the author of the multi-award–winning Hands of Gold: One Man’s Quest to Find the Silver Lining in Misfortune.