Observations Ethics Man

Is being a doctor “just a job”?

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5257 (Published 14 November 2017) Cite this as: BMJ 2017;359:j5257
  1. Daniel Sokol, medical ethicist and barrister
  1. 12 King’s Bench Walk, London
  1. daniel.sokol{at}talk21.com

Oaths and declarations signify a deeper vocation

Over at the blog site of the Journal of Medical Ethics Iain Brassington, senior lecturer in bioethics and medical law at the University of Manchester, has launched an acerbic critique of the Declaration of Geneva, the modern day Hippocratic oath whose latest revision was adopted by the World Medical Association on 14 October 2017.1

Brassington methodically dissects the declaration. I focus here on one aspect of his analysis. The declaration states, “I will foster the honour and noble traditions of the medical profession.” This clause existed in near identical form in the original 1948 version of the Geneva declaration. Brassington comments dismissively: “Huh? It’s just a job, mate. Get over it.”

Is being a doctor just a job? Is that clause “phenomenally pompous,” as Brassington asserts?

The adoption of the Declaration of Geneva in 1948 came only a year after the doctors’ trial at the Nuremberg Tribunal, in which 20 Nazi doctors were charged with “murders, tortures, and other atrocities committed in the name of medical science.” These atrocities included freezing people to death and infecting people with typhus, cholera, smallpox, and other diseases. Against this backdrop, the clause serves as a warning against the dishonourable and ignoble use of medicine.

The Hippocratic oath contains similar language to the declaration: “In a pure and holy way I will guard my life and my techne [τέχνη, which translates as craft or art],” and, “If I render this oath fulfilled, and if I do not blur and confound it may be granted to me to enjoy the benefits both of life and of techne, being held in good repute among all human beings for time eternal. If, however, I transgress and perjure myself, the opposite of these.”

Although the language is outdated, these are calls to integrity, moral vigilance, and high moral standards. Only then will the doctor be held “in good repute” by his fellow men and women.

The Declaration of Geneva’s injunction to “foster the honour and noble traditions of the medical profession” is also a call for virtuous and honourable conduct. It is a fine sentiment to instil in doctors and medical students.

It is also timeless in its relevance.

Still today, 70 years after the Nuremberg trials, doctors in countries such as North Korea, China, Uzbekistan, Syria, and others are complicit in torture, whether by direct participation or by failing to record signs and symptoms of torture in medical records and death certificates.

Only recently The BMJ published an article on the role of clinicians in the solitary confinement of prisoners in US prisons, with reference to the case of Arthur Johnson.2 Johnson had been in solitary confinement for 36 years. The healthcare providers seemed to have made no attempt to raise concerns about his appalling treatment.

Unlike Brassington, I do not believe that being a doctor is “just a job.” Few jobs have senior lecturers whose subject is the ethics of the job, let alone an oath. Few jobs require its practitioners to examine the body of a fellow human being, or expose those practitioners to death and suffering to quite the same degree: the unforgiving decline of a demented patient, the child dying from cancer. Few jobs require that intricate balance between the cool head and the kind heart; detachment and compassion.

Nor do I believe that the clause is pompous. It should, in fact, be an antidote to arrogance, because no doctor aware of his or her medical lineage—and of the collective toil of previous generations of doctors that has allowed today’s doctors to enjoy the trust and respect of the public—could be arrogant.

Even with morale at a low ebb, I doubt that many doctors would agree that theirs was “just a job.” It never has been and never will be.

Footnotes

  • Competing interests: None declared.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

References

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