The “Soul of Professionalism” in the Hippocratic Oath and today

Abstract

This article views the Hippocratic Oath from a new perspective and draws consequences for modern health care. The Oath consists of two parts, a family-like alliance where the teacher of the "art" is equal to a father and a set of maxims how the "art" is to be practiced. Self-commitments stated before the gods tie the parts together and give the alliance trustworthiness. One might call this a proto-profession. Modern physicians form a similar alliance. Specific knowledge and skills and specific action guiding rules are elements of a profession but its trustworthiness rests on a combination of professional autonomy and public control. In order to be granted autonomy the profession must show some effort in enforcing its specific rules and in order to do so its members need to be convinced of the intrinsic value of their profession (the "soul of professionalism" according to Freidson). Whereas in antiquity physicians acted as single individuals the modern alliance is shaped by division of labour. Physicians use each other and other professions by mutual consent and the health care system as means in the diagnostic-therapeutic process. As any actor is reponsible for the means he uses physicians are co-responsible accordingly. Thus, professional conduct now entails care for the organisation of the alliance as detailed in the "Charter on Medical Professionalism". The effort the profession gives to this task will confirm its trustworthiness.

Rethinking medical oaths using the Physician Charter and ethical virtues

“…It can be argued that such differences are largely overshadowed by a congruence of ethical values among physicians that transcends culture, and historical era because of the moral values inherent in medicine as a human activity . It is a congruence organised around an obligation to care for the sick that is so basic that it spans cultures and continents and can be seen as connecting the Hippocratic Oath to the Physician Charter …”

“…Foremost among these values is the primacy of patient welfare, the first principle of the Physician Charter. This principle is ‘based on a dedication to serving the interest of the patient’ and it communicates a foundational personal commitment that lies at the heart of medical professionalism and may be considered its ‘soul’ . It is the key to understanding what unites the medical profession as a moral community defined by a shared moral purpose that can resist impulses of self‐interest, market forces or fiscal policies when they run counter to the needs of patients .…”

The need for a rights-based public health approach to Australian asylum seeker health

“…As Australia’s offshore immigration detention facilities have been found to be torturous institutions by a number of prestigious and experienced international authorities, it would be unethical and potentially unlawful for Australia’s public health professionals to turn a blind eye [ 55 , 56 ]. General silence and inaction is unconscionable—in fact, in breach of the foundational Hippocratic Oath and “Do No Harm” principle [ 57 – 59 ]. The interplay between international law, medical ethics, the conditions of detention and the contractual conditions of employees of detention providers also creates issues of conflict and tension for healthcare professionals [ 60 ].…”

Ethical conflicts in patient-centred care

“…Today, professionalism in the healthcare professions requires collaborations within and between professions and specialties. 37 The personal relationships that are fostered in person-centred care require continuity of care and concentrate the patient's contacts with healthcare to a small number of healthcare personnel. Such arrangements tend to be advantageous in terms of the psychological quality of the patient's encounters with healthcare.…”

“…Today, professionalism in the healthcare professions requires collaborations within and between professions and specialties. 37…”