be protected, defended and preserved.”64 These precepts are especially important in medicine, considering the power accorded physicians to cut, drug, and manipulate the bodies of their patients. Meilaender summarized the obligation as a positive obligation of physicians to “be committed to the bodily life of their patients.”65 A robust belief in the equality/sanctity of human life takes these prescriptions one step further by positing the obligation of physicians to view each of their patients as having equal moral worth. Thus physicians are not free to pick and choose among the patients to whom they will give optimal care. All patients are owed the same level of dedication, excellence, loyalty, and fidelity, regardless of their physical or cognitive condition.
These worthy concepts are famously embodied in the Hippocratic tradition. Indeed, medicine may actually have been the first field in which the underlying principles of the equality of life ethic were recognized as applying generally rather than parochially. The Oath, bearing the name of Hippocrates (approximately 470–360 BCE) was created hundreds of years before the advent of Christianity. It required physicians to “apply dietetic measures for the benefit of the sick according to my ability and judgment,” to “keep them from harm and injustice,” foreswear abortion, and “give no deadly medicine to any one if asked, nor will I make a suggestion to this effect.” The Oath taker promised, “Whatever house I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of all sexual relations with both female and male persons, be they free or slaves.” Physicians further pledged to keep patient confidences, holding what the doctor sees or hears “in the course of treatment” to be “shameful to be spoken about.”66 These life- and dignity-affirming doctrines of the Oath are generally summarized by a familiar summarizing phrase: “do no harm” (the exact phrase is not found in the great document itself, although it is discussed in Hippocratic literature). These principles were and are upheld by physicians in myriad ways: by rendering optimal care to each patient; promoting bodily healing; alleviating pain and suffering; respecting patient dignity; refusing to disclose patient confidences, even in a court of law; and refusing to kill patients.
As we move further into the twenty-first century, the Hippocratic tradition is ailing and in acute danger of collapse. “It was when bioethics came on the scene that the Hippocratic tradition of the physician/patient relationship started to fall apart,” philosopher Dianne N. Irving, PhD, a longtime critic of bioethics, told me. “Once it was weakened, bioethics began to replace it with medicine practiced for the greater good of the society rather than the individual patient. That threatens patient welfare and denigrates medicine into a business rather than a profession.”67 Irving’s criticisms find support among many mainstream bioethicists who celebrate their calling as “post professional.”68
A recent study of physician oath taking published in the Journal of Clinical Ethics69 illustrated how far modern medicine has strayed from the traditional values of the Hippocratic Oath. The authors analyzed contemporary medical oaths and compared them to the Hippocratic original. Considering Roe v. Wade, it is not surprising that 8 percent of doctors pledged to forswear abortion, but only 14 percent promised not to commit euthanasia (active killing by doctors). In 1977, only 31 percent of oaths required the taker to “respect life,” and only 43 percent of present-day oaths require physicians to be “accountable to their profession.” There has also been a stunning “nearly complete” disappearance of the proscription against sexual relations between physicians and patients, a key factor in professionalism, since it is a matter “of character and justice . . . and not taking advantage of vulnerable patients.”70
Many of the most prominent doctors and bioethicists could care less. Thus the late author and physician Sherwin Nuland of Yale University School of Medicine wrote in the New England Journal of Medicine, “Those who turn to the oath in an effort to shape or legitimize their ethical viewpoints must realize that the statement has been embraced over approximately the past 200 years far more as a symbol of professional cohesion than for its content. . . . Ultimately, a physician’s conduct at the bedside is a matter of individual conscience.”71 Yikes!
When I tell my lecture audiences that most doctors no longer take the Hippocratic Oath upon becoming physicians and that many no longer see it as relevant to their profession, they are shocked and disturbed. They believe, quite correctly, that the Oath exists for their protection. They want their doctors to practice a do-no-harm style of medicine. “Why have they abandoned a tradition that has served medicine—and us—so well?” they ask.
The answer to this important question is complex, having much to do with who we are as a culture and a people. According to the late physician and sanctity-of-life bioethicist Edmund D. Pellegrino—who spent a long and productive career as a professor of medical ethics—the Hippocratic system came under attack both from without and within the medical profession: “These constructs first came into question in the mid-1960s as part of the general upheaval of moral values that occurred in the United States. Concomitantly, the character of medicine was being altered by the specialization, fragmentation, institutionalization, and depersonalization of health care. At the same time, the number and complexity of medical ethical issues expanded as the power of medical technology presented new challenges to traditional values.”72
These challenges could have been met without destroying the “do no harm” tradition. However, medicine, perhaps having lost confidence in its own ethical instincts, “turned to the philosophers”73 of bioethics. Unfortunately, by this time, the most influential practitioners in the field had enlisted in the relativist branch epitomized by Fletcher rather than the more traditional equality-of-life-affirming approach espoused by Ramsey. In a philosophical milieu in which the most helpless patients were already viewed widely as less than fully human, the Hippocratic tradition didn’t stand a chance. This sad fact is illustrated by the treatment given the tradition in The Principles of Biomedical Ethics, first published in 1979, in which Beauchamp and Childress blithely dismiss it as “a limited and unreliable basis for medical ethics.”74 As for the do-no-harm ethic the Oath spawned, readers are informed that it is merely a “strained translation of a single Hippocratic passage.”75 So much for more than 2,000 years of applied ethics and medical wisdom.
BIOETHICS AND RELIGION
The antipathy of mainstream bioethics to religion began early. It is not coincidental that Joseph Fletcher, the “patriarch,” insisted on forming his views upon the premise that “man is not a worshipper.”76 In recounting the reasons why he believed that bioethics became so influential in such a short time, Daniel Callahan wrote, “The first thing that . . . bioethics had to do—though I don’t believe anyone set this as a conscious agenda—was to push religion aside.”77 Dan Brock, a prominent philosopher and member of the bioethics elite, was similarly blunt in an article urging the legalization of euthanasia: “In a pluralistic society like our own, with a strong commitment to freedom of religion, public policy should not be grounded in religious beliefs which many in that society reject.”78
After welcoming theologians in its formative years (ironically, Fletcher was a lapsed Episcopal priest), bioethics now stresses that morality and proper behavior are best determined through “rational analysis” based on secular philosophical precepts. Theology, religious values, spirituality, faith—these are considered “external” and thus “unconvincing” in determining wrong from right.79 Moreover, unlike most of the general population that bioethics supposedly serves, many (although certainly not all) modern bioethicists are agnostic or atheistic, a personality factor that colors their entire approach to these important issues as much as the Pope’s Catholicism does his. Indeed, some bioethicists view religion with utter disdain, as mere “mumbo jumbo,” to use Peter Singer’s pejorative term.80 Even those bioethicists who have strong spiritual beliefs—including some Catholic priests—are so worried about imposing their religion upon secular society that they leave their personal faith-inspired values at the door when discussing public
