The Hippocratic oath and good medical practice

What is the Hippocratic Oath?

Hippocrates was a Greek philosopher and physician, known as the "father of modern medicine", who lived from 460 to 377 BC.¹ His work included the Hippocratic Oath which described the basic ethics of medical practice and laid down a moral code of conduct for doctors. The classical Hippocratic Oath has been translated into English.² Modern versions have also been proposed, using many of the basic principles of the original. Many people think that doctors still swear the Hippocratic Oath; a study published in 2024 showed that almost 90% of the UK population believe that all doctors have sworn the Hippocratic oath.³Although this is not compulsory, many medical schools still hold a ceremony where graduating doctors swear an updated version. The British Medical Association (BMA) drafted a new Hippocratic Oath for consideration by the World Medical Association in 1997 but it was not accepted and there is still no one single modern accepted version.⁴ In many UK medical schools, the Declaration of Geneva physician's oath is used.⁵ In others, an oath individualised by the institution is used. In 1997 only 50% of UK medical schools used a form of the Hippocratic Oath whereas in 2017 this study found that 19/27 (70%) of schools required an Oath, indicating an increase in the use of the Oath over the preceding 20 years.⁶

A separate article discusses Etica medica.

The classical Hippocratic Oath has been summarised as:

"A solemn promise:

• Di solidarietà con insegnanti e altri medici.

• Of beneficence (to do good or avoid evil) and non-maleficence (from the Latin 'primum non nocere', or 'do no harm') towards patients. (In fact the well-known "first do no harm" phrase does not feature in the classical Hippocratic Oath.)

• Non assistere al suicidio o all'aborto.

• Lasciare la chirurgia ai chirurghi.

• Non nuocere, soprattutto non sedurre i pazienti.

• To maintain confidentiality and never to gossip."

Modern oaths have incorporated many of these principles, but exclude the sections on suicide and abortion, instead using the phrase "I will maintain the utmost respect for human life from its beginning". They also ensure that no section of society is discriminated against with the promise to "not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, or social standing to intervene between my duty and my patient".⁵

The GMC is charged with the supervision of the conduct of the medical profession. This includes educational standards, ethics, and behaviour. The extent to which the GMC should question personal ethics and behaviour if they do not impinge on medical practice may be debated.

The GMC publishes advice to doctors on the standards expected of them in the form of the document 'Good Medical Practice'. It discusses the duties of a doctor registered with the GMC. This covers many of the principles of the original Hippocratic Oath.

Patients must be able to trust doctors with their lives and health. To justify that trust you must show respect for human life and you must fulfil certain duties which the GMC categorises into four domains:

Domain 1. Knowledge, skills and performance

• Make the care of your patients your first concern.

• Provide a good standard of practice and care:

  • Develop and maintain your professional performance.

  • Apply knowledge and experience to practice.

  • Recognise and work within the limits of your competence.

  • Record your work clearly, accurately and legibly.

Domain 2. Safety and quality

• Contribute to and comply with systems to protect patients.

• Respond to risks to safety.

• Protect patients and colleagues from any risk posed by your health.

Domain 3. Communication, partnership, and teamwork

• Communicate effectively.

• Work collaboratively with colleagues to maintain or improve patient care.

• Teaching, training, supporting, and assessing.

• Continuity and co-ordination of care.

• Establish and maintain partnerships with patients:

  • Listen to and respond to their concerns and preferences.

  • Give patients the information they want or need in a way they can understand.

  • Respect patients' right to reach decisions with you about their treatment and care.

  • Support patients in caring for themselves to improve and maintain their health.

Domain 4. Maintaining trust

• Show respect for patients:

  • Treat patients as individuals and respect their dignity.

  • Treat patients politely and considerately.

  • Respect patients' right to confidentiality.

• Treat patients and colleagues fairly and without discrimination.

• Act with honesty and integrity.

• Never abuse your patients' trust in you or the public's trust in the profession.

You are personally accountable for your professional practice and must always be prepared to justify your decisions and actions.

For full details and elaboration, refer to the GMC's Good Medical Practice advice.⁷

The GMC also has further guidance on the duty of confidentiality, and on acting on concerns about patient safety (for example, due to a colleague's ill health or performance or due to inadequate premises, equipment, systems, or policies).^{8 9}

Ethics can be a very difficult issue and it often helps to discuss ethical dilemmas with others. Partners, trainers or other colleagues may be the first point of call, but others are also available to offer advice. Difficult decisions are often best shared. Nowadays there are specialist medical groups online which can help with particularly tricky ethical issues (always bearing in mind the need for confidentiality). Your medical defence organisation will be happy to offer advice. The BMA also has a number of publications which may be of help.¹⁰ The GMC has an advice line but this is more related to whistle-blowing and raising concerns about the medical practice of others and does not deal with majority of ethical dilemmas.¹¹

When you make an ethical decision, remember that you may be called upon to justify it. Complex matters of ethics often do not have a simple right or wrong but all aspects of the argument need to have been explored. It is important to consider the implications of your actions.