- The Pacemakers

28 Oct 2023
Dr. Raj Shekhar Yadav
Medicolegal
Last Edited 30 Oct 23

Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 mandates that at the time of registration , each applicant shall be given a copy of the following declaration by the Registrar concerned and the applicant shall read and agree to abide by the same:

DECLARATION:

1) I solemnly pledge myself to consecrate my life to service of humanity.

2) Even under threat, I will not use my medical knowledge contrary to the laws of Humanity.

3) I will maintain the utmost respect for human life from the time of conception.

4) I will not permit considerations of religion, nationality, race, party politics or social standing to intervene between my duty and my patient.

5) I will practice my profession with conscience and dignity.

6) The health of my patient will be my first consideration.

7) I will respect the secrets which are confined in me.

8) I will give to my teachers the respect and gratitude which is their due.

9) I will maintain by all means in my power, the honor and noble traditions of medical profession.

10) I will treat my colleagues with all respect and dignity.

11) I shall abide by the code of medical ethics as enunciated in the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations 2002. I make these promises solemnly, freely and upon my honor.

History of Hippocratic Oath:

Medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. The oldest expression of this basic principle comes from Hippocrates, an early Greek Physician, born in 460 B.C. who came to be known as the "Father of Medicine" and had devoted his entire life to the advancement of medical science. He formulated a code of conduct in the form of the Hippocratic Oath, as he realized that knowledge and skill were not enough for a physician without a code of standards and ideals. He coined an oath of integrity for physicians, a code of standards and ideals to which they must swear to adhere in the practice of their profession. This continues till date to be the oath administered to doctors when they join the profession.

Many versions of Hippocratic Oath are prevalent. "Light from Many Lamps" a book edited by Lillian Richler Watson contains a little different phraseology of that oath but certainly a beautiful commentary on the significance of the Hippocratic Oath. We would like to reproduce the oath and the commentary hereunder;

"I do solemnly swear by that which I hold most sacred:

That I will be loyal to the profession of medicine and just and generous to its members;

That I will lead my life and practice my art in uprightness and honor;

These things I do promise, and in proportion as I am faithful to this my oath may happiness and good repute be ever mine __ the opposite if I shall be forsworn."

The Hippocratic Collection, containing the best of the ancient Greek medical writings, was put together by Aristotle and has survived through the centuries. The "Hippocratic Oath" is one of the last and most inspiring passages in this Collection. There are a number of versions of the famous Oath; but the form given here is the one commonly used today; and is an adaptation of a translation from the original Greek.

The medical profession is and always has been one of the most ethical of all professions; and this is due at least in part to the centuries-old influence of the Hippocratic Oath. This famous Oath has kept alive the high standards and ideals set by Hippocrates, and form the basis of modern medical ethics.

Written more than twenty centuries ago, the Hippocratic Oath has inspired generations of doctors . . . and continues to do so even now. The Oath is still administered by medical schools to graduating classes; and thousands of physicians have framed copies on their walls along with their diplomas. Conscientious practitioners continue to live up to the principles and ideals set down for their profession so long ago by the "Father of Medicine."

Though it was written specifically for physicians, the Hippocratic Oath sets an enduring pattern of honor, integrity, and devotion to duty for all people, in all professions."

Charak Samhita

Ancient Indian script The Charka Samhita was among the earliest texts that set a code of ethics on physicians and nurses, attributing moral as well as scientific authority to the healer.The text, in chapters 8 and 9 of the Vimana Sthana dedicate numerous verses to discussing the code. It mandates that the physician must seek consent before entering a patient's quarters, must be accompanied by a male member of the family if he is attending a woman or minor, must inform and gain consent from patient or the guardians if the patient is a minor, must never resort to extortion for his service, never involve himself in any other activities with the patient or patient's family (such as negotiating loans, arranging marriage, buying or selling property), speak with soft words and never use cruel words, only do "what is calculated to do good to the patient", and maintain the patient's privacy.

There is no end in the knowledge of medical science, claims verse 3.8.12 of the Charka Samhita, and the physician must constantly learn and devote himself to it. The text asserts that a physician should discuss his findings and questions with other physicians because "when one discusses with another that is possessed of knowledge of the same science, such discussion leads to increase of knowledge and happiness". The verses that follow outline that discussions can be hostile or peaceful, the former are unproductive, the latter useful; even if one faces hostile criticism, one must persuade with gentle words and manner, asserts the text.

The Charka oath goes like this-

“I will remain celibate for the rest of my life. I will be disguised as sages. I will not hate anyone. I will eat simple food. I will not do violence. I will not ignore patients. I will consider their service as my religion. I will not talk about the house of whose family I will go for medical treatment. I will not be proud of my knowledge. I will always consider Guru as my Guru.”

The importance of nursing care in Healthcare delivery was recognized by ancient sages Sushrut and Charka and Sushrut Samita mentions qualifications of a Nurse

“That person alone is fit to nurse or to attend the bedside of a patient, who is cool-headed and pleasant in his demeanor, does not speak ill of any body, is strong and attentive to the requirements of the sick, and strictly and indefatigably follows the instructions of the physician.”

Self regulation is the best regulation;

In India The Code of Medical Ethics drawn up with the approval of the Central Government under Section 33 of the Indian Medical Council Act and observed "Every doctor whether at a Government Hospital or otherwise has the professional obligation to extend his services for protecting life. The obligation being total, absolute and paramount, laws of procedure whether in statutes or otherwise cannot be sustained and, therefore, must give way. It is the duty of the doctor in an emergency to begin treatment of the patient and he should not await the arrival of the police or to complete the legal formalities. The life of a person is far more important than legal formalities." This view is in accordance with the Hippocratic Oath of doctors.

The courts and Consumer Fore are not experts in medical science, and must not substitute their own views over that of specialists. It is true that the medical profession has to an extent become commercialized and there are many doctors who depart from their Hippocratic Oath for their selfish ends of making money. However, the entire medical fraternity cannot be blamed or branded as lacking in integrity or competence just because of some bad apples. It must be remembered that sometimes despite their best efforts the treatment of a doctor fails. For instance, sometimes despite the best effort of a surgeon, the patient dies. That does not mean that the doctor or the surgeon must be held to be guilty of medical negligence, unless there is some strong evidence to suggest that he is.

Since ages Medical Profession is being self guided and self regulated by code of high moral standards and a sense of duty towards the sick. Medical professionals must understand that self regulation is a privilege and not the right. If the medical community fails to regulate itself adequately someone will have to regulate it from outside. This is exactly what has happened to regulations in healthcare worldwide. In India there is exponential rise in litigations against doctors and hospitals in various Civil Courts, Medical Councils, and Consumer Courts and even in Criminal Courts. Though the vast majority of these complaints could never sustain the test of law and were found to be frivolous yet the alarming rate with which complaints against doctors and hospitals are increasing is a cause of concern.

The History and Relevance of Hippocratic Oath

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