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Should a Public Health Practitioner Swear an Oath?

HPPH 2011

Scott Frank

on 27 August 2014

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Transcript of Should a Public Health Practitioner Swear an Oath?

Scott Frank, MD, MS
Should Public Health Practitioners Swear an Oath
The Pubic Health Mandate
“The mandate to assure and protect the health of the public is an inherently moral one. It carries with it an obligation to care for the well being of others and it implies the possession of an element of power in order to carry out the mandate.”
“The need to exercise power to ensure health and at the same time to avoid the potential abuses of power are at the crux of public health ethics.”
“Until recently, the ethical nature of public health has been implicitly assumed rather than explicitly stated. Increasingly, however, society is demanding explicit attention to ethics.”
Hippocratic Oath—Classical Version
I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfil according to my ability and judgment this oath and this covenant:

To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art - if they desire to learn it - without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else.

I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

Whatever houses 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 sexual relations with both female and male persons, be they free or slaves.

What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.

If I fulfil this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.

Translation from the Greek by Ludwig Edelstein. From The Hippocratic Oath: Text, Translation, and Interpretation, by Ludwig Edelstein. Baltimore: Johns Hopkins Press, 1943.
Hippocratic Oath—Modern Version
I swear to fulfill, to the best of my ability and judgment, this covenant:I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter.

May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, and used in many medical schools today.
The Purpose of a Code of Ethics
Clarify the distinctive elements of public health
Make clear to populations and communities the ideals of the public health institutions (or practitioners) that serve them
Provide goals to guide public health institutions and practitioners
Provide standards to which we could be held accountable
Characteristics of Ethical Codes
Typically relatively brief
Not designed to provide a means of untangling convoluted ethical issues
Does not typically provide a means of resolving a particular dispute, rather provides those in a dispute over a public health concern with a list of issues and principles that should be considered
American Medical Association Code of Ethics
1. Be honest
2. Follow the law and work to change it when contrary to the best interest of the patient
3. Respect the rights of others (including right to privacy)
4. Stay current and ask for help when needed
5. Retain the freedom to choose who to serve, where to serve, who to work with (except in emergency)
6. Contribute to a better community
Principles for the Ethical Practice of Public Health
1. Address fundamental causes of disease and requirements for health
2. Respect individual rights
3. Ensure community input
4. Advocate for and empower the disenfranchised
5. Use evidence to drive programs and policies
6. Be transparent with information and seek permission to proceed
7. Act in a timely manner
8. Respect diverse values, beliefs, and cultures
9. Enhance the physical and social environment
10. Protect confidentiality (when possible)
11. Ensure professional competence
12. Build public trust and public health effectiveness
I will strive to understand the fundamental causes of disease and good health and work both to prevent disease and promote good health.
I will respect individual rights while promoting the health of the public.
I will protect and help to empower disenfranchised persons to ensure that the basic resources and conditions necessary for health are available to all.
I will seek out and use the best available information to guide my work.
I will work with the public to ensure that my work is timely, open to review, and responsive to the public’s needs, values, and priorities.
I will anticipate and respect diverse values, beliefs, and cultures.
I will promote public health in ways that most enhance the physical and social environment
I will always respect confidential health information.
I will strive to maintain and improve my own competence and effectiveness.
I will promote the education of students of public health, other public health professionals, and the public in general, and work to ensure the competence of my colleagues.
I will respect the collaborative nature of public health, working with all health professionals who labor to protect and promote health.
In all that I do I will put the health of the public first, even when doing so may threaten my own interests or those of my employer.
List 5 "I wills"
List 2 assets you bring to the field of public health
Full transcript