The expectations of an oath: lessons from Hippocrates

M. Çiftçi explores the evolution of a historic and contemporary commitment to protect the vulnerable.

M. Ciftci

Mehmet Ciftci has a PhD in political theology from the University of Oxford. His research focuses on bioethics, faith and politics.

While surgeons operate in the background a digital display shows numbers in the foreground

Natanael Melchor on Unsplash.

A ‘casual acceptance of infanticide seems to have been not the exception but the rule among both Greeks and Romans in the centuries immediately preceding the birth of Christ.’ That shocking fact about the pagan world’s attitudes towards children, mentioned in David Albert Jones’ The Soul of the Embryo, has been brought to our attention again recently by Tom Holland’s Dominion. Since his book was published, much has been written, even in Seen & Unseen, about the radical alteration of our attitudes towards the weak and vulnerable, especially children, women, and slaves, by the Christian faith’s love for the weak over the strong. The depictions of Christ’s suffering humanity in crucifixes over centuries slowly worked to change the attitudes of even the strong and powerful.

But to think that the Greco-Roman world was entirely callous towards the vulnerable is not true. There is a minority of voices revealing that, even then, there were some opposed to the killing of children in the womb or after birth. There were some who anticipated the revolution of values that the Judaeo-Christian tradition was about to inaugurate. Within that minority of pagan authors, the writings attributed to Hippocrates (who was roughly a contemporary of Socrates) and to his school, in particular, stand out. Translations of his writings from Greek into Syriac, Arabic, and Latin ensured their influence for centuries over Muslim and Christian physicians. The most well-known one, of course, is the Hippocratic Oath, which explicitly forbids causing an abortion using a pessary.

Its description of the moral rules and humane ideals that physicians swear to obey, is partly responsible for the honour and prestige that is still, even today, attached to the medical profession. Medical schools around the world, including 70 percent of them in the UK, still use some version of the Oath in their graduation ceremonies, so that the new medics can make their promise to obey a short summary of the ethical ideal that should guide their practice. The revival of interest in the Oath more recently dates from the post-war period, when the appalling example of medical experimentation in the Nazi regime led the then newly founded World Medical Association to draft the Declaration of Geneva in 1948, since revised multiple times, which have in turn inspired many other versions of the Oath to be written. Some of them are banal and frankly silly, such as one version by the poet David Hart: ‘I will not knowingly do harm to those in my care, I will smile at them and encourage them to attend to their dreams and so hear the voices of their inner strangers’.

Doctors today, in their day-to-day work, rely more often on complex documents detailing their professional obligations. So, what can we and they learn from the Oath?

The Oath includes general promises to use treatments for the benefit of patients and to protect them from harm and injustice, but more specifically it also promises to not give a deadly drug to anyone if asked, nor to suggest giving one to a patient, including a pessary to cause an abortion as I’ve already mentioned. Later the Oath states:

‘Into whichever houses I enter, I will go for the benefit of patients, keeping myself free of any intentional injustice or corruption, particularly in sexual matters, involving both female and male bodies, both of the free and of slaves.’

Already, this tells us, there was an awareness that patients are vulnerable when in the care of another. The physician must not take advantage of their vulnerability, either sexually, or by euthanising them, or by enabling those in despair to commit suicide. A renewed commitment to these rules should be urged, since some doctors continue to abuse their power over patients in these ways, sometimes even with legal permission in countries that permit assisted suicide.

That the Oath was written by a pagan points to the possibility of us all finding our way, without appeal to any holy book or revelation, to an agreement about some basic moral rules that should guide doctors. However, Christianity put its own spin on the Hippocratic Oath, as we can see from a Christian version of it dating from the early Middle Ages. Gone is the reference to swearing by Apollo and Asclepius, whose serpent-entwined rod remains a symbol of medicine today. But, more importantly, the Christian oath forbids causing an abortion by any means, making the promise more definite and explicit. This provides further evidence of the argument mentioned at the beginning of Christianity’s preoccupation with defending the most vulnerable from harm.

Whereas the original Oath envisages belonging to a closely-knit circle of physicians, led by a teacher, from which outsiders are to be excluded, those sections are completely missing from the Christian version. According to W.H.S. Jones, this could be because creating ‘an inner circle of practitioners shows an aristocratic exclusiveness, which is in sharp contrast with the universal brotherhood of Christianity. The relief of pain and suffering … should be tied by no fetters and hindered by no trade-union rules. Christian benevolence should be universal.’ For that reason, Jones thought that the Christian Oath might have been originally written during the earliest centuries of Christianity, when Jesus’ healing missions and the Apostles’ practice of holding all possessions in common had not yet been ‘forgotten or neglected.’

In Westminster Abbey, last year, we saw at the Coronation that the heart of our political system is an exchange of vows between monarch and his people, vows sworn in the belief that to remain faithful to what was promised are gifts given by something above us and beyond our ability to control. Similarly, the weighty responsibilities of marriage have inspired societies across generations to begin married life by pledging solemn promises. Why should we expect anything less from those who take us into their care when we are struck by disease, or facing death?

Review

Books

Culture

Ethics

Film & TV

8 November 2024

4 min read

Small Things Like These: putting the spotlight on backstage goodness

What it means for a film to be good.

Kevin Hargaden

Kevin is a social theologian studying ethics and economics.

The gaunt face of a dishevelled man stares into the distance

A ‘stellar’ Cillian Murphy plays Bill Furlong.

Lionsgate.

Small Things Like These is a novella by the Irish writer Claire Keegan. Published in 2021, it compresses a remarkable story into 128 pages. Acclaimed widely by critics and readers, it follows Bill Furlong, a fuel merchant living in the small County Wexford town of New Ross in 1986, as Christmas approaches. While delivering coal to the local convent, Bill makes an alarming discovery. Memories of his childhood begin to press in on him and he finds himself in an existential crisis.

Like her previous (very short) work, Foster, Small Things Like These is an understated book with a searing moral clarity. And just as Foster was adapted for the screen – in the astonishing Irish-language film The Quiet Girl – a movie version of Small Things Like These is now likely showing at a cinema near you.

The movie is built around a stellar performance from Cillian Murphy. It would be criminal if his name is not featured among the shortlists when awards season comes round. Many of the film’s most arresting scenes feature close-ups of his face as Bill wrestles with the implications of his discovery and the phantoms of his past. The effect is that the film serves as an almost literal portrait of what it means to be a decent person.

The story begins with Bill making a delivery to the convent. He sees a mother drop off her screaming daughter to the back door, where she is met and manhandled inside by a nun. The teenager protests passionately, but to no avail. The viewer understands that this girl has “fallen pregnant”, to use the Hiberno-English idiom that was so common in the twentieth century. She has been dispatched by her family to this institution to serve out the months of pregnancy and to remove any shame or taint from their reputation. Bill watches as the girl shouts out for her father, who is entirely absent.

And, after a tense interaction with an aggressive nun, he goes home to his five girls and his wife, clearly shaken.

A few days later, unable to sleep, haunted by memories of his own childhood being raised by a single mother, with an absent father, relying on the kindness of a wealthy local landowner, he begins his deliveries before dawn. As he deposits peat briquettes in the coal shed of the convent, he discovers a teenaged girl abandoned in the corner of the tiny, filthy room. She is in deep distress and Bill responds instinctively, wrapping his coat around her shoulders and bringing her inside to the convent.

While the existence of Magdalene Laundries and Mother and Baby Homes were not a secret in twentieth century Ireland, the exact details of their operations were not widely understood. With these two encounters, so close together, and his own personal biography as the son of a woman who was subject to exactly the same marginalising dynamics, Bill can no longer be satisfied to turn a blind eye to the oppression and alienation endured by those sent for reformation.

It evokes the ways in which all such systems of oppression are socially constructed and maintained. Otherwise, good people learn to look the other way.

The film gathers momentum as Bill is forced to confront the way his mother had been treated for “falling pregnant” and the reality experienced by girls the same age as his daughters who were in a similar situation. In the midst of his existential angst, he finds little solace in the no-nonsense pragmatism of his wife who reminds him “there are things you have to ignore” to get on in life. He is taken aside by his local publican, a woman who has similarly scrabbled up from humble origins to establish a thriving business and cautioned to not make trouble for the nuns since “their fingers are in every pie in the town”.

I will refrain from fully revealing every detail of the film’s plot. But this element of the screenplay – where Claire Keegan along with Enda Walsh – draw out the sense in which the oppressive ecclesial institutions were enabled and even sanctioned by the wider population is exceptionally well done. The film does not pull any punches on the evils that were committed in the name of churches in Ireland. Indeed, if anything, the presentation of the nuns veers too far towards caricatures of pure malevolence. But with surgical precision, it evokes the ways in which all such systems of oppression are socially constructed and maintained. Otherwise, good people learn to look the other way.

And that is the lasting significance of this film. Toni Morrison has spoken about how it can seem harder to write about goodness than evil. “Evil has a blockbuster audience; goodness lurks backstage.” In Small Things Like This, Claire Keegan introduces us to a hardworking small business owner who treats his staff well, a loving father who seeks to care for his wife, a man who lives down a back street of a provincial town in an overlooked part of a small island on the periphery of Europe. And in this very definitively backstage context, he is presented as heroic in his pursuit of the Good.

We all fancy ourselves to be the one person who would stand up and oppose systems of oppression if we ever found ourselves enmeshed in them. Cillian Murphy’s depiction of Bill Furlong whispers to us that we likely are enmeshed in just that way and are choosing not to notice. Small Things Like These is a heavy film that somehow liberates. It reminds us that there is, within each of us, this appetite for seeing the Good and bring brave enough to do it. It is worth your time far more than any competing blockbuster.