Article
Ethics
4 min read

The expectations of an oath: lessons from Hippocrates

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

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?  

Article
AI
Creed
Ethics
5 min read

Whistleblowing: what if your CEO is a Caesar?

What are the boundaries of legitimate protest?

Professor Charles Foster is a Fellow of Exeter College, Oxford, and a member of the Oxford Law Faculty.

On a conference stage, a seated speaker leans back and opines
Sam Altman, CEO of OpenAI.
TechCrunch, CC BY 2.0, via Wikimedia Commons .

If you discovered that the company you worked for was doing work that posed an existential risk to humanity, would you consider yourself entitled – or perhaps morally obliged – to blow the whistle? 

This issue provoked a recent open letter from current and former employees at AI companies including Sam Altman’s OpenAI, asserting that the laws protecting whistleblowers are inadequate because they typically focus on illegal activity – and the AI companies concerned are doing nothing which is (yet) illegal. It called for companies to take a number of steps (including not entering into or enforcing agreements prohibiting the raising of risk-related concerns). 

Some might say that if an employee takes the company’s money, that money should buy loyal silence, and that if the public interest demands a different approach, the remedy is the extension to risk-related concerns of existing whistleblower legislation. But unless and until that legislation is extended, should we applaud conscience-driven breaches of contract?  

What about breaches of the criminal law for morally justifiable reasons – for instance to draw attention to the risks that the protestors say are associated with climate change?  

The reality of modern corporate governance means that the CEO may be more practically Caesarean than a country’s government. 

Christian debate about these issues has traditionally turned on two Bible texts. Paul, in writing to those in a Roman church, declares: ‘Let every person be subject to the governing authorities, for there is no authority except from God, and those authorities that exist have been instituted by God. Therefore whoever resists authority resists what God has appointed….the authority… is the agent of God.’ And Jesus, in Matthew's gospel, advises us to ‘render to Caesar that which is Caesar’s, and to God that which is God’s.’ 

Who are the ‘authorities’ spoken of by Paul? Who is the modern Caesar spoken of by Jesus? Presumably in each case – in a parliamentary democracy – it is the combined legislature and executive of the day. Perhaps, these days, we should translate ‘Caesar’ as ‘the social contract’. But does this mean that (if we take these injunctions seriously) we should regard ourselves as bound not to commit criminal offences (which are offences against the state), but should feel no corresponding inhibition about breaching private law obligations, such as those owed under contracts of employment? My instinct is to say that this is indeed what it means, but that is not self-evident. After all, much employment law is statutory – an emanation of Parliament, and the reality of modern corporate governance means that the CEO may be more practically Caesarean than a country’s government. 

Rendering the right thing to Caesar in a theocracy such as Byzantium might mean something very different in a modern tyranny or a democracy.

Should Christians, though, feel constrained by these scriptural passages? Both Paul and Jesus seemed to think that there was little point in establishing lasting social, legal or governmental structures because the end times were just around the corner. Jesus thought that some of his audience would still be alive when the Son of Man returned to complete the messianic project without any help from any secular governor. Paul’s belief that the Second Coming of Christ was at hand was behind his advice that the unmarried (unless they really couldn’t stay celibate) should remain unmarried and get on with the urgent business of preparing for the imminent in-rush of the true Kingdom. Both Jesus and Paul were dramatically wrong about the chronology. Why, then, should we take seriously advice about the regulation of society that was based on their mistake? Should Paul’s advice to those Romans be read as pragmatism – intended by him to convince rulers that Christians wouldn’t make trouble, and that therefore the Christians should be left alone? He may have thought that a shabby compromise with secular powers didn’t matter much because it wouldn’t last long.  

Even if these texts are in some meaningful sense authoritative, what do they mean for modern life? As ever, the devil (and potentially the angel) is in the detail, and Paul and Jesus left the church to work out the relevant details. There is no consensus. Rendering the right thing to Caesar in a theocracy such as Byzantium might mean something very different in a modern tyranny or a democracy. Only in a few situations is the correct answer obvious: no one would doubt that those martyred for refusing to worship the Caesar of the day had made the (or at least a) right choice. But as soon as we move away from such cases the waters get muddy. Would Paul have denounced Dietrich Bonhoeffer for the plot to kill Hitler? If so, would he have been right? It cannot be seriously argued that it is illegitimate to protest against the policies of the day, any more than it could be suggested that Paul requires us to cast our vote in favour of the currently ruling party. 

What, then, are the boundaries of legitimate protest?  

Suppose that AI really does pose a threat to the whole of humanity. Does ‘rendering to God’ not then demand, in a private law context, that the whistle be blown, even if it involves a breach of a contractual obligation? It seems at least arguable.  

Is a breach of the criminal law – for instance in the case of climate change protestors – different? It may well be.  

In England the law has evolved a nuanced approach to ethically motivated criminality. That approach was recently displayed in the sentencing of five Extinction Rebellion activists for criminal damage to the premises of a bank. The judge accepted that each defendant believed that the bank was culpably involved in funding fossil fuel extraction projects, and that such projects endangered the planet. He noted that Lord Hoffman had said: ‘People who break the law to affirm their belief in the injustice of a law or government action are sometimes vindicated by history [for instance the suffragettes]. It is the mark of a civilized community that it can accommodate protests and demonstrations of this kind. But there are conventions which are generally accepted by the law-breakers on one side and the law-enforcers on the other. The protestors behave with a sense of proportion and do not cause excessive damage or inconvenience. And they vouch the sincerity of their beliefs by accepting the penalties imposed by the law.’ In return, he went on, the state behaves with restraint, and the judiciary imposes sentences which take the conscientious motives into account. 

This approach, said the sentencing judge, amounts to a ‘social compact between the courts and protestors.’  

Perhaps, in the realm of the criminal law, that sort of social compact encodes the relevant moral and theological principles as well as anything can.