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Badilisha Lugha KISWAHILI

What became of Hippocratic Oath?

12th February 2012

The just ended medical doctors’ strike has reminded me of the late Mwalimu Nyerere address at the Nyamagana Stadium in Mwanza in 1995. In his speech, Mwalimu of many things he spoke about touched on the issue of corruption and in his view he thought a medical doctor would be the last person to take a bribe.

The belief that Mwalimu Nyerere cherished had roots in the oath the medical doctors take upon graduation into the profession. Mwalimu said that he has administered the doctors’ oath taking several times, but every time the act takes him to tears as he thought no human being can swear by that and live to do exactly what the oath require him or her to be and to do.

The oath called the Hippocratic Oath is named after the ancient Greek physician Hippocrates who formulated it in his writing. It is a set of ethical principles. By the original Hippocratic Oath the medical doctor swears:

“I SWEAR by Apollo the physician, and Aesculapius, and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgment, I will keep this Oath and this stipulation to reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others.

I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion.

With purity and with holiness I will pass my life and practice my Art. I will not cut persons labouring under the stone, but will leave this to be done by men who are practitioners of this work.

Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further from the seduction of females or males, of freemen and slaves.

Whatever, in connection with my professional practice or not, in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times! But should I trespass and violate this Oath, may the reverse be my lot!”

Like any other phenomenon, the Hippocratic Oath has undergone evolution to match with changes in the society. The British Medical Association has been pushing for the upgrading of Hippocratic Oath in the World Medical Association. The updated is aiming at putting the patients first, a unifying force, superseding national, ethnic, religious and cultural boundaries by focusing on widely shared values. The British Medical Association’s oath which was worded in 1997 makes the medical doctor to swear thus:

“The practice of medicine is a privilege which carries important responsibilities. All doctors should observe the core values of the profession which centre on the duty to help sick people and to avoid harm. I promise that my medical knowledge will be used to benefit people's health.

They are my first concern. I will listen to them and provide the best care I can. I will be honest, respectful and compassionate towards patients. In emergencies, I will do my best to help anyone in medical need.

I will make every effort to ensure that the rights of all patients are respected, including vulnerable groups who lack means of making their needs known, be it through immaturity, mental incapacity, imprisonment or detention or other circumstance.

My professional judgment will be exercised as independently as possible and not be influenced by political pressures nor by factors such as the social standing of the patient. I will not put personal profit or advancement above my duty to patients.

I recognise the special value of human life but I also know that the prolongation of human life is not the only aim of healthcare. Where abortion is permitted, I agree that it should take place only within an ethical and legal framework. I will not provide treatments which are pointless or harmful or which an informed and competent patient refuses.

I will ensure patients receive the information and support they want to make decisions about disease prevention and improvement of their health.

I will answer as truthfully as I can and respect patients' decisions unless that puts others at risk of harm. If I cannot agree with their requests, I will explain why.

If my patients have limited mental awareness, I will still encourage them to participate in decisions as much as they feel able and willing to do so.

I will do my best to maintain confidentiality about all patients. If there are overriding reasons which prevent my keeping a patient's confidentiality I will explain them.

I will recognise the limits of my knowledge and seek advice from colleagues when necessary. I will acknowledge my mistakes. I will do my best to keep myself and colleagues informed of new developments and ensure that poor standards or bad practices are exposed to those who can improve them.

I will show respect for all those with whom I work and be ready to share my knowledge by teaching others what I know.

I will use my training and professional standing to improve the community in which I work. I will treat patients equitably and support a fair and humane distribution of health resources. I will try to influence positively authorities whose policies harm public health.

I will oppose policies which breach internationally accepted standards of human rights. I will strive to change laws which are contrary to patients' interests or to my professional ethics.”

A critical analysis of the original and the Revised Hippocratic Oath (RHO) reveals that the patient is the core of the medical profession. Recognizing the role of patients, labour laws including the law governing hospital issues in Tanzania do not give the medical doctors an outright right to strike.

From the oath and the legal framework it is difficult to understand why the doctored are walking away from their patients especially these they have already started to attend.

We all understand the situation all of us have created. We all know that this modern world is a world in which selfishness overweighs collectivity; individuals are motivated by personal interest than social welfare.

On the other hand we should note that in the same modern world which is characterized by specialisation, there is interdependence among specializations in a way which makes the world one organised system. Functionalist sociologists see society as a system made up of interdependent parts which exist in harmony in order for the system to exist and survive all its challenges.

It is noted with concern the unbecoming behaviour among parts of our system whereby one part sees itself as superior to other parts and take advantage of the situation at the expenses of other parts. Can we in reality have a superior part in the system? Science says no, that is not possible.

Remuneration which is actually what an individual is rewarded for work done is what causes all this noise. We have a handful of individuals who this country has laboured to make them what they are now who in turn are causing us a lot of trouble, accusing one another.

When thieves fight they put themselves in the danger of opening up their secret that ill benefits the public. Because of the strike it has been made clear to us that the medical doctors get paid less as compared to the members of Parliament. The former get Sh10,000 per call while the later Sh330,000 per sitting.

Is that not enough as compared to what a peasant who labour for six good months and ends up getting Sh250,000 on which she or he will relay for the rest six months of the year? The list has been elongated and now it includes our brothers and sisters working in the Bank of Tanzania (BoT), Tanzania Revenue Authority (TRA) and numerous semi-autonomous government institutions.

If we count our fellow Tanzanians in these institutions and their families they hardly make a million. And these have been holding the rest forty three million Tanzanians at ransom either by refusing to teach, cure or give services at less than what they demand.

The medical doctors are on strike because they think they are important and the government seems not to acknowledge their importance and remunerate them accordingly.

While they what us to believe is that they are being mistreated, the life they are living does not reflect the picture they are painting. They only manage to leave us with more questions than can answers be available.

The strike could be aiming at pointing at the weakness of the government, but the timing is off target. If they are not happy with the government they should have gone on strike during the election time, and influence the voters, as they are the people who can punish the government in the ballot box.

If they wanted pay increase they should have gone on strike during the budget session; doing it now is a waste of time as nothing substantive can come out of it, serve for punishing poor ordinary Tanzanians.

The medical doctors should revive the Hippocratic Oath and see if there is any justification in the act of striking while leaving the patients suffering in pain. If they still think that they are right, then they would be morally and spiritually corrupt, which the almighty God and the gods punish.

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