# A Hippocratic Oath for a Free Society 

As modern medical schools allow faculty and students to compose new Hippocratic oaths that depart from issues of traditional patient care, here is how to craft a modern oath to address the most central health care issue: respecting patients’ rights and autonomy.

May 8, 2023 • Visual Feature 

Jeffrey A. Singer, MD, FACS 

![Gold Medical Serpent Symbol Rod of Asclepius/Caduceus.](/sites/cato.org/files/styles/aside_3x/public/2023-02/Rod-Caduceus_0.jpg?itok=lV7sJoGO) 

# A Hippocratic Oath for a Free Society 

As modern medical schools allow faculty and students to compose new Hippocratic oaths that depart from issues of traditional patient care, here is how to craft a modern oath to address the most central health care issue: respecting patients’ rights and autonomy.

May 8, 2023 • Visual Feature 

Jeffrey A. Singer, MD, FACS 

![Stethoscope on stack of books.](/sites/cato.org/files/styles/aside_3x/public/2023-02/Books-Stethoscope.png?itok=edHg5itg) 

Medical schools worldwide have been administering modern versions of the Hippocratic oath to graduating students for centuries, and medical schools in the United States are no exception.

Over time, many medical schools have created *unique versions* of the oath.

![A lecture using x-rays at a medical facility, USA, circa 1950.](/sites/cato.org/files/styles/aside_3x/public/2023-02/Med-Students-Lecture_1.png?itok=L_X0Nwa9) 

**1948**

The World Medical Association drafts a version of the Hippocratic oath called the Declaration of Geneva.

The W.M.A. publishes updated versions in 1968, 1983, 1994, 2005, and 2006.

#### Read the Declaration of Geneva 

I solemnly pledge myself to consecrate my life to the service of humanity; 
I will give my teachers the respect and gratitude which is their due; 
I will practice my profession with conscience and dignity; 
The health of my patient will be my first consideration; 
I will respect the secrets which are confided in me, even after the patient has died; 
I will maintain by all the means in my power, the honor and the noble traditions of the medical profession; 
My colleagues will be my brothers; 
I will not permit considerations of religion, nationality, race, party politics or social standing to intervene between my duty and my patient; 
I will maintain the utmost respect for human life from its beginning even under threat and I will not use my medical knowledge contrary to the laws of humanity; 
I make these promises solemnly, freely and upon my honor.

**1964**

Dr. Louis Lasagna, the Academic Dean of Tufts University School of Medicine, drafts a modern version of the Hippocratic oath many United States medical schools use for the next four decades.

#### Read the Lasagna Version of Hippocratic Oath 

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;

For the benefit of the sick, I will apply all measures 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 hereafter. 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.

![Students of the University of Minnesota Medical School reciting an oath at the annual white coat ceremony.](/sites/cato.org/files/styles/aside_3x/public/2023-02/White-Coat-Ceremony-Transparent-BG-3.png?itok=trzElf3d) 

**1993**

Columbia University College of Physicians and Surgeons becomes the first medical school to hold a “white coat ceremony” for students beginning their medical education.

Students, donning the physician’s white coat for the first time, take the oath during this welcoming ceremony instead of at graduation.

Many other medical schools later adopt this ritual.

**2015**

A survey of 111 medical schools in the United States and Canada finds that 80 had students recite oaths at graduation and 72 had white coat oaths.

The 2015 survey finds that *more than half of the schools* no longer hewed to the Lasagna or Geneva versions of the oath that were popular since the end of World War II.

**Today**

Many medical schools draft their unique versions of the oath, which faculty committees sometimes write. Frequently student class representatives compose the oaths.

For example, the University of Pittsburgh School of Medicine created its version of the oath in 1883 and, in 2020, updated it for the first time.

#### Read the Harvard University Medical School/Harvard University School of Dental Medicine White Coat Ceremony Oath (2019-2020) 

We take this oath with gratitude to all those who have supported us.

In accepting these white coats, we will carry ourselves with humility, integrity, and empathy.

To empower our patients, we pledge to recognize that behind every illness is a human story, including a cast of loved ones and a landscape of unique cultural values. Celebrating this diversity, we will place ethics and equity at the core of each patient interaction.

To foster a community of collaboration among our peers and faculty, in which we can mutually grow and achieve our unique goals, we will seek opportunities to give and receive mentorship while challenging ourselves to honestly and openly share our vulnerabilities.

To fully dedicate ourselves to our profession, we pledge to practice self care. Through self-forgiveness and self-reflection, we will cultivate resilience, pursue lifelong learning, and allow our experiences to transform us.

To truly care for all, we pledge to combat structural oppression and promote social justice. We will leverage our position of privilege to confront health inequities and promote wellness by restructuring systems that are failing patients.

We will strive to advance medicine and our ability to treat disease by expanding our knowledge through inquiry.

In accepting these white coats, we embrace our responsibilities as medical and dental students in partnership with patients and the people by our sides.

#### Read the University of Pittsburgh School of Medicine White Coat Ceremony Oath (2020) 

As the entering class of 2020, we start our medical journey amidst the COVID-19 pandemic and a national civil rights movement reinvigorated by the killings of Breonna Taylor, George Floyd and Ahmaud Arbery. We honor the 700,000+ lives lost to COVID-19, despite the sacrifices of health care workers.

We recognize the fundamental failings of our health care and political systems in serving vulnerable communities. This oath is the first step in our enduring commitment to repairing the injustices against those historically ignored and abused in medicine: Black patients, Indigenous patients, Patients of Color and all marginalized populations who have received substandard care as a result of their identity and limited resources.

Acknowledging the privilege and responsibility of being a physician, I take this oath as a call to action to fulfill my duty to patients, the medical profession and society.

Thereby, I pledge as a physician and lifelong student of medicine:

I will support and collaborate with my colleagues across disciplines and professions, while respecting the patient’s vital role on the health care team.

I will honor my physical, mental and emotional health so as to not lessen the quality of care I provide.

I will carry on the legacy of my predecessors by mentoring the next generation of diverse physicians.

I will recognize the pivotal role of ethical research in the advancement of medicine and commit myself to endless scholarship with the ultimate goal of improving patient care.

I will care for my patients’ holistic well-being, not solely their pathology. With empathy, compassion and humility, I will prioritize understanding each patient’s narrative, background and experiences while protecting privacy and autonomy.

I will champion diversity in both medicine and society, and promote an inclusive environment by respecting the perspectives of others and relentlessly seeking to identify and eliminate my personal biases.

I will be an ally to those of low socioeconomic status, the BIPOC community, the LGBTQIA+ community, womxn/​women, differently-abled individuals and other underserved groups in order to dismantle the systemic racism and prejudice that medical professionals and society have perpetuated.

I will educate myself on social determinants of health in order to use my voice as a physician to advocate for a more equitable health care system from the local to the global level.

I will restore trust between the health care community and the population I serve by holding myself and others accountable and combating misinformation to improve health literacy.

In making this oath, I embrace the ever-changing responsibilities of being a physician and pledge to uphold the integrity of the profession in the clinic and beyond.

#### Read the Columbia University College of Physicians and Surgeons White Coat Ceremony Oath (2021) 

We enter the profession of medicine with appreciation for the opportunity to build on the scientific and humanistic achievements of the past. We also recognize the acts and systems of oppression effected in the name of medicine.

We take this oath of service to begin building a future grounded in truth, restoration, and equity to fulfill medicine’s capacity to liberate.

I make this pledge to myself, my classmates and future colleagues, and the individuals and communities I will serve. I acknowledge that my role is to inform my patients, accompany them in moments of wellness and vulnerability, and respect their privacy and autonomy while empowering them to flourish. I promise to take care of my future patients by engaging in dialogue, listening to their lived experience, and tailoring my recommendations to their unique circumstances. I commit to honor the relationship formed between patient and physician by maintaining confidentiality at all times.

I vow to contribute to the field of medicine through ethical study and equitable evidence-based care, and to treat my patients and represent my profession with compassion, humility, and equanimity. I acknowledge the past and present failures of medicine to abide by its obligation to do no harm and affirm the need to address systemic issues in the institutions I uphold. I promise to critically examine the systems and experiences that impact every person’s health and ability to receive care.

I vow to use this knowledge to uplift my patients and disrupt the injustices that harm them as I forge the future of medicine. I acknowledge the background and experiences that enrich my perspectives while recognizing the limitations, shortcomings, and biases that I bring to each encounter with patients and colleagues. I promise to self-reflect diligently, to confront unconscious prejudices, and to develop the skills, knowledge, and character necessary to engender an inclusive, equitable field of medicine. I commit to fostering empathy and a culture of care, not just for our patients but for ourselves and our colleagues in healthcare.

I vow to remember the humanity and fallibility of myself and every member of the care team, and to call upon my colleagues for assistance in recognition of the limits of my knowledge and skills. I acknowledge and embrace the diversity that exists within all communities, and the formative influence that the Washington Heights community will have on my future as a physician.

I promise to respect, regardless of identity or socioeconomic status, the fundamental dignity of all patients, colleagues, and community members, and their right to quality care. I vow to restore trust where it has been broken and to inspire and nurture trust in the relationships I build with patients, through collaborative effort with my classmates, colleagues, and communities.

Let us bow our heads in recognition of the gravity of this oath; we swear to faithfully engage with these ideals and obligations for the ongoing betterment of medicine and humanity.

#### Read the University of Minnesota Twin Cities Medical School White Coat Ceremony Oath (2022) 

With gratitude, we, the students of the University of Minnesota Twin Cities Medical School Class of 2026, stand here today among our friends, families, peer, mentors, and communities who have supported us in reaching this milestone. Our institution is located on Dakota land. Today, many Indigenous people from throughout the state, including Dakota and Ojibwe (ooj-jib-way), call the Twin Cities home; we also recognize this acknowledgment is not enough.

We commit to uprooting the legacy and perpetuation of structural violence deeply embedded within the healthcare system. We recognize inequities built by past and present traumas rooted in white supremacy, colonialism, the gender binary, ableism, and all forms of oppression. As we enter this profession with opportunity for growth, we commit to promoting a culture of anti-racism, listening, and amplifying voices for positive change. We pledge to honor all Indigenous ways of healing that have been historically marginalized by Western medicine. Knowing that health is intimately connected to our environment, we commit to healing our planet and communities.

We vow to embrace our role as community members and strive to embody cultural humility. We promise to continue restoring trust in the medical system and fulfilling our responsibilities as educators and advocates. We commit to collaborating with social, political, and additional systems to advance health equity. We will learn from the scientific innovations made before us and pledge to advance and share this knowledge with peers and neighbors. We recognize the importance of being in community with and advocating for those we serve.

![Miniature Hippocratic oath and blood pressure cuff sitting on a desk.](/sites/cato.org/files/styles/aside_3x/public/2023-02/Mini-Oath-Stethoscope-Transparent_0.png?itok=djhT-Gon) 

The newer versions stray *significantly* from the long-established oaths.

They still retain a few elements of the more traditional oaths, notably pledges to respect patient privacy, avoid harm, and defend the profession’s uprightness.

Most oaths still commit to sharing and advancing knowledge and preventing and treating disease.

Yet no oath, including the oath of Hippocrates, makes more than a passing mention of 
*respecting patients’ rights* 
as sovereign autonomous adults.

The following is the 5th century B.C. 
Oath of Hippocrates of Kos, 
translated from ancient Greek:

Sound Off

## **The Original Hippocratic Oath**

**\[UNMUTE FOR NARRATION BY CALEB O. BROWN\]**

I swear by Apollo the physician, by Aesculapius, Hygeia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and judgment the following oath: 

To consider dear to me as my parents him who taught me this art; to live in common with him and if necessary to share my goods with him; to look upon his children as my own brothers, to teach them this art if they so desire without fee or written promise; to impart to my sons and the sons of the master who taught me and to the disciples who have enrolled themselves and have agreed to the rules of the profession, but to these alone, the precepts and the instruction. 

I will prescribe regimen for the good of my patients according to my ability and my judgment and never do harm to anyone. To please no one will I prescribe a deadly drug, nor give advice which may cause his death. Nor will I give a woman a pessary to procure abortion. But I will preserve the purity of my life and my art. 

I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by specialists in this art. In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction, and especially from the pleasures of love with women or with men, be they free or slaves. 

All that may come to my knowledge in the exercise of my profession or outside of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and never reveal. If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot.

The original Hippocratic Oath makes 
*no mention* of individual rights or autonomy and is implicitly paternalistic.

It also makes doctors pledge to share their knowledge *only* with members of the same profession, and not outside of the profession.

In doing so, it anticipates the 
modern medical cartel.

Medical school administrators willing to depart from tradition and accept new proposals should consider the following oath that prioritizes the *autonomy and rights of individual patients.*

**A new oath** 
for the medical profession:

Sound Off

## **Recommended Oath**

**\[UNMUTE FOR NARRATION BY SALLIE JAMES\]**

As a member of this class, I swear to fulfill, to the best of my ability, this covenant: 

I will respect the crucial scientific advances in medicine but will always question the assumptions my profession has inherited and judge them in the light of the latest evidence. I will gladly share any knowledge I have gleaned from years of research, study, and clinical experience with health professionals in all disciplines. I will respect my patients’ autonomy, thoroughly explain all the diagnostic possibilities and therapeutic options as I understand them, offer them my best opinion and advice from among those options, and accept their decisions. 

I will never examine a patient or perform a diagnostic test or procedure without informed consent. I will not be afraid to say ‘I don’t know,’ and I will not hesitate to ask my colleagues for assistance or advice when I need it to care for my patient. 

Even if they act against my advice and I disapprove of their choices, I will respect the right of my patients as autonomous adults to self‐​medicate and oppose any laws and regulations that force them to seek my permission—or permission from any other health professional, through a prescription or otherwise—to consume medications or treatments according to their independent judgment. I will respect the privacy of my patients, for when they disclose their problems to me, they expect and deserve confidentiality. 

Respecting individual autonomy, I will oppose laws that punish people for choosing to consume substances or engage in activities that might potentially harm them but do not infringe on the rights of others. If patients engage in lifestyle choices or use substances against my advice that I disapprove of and deem harmful, I will offer them advice, medication, equipment, and techniques to reduce the harm that may come from their choices. I will not morally judge patients with substance use disorder, addiction, or other behavioral health problems, but I will treat them with dignity and compassion. 

I will oppose all efforts, and existing laws and regulations, including professional licensing and ‘scope of practice’ laws, that limit patients’ freedom to choose a health plan or health care arrangement or prevent patients from seeking advice or care from non-physician health professionals, regardless of the type of health care service such professionals offer and irrespective of their level of expertise and training. 

I will remember that there is an art to medicine as well as science and that warmth, sympathy, and understanding are crucial to the healing process. I will remember that treating pain is crucial to my professional mission to ease human suffering. I will use my best judgment and follow my conscience to prescribe adequate treatments for my patients who are in pain, despite the prejudices of public policymakers and law enforcement who might try to interfere. 

I will remember that I do not treat a medical chart, a set of vital signs, or a cancerous growth, but a sick person whose illness may affect the person’s family and economic stability. My responsibility includes helping my patient to weigh the tradeoffs, making a personal risk/​benefit analysis when deciding on a therapeutic course of action, and respecting my patient’s ultimate decision. I will strive to prevent disease, for prevention is preferable to cure. 

I hope my patients and colleagues will remember me with respect and affection if I stay true to this oath.

![Blurred rod of Caduceus, transparent.](/sites/cato.org/files/styles/aside_3x/public/2023-03/Caduceus-BG-Transparent.png?itok=69uFXqzA) 

Over the past two decades, medical schools increasingly substitute their unique oaths for the more traditional ones students take at graduation and white coat ceremonies. Administrators frequently permit students to compose these oaths.

*None of these oaths* prioritize or consistently apply a commitment to individual patient autonomy, including respect for patients’ rights to self-medicate and to seek treatment from any health care provider they choose.

Medical school administrators should ask students to recite an oath that correctly reveres

**patients’ rights and autonomy.**