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The Hippocratic Oath: Has It Ceased to Be Relevant? W 1990;35:704-9. Fam Physician 1999;48:2165-74. 7. Sternfeld B, Quesenberry CP Jr, Eskenazi B, et al. Exercise during pregnancy 22. Clapp JF 3rd, Simonian S, Lopez B, et al. The one year morphometric and and pregnancy outcome. Med Sci Sports Exerc 1995;27:634-40. neurodevelopmental outcome of the offspring of women who continued to 8. Pivarnik JM, Lee W, Clark SL, et al. Cardiac output responses of primigravid exercise regularly throughout pregnancy. Am J Gynecol 1998;178:594-99. women during exercise determined by the direct Fick technique. Obstet 23. Cowlin A, Shelley S. Exercises to ease pregnancy, birth and recovery. Gynecol 1990;75:954-9. Washington: parent articles 1994; 352:9707-10. 9. Clapp JF 3rd. Exercise during pregnancy. A clinical update. Clin Sports Med 24. Davies GA, Wolfe LA, Mottola MF, et al. Exercise during pregnancy and the 2000;19:273-86. postpartum period. ACOG Technical Bulletin number 189- February 1994. Int 10. Clapp JF 3rd, Little KD, Appleby-Wineberg SK, et al. The effect of regular J Gynaecol Obstet 1994;45:65-70. maternal exercise on erythropoietin in cord blood and amniotic fluid. Am J 25. Teasdill W. Step-by-step yoga for pregnancy: essential exercises for the Obstet Gynecol 1995;172:1445-51. childbearing year. Chicago: Contemporary Books, 1999, pp.178-85. 11. Clapp JF 3rd. Guiding the athlete during pregnancy and lactation. 26. Clapp JF 3rd. The effect of maternal exercise on early pregnancy outcome. Contemporary. Obstet Gynaecol 1996;41(sports medicine suppl):20-26. Am J Obstet Gynecol 1989;161:14. 12. Crane SS, Wojtowycz MA, Dye TD, et al. Association between pre-pregnancy 27. Veille JC, Hohimer AR, Burry K, et al. The effect of exercise on uterine obesity and risk of cesarean delivery. Obstet Gynecol 1997;89:213-6. activity in the last eight weeks of pregnancy. Am J Obstet Gynecol 13. Phatak MS, Kurhade GA. A longitudinal study of antenatal changes in lung 1985;151:727-30. function tests and importance of postpartum exercises in their recovery. Indian J Physiol Pharmacol. 2003;47:352-6. 28. Bø K, Hagen RH, Kvarstein B, et al. Pelvic floor muscle exercise for the treatment of female stress urinary incontinence. III: Effects of two different 14. Clapp JF 3rd, Lopez B, Harcar-Sevcik R. Neonatal behavioral profile of the degrees of pelvic floor muscle exercise. Neurourol Urodyn 1990;9:489-502. offspring of women who continued to exercise regularly throughout pregnancy. Am J Obstet Gynecol. 1999;180:91-4. 29. Bø K, Talseth T, Holme I. Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and treatment 15. Clapp JF 3d. Exercise in pregnancy: a brief clinical review. Fetal Med Rev 1990;2:89-101. in management of genuine stress incontinence in women. BMJ 1999;318:487-93. 16. Clapp JF 3rd, Kim H, Burciu B, et al. Beginning regular exercise in early pregnancy: effect on fetoplacental growth. Am J Obstet Gynecol 30. American College of Sports Medicine. Position stand. The recommended 2000;183:1484-8. quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness in healthy adults. Med Sci Sports Exerc 17. Clapp JF 3rd. Morphometric and neuro-developmental outcome at age five 1990;22:265-74. years of the offspring of women who continued to exercise regularly throughout pregnancy. J Pediatr 1996;129:856-63. 31. Stevenson L. Exercise in pregnancy: part 2: recommendations for individuals. Can Fam Physician 1997;43:107-111. 18. Pivarnik J. Potential effects of maternal physical activity on birth weight: brief review. Med Sci Sports Exerc 1998;30:400-6. 32. Hatoum N, Clapp JF 3rd, Newman MR, et al. Effects of maternal exercise on 19. Clap JF 3rd. Cover story: recommending exercise during pregnancy. fetal activity late in gestation. J Matern Fetal Med 1997;6:134-139. Contemporary Obstet Gynaecol 2001;1:30-49. 33. Clapp, JF 3rd. Exercise and fetal health. J Dev Physiol 1991;15:9-14. 20. Clapp JF 3rd, Kim H, Burciu B, et al. Continuing regular exercise during 34. Clapp JF 3rd, Capeless EL. Neonatal morphometrics after endurance exercise pregnancy: effect of exercise volume on fetoplacental growth. Am J Obstet during pregnancy. Am J Obstet Gynecol 1990;163:1805-11. Gynecol 2002;186:142-7. 35. Artal R, Platt LD, Sperling M, et al. Maternal cardiovascular and metabolic 21. Thomas W, Wang Y, MacNeal KE, et al. Exercise during pregnancy. Am Acad responses in normal pregnancy. Am J Obstet Gynecol 1981;140:123-7. The Hippocratic oath: Has it ceased to be relevant? W. Qidwai Department of Family Medicine, The Aga Khan University, Karachi. The Greek physician Hippocrates (460-377 B.C) is its precepts are as valid today as they were in Hippocrates' traditionally regarded as the founder of medicine, scientific time. This can be best understood through an historical discipline and medical ethics.1 The Hippocratic Oath, taken review of the oath's transmission and acceptance in different by ancient and medieval doctors, requires high ethical eras of western history. The longevity of the oath, however, standards from medical doctors. Its principles are is clearly attributable to its intrinsic merit, its high moral considered important in professional and ethical education reverent tone, and a literary eloquence that placed of medical doctors even today. 2 Hippocrates among the best writers of antiquity.4 The Hippocratic Oath has survived, with over-riding Historically, the ethics of a professional were the power, the test of time since it addresses the intrinsic nature ethics of a gentleman. Since the industrial revolution in the of medicine. Even those who know little of it or reject parts 19th century, it has been argued that it has become of it acknowledge it to be a symbol of the values of imperative to apply the principle of autonomy to issues in medicine. It has been argued that it is its drive to the heart the ethics of health care.5 of medicine that makes the Hippocratic Oath inspiring even The social changes in the 1960s, where citizens today.3 asked for a greater voice in all affairs that affected them The moral and ethical message of the Hippocratic gave rise to formal approaches to ethics in the health fields.6 Oath has exhibited remarkable resiliency through the ages, The increasing incorporation of medical technology in varied cultures. Although its language may appear odd, coupled with social demands (including those for health 229 J Pak Med Assoc care) has brought about significant changes in medical As a whole, the Hippocratic Oath expresses an ideal practice. This situation has in turn sparked a growth in the of medical behavior and it must be interpreted in the context philosophical debate over problems pertaining to ethical of ancient Greek culture and history. Some uncertainties practice. It is argued that these issues no longer find answers about its relevance are due to a lack of understanding of its in the Hippocratic ethical model. It is said that the crisis in exceptional content of values. Modified versions of the oath Hippocratic ethics could be described as a period of or original texts presumptuously pretend to replace a paradigm shift in which a new set of values appears to be document that has lasted 2500 years and that meant a emerging.7 revolution for medical practice. Recent studies suggest that there is a great distance Students should have the opportunity to analyze between the thinking of Hippocrates and present scientific content of the Hippocratic Oath and the way its values are medicine. Hippocratic philosophy rejects the related to concrete situations of present medical practice. epistemological principles of modern science, which studies Medical schools should shelter it without objections, as the the nature of knowledge with reference to its limits and expression of a reflexive compromise acquired by validity. The Hippocratic logic is probabilistic and temporal physicians during their studies and to be applied in medical and rejects the principles of non-contradiction, of identity practice.11 and therefore the abstract determinism of contemporary The identified limitations of the Hippocratic Oath or science. The present force of the oath is explained because other pertinent oaths and codes enable students to its ethics and epistemology are matters of medicine that appreciate the value of the broader principles that support understands the real world of the ill, trying to avoid medical ethics.12 In student's view, the oath seems to be an suffering and injustice.8 Despite all the criticism, the emotionally important ritual, whose value probably Hippocratic oath is sworn by graduating medical students at transcends its actual content.13 more than 60% of US medical schools, and is perhaps the Oaths are like promises but generally have greater most enduring medical oath of Western civilization.9 moral weight and have a public character along with The underlying purpose of the Hippocratic oath and prescription of consequences for failure to uphold them.14 It most medical ethics codes dictated during the twentieth signifies a willingness to submit to a way of life that century, is patient protection. Nowadays, however, clients demands some suppression of self-interest. If studying the of health services do not conform themselves with ethical oath more explicitly strengthens the physician's dedication declarations of the medical profession but demand that the to the welfare of the patient, the effort will be worthwhile.15 rights that arise from those declarations, become legal Ethical rules are similar for physicians in most instruments that force professionals, health authorities and countries that follow the Hippocratic oath. They have no governments to satisfy their health needs and respect their formal legal force, but can be used as a reference to provide individual rights.
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