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Oaths in the modern age: Do they still matter?
The Hippocratic oath is giving way to modern pledges at some medical schools. Do oaths and vows lose their power when shorn of their history, or do they still influence behavior for the better? - photo by Jennifer Graham
When the Hippocratic oath was written, doctors believed that health was controlled by the four humors and a woman's womb wandered around her body like a nomad, causing disease and insanity.

No wonder that some medical students believe the 2,400-year-old oath is due for an update especially the "I swear by Apollo" part. A number of medical schools are allowing students to either write their own oaths or recite an updated version of the ancient oath, once standard at graduation ceremonies for new physicians.

The decline of the Hippocratic oath, along with the troubling number of married couples who forsake their wedding vows, suggest that spoken promises wield little power in the modern age. That's a worrisome idea as America prepares to hear its most most famous oath the one our new president will recite on Jan. 20.

Doctors and presidents, of course, aren't the only people who take oaths. There are oaths for new citizens, nurses, lawyers, pharmacists, military recruits, Boy Scouts and even people who have earned an MBA. It's been argued that other professions should adopt oaths, too: In 2014, The Atlantic asked, "Would a Hippocratic Oath for Bankers Lead to Better Behavior?"

Cynics would say not. Richard M. Nixon, like all presidents dating to George Washington, took the 35-word oath to uphold U.S. laws, and many a lawyer who took an attorney's oath was later disbarred.

But the continued use of oaths at joyful ceremonies and solemn occasions suggest they still hold power as an ideal, and that there are ways they can make us better at what we do. Whether they're improved when updated for the times, however, remains up to debate.

Does the act of writing their own oath compel new doctors to thoughtfully consider the ethics they will uphold in their practice, or does it sever an important link to the past that is an essential part of an oath, whether in medicine or other professions?

Religious oaths, secular laws

Oaths work on two levels: first, in identifying standards of ethical behavior, and later, in reminding us of promises we made.

While oaths, pledges and vows are all essentially promises, there are significant differences between them. Historically, an oath invokes God to bear witness to a person's promise to behave ethically. A vow is a promise made before God. (The Catholic Church even codifies the meaning in its catechism. )

A covenant is an agreement between God and a person or group of people. And a pledge or a promise is a declaration that one will behave in a certain way.

In an effort to dodge the sacred implications of such promises, some people elect to use the word "affirm" instead of "swear" when taking an oath. The oath of enlistment for new military recruits, for example, offers the option to say "affirm" instead of "swear."

But in an essay for the journal First Things, Dale Coulter, a university professor and co-editor of "The Spirit, the Affections and the Christian Tradition," contends that the seriousness with which we approach a commitment is related to our perception that the endeavor is holy.

"It is a fundamental human impulse to ground our vows in something greater than ourselves, which carries with it connotations of worship," Coulter wrote.

In today's society, oaths are often viewed as temporary, in part because the consequences of breaking one are rarely serious, and also, because we have secular ways of governing behavior.

"In the absence of oath-taking, you have litigation and contract law," Coulter said. "If people don't keep their oaths, you have to build up a body of law, a body of regulation that attempts to mimic what someone should be doing when they take an oath seriously."

Coulter said he became interested in the meaning of oaths after watching his 10-year-old son take an oath for his school's student government. The children were accepting their responsibilities and duties in a way many adults fail to, in part because we have lost the communal respect for behavioral governance by oath, Coulter said.

"It's fragmented now. Whether it's an oath of allegiance, an oath of office or marriage vows; we don't see them as a whole anymore. People are not treating oaths in a serious way," he said.

"We have to rebuild the cultural practice, and the only way to rebuild it is to reinforce it through what you teach and live it out and how you conduct your business."

Not all people of faith, however, believe that oath-taking is moral.

Jehovah's Witnesses and Quakers are among those who reject some oaths as contrary to God's will. The Bible has contradictory passages, among them the Old Testament passage in Numbers 30:20 ("When a man voweth a vow unto the Lord, or sweareth an oath to bind his soul with a bond, he shall not break his word; he shall do according to all that proceedeth out of his mouth"); and in the New Testament, James 5:12 ("But above all, my brethren, do not swear, either by heaven or by earth or with any other oath").

'I swear by Apollo'

In antiquity, what we know now as the Hippocratic oath was simply called "Oath." It is believed to have been written around 400 years before Christ, and while it was clearly meant to serve as an oath for someone beginning a career as a healer in ancient Greece, it likely wasn't written by Hippocrates, the famed physician born in 460 B.C.

Some scholars even believe it wasn't written for physicians, but for philosophers, because of its admonition not "to cut" or perform surgery.

Dr. Steven H. Miles, who has extensively studied the oath and what it meant in ancient Greece, believes that sentence simply reveals a division between specialties such as exists in medicine today. Saying 'I will not cut or sew but defer to those who do' reflected a medical advance, he said.

In his book "The Hippocratic Oath and the Ethics of Medicine," Miles calls the oath "a literary gem" that still sets the standard for medical ethics, even as some new physicians push at the boundaries of its solemnity.

In some new iterations of the oath, one student has sworn by "the music of the expanding universe" and another has sworn by "Humana and health maintenance organizations." Most hold to more traditional renditions that retain at least a memory of the original.

One commonly used rendition of the oath, written in 1964 by Dr. Louis Lasagna, then dean of the School of Medicine at Tufts University, recalls some themes of the original, such as respect for predecessors and mentors, and the need to safeguard the privacy of patients, and also notes that "prevention is preferable to cure."

But it departs not only from the archaic (a promise not to have sex with slaves) but also the controversial. In the original, physicians promise not to give a deadly drug and also not to give women a "destructive pessary," widely interpreted to mean a drug that causes them to abort.

Lasagna's oath says, "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."

While some people see this and other iterations as a perversion of an ancient oath that governed medicine until recently, the original oath wasn't even discovered until 900 A.D. and it has been frequently rewritten in the ensuing 1,100 years, starting with the Catholic Church's replacement of "I swear by Apollo" to "I swear by Jesus Christ, son of God."

We lost the oath for 1,400 years. We dont even know if it was widely used. It could have been a draft intended for some particular medical school. There is no ancient reference to it being used; theres only the document itself," Miles said.

It wasn't until the late 1800s that the oath turned up at medical school graduations in Europe, and it took another half-century to reach the U.S.

Miles said that oaths are important in defining both a profession and its ethical code. But he believes their value is diminished when divorced from their history. "Medicine is a moral community, and all moral communities have a historical dimension to them," Miles said. Im troubled by the idea of ahistorical oaths. To some degree, its a contradiction in terms.

One group that has held firm to its oath is the Boy Scouts of America, which adopted an oath a year after its founding in 1910. Then as now, Scouts pledge to "do my best to do my duty to God and my country and to obey the Scout Law; to help other people at all times; to keep myself physically strong, mentally awake, and morally straight."

Setting the standards

Dr. Robert Orr, a physician who lives in Vermont, has analyzed oaths in his profession and found that their usage increased dramatically in the 20th century.

In 1928, 24 percent of medical schools administered an oath. That jumped to 72 percent in 1958, and 100 percent in 1989. The oaths ranged from the original, to the one written by Lasagna, to that of Moses Maimonides, a 12th century Jewish philosopher and physician, whose oath was a prayer that included the line, "May I never see in the patient anything but a fellow creature in pain."

In a modern, pluralistic society awash with specialized professions, it's hard to find oaths that are one-size-fits all, Orr said, but that doesn't mean we should abandon them, or water them down.

"I put value in ceremony. I think the concept of taking an oath is a very good idea, but selecting what text to use is critically important. My bias is that it shouldn't be selected by students but by the profession itself," he said.

"If there are standards and I think there are practitioners of the art should articulate them, instead of asking new inductees to choose their own standards and boundaries."

Oaths are most often seen in the legal profession. In some states, including California, attorneys must take them before they are eligible to join the bar; they can either be professed with a group or in front of a notary public.

Witnesses in court swear to "tell the truth, the whole truth and nothing but the truth" in a practice that dates to ancient Rome; disrespectfully refusing to do that can land you in jail. This is true in Europe as well as America, and inattention to detail can cause problems. In Liverpool, England, in 2015, a mistrial was declared when it was noted that a Muslim witness swore his oath on a Bible, which the judge said rendered the oath invalid.

One oath that hasn't changed with the times is the one uttered by an incoming president. Whoever is elected Nov. 8, the transfer of power takes place in January after the new president utters the same words used by George Washington, plus four additional words that became traditional after Chester Arthur was inaugurated in 1881: "So help me God."

As allowed by the Constitution, the president will have the option of affirming or swearing to the oath, but only one previous president Franklin Pierce chose not to swear, for reasons unknown.
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