‘Swear by Thy Gracious Self’: North American Medical Oath-Taking in 2014/2015

Abstract

Over the past century, six studies – the most recent data from 2000 – and one review have comprehensively examined the content of medical oaths and oath-taking practices, all focusing on North America, providing an insight into the ethical beliefs of each era. Our study sought to establish a new point of reference. In 2014/2015, oaths from 150 of all 153 US and Canadian medical schools were collected and analyzed. All but one school administered medical oaths and most schools administered more than one. Since 2000, student-written oaths became more popular, and new themes, such as self-care and professionalism, were identified in the oaths for the first time. However, as was identified in 2000, the oaths’ contents are disparate and even conflicting at times, raising questions as to whether medicine is being taught or practiced with a coherent ethical worldview.

KEYWORDS:

• Medical oaths
• hippocratic oath
• white coat ceremonies
• medical ethics
• oath-taking
• medical education

Acknowledgements

The authors would like to thank Dr John Patrick for inspiring us to perform this research and Dr Gul Russell for her ongoing academic and moral support as it was written (and regularly rewritten). We would also like to thank Linda Gamble for her kind assistance in helping to proof and edit the manuscript in its various stages of development.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 Code of Professional Conduct, Oath of Commitment, Sponsio Academica, Declaration of Geneva, Oath of Louis Lasagna, faculty written oath, modified Hippocratic Oath, and ‘Physician’s Oath’. ‘Unsure of oath origin’ designations were also placed in this category.

2 Traditional Hippocratic oath, Oath of Maimonides.

3 Our study did not anticipate the substantial number of schools that were administering multiple oaths and thus our data collection was not set up to compare oaths within each school. It would be an interesting point of future inquiry to see whether subsequent oaths are repeats of the oath first administered, supersede/build upon the first oath, or are entirely incongruent with that first oath.

4 A smaller study of 2015 oaths found that the traditional Oath was not administered, but this conclusion was likely limited by a smaller sample size (Dossabhoy et al. 2018).

5 All figures in this paragraph reflect theme prevalence by school, not by oath (some schools administer multiple oaths as noted above).

6 No comparator exists here as this paper was the first to explicitly track the theme of ‘self-accountability’.

7 We commend the translation and commentary of Edelstein for a more detailed analysis of the Hippocratic Oath (Edelstein, 1943).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Nathan Gamble

Nathan Gamble is completing his Royal College fellowship in cardiology at the University of Alberta, having received his medical doctorate from the University of Toronto and his Royal College qualifications in internal medicine. He holds an MA in Bioethics and Medical Law and is completing an MSc in Clinical Trials at the London School of Hygiene and Tropical Medicine.

Benjamin Holler

Benjamin Holler earned his medical degree and MBA from Texas A&M University. He also attained a master’s degree in medical ethics and works as an ER physician around Nashville, TN.

Stephen Murata

Stephen Murata, MD is a physician resident in psychiatry at Michigan State University/Pine Rest Christian Mental Health Services. His interests include bioethics in psychiatry, suicide prevention, biomarkers, and child adolescent psychiatry.