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Medicina y ética
versión On-line ISSN 2594-2166versión impresa ISSN 0188-5022
Med. ética vol.35 no.2 Ciudad de México abr./jun. 2024 Epub 04-Jun-2024
https://doi.org/10.36105/mye.2024v35n2.02
Articles
Analysis of the applicability of medical oaths from the perspective of personalist bioethics with an ontological foundation
*Miembro activo de la Asociación Médica Mundial, Médico Cirujano por la Universidad Anáhuac México Norte, Huixquilucan, México. Máster Universitario en Bioética por la Universidad Francisco de Vitoria, Madrid, España. Correo electrónico: sandovalop.97@gmail.com
The medical profession has always been willing to serve mankind, which has historically required the establishment and development of different oaths, codes, and laws on the actions of physicians, as well as the application of responsibilities and rewards or punishments derived from their actions. This paper aims to define and analyze the presence of the guiding principles of bioethics in the Hippocratic Oath, the Declaration of Geneva and in the formula for today of the Hippocratic Oath of Dr. Herranz, as well as to demonstrate the importance of their compliance in contemporary medical practice. Finally, what is considered the best oath proposal according to the guiding principles of personalist bioethics with an ontological foundation is presented.
Keywords: human life; medicine; history of medicine; law
La profesión médica siempre ha estado dispuesta al servicio del hombre, lo cual ha exigido, históricamente, que se establecieran y desarrollaran diferentes juramentos, códigos y leyes sobre el actuar del médico, así como la aplicación de responsabilidades y gratificaciones o castigos derivados de sus actos. Este trabajo pretende definir y analizar la presencia de los principios rectores de la bioética en el juramento hipocrático, la declaración de Ginebra y en la fórmula para hoy del Juramento de Hipócrates del doctor Herranz, así como busca demostrar la importancia de su cumplimiento en la práctica médica contemporánea. Para finalizar se presenta, la que se considera la mejor propuesta de juramento de acuerdo con los principios rectores de la bioética personalista con fundamentación ontológica.
Palabras clave: vida humana; medicina; historia de la medicina; leyes
1. Introduction
Medicine is as old as the presence of man in the world, the first manifestations date back to 4000 BC in Mesopotamia and Egypt, where magical medicine was considered the cornerstone of treatment, mainly focused on the expulsion of impure or evil spirits that took possession of the sick person and was attended by priests, soothsayers and exorcists as deemed necessary.
With the passage of time, this magical-spiritualist conception of medicine underwent a great change when it was modified by the medical therapeutics that oversaw the Azu or healers (1). Therapeutics at that time was based on taking advantage of elements of nature to cure certain ailments. Later, around the 21st century BC in Mesopotamia “The Sumerians wrote the first medical prescription on a clay tablet in 2200 BC” (2, p. 209) known as the Nippur tablets, the first engraving containing specific treatments, and by the 22nd century BC. Hammurabi king of Babylon established a code based on rewards and punishments related to medical practice that is not considered a code of ethics (3).
The evolution of medicine continues to the present day. The development of technosciences in the medical field, as well as the sensitive characteristics of patient care, has made it necessary to establish oaths focused on ensuring the best care for patients and avoiding errors that could harm the people being treated.
This paper presents the historical narrative and bioethical analysis of the Hippocratic Oath, its contemporary update represented in the Geneva Declaration, as well as the formula for today of the Hippocratic Oath of Dr. Herranz. Finally, the aim is to demonstrate and determine the validity and bioethical applicability of medical oaths in today’s world and the new oath proposal is presented from the perspective of personalist bioethics with an ontological foundation.
2. Methodology
An exhaustive search was carried out in different databases of medical-scientific literature in both Spanish and English related to medical oaths. The following keywords were used as inclusion criteria: medical oaths, principles of bioethics, history of medicine; duplication of information between articles was considered as an exclusion criterion. Forty-seven files were obtained and after the application of the inclusion and exclusion criteria, 33 bibliographic sources relevant to this work were selected.
3. Hippocratic medicine
Hippocratic medicine is based on observations of nature and its influence on man. It was born approximately in the 5th century B.C. with Hippocrates of Cos who is known as a direct descendant of Asclepius,1 and who by then used an important part of the scientific method and according to Campohermoso et al. “Hippocrates2 used his senses and his reason as the only diagnostic instruments, developing a rational system based on observation and experience” (4). With the presence of Hippocrates and his school, the clinical history was also born as the starting point of all medical-health care that originates through detailed observation and seeks to define the disease, “he began clinical practice at the bedside (clinic) of the patient and repeated the observations over and over again until he knew the distinctive signs of each syndrome” (4). It is clear that the contributions made by Hippocrates have validated the title of “father of medicine” (4).
4. Hippocratic Oath
The school founded by Hippocrates is credited with creating the first treatise related to the practice of medicine, it was included as part of the compendium of the “Corpus Hippocraticum to convert medicine into a systematic science and defined a code of ethics and deontology” (5), it allowed to understand medicine as a rational practical knowledge and completely moved away from empiricism. The oath in its Spanish version translated by Herranz (6) reads:
I SWEAR by Apollo, physician, by Asclepius, and by Hygieia and Panacea, and by all the gods and goddesses of Olympus, taking them as witnesses, to fulfill this oath according to my ability and my conscience:
I WILL hold him who taught me this art in the same esteem as my parents, I will share my goods with him, and, if he should need it, I will help him with my goods. I will consider his children as if they were my brothers and, if they wish to learn the medical art, I will teach it to them without demanding anything in payment. To my children, to the children of my master and to those who will obligate themselves with the oath that the law of Medicine commands, and to no one else, I will teach the precepts, the lessons, and the practice.
I WILL APPLY my treatments for the benefit of the sick, according to my ability and good judgment, and I will refrain from doing them harm or injustice. To no one, even if asked, will I give poison, nor will I suggest to anyone to take it. Likewise, I will never give any woman an abortifacient pessary.
I WILL ALWAYS LIVE and practice my art in purity and sanctity. I will not practice surgery on those who suffer from calculi but will leave that operation to those who are engaged in it. Whenever I enter a house, I will do it for the good of the sick person. I will abstain from any evil deed or injustice and from having erotic relations with women or with men, whether they are free or slaves.
I WILL KEEP silence about what, in my practice or out of it, I see or hear, which concerns the lives of men, and which should not be divulged. I will keep secret all that would be disgraceful if known to people.
IF I WOULD BE FAITHFUL to this oath and not violate it, may I be granted to enjoy my life and my art, and be honored forever among men. If I should break it and swear falsely, may the contrary befall me.”
4.1 Analysis
The triangular method of personalist bioethics with ontological foundation proposed by Elio Sgreccia, allows to consider the application of an “examination that has three points of connection” (7) and as a first step allows the objective analysis of the anthropological implication of all the actions of man, therefore, the initial paragraph of the oath places the physician before the commitment in front of various deities.
Apollo is the father of Asclepius, god of medicine instructed in the arts by the centaur Chiron and later annihilated by Zeus because of his great ability to circumvent the patient’s illness by resurrection (8). The daughters of Asclepius, Hygieia “Goddess of healing, cleansing and healing” and Panacea “the goddess of health” (9). The above shows that the religious reality of physicians has never been completely uprooted from the very essence of the profession, i.e. trust in the deity, in this case highlighting deities that together can heal or improve the health of those who seek their help. The religious belief of this time is an essential part of medicine and is an element very similar to the current beliefs where the deities are also attributed gifts and healing qualities.
The second paragraph demands the obligations to others and society, it focuses on the search for the good for one’s own and the imperative need to transmit knowledge to anyone who is willing to swear, always under the commitment not to break the stipulated. It is, in Insua’s words, the principle that “highlights life as a social good, and the promotion of the common good to achieve it” (10), where the physician is a participant and promoter of the welfare of others, specifically of the sick, understanding them as the most vulnerable people.
Promoting benefits is the purpose of the third paragraph, doing good (4) and avoiding harm related to the treatment provided to the patient places us directly in the principle of beneficence. However, we cannot abandon the consideration of the use of the science available up to that moment, clarifying by Hippocrates himself the act regarding good judgment, which according to the first definition of the dictionary of the Spanish language is the “Faculty by which the human being can distinguish good from evil and the true from the false” (11). There is no better way to seek to confirm what is true if not by the hand of scientific verification, attending then to the second edge of the triangular method proposed by Sgreccia, which puts science at the service of man and seeks in this way to explain and confirm the reality in which we live.
The primum non nocere, Latin translated into English as the first thing is to do no harm, is found in the content of this same paragraph which is accompanied by the care of human life, because it is true and proven that the principle of every right of man is born in his right to live, without this right it is impossible that all the others can be given.
“The ethical precepts of the Hippocratic Oath constitute, throughout history, the unity and foundation of Medical Ethics” (12). Ethics, the last part of Sgreccia’s method, is dominated by the physician’s duty to do his best for the preservation of man, who cannot be and will not be if life does not exist in him. The Hippocratic impediment is extremely clear, the doctor’s duty is to cure, to palliate, to accompany and to serve, but it will never be to kill. This idea is clearly reinforced in the third article of the Universal Declaration of Human Rights “Everyone has the right to life, liberty and security of person” (13), where life as a right is recognized as a matter of course by all participating member countries and has been ratified on many occasions. We can recognize that Hippocrates coincides perfectly with the principle of defense of physical life as part of personalist bioethics.
The fourth paragraph follows the idea of the previous one in which this oath makes clear the correct action, the ethics in the daily work of the physician who practices the profession, an impeccable character and conduct aimed at the personal welfare, of the guild, but above all, of the patient. In short, respect for the value of the person by the mere fact of being a person, that value is the ontological dignity recognized in everyone and by everyone.
The second last paragraph limits the duty of the physician in relation to the secrecy he must keep about the ailments that afflict his patient, ailments that can be of any kind if we consider that the definition of health in our time will not only deal with the physical aspect, but according to the World Health Organization (WHO) it is: “a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity” (14), and from the perspective of bioethics discussed here this definition is incomplete, since it should not exclude the part that corresponds to spiritual health, because “it is an important element in humanizing health care” (15).
The integrality of the person implies respect for all the parts of which he is composed, both materially and immaterially, in accordance with the personalist principle of totality which “derives directly from the imperative of respect for life” (16). The duty of the physician to his patient is established from the first consultation and is renewed in the subsequent ones, this relationship imposes on the physician the obligation to take care of what is entrusted, it is a secret that seeks to safeguard the good name and image in public and private life, in the most intimate part of the person, which is health. The document that currently allows this duty to consider the person as such and to treat him/her in the same way is the informed consent.
Every oath implies the obligation in its fulfillment, and as the Hippocratic expresses it well, there are realistic and punishable consequences if the given word is followed or not, and in law an oath seeks to strengthen the word of the one who professes it and reaffirms this commitment before the deity before the one who presents it, that is to say, it is supported and sustained in the transcendental plane and the beliefs of man that ultimately is the most intimate part of the own being. The transcendental part is found in the ontological conformation of man himself, specifically of the doctor who swears and whose goal leads him to develop his own nature by putting himself at the service of man. He becomes a man for other men.
In the last part of the oath Hippocrates mentions medical responsibility, which was not a novelty even for the time, but was a customary practice that should and must be followed by everyone who professes the oath. The doctor who exercises the profession is committed to cure the patient, not to heal him completely (17), healing is something impossible to achieve and that is why healing implies being attentive to the patient’s requirements and providing him with the adequate and necessary help, always with prudence and adhering to the principles of therapeutic proportionality, which “is the technical-medical adequacy or inadequacy, that is to say, to evaluate with technical-medical criteria its use, in relation to reach a certain health or vital support objective for the patient” (18), and will depend on the characteristics that the care of the sick person requires, therefore the objective is to take advantage of science using all the resources and lawful means available within its reach.
5. Medicine in World War II
The Second World War3 was a key historical event for the birth of important advances in science and its use in the war economy, where one of the most important bastions was focused on health. Physical health has always been considered extremely important in all the armies of the world, because by having it, it is possible to have people fit and willing to fight in times of war and not only that, but to consider the possibility of winning.
Ignoring the established codes of war, as well as the inherent characteristics of war, results in abuses that can be perpetrated by all parties involved. These abuses are born where the ultimate consideration of the higher value of a person’s life is lost, as it is most unnatural for men to kill each other. However, it is also important to understand that in these historical episodes there are aspects that promote positive and negative outcomes related to the health of the people involved, mostly civilians.
Science has required research to nourish itself to understand the world more accurately. During World War II, many of the most aberrant experiments in the history of mankind were carried out by the German ruling power, represented by the National Socialist Party. The ideological conception of reality makes it seek to be adapted to the way it is thought that the criterion of what is believed to be the most valid is established.
The absence of any ethical approach motivated by an extremely racist ideology, caused personalities such as the physician Joseph Mengele, who was better known as the “angel of death” (19),4 to take advantage of his situation of power and domination. He, together with other doctors developed and promoted the worst experiments that were mostly performed on Jewish and Roman Catholic Polish prisoners, and it is worth mentioning that, among these, most of them were women (20), not being enough, in the last years of war, Mengele focused his attention on experimentation with children, particularly twins (19).
Not everything that was done was bad, there are also many examples of advances for the benefit of society. As an example, the use of new antibiotics allowed higher cure rates and decreased mortality caused by infectious diseases, as well as allowed advances in the field of surgery. The conclusion is that wars mobilize the world, the problem is that the mobilization that is generated involves many deaths.
After the defeat of Germany in 1945 and the discovery of the atrocities perpetuated in the different concentration camps, the whole world looked with contempt on the actions committed, this demanded the realization of the Nuremberg trials. Within these trials was the medical trial that was held from December 1946 to August 1947. It is highly relevant to mention that according to Lichterman: “The defendants claimed that their opinions were in accordance with the Hippocratic oath, but the text of the oath is so opaque that it admits of various interpretations and, in any case, no German doctor has ever taken it” (21) and as a final result of the trials it was understood that in the world there is no place for this type of actions and they are by all reprehensible, so driven by the ethics of research the Nuremberg code was promulgated in 1948 which dictates the rules to follow in relation to human experimentation (22).
6. Geneva Convention of 1949
The Geneva Convention was developed “by combining the three previous conventions of 1864, 1906 and 1929 and adding a fourth in 1949” (23). As a result of the techno-scientific aberrations committed during World War II the World Medical Association (WMA) in 1948 adopted the Geneva declaration, considered as the modern version of the Hippocratic oath.
6.1 Declaration of Geneva updated in 2017(24)
Promise of the physician
AS A MEMBER OF THE MEDICAL PROFESSION:
I PROMISE SOLEMNLY to devote my life to the service of humanity.
TO ENSURE first and foremost the health and well-being of my patients.
TO RESPECT the autonomy and dignity of my patients.
TO ENSURE with the utmost respect for human life.
I will NOT ALLOW considerations of age, illness or disability, creed, ethnicity, gender, nationality, political affiliation, race, sexual orientation, social class, or any other factor to come between my duties and my patients.
TO KEEP AND RESPECT the secrets entrusted to me, even after the death of my patients.
TO EXERCISE my profession with conscience and dignity, in accordance with good medical practice.
PROMOTE the honor and noble traditions of the medical profession.
GIVE my teachers, colleagues, and students the respect and gratitude they deserve.
SHARE my medical knowledge for the benefit of the patient and the advancement of health.
CARE for my own health, well-being, and abilities to provide the highest level of medical care.
NOT USE my medical knowledge to violate human rights and civil liberties, even under threat.
I MAKE THIS PROMISE solemnly and freely, pledging my word of honor.”
6.2 Analysis
The physician’s promise is very important as it expresses the will to do and fulfill what is professed. The will must be understood as the superior capacity of man that allows him to develop as a person, based on discernment and the good use of reason expressed in a precise, objective, and unwavering decision. It requires, therefore, to be fully aware of what is promised and to be willing to fulfill it.
Every physician who swears or expresses his will on the basis of this promise, consecrates himself to the service of man and becomes the servant of others, therefore the declaration clearly states that the promotion of well-being will be sought because it allows man to express his being and the ultimate purpose of his nature, which is always accompanied by respect for his capacity of decision within the good use of reason. Respect that is expressed in the autonomy of the patient, but without ever forgetting the dignity that, from the ontological personalism, every person will have by the simple fact of being a person. It should be understood then that human life from fertilization (25) until death has the protection and respect of the physician who promises, since the value of this is found and the ability to be lived.
There are patients suffering from diseases5 and the duty of the physician is to treat them as such, since the person is the center and origin of the medical profession. The relationship that is created then is that of peers because there is mutual collaboration in the doctor-patient relationship, where both seek to benefit the health of the one who is most vulnerable and who must be helped. All efforts must be directed towards this single objective.
The value of a person can never be defined by his or her way of thinking, dressing or being. Discriminatory attitudes have no place in the medical profession; everyone should be treated equally, according to the specific needs and requirements of the patient. The physician is obliged to know the medical particularities that exist related to each of the phototypes, population subgroups and people with special characteristics, since this allows optimizing medical care and thus the service provided is always the best.
Knowledge that is not practiced and not transmitted is dead knowledge, the art of caring is for anyone who seeks it and is willing to commit, this promise, as in the Hippocratic oath, requires the doctor to be an agent of change, to lead by example. The same promise demands the pursuit of honor, which originates from doing what is done in the best possible way and is based on respect, above all things, for the dignity of the physician, which requires him to take care of himself, since it is impossible for a sick person to take care of another sick person.
The word of honor, the last sentence of the promise affirms the duty of fulfillment of the one who promises, the given word obliges to fulfill all the above mentioned at the risk of losing the good honor forged. And swearing does not imply that the person complies, since that depends on individual responsibility, losing the good image of the physician is to have a reputation that does not go according to the search for the best for society (26) and at the same time the guild as a profession is disrespected. The importance of the word lies in the fulfillment of saying what one thinks and doing what one says, in short, is to be coherent in daily life.
7. Oaths today
The use of the Hippocratic oath, as well as the promise in the declaration of Geneva is a commitment adopted by the doctors in the world, and for it “to be licit it is required that it be truthful, fair and with judgment. One cannot swear not to express what is true or not to want to fulfill what is promised” (27), it is important to remember what the care of the sick means for Hippocrates and according to Jaramillo: “He maintained that there can be nothing more noble and important than protecting the health or caring for the illness of the human being, since this is the central figure of history and the end of it” (28).
It is true that cultural factors have changed throughout history and there are multiple oaths that the physician can profess, however, the adaptability of these oaths makes them an updated and applicable instrument in medical practice today, since they respect the value of the person as the highest good to be protected. It is true that if one is exact, precise, and pragmatic, the Hippocratic Oath and its updated version in the Geneva Code do not mention each one of the praiseworthy principles that the physician must follow, but any person with judgment and reason will understand them in the text.
To provide a published oath which, in the author’s opinion, is easily adaptable and applicable from the perspective of personalist bioethics with an ontological foundation, I recommend the use of the one created by the Value of Life Committee, Inc. and translated into Spanish by Dr. Gonzalo Herranz (29):
A formula for today from the Hippocratic Oath:
I SWEAR in the presence of the Almighty and before my family, my teachers and my colleagues that, according to my ability and my judgment, I will keep this Oath and each of its Clauses: I WILL have the same affection for all who have taught me this art as for my parents, and with their same spirit and devotion I will impart to others the knowledge of medical art. I will diligently keep abreast of the progress of Medicine. Without discrimination and to the extent that it does not jeopardize the care I owe to my other patients, I will treat all who seek my services and will seek, when required for the benefit of my patient, the advice of more competent colleagues.
I WILL FOLLOW the method of treatment which, according to my skill and judgment, appears to me to be in the best interest of my patient, and I will refrain from any harmful or malicious action. I will never prescribe or administer to any patient, even at his request, a medicine in lethal dosage, and I will never advise any such thing; nor will I do anything, by act or omission, with the direct and deliberate purpose of terminating human life. I will have the utmost respect for all human life from the moment of fertilization to the moment of natural death, and I will reject abortion which intentionally destroys a unique and unrepeatable human life.
WITH PURITY, HOLINESS AND BENEFIT I will conduct my life and practice my art. Unless necessary for the prudent correction of imminent danger, I will never treat my patients or do any research on any human being without the valid informed consent of the subject or his or her relevant legal guardian, provided that the research is for the purpose of improving the health of that individual. Wherever I go to treat patients, I will go for their benefit, I will refrain from any willful malicious or abusive action, and I will never seduce any patient.
EVERYTHING that I may see or hear of my patients’ lives, either in connection with my practice or unrelated to it, which should not be divulged, I will tell no one, knowing that I must keep it all secret.
SO LONG AS I KEEP this Oath inviolate, may I be granted the opportunity to enjoy life, and to practice the art and science of Medicine with the blessing of the Almighty and the respect of my colleagues and of society. But should I break and violate this Oath, may the contrary be my fate.
7.1 Discussion
Medical oaths must be fully complied with and with the respect that has the value of the word of every health professional who professes them. In the case of those discussed here, it is evident that they are in line with respect for the dignity of the person (by the mere fact of “being” a person) and thus seek to safeguard the respect for life that is given in the very configuration of its existence.
Table 1 shows whether the oaths analyzed here mention the most important principles in the most important bioethical currents.
Table 1 Bioethical principles in medical oaths
| OATHS | BIOETHICS TREND | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Principlist | Personalist | Ontological Personalist | |||||||
| Non maleficence | Beneficence | Autonomy | Justice | Defense ofphysical life | Tatality or therapeutic | Freedom and responsability | Sociability and subsidiaity | Dignity | |
| Hippocratic Oath | P | P | O | P | P | O | O | P | O |
| Geneva Declaration | O | P | O | O | P | O | O | P | P |
| A formula for today from the Hippocratic Oath. | P | P | P | O | P | P | O | P | O |
| Symbology |
P IT IS TREATED O IT IS NOT TREATED |
||||||||
Source: prepared by author.
The deficiencies in the Hippocratic Oath, the Geneva Declaration and the formula proposed by Herranz are the existence of omissions with respect to the non-explicit or poorly developed mention of the principles indicated in Table 1 as not being dealt with; however, we consider that all three are applicable as long as certain modifications are made that consider above all the respect for enforcing the oath, as well as the promotion and care of human life as the starting point and center of medical-health care.
8. Conclusions
To understand that the bad ideologies in the world, specifically the fascist ideology represented in this article by Nazism (fully racist) in which we can clearly identify key ideas to relate it directly to transhumanism. In this regard, Dr. Elena Postigo (31) adequately explains that this idea seeks the perfectibility of the human species through its improvement using technological tools that allow it to be superior to others, this generates racism due to differences in the conditions of development and the degree of superiority of one against the other.
The phrase “as medical technology advances, medical humanism regresses” (32) is often true. From the point of view of personalist bioethics with an ontological foundation, it is thought that science and its use should always be focused on what is best for man without him losing his quality of man, i.e., what makes him enhance his capabilities without losing his dignity or overpassing that of others.
9. The importance of swearing
The focus of the good deed expressed in oaths, codes and norms will always be for the greatest benefit of man in any of the stages and conditions in which he finds himself, always attending to the principles of personalist bioethics with ontological foundation, which is not a novelty, it has existed and has been part of the history of medicine even when it had not been recognized as such.
The person who takes the oath accepts and must be aware that accepting the precepts mentioned is not a game, nor a mere commitment. The person who swears an oath and then does not fulfill what he promised cannot be integral, because then he would not keep his word and would lose the value of everything he does and says, not only what he does in relation to the medical act, but also what he does in everyday life. Being integral, ethical, and complete in the minimum, allows us to be complete in the maximum, man is much more than the sum of the parts that compose him, man is body and unified spirit. Failure in the smallest portion of one of these affects the others.
The timeliness, validity and values highlighted in the oaths and promises discussed here, particularly the one proposed by Dr. Herranz, make it inconceivable that they are prone to be broken by fads or ideological fallacies that appeal to end the life of the most vulnerable, as Dr. Jérôme Lejeune puts it: “the doctor can overcome the disease on condition that he respects the patient” (30) and the patient cannot be respected unless his right to live is promoted in the first instance. The clear wording and actuality of the oath proposed by Herranz makes this proposal, from the point of view of personalist bioethics with an ontological foundation, the most complete to be professed by the medical profession; however, it is important to point out that any oath that is professed and as long as it is done with good intentions will allow the physician to respect the dignity of the person, which is ultimately expressed in respect for life.
Aristotle understood very well the importance of man’s being and it is prudent to affirm that “the philosopher must begin by studying medicine and the physician must finish by studying philosophy” (33), in the end the truth always prevails and the value of the person as the center of all the physician’s work for the benefit of society must be present and guide his steps.
10. Author’s proposal
The purpose of my proposal for an oath is to synthesize and take advantage of the principles that guide the currents of bioethics with the greatest influence in society and those that in my opinion are broadened and deepened from the perspective of personalist bioethics with an ontological foundation:
Ontological personalist oath for healthcare professionals.
Under oath to tell the truth, I, as a physician, swear before God, my family, my guild and society as witnesses, that I will fully comply with all the precepts presented here.
I will teach the medical arts with passion and dedication. I will never fail to update myself or prevent others from doing so. I will always share my knowledge with those who request it, always for the greater benefit of the patient and society.
I will respect and promote the life of every person and will never practice or promote abortion. I declare that I will not directly or indirectly apply any medication or procedure that will procure the unreasonable harm or death of any person from fertilization to natural death.
I will treat my patient in a preventive manner, avoiding as far as possible the appearance of the disease in him/her, and if it is necessary to intervene on him/her, I will do it in a manner proportionate to his/her clinical conditions and I will seek to promote life as the first instance, function as the second and aesthetics as the third, always adhering to the principle of therapeutic totality.
In case of not being able to cure my patient, I will provide palliative care so that through adequate attention and orthothanasia, he/she can cope with the disease and move to death accompanied by his/her family and loved ones in the best possible conditions.
I will provide medical care with dignity to all patients for their benefit and will never seek to harm them. I will apply medicine with fairness and diligence as far as my knowledge permits and when this is not possible, I will refer my patients in a timely manner to whom I believe can care for them better than I can. I will always be attentive to the needs of my patients, I will allow them to act and decide in freedom and responsibility, so I will respect their autonomy by providing them with the different therapeutic possibilities explained in depth, all of which will be expressed in the informed consent. Accordingly, I will keep professional secrecy of everything that happens during my medical care, to safeguard the integrity and good image of my patient. I will be a reference in my dress, behavior, and treatment of others, I will always act in conscience and for the greater benefit of myself and society, I will never seek actions or omissions that damage my good image or that of my colleagues under any circumstances.
I pledge above all my word of honor and if I follow these precepts, I will demand that I be allowed to live happily and abundantly, but if on the contrary I do not comply with this oath that I be severely punished and never be allowed to practice this noble profession.
11. Acknowledgements
To Montserrat Gutiérrez and the Sandoval family who always helped me to improve the manuscript by revising it.
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Received: November 22, 2023; Accepted: December 21, 2023
Este es un artículo publicado en acceso abierto bajo una licencia Creative Commons
