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What happened to the Hippocratic Oath?

February 6, 2009

Please read this article first: Fla. doctor investigated in badly botched abortion

This post is a result of a friend posting the article on Facebook, and my comments in reply to his posting and any other readers are as follows:

  1. First of all, developmentally speaking, a fetus is considered viable once it has developed to an age at which the lungs will support life – usually 21-24 weeks. Though intensive, extensive, and expensive medical care will be required initially and likely throughout the individuals life. In this case, the mother was determined to be at 23 weeks gestation, well accepted academically to be old enough to support life, however fragile.
  2. The article states that the infant was determined to have lungs filled with air (not amniotic fluid). This means that the child had taken at least one breath. At this point, we can no longer allow the “is a fetus a life” argument because the lungs were developed enough to fill with air on a breath.
  3. Now… based on the little bit of forensics I’ve learned from my professor, William, the prosecutor can press for murder charges because the burden of proof that the infant was born “alive” is supported by the findings at autopsy (see point 2). I do not necessarily agree with the cause of death (COD) (“extreme prematurity”) as stated in the article. I feel that there must be – have to be – at least one or two subsequent CODs (i.e. extreme prematurity due to _____ due to _____).
  4. I do not have much knowledge in this area yet, but I am of the opinion that this physician has committed gross negligence and medical malpractice, and as such, should have his license revoked by the state and not allowed to practice in any other state. His lack of ability to provide care for this patient demonstrates that he is incapable of providing care to anyone else.
  5. Finally, I bring in the Hippocratic Oath (from the NLM, NIH). The Hippocratic Oath, according to this NLM document, is no longer required recitation of graduates from Allopathic – or M.D. – medical schools (Osteopathic – or D.O. – medical schools use their own Oath). I believe that I had heard this before, along with the understanding that the schools not using the Hippocratic Oath were using an oath that is more politically correct and “in tune” with today’s society. This is a travesty. What is wrong with saying (in my verbage), “To the best of my ability, I will not harm my patients.” Or what about, “I will not prescribe or administer a lethal drug to any patient for the purpose of assisting in their suicide.” Those are not so bad. Oh, but the next one is the catch: “I will not perform abortions or assist with the practice of abortion.” That is not kosher in today’s society. Abortion is OK. Well, at least by societal standards. In this discussion point I have strayed far. I am sure I will return to one or several of these soon. This physician did harm: to the mother emotionally and to the child who died.

In summary: this physician and these clinics screwed up. They failed to meet a standard of care (in my opinion). They let an 18-year-old deliver a baby, which has been shown to have breathed, and then allowed it to die without an effort to provide medical care. If one wants to attempt to argue the point of a lack medical care – go for it. I would like to see what you have to say. But I hope you do not make it very far down that road, because if there was adequate medical care (or referral to adequate medical care) how does the child, umbilical cord, placenta, and afterbirth end up in medical waste refuse?

I swear by Apollo the physician, and Asclepius, and Hygieia and Panacea and all the gods and goddesses as my witnesses, that, according to my ability and judgement, I will keep this Oath and this contract:

To hold him who taught me this art equally dear to me as my parents, to be a partner in life with him, and to fulfill his needs when required; to look upon his offspring as equals to my own siblings, and to teach them this art, if they shall wish to learn it, without fee or contract; and that by the set rules, lectures, and every other mode of instruction, I will impart a knowledge of the art to my own sons, and those of my teachers, and to students bound by this contract and having sworn this Oath to the law of medicine, but to no others.

I will use those dietary regimens which will benefit my patients according to my greatest ability and judgement, and I will do no harm or injustice to them.

I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.

In purity and according to divine law will I carry out my life and my art.

I will not use the knife, even upon those suffering from stones, but I will leave this to those who are trained in this craft.

Into whatever homes I go, I will enter them for the benefit of the sick, avoiding any voluntary act of impropriety or corruption, including the seduction of women or men, whether they are free men or slaves.

Whatever I see or hear in the lives of my patients, whether in connection with my professional practice or not, which ought not to be spoken of outside, I will keep secret, as considering all such things to be private.

So long as I maintain this Oath faithfully and without corruption, may it be granted to me to partake of life fully and the practice of my art, gaining the respect of all men for all time. However, should I transgress this Oath and violate it, may the opposite be my fate.

  1. Ian Speir permalink

    Holz — we are in heated agreement. My comment to the posted item was pure sarcasm, meant to demonstrate the absolute absurdity by which the mind conceives a life in (or outside of) the womb. The woman’s “choice” as to the child does not make it any less “a life.” If that were so, the value of life would follow the spectrum of “choices” as to a child (from doting affection to malicious beating). Where parental “choice” did not protect the child from harm, then the state would have no right to intervene to protect the child from harm.

    But this is absurd. Inchoate “choice” (a mother’s intent) does not change the fundamental character of a thing — it is either “life” worthy of protection or “not life,” entitled to nothing at all. And we contend a child (in or out of womb)is “life.” “Choice” plays no part in the matter, and in almost ALL OTHER cases in our legal system, “choices” taken as to a life which imposes harm on that life is criminal.

  2. Your link doesn’t work. I’d be interested to see the story before making a comment, though based on what you have said:

    If this was not an induced labour, and the delivery was done at 23 weeks, or indeed up to 25 weeks, this is a grey zone. It is not an abortion, but neither is a parent or physician obliged to go to heroic measures to keep such a baby alive, as it is a. unlikely to survive even with the best care and b. if it should survive, likely to suffer a great deal.

    My read on things is this was an acceptable, if distasteful and difficult choice.

    What does, however, disturb me, is the manner in which you imply the remains were treated. They do deserve a respectful “disposal.”

    PS best of luck on the match

  3. mholzmann permalink

    The link to the article has been updated to a print version from the ABC News website. Hopefully this link will remain longer than my original link from the Buffalo News.

  4. williamthecoroner permalink

    The “new” Hippocratic oath is updated to take into account the actions of physicians in Nazi Germany (who took the old Hippocratic oath, btw) and to remove references to Pagan gods, which bothers some folks.

    I’d concur, make that “extreme prematurity due to elective termination” on the DC, and that’s a good point. If the infant is old enough to breathe on its own, is there not then a responsibility to treat that infant? Something to look up.

    And good luck with OSU.

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