May is the month most American medical students finally see four years of grueling work bear fruit. Most U.S. medical schools hold commencement exercises in May, conferring “doctor of medicine” degrees in elaborate ceremonies. During these ceremonies, graduates recite oaths inspired by the 5th-century B.C. oath of Hippocrates of Kos, the “father of medicine.”
In the mid-20th century, medical schools began administering modernized versions of the oath, more applicable to modern times and sensibilities. In the last 20 or so years, many medical schools have created unique versions of the oath, often allowing students to compose them. These newer versions stray far from the oaths that older-generation doctors like me recited. Some have shifted the emphasis from patient care to social justice, generating a firestorm of controversy.
Yet all these oaths—traditional or modern—are self-indulgent. They focus primarily on how physicians should comport themselves, relate to professional colleagues, and view the medical profession’s role. But they also regard patients similarly to how parents regard children.
The original oath states, “I will prescribe for the good of my patients … and never do harm to anyone … nor give advice which may cause his death.” But it also pledges to impart to “the sons of the master who taught me and to the disciples who have enrolled themselves and agreed to the rules of the profession, but to these alone, the precepts and the instruction” (emphasis added) anticipating the protectionism of cartelized modern medicine.
The Declaration of Geneva, composed by the World Medical Association, states, “the health of my patient will be my first consideration,” while “maintaining the honor and noble traditions of the medical profession,” but makes no mention of informed consent or respecting patients’ choices.
Many medical school graduates of my generation recited the oath that Dr. Louis Lasagna, dean of Tufts University Medical School, composed in 1964. The oath pays proper fealty to patients’ privacy and to treat the whole patient—not just a set of lab tests or x-rays. And it pledges to “not play at God.” But the oath makes no references to patients’ freedom and autonomy.
Since the 1990s, many medical schools have added “white coat ceremonies” to the list of medical school rituals. These are ceremonies for incoming classes of medical students, where they also recite a version of the Hippocratic oath. The 2019 white coat ceremony oath for Harvard Medical School and Harvard School of Dental Medicine vowed to “place ethics and equity at the core of each patient interaction,” “combat structural oppression,” “promote social justice,” and “leverage our position of privilege to confront health inequities.” No mention of patients as autonomous individuals.
In 2020, students at the University of Pittsburgh School of Medicine white coat ceremony stated, “This oath is the first step in our enduring commitment to repairing the injustices against those historically ignored and abused in medicine: Black patients, Indigenous patients, Patients of Color and all marginalized populations who have received substandard care as a result of their identity and limited resources.” The students pledged to respect “the patient’s role as a vital member of the health care team” and “carry on the legacy of my predecessors by mentoring the next generation of diverse physicians.” (How good of them to recognize that patients should have some input into their care!)
Among the most controversial oaths was the white coat ceremony oath taken last September by incoming medical students at the University of Minnesota Twin Cities Medical School. After noting that the Medical School “is located on Dakota land” and committing to “uprooting the legacy and perpetuation of structural violence within the health care system,” the students pledged to “honor all indigenous ways of healing that have been historically marginalized by Western medicine” and did not only commit to healing the sick but to “healing our planet and communities.”
None of the oaths, dating back to the original, make more than a passing mention of respect for patients as autonomous, sovereign adults. All of them smack of paternalism. None of these oaths prioritize or consistently apply a commitment to individual patient autonomy, including respect for patients’ rights to self-medicate and to seek treatment from any health care provider they choose—an oath that states, for example, “Even if they act against my advice and I disapprove of their choices, I will respect the right of my patients as autonomous adults to self-medicate and oppose any laws and regulations that force them to seek my permission—or permission from any other health professional, through a prescription or otherwise—to consume medications or treatments according to their independent judgment.”
Today’s medical students should reject being forced to take oaths that have nothing to do with patient care. Instead, a noble profession should require its students and graduates to swear an oath revering patients’ rights and autonomy.