Hippocrates (460-377 BC), acknowledged to be the father of medicine, trained students and taught at the Asklepieion of Kos, a healing temple. He authored many of the books subsequently known as the Hippocratic Corpus. This was a collection of about seventy early medical works compiled by Hippocrates or his disciples, the most important of which was certainly the Hippocratic Oath, written in the latter half of the fourth century BC.1
Because man is a material being, he is by nature subject to illness and inevitable death. Individuals knowledgeable about and skilled in the treatment of diseases have emerged in all human societies. Initially, religious causes as well as physical causes were felt to be responsible for human sickness, but in the fifth century BC the role of the physician became separated from that of the shaman, or medicine man. Hippocrates and the golden age of Greek scientific development represent the beginnings of medicine as we know it today.
In this brief essay, I want to touch on the importance of Greek philosophy, particularly natural law and virtue, in the development of medicine; the place of ethics, or a sense of right and wrong, in medical practice; the value of philanthropia, meaning one's relationship to mankind and, for the physician, the love for one's patients; and the Christian ideal of compassion.
Medicine is a noble calling, perhaps the most noble, the priesthood excepted. This is because of the importance of the healing art to the well-being and the very life of every human being, but perhaps even more importantly because of the virtue and ethical standards required of the physician, which are exemplified in the Hippocratic Oath.
The oath is a mere 380 words in eight paragraphs (slightly longer than the Gettysburg Address, which is 272 words). It begins with a prayer; acknowledges past teachers; discusses dietetic, herbal, and surgical treatments as well as decorum; and ends with an admonition against, and sanctions for, violations of these injunctions. It is virtue-based and explicitly affirms the intrinsic value of human life by forbidding abortion and euthanasia.2
The essence of medicine is a covenant between a doctor and a sick patient. The term "doctor-patient relationship" (denigrated in this age of autonomy) sums it up. In an age of super-specialization, gatekeepers, and third-party payers, a "covenant" may sound trite, but the existential angst of a life-threatening illness demands unique human bonds.
Hippocrates taught and wrote at a time when Athenian philosophy was being classically defined by men of genius like Socrates, Plato, and Aristotle. Deductive science flourished. Nature was studied so that its laws might be discovered, and therapy was based on conformity to nature. Leon Kass put it well when he paraphrased the Hippocratic principle: "The physician is but an assistant to nature" and "the body is its own healer."3
The concept of virtue was also being explored. Happiness, as emphasized in Aristotle's Nicomachean Ethics, was conceived as the habitual practice of virtue. The decorum elements of the Hippocratic Oath reflect this standard by proscribing covetous desires toward members of the patient's family, breeches of confidentiality, and all "intentional injustice."
Ethics is a corollary of virtue. Some human actions are good and some are not. Human life is good and the taking of human life is wrong. Whether the Pythagorean philosophy contributed to this Hippocratic mandate is an interesting question, but ultimately immaterial. Critics like Steven Miles, Robert Veatch, and Albert Jonson aside,4 Hippocrates affirms that physicians must respect nature and human life.
Greek medicine, in contrast to the healing arts of oriental societies, such as those of Egyptian, Mesopotamian, and Indian cultures, employed science in the evaluation of symptoms to arrive at a diagnosis and prognosis. These efforts resulted in the beginnings of a medical practice grounded in a scientific understanding of nature. But Hippocrates' medicine was first and foremost an art - a techne, or technical endeavor. It was the relationship of a knowledgeable practitioner and a suffering sick patient.
The modern doctor-patient relationship is rooted in the Hippocratic concept of covenant. Leon Kass defines covenant as a "binding promise."5 This covenant is between the physician and the gods, as mentioned in the first sentence of the oath, but it can also be, as is now commonly believed, between the doctor and the patient. Does this include a simple contract between two legal persons? Yes, but it requires more. The true physician is guided by philanthropia, or love of mankind.
Compassion is a sharing in the suffering of another. This is a uniquely Christian virtue.6 Greek medicine was scientific and technically competent for its day. It expressed philanthropia, but it was not compassionate in the more profound sense of the word. Christ specifically made it a point to heal the sick. His agape, or selfless love, gives rise to compassion. In fact, most of His public miracles were about the healing of illness, and He healed specifically because He was moved with pity.7
Although Greek medicine dominated the Roman Empire, medicine changed as the empire became Christian, particularly after the edict of Milan in 313. With the breakdown of civil order, the monasteries and religious communities gradually assumed the role of medical practitioners. This Christian influence gradually pervaded the medicine of the declining Roman Empire. Compassion became a hallmark of medieval medicine, even making up for some of its technical deficiencies. (Unfortunately, much of this was dissipated with the Reformation and the dissolution of many religious orders.) Compassion became even more evident in the Byzantine east, where the Christian influence in medicine led to the development and founding of the first hospitals.8
Few human relationships are as basic as that between a healing physician and a sick patient. The doctor-patient relationship is defined by the Hippocratic Oath, which affirms the need to conform to nature and to the natural law; we are to respect life and not destroy it. However, the oath does not highlight compassion. This is a singular Christian virtue that has been introduced into medicine. While the doctor must be technically competent and professionally ethical, he should also strive to be compassionate as Christ was.
1 See Ludwig Edelstein, "The Hippocratic Oath: Text, Translation, and Interpretation," in Ancient Medicine and Selected Papers of Ludwig Edelstein, ed. Oswei Temkin and C. Lillian Temkin (Baltimore: Johns Hopkins University Press, 1983). [Back]
3 Leon Kass, Toward a More Natural Science: Biology and Human Science (New York: Free Press, 1985), 233. [Back]
4 See Steven Miles, The Hippocratic Oath and the Ethics of Medicine (Oxford, U.K.: Oxford University Press, 2005), 89; Robert M. Veatch and Carol G. Mason, "Hippocrates and Judeo-Christian Medical Ethics: Principles in Conflict," Journal of Religious Ethics 15 (1987): 86-105; and Albert Jonsen, A Short History of Medical Ethics (New York: Oxford University Press, 2000), 285. [Back]
5 Kass, Toward a More Natural Science, 243. [Back]
6 See my "The Christian Origin of Medical Compassion," National Catholic Bioethics Quarterly 5.2 (Summer 2005): 243-248. [Back]
7 See Matthew 14:14, Mark 1:41, and Mark 8:2. [Back]
8 See Timothy Miller, The Birth of a Hospital in the Byzantine Empire (Baltimore: Johns Hopkins University Press, 1985). [Back]