THE EGYPTIAN DOCTORS OATH- DIVISIVE, DISHONEST AND POTENTIALLY DANGEROUS القسمُ الطبي المصري مقسِّمٌ للأطباء، باعثٌ على النفاق، ومحملٌ بالإحتمالات الخطرة
Hippocrates (ca. 460 BC – ca. 370 BC) , the ‘father of modern medicine’
On 5 September 2003, the Egyptian Ministry of Health & Population, headed by Dr. Muhammad Awad Taj al-Din, issued its Medical Code of Conduct[i] after it had been discussed and approved by the Egyptian Medical Syndicate that is dominated by the Muslim Brotherhood. The Muslim Brotherhood Spokesperson, Dr. Issam al-Aryan, is in fact a member of the Syndicate. It was supposed to replace a previous code issued in 1974.
Its first chapter (composed of one article) deals entirely with the Doctors Oath. It reads as follows:
Each physician must take the following oath prior to practicing the profession before the President of the Medical Syndicate or whoever acts on his behalf (Arabic text first [iii] and then English translation):
I swear by Great Allah to watch his guidance while discharging my profession, preserve human life at all its stages in all circumstances and conditions; do my best in saving it from destruction, illness, pain and anxiety; preserve peoples’ dignity, hide their privacies and keep their secret; always be a tool for Allah’s mercy; use my medical knowledge with the near and the distant, with the good and the sinful, with the friend and the enemy; pursue science, and use it to help humans, not to harm them; respect those who educate me, educate my juniors, and be a brother to all colleagues in the profession, collaborate with them in doing good and fearing Allah; ensure that my life reflects my Faith in secret and in the open, pure from anything which can defile it in front of Allah, his Messengers and the Believers; and may Allah be a witness to what I say.[ii]
This is an Islamised version of the Hippocratic Oath. Hippocrates was a Greek philosopher and physician, who lived in the 5th Century BC, and is widely regarded as ‘father of modern medicine’. One of his achievements is thought to be what is called the Classical Hippocratic Oath. This oath was sworn by Greek doctors, invoking the names of Greek gods and goddesses, and inviting them to be witnesses to their commitment to the service of their patients to the best of their abilities. The Oath has been summarised as “a solemn promise:
– Of solidarity with teachers and other physicians.
– Of beneficence (to do good or avoid evil) and non-maleficence (to do no harm) towards patients.
– Not to assist suicide or abortion.
– To leave surgery to surgeons.
– Not to harm, especially not to seduce patients.
– To maintain confidentiality and never to gossip.”[iv]
The Classical Oath of Hippocrates thus provided the basics of medical ethics and code of conduct for doctors. However, it was essential for the oath to be modified to remove its religious underpinnings, which are pagan Greek, and to add to it new understandings of what could be regarded as a modern and universal medical code of conduct, with particular attention to provision of good medical care to all patients without distinction between them based on ethnicity, religion, sex, or social status, or any other factor; and avoidance of participation in any inhumane practices that the state could request the doctor to undertake. Modern versions of the Oath have thus been developed.[v] , [vi] On this matter the World Medical Association (WMA) has been taking the lead.[vii] The stated mission of the WMA is “to serve humanity by endeavouring to achieve the highest international standards in Medical Education, Medical Science, Medical Art and Medical Ethics, and Health Care for all people in the world.” As part of its objectives, it produced an ideal doctors’ oath, which it labelled the Declaration of Geneva, to be read by all doctors at the time of being admitted to the medical profession:[viii]
- I solemnly pledge to consecrate my life to the service of humanity;
- I will give to my teachers the respect and gratitude that is their due;
- I will practise my profession with conscience and dignity;
- The health of my patient will be my first consideration;
- I will respect the secrets that are confided in me, even after the patient has died;
- I will maintain by all the means in my power, the honour and the noble traditions of the medical profession;
- My colleagues will be my sisters and brothers;
- I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;
- I will maintain the utmost respect for human life;
- I will not use my medical knowledge to violate human rights and civil liberties, even under threat;
- I make these promises solemnly, freely and upon my honour.[ix]
It is clear that the world is moving away from any medical oath that includes any religious connotation; that does not stress the equal respectful treatment of all patients without any distinction; that advocates, implicitly or explicitly, any violation of “human rights and civil liberties, even under threat”.
Any doctor, who participates in any inhumane practice, whether voluntarily or involuntarily, on patients or individuals, whether prisoners or convicts, degrades the whole medical profession. It is difficult to imagine that some doctors, who carry certain ideologies, do participate in torturing other human beings, or can carry out inhumane punishments on them, such as amputation of limbs or injuries of other parts of the body.
To fight such practices, the WMA has issued a few declarations and statements:[x]
1. WMA Declaration concerning Support for Medical Doctors Refusing to Participate in, or to Condone, the Use of Torture or Other Forms of Cruel, Inhuman or Degrading Treatment.[xi]
2. WMA Declaration of Tokyo – Guidelines for Physicians Concerning Torture and other Cruel, Inhuman or Degrading Treatment or Punishment in Relation to Detention and Imprisonment.[xii]
3. WMA supports Physicians in Refusing Punishment Request.[xiii]
The last document[xiv] is worth mentioning here, since it describes cruel practices which one find being undertaken by Islamic states that implement Shari’a laws, e.g., hudud[xv] and quasas[xvi], such as Saudi Arabia, Nigeria, Sudan, and Somalia. In 2010, a Saudi Arabian judge requested doctors to damage a man’s spinal cord as a punishment for his attacking and paralysing another man. Some physicians refused to carry out that injunction; and the WMA supported them. Dr. Dana Hanson, President of the WMA, said: “This is an appalling request and one which every physician must resist. As the WMA’s Declaration of Tokyo clearly states no physician should participate in the practice of torture or any other forms of cruel, inhuman or degrading procedures, whatever the offence of which the victim of such procedures is suspected, accused or guilty of. The Declaration also includes a prohibition of participation in the planning or advising for such a procedure. Physicians must at all times preserve their ethical independence.”
The Egyptian Doctors Oath of 2003 has been met with dismay by many in the medical profession in Egypt, including the Copts. While the world is moving away from retaining any religious vestiges of the Hippocratic Oath, to make it applicable to all, Egypt islamises it, and in so doing, leads to regrettable and unfavourable outcomes:
1. IT IS DIVISIVE OF THE EGYPTIAN MEDICAL PROFESSION: Egypt’s doctors have different faiths or no faith – there are theist, agnostic and atheist doctors; and those who are theists are divided into many faiths, Sunni Muslim, Shia’a, Ahmadiyya, Baha’is, Christians, Jews, etc. The oath is evidently not religiously neutral – its tone and vocabulary are Islamic. Just ponder upon the sentence “(I) ensure that my life reflects my Faith in secret and in the open, pure from anything which can defile it in front of Allah, his Messengers and the Believers and may Allah be a witness to what I sayوانتكونحياتىمصداقإيمانىفىسرىوعلانيتىنقيةممايشينهاتجاهاللهورسلهوالمؤمنين،واللهعلىماأقولشهيد”.
2. IT ENCOURAGES DISHONESTY: as there are many who are non-Muslim, be them atheists, agnostics or theists from other faiths, who will find it difficult to swear in the name of the Islamic God, and use an oath which invokes the name of ‘Allah’ four times, as the name of ‘his Messengers’ and ‘the Believers’. Taking such an oath by those who don’t believe in Islam means that they take it, if they take it, only dishonestly – this amounts to at least not taking any oath at all.
3. IT CAN POTENTIALLY LEAD DOCTORS TO BE INVOLVED IN PRACTICES THAT ARE CONTROVERSIAL to say the least – practices that form part and parcel of what “Allah, his Messengers and the Believers” may want implemented, such as amputation of limbs in hudud and injuring of other parts of the body in quasas. This means that Egyptian doctors may be swearing, intentionally or inadvertently, to participate in the practice of torture or any other forms of cruel, inhuman or degrading procedures, in the words of the WMA.
[i] Ministerial Edict 238; year 2003. The Syndicate call it in its English translation, “Profession Ethics Regulation”, which stands for the Arabic لائحة آداب المهنة
[ii] The English translation is mine, and is intended to reflect the Islamic language used. The English translation by the Syndicate manages to obscure its religious nature: you can find it here http://www.ems.org.eg/images/leha_eng.doc
[iii] The Arabic text is as it is: http://www.mohp.gov.eg/Sec/about/%D8%A7%D8%AF%D8%A7%D8%A8%20%D8%A7%D9%84%D9%85%D9%87%D9%86%D8%A9.doc
[v] Many medical schools have done away with any oath, and satisfied themselves with a code of practice to which all doctors subscribe. See, e.g., the British General Mrdical Council (GMC): Good Medical Practice 2006 http://www.gmc-uk.org/static/documents/content/GMP_0910.pdf
[vi] Hurwitz B, Richardson R; Swearing to care: the resurgence in medical oaths.; BMJ 1997;315:1671-1674 (20 December) http://www.bmj.com/content/315/7123/1671.full#ref-12
[vii] One of the members of the WMA is Egyptian Medical Association “Dar El Hekmah” 42, Kasr El-Eini Street
[viii] Adopted by the 2nd General Assembly of the World Medical Association, Geneva, Switzerland, September 1948and amended by the 22nd World Medical Assembly, Sydney, Australia, August 1968and the 35th World Medical Assembly, Venice, Italy, October 1983
and the 46th WMA General Assembly, Stockholm, Sweden, September 1994and editorially revised at the 170th Council Session, Divonne-les-Bains, France, May 2005 and the 173rd Council Session, Divonne-les-Bains, France, May 2006. Review: http://www.wma.net/en/30publications/10policies/g1/index.html
[x] The WMA has also issued its International Code of Medical Ethics, to be found here http://www.wma.net/en/30publications/10policies/c8/index.html
[xiv] Issued on 24 August 2010.
[xv] Hudud الحدود الشرعية are the religiously prescribed punishments, which are encoded in Sharai Law.
[xvi] Quasas is the punishment of a convicted murderer, or somebody who has caused the amputation of a limb or wounded another. The punishment will be exactly like the death, amputation or injury he has caused: so, if he has killed he will be killed; if he has amputed a hand, his hand will be amputated; if he has caused any injury, a similar injury will be inflicted on him. This is taken from Quran, al-Baqarra (The Cow): 178-9).