Abortion is a widely contested topic, not only socially but professionally as well. For physicians, the Hippocratic oath and informed consent have been altered greatly as attitudes on abortion shift. This shift not only affects physicians performing abortions, but patients receiving them as well.
Hippocratic Oath
The Hippocratic oath is a vow that new physicians take in which they agree to uphold various ethical standards while practicing medicine [2]. The exact origins of the Hippocratic oath are uncertain, but it is widely accepted that it was written in the 4th century B.C.E. by Hippocrates [4]. Although it was devised in the 4th century B.C.E., it was not commonly used until after World War II in attempts to prevent atrocities like those committed by Nazi doctors from occurring again [7]. This delayed use of the Hippocratic oath demonstrates the processual aspect of memory by showing how the changing situation of the present can alter the importance of concepts that were previously situated in the past.
There are multiple versions of the Hippocratic oath, with many medical institutions modifying it to a version more reflective of their ideals [4]. The alteration of the oath reflects the partial and selective nature of memory. As institutions choose to remember certain parts of the Hippocratic oath, others are forgotten. Two common versions of the Hippocratic oath exist- the traditional Hippocratic oath and the modern Hippocratic oath- in which the topic of abortion is heavily disagreed upon. In the traditional Hippocratic oath, a physician must swear to never “give a woman a pessary to cause an abortion” [4]. Alternatively, in the modern Hippocratic oath, the word abortion is omitted completely, with the closest reference being, “If it is given me to save a life, all thanks. But it may also be within my power to take a life…” [5]. The editing of the role that the physician has in inducing an abortion in the oath further reveals the processual nature of memory. As time progressed, the attitudes surrounding abortion have also progressed and this has been reflected in the modified oath. By altering the oath, it forgets this part of physician’s history.
Informed Consent
Informed consent is a way of educating a patient about the procedure they are getting in order to ensure they are fully knowledgable as a means of protecting both the patient and physician. Typical features of informed consent include:
- “affirming the patient’s role in the decision-making process
- describing the clinical issue and suggested treatment
- stating alternatives to the suggested treatment (including the option of no treatment)
- stating risks and benefits of the suggested treatment (and comparing them to the risks and benefits of alternatives)
- stating related uncertainties
- assessing the patient’s understanding of the information provided
- eliciting the patient’s preference (and thereby consent)” [3]
Despite this standard, extra requirements have been added to achieve informed consent prior to an abortion in many states. In North Carolina, a law called the “Women’s right to know act” was passed, requiring that 72 hours before an abortion, the patient must be informed of the name of the physician, the medical risks, the probable gestational age of the unborn child, the insurance of the physician who is to perform the abortion, and “the location of the hospital that offers obstetrical or gynecological care located within 30 miles of the location where the abortion is performed..” [9]. Beyond this, the act required that in order for informed consent to be fulfilled, at least 4 hours before a patient receives an abortion, the physician must perform a live ultrasound and simultaneously explain things such as, “the presence, location, and dimensions of the unborn child within the uterus and the number of unborn children depicted” [9]. The ultrasound and heart beat must be displayed to the patient and they may choose not to look or listen, but the physician must continue.
The constitutionality of this act was later challenged by Stuart v. Huff, in which the Center for Reproductive Rights and its partners challenged the medically unnecessary ultrasound and its associated speech in the “Women’s right to know act.” A federal trial court ruled “that this coercive requirement violates physicians’ First Amendment rights..” [8]. North Carolina appealed this ruling, but the US Court of Appeals for the Fourth Circuit upheld the district court’s decision. North Carolina then petitioned for the US Supreme Court to hear the case, which was denied and effectively upheld the Fourth Circuit’s decision, blocking this act. The implementation of this act that was later deemed unconstitutional further reveals the selective nature of memory. The Constitution, the founding document of America, was selectively forgotten with this creation of this act in order to fit the needs of politicians. This unconstitutional act was then forgotten from collective memory once it was no longer allowed to be selective due to the decision of the courts.
Roe v. Wade
The concepts of the Hippocratic oath and informed consent are connected to Roe v. Wade via their underlying implications. All three are some sort of “decree” regarding the changing nature of how a physician and patient should handle an abortion procedure. Depending on which version of the Hippocratic oath a physician takes, he or she may promise to never “give a woman a pessary to cause an abortion” or to take life when necessary [4]. Depending on the laws in certain states, physicians and patients may have to perform or undergo unnecessary procedures in order for the abortion to even be considered. Roe v. Wade is no different in the sense that regardless of what era one looks at- during Roe or post Roe– it is a declaration of how abortion procedures should be handled.
Madison Leary
References
[1] Bingham, Richard P. “What Fixes It? the PQ Hippocratic Oath – Electrical Contractor Magazine.” Electrical Contractor, Electrical Contractor Magazine, 2018, https://www.ecmag.com/magazine/articles/article-detail/systems-what-fixes-it-pq-hippocratic-oath.
[2] “Greek Medicine – the Hippocratic Oath.” U.S. National Library of Medicine, National Institutes of Health, 7 Feb. 2012, https://www.nlm.nih.gov/hmd/greek/greek_oath.html.
[3] Hajar, Rachel. “The Physician’s Oath: Historical Perspectives.” PubMed Central, U.S. National Library of Medicine, 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5755201/.
[4] Hulkower, Raphael. The History of the Hippocratic Oath: Outdated, Inauthentic, and Yet Still Relevant. EJBM, 2010, https://www.einsteinmed.edu/uploadedFiles/EJBM/page41_page44.pdf.
[5] Lasagna, Louis. “Nova | Doctors’ Diaries | the Hippocratic Oath: Modern Version.” PBS, Public Broadcasting Service, https://www.pbs.org/wgbh/nova/doctors/oath_modern.html.
[6] Narsaria, Rachita. “The Hippocratic Oath: The Original and Revised Version.” The Practo Blog for Doctors, Practo, 10 Mar. 2015, https://doctors.practo.com/the-hippocratic-oath-the-original-and-revised-version/#:~:text=Thus%2C%20the%20classical%20Oath%20of,Gods%20of%20a%20few%20responsibilities.
[7] Smith, Larry. “A Brief History of Medicine’s Hippocratic Oath, or How Times Have Changed.” Science Direct, Elsevier B.V, 26 June 2008, https://www.sciencedirect.com/science/article/pii/S0194599808002817.
[8] “Stuart Et Al. v. Camnitz.” Center for Reproductive Rights, Center for Reproductive Rights, 10 Mar. 2021, https://reproductiverights.org/case/stuart-et-al-v-camnitz/.
[9] “Women’s Right to Know Act”. 2011, https://www.ncleg.gov/EnactedLegislation/Statutes/PDF/ByArticle/Chapter_90/Article_1I.pdf.
The difference in the wording for the Hippocratic oaths only solidifies the conforming to the times. I agree with the last sentence, banning abortions does not stop the fact that they will occur. The number of unsafe abortions and complications from the unsafe abortions will only continue to skyrocket if the restrictions become tighter.
This is an excellent examination of the processual aspect of memory. I was unaware that the Hippocratic oath only recently became used. I think the changing language in the oath not only reflects changing times but also enforces the idea of what a physician’s role is, to improve, heal, or aid the life of a patient. I was unaware of the Heartbeat Act, but I find it interesting that the physician’s rights were being violated by that act. I think the act is also a violation of the patient’s rights, although they may choose to not look at the monitor they are still forced to attend the appointment. It’s interesting to see the workarounds state laws create to make receiving an abortion harder and how these laws are particular to that state. However, the universal Hippocratic oath ensures the well-being of the patient, unrestricted by state boundaries.