As Jérôme Lejeune said
« A nation that cannot trust its doctors is exposed to all kinds of catastrophes. I am no prophet, but what I do know is that if medicine loses it only nobility which is to provide assistance to those who suffer, to those who are not handsome or powerful, the unwelcomed, the unloved, If medicine lets them down , it will lose its soul. And, for a population, medicine without a soul is dramatic. (…) Hippocrates already new this phenomenon quite well and it is why his famous oath, that all doctors take, specifies that one will not give any poison to a patient, not even to a slave. Here is a detail which, replaced in a context where slaves were seen as cattle, has a very strong meaning.»
Interview with Jérôme Lejeune by Michel Leclercq, Paris-match, November 1980
The highly topical news on the Hippocratic Oath dating from the V century before Christ
The Hippocratic Oath, taken by the doctors, cornerstone of the “caregiver-patient” relationship is a reflexion on Man which enlightens medical decisions and many political choices. It determined Professor Jérôme Lejeune’s whole life and now guides the actions carried out by the Jérôme Lejeune Foundation.
The text relative to the Hippocratic Oath which doctors take today has been adapted to the current laws. In order to understand the strength and timelessness of the Hippocratic Oath, let’s look into the translation of the original text, by Ludwig Edelstein.
«I swear by Apollo Physician and Asclepius and Hygeia and Panacea and all the gods and goddesses, making them my witnesses, that I will fulfil according to my ability and judgment this oath and this covenant:»
To make all the Gods witnesses, as does Hippocrates at the beginning of his oath, is an explicit reference to a superior law, written by the Gods, that Cicéron will later call the Natural Law and whose existence is at the heart of many of today’s social debates.
Apollo, God of healing is also the God of rational intelligence. To call around him and Asclepius (who wanted to resurrect the dead), the other Gods (Hygeia represents preventive medicine, Panacea curative medicine) extends the precepts of this oath to all forms of care, from the pharmacist to the psychologist. However, though various people are involved in the patient’s care, doctors have a specific and eminent role which explains why they are the only ones who solemnly take the oath: the doctor is the one who makes the therapeutic decisions, who signs the prescriptions or medical certificates. Their decisions are sometimes difficult to make, when they have to choose the lesser of two evils.
« To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art—if they desire to learn it—without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else.»
A doctor does not hide his discoveries in order to gain personal profit. On the contrary, he wants the greatest number to benefit from them. The transmission of this knowledge is intended to those who swore by oath to make a good use of it. A future doctor is progressively moulded by his teachers.
By doing this, the master entrusts his pupil with a part of himself, as a father with his son. None can better transmit the law of the Gods than a father. This transmission is priceless and cannot be bought.
“I will apply measures for the benefit of the sick,…”
In this case, measures means rules of life: nutrition, physical activity, leisure, material, financial and moral environment, i.e., the doctors must ensure his patients has a good quality of life, showing an interest in everything relative to it and counselling the patient in many different fields.
“… according to my ability and judgment,…”
If not in a situation of urgency, the doctor can refuse a patient when he is unavailable or when declaring himself incompetent but he must orientate the patient and show him compassion. Evaluating one’s strength and judgement is an act of humility necessary to all doctor.
“I will keep them from harm and injustice”
Primum non nocere wrote Hippocrates in the treatise “Epidemics », which means » first of all avoid harm”. But in this oath he goes even further as he speaks here of a precept which is a true way to perfection: to abstain oneself of all harm and injustice
“I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect.”
A doctor can neither mutilate nor attempt on someone’s life, even if the latter asks with insistence. The doctor must know how to analyse a patient’s demand and give the right answer. Drugs used in terminal palliative care are said to have a “double effect” by reference to a principle enunciated by Saint Thomas Aquinas: given to a patient to lessen the pain, they can hasten death but it must not be the intention. On the contrary, euthanasia relies on the intention to provoke the patient’s death. It is therefore voluntary homicide with premeditation. The doctor must love his patient sufficiently to make him want to live.
“Similarly I will not give to a woman an abortive pessary.”
A pessary was a dispositive covered with a substance which is supposed to provoke an abortion when introduced in the proper orifice. Abortion was well known in antiquity and Hippocrates who took care of pregnant women was against this practice.
« I will spend my life and practice my art in innocence and purity. »
The innocence » is the quality of he who does not do any harm. “Purity” considers the other as a person, whatever his or her physical or psychic disorder, and it prevents the caregiver to let him or herself be troubled by desire or anger. “I will carry out my job and will live in innocence and purity in order to serve patients with an undivided heart, with all my heart, with all my soul and with all my strength”. It is a programme of life. More than a job, caring is a vocation, a call for life to be lived differently. A doctor can be asked to risk his own life to save a patient.
HIPPOCRATE DE COS (460-370 before Christ)
Born before Socrates, he belonged to a family of aristocrats who claimed to be descendants of Asclepius, God of medicine. The major lines of Hippocratic thoughts are the concern of observation, rational thought and the doctor’s reflexion on his own activity. In order to accomplish his mission, abnegation, denial of vain glory, decent conduct, discretion and gentleness are moral qualities a doctor must have as well as his initial judgement and skill. Hippocrates is The prototype, i.e., he is the best representation of a doctor.
«I will not use the knife, not even on sufferers from stone. »
Such operations were dangerous. The intervention aiming at removing stones consisted in opening the urinary tract in order to retrieve the blood stones. During this intervention the patient risked death or sexual mutilation. It was reserved to those who had the right skills. A doctor must strictly limit his professional practice to his field of knowledge.
“Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.”
Knowledge and power (the power of the signature for a doctor) gives one a power of seduction one must never take advantage of, whatever the sexual orientation of the patient or the caregiver and, more largely, whatever his religion, political choices or skin colour. The Hippocratic Oath protected slaves whose social status was the worst one could have during the Greek antiquity, no one paying them any attention as long as they did that for what they had been bought. According to the Geneva Convention of 25th September 1926, Slavery is “the state or condition of an individual on which are exercised the attributes of right of property or certain of them”. One can consider that the status of slave is currently relative to human embryos. Indeed, some people wish they could use, possess and dispose of them at will. This, by definition is what characterises the attributes of the right of property.
«What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about. »
Louis Portes, chairman of the National Council of Physicians Order, after a decree which ordered all doctors to signal any person wounded by bullet, on death penalty, reminded people in 1944 that “respecting the professional secret is the necessary condition for the sick to trust their doctors and there are no administrative considerations that can remove us from this duty.” Medical secrecy is absolute, “even out of the exercise of my profession”, i.e., if during a conversation or while taking a walk the physician carries out a diagnosis he must not speak of it.
«If I fulfil this oath and do not violate it, may it be granted to me to enjoy life and art, being honoured with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot. »
The conclusion of the Hippocratic Oath is the key to happiness for the caregiver: knowing that he has always respected the divine rules and that «he has not put aside any of the people he was trusted with”.
When reading the Hippocratic Oath, one understands that the relation between the doctor and his patient is very close to the one there is between a priest and God. Indeed, the aspect of gift and respect which is the base of their relation has many points in common with the relation between a priest (doctor) and his God (the patient): Hippocrates was a descendant of a line of priests-doctors. Louis Portes, quoted further up, wrote that “the peculiar conference held between a doctor and a patient is the meeting point between trust and conscience”. This can be seen as a reminder of the song written by the people of Israel during their exile in Babylon: “May your unfailing love rest upon us, even as we put our hope in you”.
Dr Ravel, pupil of Jérôme LeJeune (1926-1994)
Jérôme Lejeune can be presented as a hospital biologist, professor in medicine, researcher, wise man, moral authority or friend of John Paul II’s but he simply saw himself as a “doctor”. When invited into his office, one could not miss seeing on the wall, visible to all, the text of the Hippocratic Oath in Greek. He always used it as a justification for his professional choices. Practising Catholic, he liked to say that all the values of the Gospel were contained in the Hippocratic Oath. As he did, the Jérôme Lejeune Foundation still carries on defending the Hippocratic Oath.
Jérôme Lejeune’s Hippocratic Oath is currently being kept at the Jérôme Lejeune Institute.