If you sought out a physician in 4th century B.C. Greece seeking an abortion, chances are, you would be out of luck.
Ditto for 2nd century Rome. Or 10th century France. Or just about anywhere thereafter, prior to the advent of the 20th century.
It just wasn’t done. Or at least, it wasn’t in good conscience and certainly not openly. (The same goes for seeking euthanasia, as it turns out.)
For the classically trained physician—be it in polytheistic, “pagan” times of yore or the Christian centuries that followed the fall of Rome—to provide an abortion was tantamount to a betrayal of the divine.
For such was the nature of the physician’s oath, dating back to its earliest inception in roughly 400 B.C.—what has become known as the Hippocratic Oath.
The influential treatise begins, “I swear by Apollo the Healer, by Asclepius, by Hygieia, by Panacea, and by all the gods and goddesses, making them my witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture.”
And just what exactly were those duties—or, we might ask, what were their limits?
While the oath begins with an injunction against sharing medical knowledge too widely or freely—as would be common for many centuries to follow, given the guild-like nature of professional training—and the well-known injunction to never do harm, what follows, precisely midway through, is known to few these days.
“I will not give to a woman a pessary to cause abortion,” the oath reveals in no uncertain terms.
Its proximity to what’s become known as the “do no harm” command, gives one hint as to why this may be. But just as important is what followed the command.
“I will keep pure and holy both my life and my art.”
Remember the opening lines: These were vows taken before supreme deities, with the utmost solemnity and stakes wrapped up in them. To break any of the vows would be to defile oneself, as it were, before the gods. And not the least of such acts would be taking the life of the unborn, it seems. It wouldn’t only be using one’s powers for harm, but also debase one’s own person as well as the medical art more broadly.
It wasn’t something up for debate. There was no room for interpretation. No wiggle room, no finessing things. One was beholden to higher powers and entrusted with a sacred duty, it would seem, with the doctor’s initiation into the medical profession.
The fact that we refer to the pledge crafted by Hippocrates and his understudies as the “original” one hints, as you might have guessed, that things have since veered course.
But it wasn’t overnight or even over centuries. It would take nearly two millennia for the original oath—which was part of the hallowed collection of ancient medical texts known, in time, as the Hippocratic Corpus—to break from the original in spirit, if not verbiage.
According to Nathan Gamble et al., writing in the journal Medical Science Educator, the prohibition against abortion seen in the original oath stayed firmly in place through political and religious upheavals near and far.
In the 10th century, the oath was Christianized, and in at least one version (the Latin), the Trinity was introduced into it. The declaration against abortion was made even more explicit, according to medical scholarship.
While we don’t know much about how the early oaths were used (were they part of a secretive initiation ceremony or more like the public, communal ones taken by a graduating class of med students today?), we do know that by the Renaissance, at least, the formal vowing of the oath had become part of medical school.
In the United States, the oath had a short stint of popularity in the mid-18th century before falling out of fashion because of a post-Enlightenment sensibility that apparently considered it antiquated.
Whatever the case, those misgivings wouldn’t last long, as in the 19th century, the oath gained renewed popularity in the United States and would continue to be increasingly embraced into the 20th century that followed. By 1993, about 98 percent of all medical schools were administering some version of the oath.
But there’s a catch: Hippocrates would barely recognize it. The late 20th-century oath became an altogether different creature.
Along the way, the oath was transformed to reflect changing social values and emerging ideologies.
Perhaps the biggest break with the original oath came in 1964, with a new, more humanistic version of the oath authored by Dr. Louis Lasagna—a former dean at Tufts University Graduate School of Biomedical Sciences.
Gone were several key components of the original oath, including any invocation of a deity—of any sort, even monotheistic. And noticeably, the prohibition against abortion was missing as well. In their place were exhortations to exercise “warmth, sympathy, and understanding” and to be willing to say “I know not” when stumped.
All personality traits we would hope for in a physician today, for sure.
But the very fabric of the oath had been radically—and, as it turns out, irrevocably—altered. It was now a secular thing, beholden only to the physician’s own conscience and powers of moral self-restraint. No god was to be overlooking the doctor’s clinical doings thereafter, from above—weighing in his or her mind the physician’s worthiness of the divine covenant joining them. You were, as a doctor, now on your own as it were—subject, yes, to human laws and lawsuits and other such mundane things, but not to any greater powers or entrustments.
With the advent of the 20th century, permutations of the oath have only continued, departing still further from that of ancient Athens.
At Harvard Medical School, each graduating class of doctors-to-be now authors its own oath—invoking terms the oath’s original progenitor would little recognize, such as calling upon graduates to “bear witness to historical injustices.”
Where this shall all go, we can only guess. Perhaps with the recent overturning of Roe v. Wade, there will be some form of reckoning or revisiting of this rather misshapen heritage. Perhaps there will emerge a greater space for those physicians who, compelled by conscience, don’t subscribe to the ending of life in the womb to vocalize their values.
If so, one thing’s for sure: Hippocrates would be pleased.
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