Explained: The ‘Physician’s Pledge’ in the new draft code of ethics for doctors, how it differs from Charak, Hippocrates oaths

Months after it triggered a row by suggesting that the traditional Hippocratic Oath in medical colleges should be replaced by a “Charak Shapath”, the National Medical Commission has released draft regulations for the professional conduct of doctors without including either of the two oaths. Instead, the draft – National Medical Commission Registered Medical Practitioner (Professional Conduct) Regulations, 2022 – has included ‘The Physician’s Pledge’ as per the World Medical Association’s Declaration of Geneva. Even earlier regulations by the Medical Council of India, that predated the NMC, had no mention of the Hippocratic Oath.

What is the Physician’s Pledge in the draft NMC resolution?

The Physician’s Pledge that is part of the WMA’s Declaration of Geneva was adopted by the Second General Assembly of the World Medical Association, Geneva, in September 1948. There were minor revisions over the years and the last amendment took place during the 68th WMA General Assembly. in Chicago, in October 2017. NMC’s draft regulations, released on May 23, mention this Physician’s Pledge from the “Declaration of Geneva 2017” as an inclusion at the end of its 14-point code of ethics. The Pledge reads, “as a member of the medical profession”:

* I solemnly pledge to dedicate my life to the service of humanity

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* The health and well-being of my patient will be my first consideration

* I will respect the autonomy and dignity of my patient

* I will maintain the utmost respect for human life

* 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 interfere between my duty and my patient

* I will respect the secrets that are confided in me, even after the patient has died

* I will practice my profession with conscience and dignity and in accordance with good medical practice

* I will foster the honor and noble traditions of the medical profession

* I will give to my teachers, colleagues, and students the respect and gratitude that is due.

* I will share my medical knowledge for the benefit of the patient and the advancement of healthcare

* I will attend my own health, well-being, and abilities in order to provide care of the highest standard

* I will not use my medical knowledge to violate human rights and civil liberties, even under threat

* I will make these promises solemnly, freely, and upon my honor.

About the code of ethics, the draft says that it will serve as the set of commitments of the registered medical practitioners towards patients, society, professional colleagues, and self. “NMC Code of Ethics is framed as a self-regulatory set of guidelines reflecting professional as well as social expectations,” it adds.

What was the controversy over the Charak Shapath?

The controversy began after the National Medical Commission (NMC), the regulator for medical education and practices (which replaced the Medical Council of India in 2020) suggested to medical colleges on February 7 that the Hippocratic Oath should be replaced by a “Charak Shapath” .

While some medical practitioners welcomed the proposal, the Indian Medical Association (IMA), the national representative platform of doctors of modern medicine, took up the matter with Health Minister Mansukh Mandaviya.

In a letter published in IMA News, the IMA’s official publication, the association’s national president Dr Sahajanand Prasad Singh said that at an “interactive meeting” with an IMA delegation on February 21 this year, Mandaviya had “assured that Charak Shapath will be optional and will not be forced to replace the Hippocratic Oath.”

Subsequently, on March 29, replying to an unstarred question by several MPs on “whether Government intends to replace the Hippocratic Oath with the Charak Shapath”, “whether it is a fact that the National Medical Commission has proposed replacing the Hippocratic Oath with Charak Shapath” ”, and “whether Government has met with the representatives of the Indian Medical Association (IMA) to discuss their opposition to this proposal”, Minister of State for Health and Family Welfare Dr Bharati Pravin Pawar told Rajya Sabha: “As informed by the National Medical Commission (NMC), there is no proposal of replacement of Hippocratic Oath with Charak Shapath.”

Days later, however, on March 31, the NMC issued a circular on “Implementation of new Competency Based Medical Education for Undergraduate Course Curriculum”, in which it said: “Modified ‘Maharshi Charak Shapath’ is recommended when a candidate is introduced to medical education”.

Interestingly, as The Indian Express reported in February, undergraduates at the country’s premier health institute, AIIMS, have been taking the Charak Oath during their annual convocation for several years now.

Dr MC Misra, former director of AIIMS, had told The Indian Express earlier that the Charak Shapath was already part of the annual convocation when he took charge in the post in 2013.

The AIIMS Charak Shapath is: “Not for the self; Not for the filter of any world material desire or gain, but for the good of suffering humanity, I will treat my patient and excel well.”

Who was Charaka and what is the Charak Samhita?

Like several other sages mentioned in the literature of ancient India, the historicity of Charaka is uncertain. The compendium of medicine that carries his name is unlikely to have been the work of a single individual, and not all of it is likely to have been written at the same time.

The Charak Samhita is a medical pharmacopoeia and collection of commentaries and discussions on medical practices that is historically dated to the 1st-2nd centuries AD.

Along with the compendium of Susruta (c. 4th century AD), which is about surgery, the Charak Samhita is considered the foundational text of ancient Indian medicine, which was an evolved system of understanding and treating disease that was in several ways ahead of the Greeks.

The ancient Indian interest in physiology is understood to have been drawn from yoga and mysticism, and to have been enriched by the growth and spread of Buddhism to new lands, the arrival of the first Christian missionaries, and the contact with Hellenic practitioners of medicine.

What are the medical ethics of the sage Charaka?

The physician was an important and respected member of ancient Indian society, and medical practice followed rules of professional conduct and ethical principles.

AL Basham (‘The Wonder That Was India’, 1954) quotes from a part of the sermon that Charaka instructs a physician to preach to his pupils at a ceremony at the end of their apprenticeship.

“…You must strive with all your soul for the health of the sick. You must not betray your patients, even at the cost of your own life… You must not get drunk, or commit evil, or have evil companions… You must be pleasant of speech…and thoughtful, always striving to improve your knowledge.

“When you go to the home of a patient you should direct your words, mind, intellect, and senses nowhere but to your patient and his treatment… Nothing that happens in the house of the sick man must be told outside, nor must the patient’s condition be told to anyone who might do harm by that knowledge to the patient or to another.”

This ethical code of Charaka is universal, and remains just as relevant and applicable today.

What is the Hippocratic Oath?

The Hippocratic Oath is attributed to Hippocrates of the island of Kos, a Greek physician of the classical period (4th-5th centuries BC), broadly corresponding to the period from the death of the Buddha (486 BC) to the rise of the Mauryas ( 321 BC) in India.

Among the great contemporaries of Hippocrates, the so-called “father of modern medicine”, were the Athenian philosopher Plato and his teacher Socrates, and Plato’s student and a tutor of Alexander the Great, Aristotle.

The Oath is a charter of ethical principles that physicians over the ages have sworn to uphold in the practice of their profession. The earliest available fragments of what is understood to be the original oath date back to the late 3rd century AD, and a millennium-old version is kept in the library of the Holy See.

To Hippocrates is attributed a collection of 70 books on medicine called ‘The Corpus Hippocraticum’; Most scholars, however, agree that the Hippocratic Oath itself may not have been the work of the individual identified as the historical Hippocrates.

What does the Hippocratic Oath say?

Two translations of the pagan oath from the Greek original, by WHS Jones (‘The Doctor’s Oath’, Cambridge University Press, 1924) and Ludwig Edelstein (‘The Hippocratic Oath: Text, Translation, and Interpretation’, Johns Hopkins Press, 1943) , are popular with scholars. According to extracts published in the BMJ, October 1998, the Oath says:

“I will use treatment to help the sick according to my ability and judgment, but I will never use it to injure or wrong them.

I will not give poison to anyone though asked to do so, nor will I suggest such a plan. Similarly, I will not give a pessary to a woman to cause abortion. But in purity and in holiness I will guard my life and my art.

I will not use the knife either on sufferers from stone, but I will give place to such as are craftsmen there.

Into whatsoever houses I enter, I will do so to help the sick, keeping myself free from all intentional wrongdoing and harm, especially from fornication with woman or man, bond or free.

Whatsoever in the course of practice I see or hear (or even outside my practice in social intercourse) that ought never to be published abroad, I will not divulge, but consider such things to be holy secrets.”


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