When budding doctors in India were to take the oath of ethics at their white-coat ceremony this year, the question confronting medical colleges was, which oath to administer – surely the age-old Hippocratic Oath?
It wasn’t quite as straightforward.
Controversy had broken out in February, when it was discovered that the National Medical Commission (NMC), regulator of medical education in India, had proposed that a modified version of the ancient Ayurvedic oath, the Charaka Shapath, replace the Hippocratic Oath. It triggered a feverish controversy in the medical fraternity.
Many doctors saw it as needless meddling; many also pointed out that the modern version of the Charaka Shapath was little different from the Hippocratic Oath. So why make the switch?
Then, on 29th March, Union Minister of State for Health, Dr Bharati Pawar, made a statement in the Rajya Sabha saying that the status quo would be maintained. She said, “As informed by the National Medical Commission (NMC), there is no proposal of replacement of Hippocratic oath with Charak Shapath.” Yet, just two days later, on 31st March, the NMC released a set of guidelines, which among other things, stated that a “modified ‘Maharshi Charak Shapath’ is recommended when a candidate is introduced to medical education”.
As the controversy continues to rage, we take a look at the tradition of the ‘Oath of Ethics’ taken by medical practitioners in cultures around the world, and the debate between the Hippocratic Oath versus Charaka Shapath.
What is the Hippocratic Oath?
The Hippocratic Oath is an ‘Oath of Ethics’ taken by medical practitioners around the world. The original oath was written between the 5th and the 3rd centuries BCE and was attributed to a Greek doctor named Hippocrates. The oath is a part of the ‘Hippocratic Corpus’ a collection of around 60 ancient Greek medical texts attributed to Hippocrates. The oldest known fragment of this oath dates back to 275 CE.
The original Hippocratic Oath began with a dedication to ancient Greek gods: ‘I swear by Apollo Healer, by Asclepius, by Hygieia, by Panacea, and by all the gods and goddesses, making them my witnesses …’ It also has several sentences which are extremely out of date, such as ‘I will not give to a woman a pessary to cause abortion’. As well as, ‘I will not use the knife, not even, on sufferers from stone… ’
A modified form of the Hippocratic Oath was incorporated into medical education by the Byzantines in the 12th century CE, German universities in the 14th century CE, and the English-speaking world in the 16th century CE.
The Modified Hippocratic Oath
The modern and further modified version of the Hippocratic Oath was adopted by the World Medical Association based in Geneva in 1948. It was modified when it was discovered that doctors in Nazi Germany had carried out horrific experiments on their patients. This modern version removed the archaic and religious parts of the oath and made it suitable for medical practitioners of the 20th century. This oath is as follows:
“In the presence of family, friends, teachers and colleagues, and in the spirit of Hippocrates, I pledge to keep this oath.
First, I will do no harm.
I will honour those who taught me the art and science of medicine. I will remember with gratitude and humility those whose illness or injury provided examples from which I learned, and, in their honour, I will continue the pursuit of knowledge. I will share my knowledge with future colleagues and all who are in want or need of it. I will practice medicine with conscience and humility, and I will act with enduring respect for the dignity of human life. Foremost in my mind will be compassion, respect, and impartial care for my patients. I will hold sacred the trust of my patients and respect the secrets that they confide in me. I will not be swayed by greed, prejudice, or selfish ego in the practice of my art.
Finally, I will do all in my power to help my patients reach physical, mental, and spiritual health, and I will strive for this balance in my own life.”
Different versions of this modified Hippocratic Oath have been adopted by medical professionals around the world. For example, Osteopathic Medical Schools in the US follows something known as the ‘Osteopathic Oath’.
Oaths of Other Traditional Medicine Systems
Different cultures with their own medical systems have their own oaths of ethics. Traditional Chinese Medicine is one of the most ancient and developed medical systems, and it has an oath known as the ‘Dao gao yao huang shi shu’ or ‘The Oath of Praying for the King of Medicine’. This is a Chinese version of the Hippocratic Oath.
The Islamic world too has its own version of the oath and it quotes verses of the Quran. The modern Islamic oath pledges:
“Praise be to Allah (God), the Teacher, the Unique, Majesty of the heavens, the Exalted, the Glorious, Glory be to Him, the Eternal Being Who created the Universe and all the creatures within, and the only Being Who contained the infinity and the eternity. We serve no other god besides Thee and regard idolatry as an abominable injustice.
The oath ends with a quote from the Quran:
"Whoever killeth a human being, not in lieu of another human being nor because of mischief on earth, it is as if he hath killed all mankind. And if he saveth a human life, he hath saved the life of all mankind.” (Quran V/35) “
Practitioners of Traditional Thai Medicine practised in Thailand, Laos, Cambodia and Vietnam take the Buddhist Oath of ‘Vejjavatapada’. It is attributed to Buddha and derived from the Pali canonical literature composed between the 3rd and 5th centuries BCE. There are also similar oaths of ethics in traditional Jewish, Native American and Japanese systems of medicine.
Charaka Samhita and the Charaka Shapath
Ayurveda is an ancient medical system followed in India for more than 4,000 years. While the earliest concepts of Ayurveda were set out in one of the Vedas – the Atharvaveda, which was composed in the 2nd millennium BCE – over time, different schools of Ayurveda developed across India.
The Charaka Samhita and the Sushruta Samhita, both composed around the 1st century CE and attributed to Rishi Charaka and Rishi Sushruta respectively, are considered the most important ancient texts of Ayurveda. Rishi Charaka was a physician while Rishi Sushruta was a surgeon.
The ‘Charaka Shapath’ or the ‘Oath of Charaka’ is a set of shlokas from the Charaka Samhita, which is a set of instructions by a teacher to prospective students. The oath or shapath deals with the code of conduct to be followed by Ayurveda practitioners and reflects the time and the society for which it was written, 2,000 years ago.
The shapath has many elements that are similar to other oaths, such as clauses relating to client confidentiality, ethics and so on. But there are a number of lines in this original shapath, which can be problematic in modern times.
For example, the Charaka Shapath begins with ‘Thou shalt lead the life of a bachelor (Brahmachari), grow thy hair and beard… ’ There are other stanzas such as ‘No persons, who are hated of the king, or who are haters of the king or who are hated of the public, shall receive treatment’ and ‘women who are unattended by their husbands or guardians shall not receive treatment’.
Obviously, these are extremely inappropriate for a practitioner of modern medicine.
Modern Version of the Charaka Shapath
Just like the Hippocratic Oath, the Charaka Shapath too has been modernised, keeping in mind a society that has evolved over the past 2,000 years. The modified version of the Charaka Shapath as recommended by the National Medical Commission, states:
“During the period of study, I shall live a disciplined life with my teachers and peers. My action shall be guarded, service oriented and free from indiscipline and envy. In my dealings, I shall be patient, obedient, humble, constantly contemplative and calm. I shall aim my full efforts and ability towards the desired goal of my profession. As a Physician, I shall always use my knowledge for welfare of mankind. I shall always be ready to serve patients, even if I am extremely busy and tired. I shall not harm any patient for the sake of monetary or selfish gains, nor shall I entertain a desire for lust, greed or wealth. Immorality shall not emerge even in my thoughts. … I shall not divulge the confidentiality related to the patient or family inappropriately. … Although an authority (in my subject), I shall not display my knowledge and skill with arrogance...”
This version of the oath is generic and very similar to the Hippocratic Oath. Then why require physicians to take a new oath, why not just the Hippocratic Oath? The only reason, it seems, is to ‘Indianise’ the oath and generate pride in the rich legacy of ancient Indian medical systems.
The Real Challenge
While the debate rages on, the powers-that-be are missing the point. Rather than change the oath that doctors take, those in positions of authority need to address a deeper, systemic malaise that affects Indian healthcare. Take, for example, the version of the Charaka Shapath which has been administered to students of AIIMS in Delhi since 2013. It states:
“Not for the self; Not for the fulfilment of any worldly material desire or gain, But solely for the good of suffering humanity, I will treat my patient and excel well.”
In view of the rising complaints regarding the gross commercialization of healthcare across India, it would seem like the problem is not whether India’s doctors take an ‘Indianised’ pledge but whether the healthcare system can root out the rot that has set in. At present, the words “Not for the fulfilment of any worldly material desire or gain” ring hollow.
Who was Charaka?
Maharshi Charaka was an Indian Rishi or a Sage, who complied a medical treatise entitled Charaka Samhita, one of the foundational texts of Ayurveda. It is believed that Maharshi Charaka lived sometime between the 1st century BCE or the 1st century CE and is believed to be a native of Kashmir.
What is Charaka Samhita?
Charaka Samhita or the ‘Compendium of Charaka’ is an ancient Indian medical treatise that deals with Ayurveda. Complied sometime between the 1st century BCE and 1st century CE, it consists of 120 verses distributed across 8 chapters dealing with the aspects of the human body, various ailments and how to treat them.
Who wrote Charaka Samhita?
While it is generally believed that the treatise was compiled by Maharshi Charaka in the 1st century CE, historians believe that in reality, it is an edition of much earlier work ‘Agnivesha Samhita’ composed in the 8th century BCE by Rishi Agnivesha. Maharshi Charaka did not complete his treatise and centuries later, in the 9th century CE, a Kashmiri physician named Dridhabala added chapters to the Charaka Samhita, bringing it to its present form.
What is the Charaka Shapath?
Charaka Shapath is a set of verses from the Charaka Samhita, written in the form of a set of instructions by a teacher to prospective students. It is a form of an ‘oath of ethics’ which were to be undertaken by those who wished to study medicine. The National Medical Commission has recommended that the Hippocratic Oath be replaced with a modified version of the Charaka Shapath.
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