When I tell my lecture audiences that most doctors no longer take the Hippocratic Oath upon becoming physicians and that many no longer see it as relevant to their profession, they are shocked and disturbed. They believe, quite correctly, that the Oath exists for their protection. They want their doctors to practice a do-no-harm style of medicine. “Why have they abandoned a tradition that has served medicine—and us—so well?” they ask.
The answer to this important question is complex, having much to do with who we are as a culture and a people. According to the late physician and sanctity-of-life bioethicist Edmund D. Pellegrino—who spent a long and productive career as a professor of medical ethics—the Hippocratic system came under attack both from without and within the medical profession: “These constructs first came into question in the mid-1960s as part of the general upheaval of moral values that occurred in the United States. Concomitantly, the character of medicine was being altered by the specialization, fragmentation, institutionalization, and depersonalization of health care. At the same time, the number and complexity of medical ethical issues expanded as the power of medical technology presented new challenges to traditional values.”72
These challenges could have been met without destroying the “do no harm” tradition. However, medicine, perhaps having lost confidence in its own ethical instincts, “turned to the philosophers”73 of bioethics. Unfortunately, by this time, the most influential practitioners in the field had enlisted in the relativist branch epitomized by Fletcher rather than the more traditional equality-of-life-affirming approach espoused by Ramsey. In a philosophical milieu in which the most helpless patients were already viewed widely as less than fully human, the Hippocratic tradition didn’t stand a chance. This sad fact is illustrated by the treatment given the tradition in The Principles of Biomedical Ethics, first published in 1979, in which Beauchamp and Childress blithely dismiss it as “a limited and unreliable basis for medical ethics.”74 As for the do-no-harm ethic the Oath spawned, readers are informed that it is merely a “strained translation of a single Hippocratic passage.”75 So much for more than 2,000 years of applied ethics and medical wisdom.
BIOETHICS AND RELIGION
The antipathy of mainstream bioethics to religion began early. It is not coincidental that Joseph Fletcher, the “patriarch,” insisted on forming his views upon the premise that “man is not a worshipper.”76 In recounting the reasons why he believed that bioethics became so influential in such a short time, Daniel Callahan wrote, “The first thing that . . . bioethics had to do—though I don’t believe anyone set this as a conscious agenda—was to push religion aside.”77 Dan Brock, a prominent philosopher and member of the bioethics elite, was similarly blunt in an article urging the legalization of euthanasia: “In a pluralistic society like our own, with a strong commitment to freedom of religion, public policy should not be grounded in religious beliefs which many in that society reject.”78
After welcoming theologians in its formative years (ironically, Fletcher was a lapsed Episcopal priest), bioethics now stresses that morality and proper behavior are best determined through “rational analysis” based on secular philosophical precepts. Theology, religious values, spirituality, faith—these are considered “external” and thus “unconvincing” in determining wrong from right.79 Moreover, unlike most of the general population that bioethics supposedly serves, many (although certainly not all) modern bioethicists are agnostic or atheistic, a personality factor that colors their entire approach to these important issues as much as the Pope’s Catholicism does his. Indeed, some bioethicists view religion with utter disdain, as mere “mumbo jumbo,” to use Peter Singer’s pejorative term.80 Even those bioethicists who have strong spiritual beliefs—including some Catholic priests—are so worried about imposing their religion upon secular society that they leave their personal faith-inspired values at the door when discussing public health policies.
This near-absolute rejection of religious values as a proper moral underpinning for debating and creating secular public policies is a fatal flaw of modern bioethics. “Ninety percent of the population identifies with the Judeo-Christian tradition,” writes the Loma Linda University professor of Ethical Studies James W. Walters. As an obvious consequence, “our society’s most fundamental moral views are rooted in religion.”81 If Walters is right, then bioethics isn’t merely reflecting a new ethic to meet changing times—it is imposing it on and applying it to a population that profoundly disagrees with bioethics’ most basic assumptions.
That is not to say that religion in the public square does not have its problems. (Murdering doctors in the name of “life” comes readily to mind.) But it is also true that religion played an indispensable role in creating an ethic of humanity that gentles the savage injustices of life.
Consider the modern hospice movement that owes its origin to the dedication and compassion rooted in the deeply held religious values of its founder, Dame Cicely Saunders. Dame Cicely, as she is known affectionately in England, was a nurse and devout Anglican who was a medical social worker in a London hospital in the years immediately following World War II. She met a Jewish émigré named David Tasma, who had escaped the Warsaw ghetto only to lie dying in a London hospital at the age of forty. Tasma was alone in the world, and Saunders made a special point to visit him every day. Their friendship changed our world.
As Saunders and Tasma spoke of his impending death, she began to comprehend “what he needed—and what all of the other dying patients and their families needed.” Saunders had an epiphany. She told me, “I realized that we needed not only better pain control but better overall care. People needed the space to be themselves. I coined the term ‘total pain’ from my understanding that dying people have physical, spiritual, psychological, and social pain that must be treated. I have been working on that ever since.”82 Tasma left Saunders 500 British pounds to begin her work, telling her, “I will be a window in your home.” Saunders told me, her eyes moistening, “It took me nineteen years to build the home around that window.”83
Saunders epiphany was not “rational” but spiritual, coming from a deep empathy inspired by her religious faith. Her work was a “personal calling, underpinned by a powerful religious commitment,”84 wrote David Clark, an English medical school professor of palliative care and Saunders’s biographer, to whom she has entrusted the organization of her archives. So strong was Saunders’s faith in what she perceived as her divine call that she began volunteering as a nurse at homes for the dying after work.85 Urged on by her deep desire to help dying people, she went to medical school at the age of thirty-three, this at a time when there were few women doctors.
Saunders focused her medical practice on helping dying people and alleviating pain. She obtained a fellowship in palliative research and began work in a hospice run by nuns, where pain control was unevenly applied, a nearly universal problem at the time, causing much unnecessary misery. Saunders conceived of putting patients on a regular pain control schedule, which, in her words, “was like waving a wand over the situation.”86
Saunders’s faith pushed her toward founding a hospice based on her concept of treating the total patient. Believing firmly that “the St. Christopher’s project [was] divinely guided and inspired,”87 she became an activist, energetically raising money for the new project and in the process raising the consciousness of the medical establishment. Based as it was on religious inspiration (“I have thought for a number of years that God was calling me to try to found a home for patients dying of cancer,” she wrote to a correspondent88), Saunders’s initial idea was for St. Christopher’s hospice to be a “sequestered religious community solely concerned with caring for the dying.” But the idea soon expanded from a strictly religious vision into a broader secular application; in Clark’s words, a “full-blown medical project acting in the world.”89
Saunders succeeded beyond even her own wildest hopes. St. Christopher’s opened in a London suburb in 1967 and