Perspectives in Biology and Medicine

THE OATH: AN INVESTIGATION OF THE INJUNCTION PROHIBITING PHYSICIAN-PATIENT SEXUAL RELATIONS MAURA L. CAMPBELL* Hippocratic Oath I swear by Apollo Physician and Asclepius and Hygieia and Panacela and all tL· gods and goddesses, making them my witnesses, that I willfulfill according to my ability andjudgment thL· oath and thL· covenant: To hold him who has taught me thL· art as equal to myparents and to live my life in partnership with him, and ifhe is in need ofmoney to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them thL· art—if fay desire to learn it—withoutfee and covenant; to give a share ofprecepts and oral instruction and all the outer learning to my sons and to the sons ofhim who has instructed me and topupils who have signed the covenant and have taken an oath according to the medical fow, but to no one ehe. I will apply dietetic measuresfor the benefit of tL· sick according to my ability andjudgment; I will keep themfrom harm and injustice. I will neithergive a deadly drug to anybody ifaskedfor it, nor willI make a suggestion to thL· effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art. I will not use the knife, not even on sufferersfrom stone, but will withdraw in favor of such men as are engaged in thL· work. Whatever houses I may vmt, I will come for the benefit of the sick, remainingfree ofall intentional injustice, ofall mischiefand in particular ofsexual refations with bothfemale and male persons, be theyfree orsfaves. What I may see or hear in the course of tL· treatment or even outside of the treatment in regard to tL· life of men, which on no account one must spread abroad, I will keep to myself holding such things shameful to be spoken about. IfIfulfill thL· oath and do not violate it, may it be granted to me to enjoy life and art, being honored withfame among all menfor all time to come; if I transgress it and swearfalsely, may iL· opposite ofall thL· be my lot. [Y] The author thanks Drs. Robert Prichard and Richard Vance of the Bowman Gray School of Medicine of Wake Forest University for their help and encouragement. ?Department of Obstetrics and Gynecology, Eastern Virginia Graduate School of Medicine, Norfolk, Virginia 23507.© 1989 by The University of Chicago. All rights reserved. 0031-5982/89/3202-0630$01 .00 300 I Maura L. Campbell ¦ The Oath The Hippocratic Oath has long been known to both graduating medical students and the general public. It has been subjected to the scrutiny of philosophers and historians for generations. Few authors, however, have addressed the Oath's directive against sexual misconduct [2]: "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 ofsexual relations with both female and male persons, be they free or slaves." Other concerns of the Oath, such as abortion, euthanasia, and surgery, have generated volumes of material. The dearth of historical literature concerning sexual misconduct, then, is quite conspicuous and raises questions about why such analyses have been neglected. There are several possible explanations. First, it may seem unnecessary to investigate the patently obvious. Such an argument is predicated on the assumption that all physicians share a moral consensus prohibiting sexual contact with patients. This position, however, appears ill informed in the light of recent research. Twenty-five percent of first-year medical students surveyed by Wagner in 1972 responded that sexual intercourse could be appropriate with a patient if the doctor was "genuine" and the circumstances were right [3]. In an anonymous questionnaire survey conducted by Kardener, Fuller, and Mensh, 5-13 percent of 460 physician-respondents reported engaging in erotic behavior, and 5-7.2 percent admitted to sexual intercourse with their patients [4]. Going still further, Shepard has proposed that sex between psychiatrist and patient can be "enabling, rewarding and productive of growth" [5]. Though unthinkable to many, the fact remains that universal adherence...