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Hippocrates and his principles of medical ethics.

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 HISTORY OF THE MEDICINE 117

Hippocrates and his principles of medical ethics

Bujalkova M

Hippokrates a jeho zásady lekárskej etiky

Abstract Abstrakt

Bujalkova M: Bujalková M.:

Hippocrates and his principles of medical ethics Hippokrates a jeho zásady lekárskej etiky
Bratisl Lek Listy 2001; 102 (2): 117–120 Bratisl. lek. Listy, 102, 2001, è. 2, s. 117–120

“The Father of Medicine”, as Antiquity called Hippocrates “Otec medicíny”, ako nazýval starovek Hippokrata, nám zane-
has left rich medical and ethical heritage for us. His heritage chal bohaté odborné i etické dedièstvo. Jeho zbierka spisov Cor-
— the collection of treatises Corpus Hippocraticum, from 5th pus Hippocraticum, ktorá vznikla v 5. a 4. stor. p.n.l., obsahuje
and 4th centuries BC, comprise not only general medical pre- nielen všeobecné lekárske predpisy, opisy chorôb, diagnózy,
scriptions, descriptions of diseases, diagnoses, dietary recom- diétne predpisy atï., ale i jeho názory na odbornú a morálnu
mendations etc., but also his opinion on professional ethics of kompetenciu lekára. Hippokratova prísaha, ktorú skladali antickí
a physician. The Hippocratic Oath, taken by ancient and me- a stredovekí lekári, sa vyznaèovala vysokými etickými požiadav-
dieval doctors, requires high ethical standards from medical kami. Zásady tejto prísahy sú významné aj dnes pri výchove
doctors. Its principles are important in professional and ethi- a etickom formovaní lekára. (Lit. 4.)
cal education of medical doctors even today. (Ref. 4.) K¾úèové slová: antická medicína, lekárska veda, lekárska etika.
Key words: ancient medicine, medical science, medical ethics.

The biography of Hippocrates comprises noteworthy compo- Životopis Hippokrata skrýva v sebe pozoruhodné spojenie his-
nents of history and myths. Belonging to Aesculapius extraction torických a legendárnych prvkov. Ako asklepiad odvodzuje svoj
he was derived through his father Heracleides from Aesculapius pôvod cez svojho otca Herakleida od Asklépia, ktorý bol uctieva-
worshipped as the son of Apollo. His mother Phainarete traced ný ako syn Apollóna. Jeho matka Phainarete odvodzovala svoj
her origin directly from Heracles. The sparce truth about him con- rodokmeò priamo od Herakla. Èo vieme naozaj, sú len niektoré
sists of a mere handful of biographic data: Hippocrates was born údaje z jeho života: okolo r. 460 p.n.l. sa Hippokrates narodil na
about 460 B.C. on the island of Cos where even today the Hippoc- ostrove Kos, kde sa ešte aj dnes ukazujú Hippokratove platany.
rates’ plane trees are admired. He had been taught by his father Vyuèoval ho jeho otec Herakleides, ako aj najslávnejší uèitelia
Heracleides as well as by the most famous teachers of that time. tých èias. Medicínu sa uèil údajne u uznávaného dietetika Herodi-
He is believed to be taught medicine by an acknowledged dietolo- ka zo Selymbrie, rétoriku u Gorgiasa z Leontíny a filozofiu u svojho
gist Herodicos of Selymbria, retorics by Georgias of Leontina, and rovesníka Demokrita z Abdéry. Hippokrates vykonával svoju prax
philosophy by his peer Democritos of Abdera. Hippocrates made ako podomový lekár, takzvaný periodeut, založil kójsku lekársku
his career as a house-to-house physician, the so called periodeut. školu, ktorá neskôr tvorila konkurenciu knidskej lekárskej škole.
He had founded the Coyan Medical School that later on competed Dlhé roky pôsobil v Trákii a zomrel vo vysokom veku v Larisse
with the Knidean Medical School. For a long time he acted in v Tesálii asi r. 377 p.n.l.
Thrace and died in old age in Larissa in Thessalia about 377 B.C. Do obdobia od roku 460 do roku 380 p.n.l. spadá však vzos-
That is about all we know of his life. However, into the period tup a úpadok Atén. Spadá doò éra Periklova — vedy a umenia
between 460 and 380 B.C. falls the rise and decline of the Athens, prekvitali. Vznikli mohutné aténske reprezentaèné stavby: Parte-
including the era of Pericles when science and arts flourished. In nón, Propylaje. Tukydides píše Dejiny peloponézskej vojny, ktorá
Athens huge representative buildings are erected — Parthenon and trvala od r. 431 do r. 404 p.n.l. a mala vies ku skaze Atén. Je to

Institute for Foreign Languages, Jessenius Faculty of Medicine, Come- Ústav cudzích jazykov Jesseniovej lekárskej fakulty Univerzity Komen-
nius University, [email protected] ského v Martine
Address for correspondence: M. Bujalkova, Dr, PhD, Institute for Fore- Adresa: PhDr. M. Bujalková, CSc., Ústav cudzích jazykov JLF UK, Zá-
ign Languages JLF UK, Zaborskeho 2, SK-036 45 Martin, Slovakia. borského 2, 036 45 Martin.
Phone: +421.842.4134 982, Fax: +421.842.413 6332
118 Bratisl Lek Listy 2001; 102 (2): 117–120

Propylaia. Tukydides writes his History of Peloponesan War that epocha, v ktorej pôsobili ešte jónski prírodní filozofi Anaxagoras
lasted from the year 431 to 404 B.C. and was going to cause the a Parmenides, v ktorej vystupujú sofisti a svojím uèením rozbíja-
destruction of Athens. That was the epoch in which the Ionic natu- jú archaický obraz sveta, teda Protagoras a Gorgias. Je to však
ral philosophers were still acting — Anaxagoras and Parmenides, najmä doba, v ktorej rozvinul svoju vlastnú dialektickú metódu
and in which the sophists with their learning started to destroy the Sokrates. Skvelé obdobie duchovného vzplanutia a sociálneho
archaic picture of the world — Protagoras and Gorgias. However, prevratu, ale aj doba plná hrôz. V r. 430—425 p.n.l. vypukol v Até-
it was also, and most of all, the time when Socrates developed his nach mor, epidémia, ktorú podrobne opísal Tukydides a ktorej
own dialectic method. A unique epoch of spiritual breakthrough skutoènú podstatu ešte nedokážeme urèi ani dnes.
and social revolution, but also the time full of horrors. Between Keï Hippokrates v tejto pohnutej dobe zomrel vo veku 83
the years 430 and 425 B.C. an epidemic outbreak of plague burst rokov, zanechal dvoch synov, Tessala a Drakonta, ktorí pôsobili
out in Athens, described in detail by Tukydides, the true cause of ako osobní lekári v Makedónii, ako aj široko presláveného zaa
which still remains unsolved. Polyba, ktorý vyuèoval v asklepiadskej škole na ostrove Kos. Tu
When Hippocrates died in that turbulent time at the age of 83, napísal Polybos svoj známy spis Peri fýseós antrópú, ktorý sa ne-
he left behind two sons — Thessalos and Dracon who worked as skôr prostredníctvom Nemesia z Emesy dostal do latinského stre-
personal physicians in Macedonia, as well as his far and wide re- doveku (De natura hominis).
nowned son-in-law Polybos who was a teacher at the Aesculapian Toto dôležité dielo, ktorému vïaèíme za známu teóriu o tele-
School on Cos Island. Here Polybos completed his famous work sných tekutinách a ktorým vzniká antická humorálna patológia,
“Peri fýseós antrópú” which later, through Nemesios of Emesa, stojí v centre zbierky spisov Corpus Hippocraticum. Táto obrov-
entered the Latin Middle Ages under the title “De natura homi- ská zbierka 58 spisov (so 73 knihami) bola zavàšená pravdepo-
nis”. This important work,to which we are obliged for the well dobne okolo roku 300 p.n.l. Zaèiatok a spôsob vzniku tejto zbier-
known theory of the body fluids and which had given rise to the ky nie je presne známy. Jej prevažná èas vznikla v 5. a 4. stor.
ancient humoural pathology, stands in the centre of the collection p.n.l., sú v nej však i èasti ove¾a mladšie. Niet pochybností o tom,
of works titled “Corpus Hippocraticum”. This immense collection že Hippokrates nie je autorom celého kompendia, teda nedá sa
consisting of 58 writings (in 73 books) was most probably com- zisti, ktoré èasti sú skutoène Hippokratove. Je však isté, že dielu
pleted about 300 B.C., though the time of its beginnings remains vtlaèil peèa svojej osobnosti, èi už priamo, alebo prostredníc-
obscure. Its major part originated in the 5th and 4th centuries B.C., tvom svojich žiakov. Obsah i forma zbierky sú pestré: opisy cho-
however, it contains also much younger parts. Undoubtedly, Hip- rôb, všeobecné predpisy, diagnózy, diétne predpisy — urèené nie-
pocrates is not the author of the whole compendium, but today it len pre chorých, ale i zdravých, návody pre chirurgov. Sú tu však
is impossible to prove which part of it was written by him. Howe- i spisy obsahujúce uèenie konkurenènej knidskej školy, ktorá kládla
ver, it is quite clear that it bears the signs of his immense persona- dôraz na špeciálnu patológiu.
lity, either directly or through his disciples. Both the contents and Každý výber textu z Corpus Hippocraticum by mohol by
the formal side of the collection are very diverse: description of korunovaný pyšným Hippokratovým výrokom: „Omnium artium
diseases, general prescriptions, dietary regulations — addressed medicina nobilissima“ – („Lekárske umenie je zo všetkých umení
not only to the sick but also to the healthy, instructions for surge- najvznešenejšie“). Predsa však otec medicíny pokraèuje ïalej ve¾-
ons, etc. However, it contains as well the writings of the compe- mi triezvo a vystihuje situáciu vari každej doby: „Ale pre nevedo-
ting Knidean School that put main stress on special pathology. mos tých, ktorí ho vykonávajú, a tých, ktorí povrchne posudzujú
Each text selected from “Corpus Hippocraticum” might be lekárov, zaostáva medicína èo do vážnosti (úcty) ïaleko za inými
topped by the proud statement ascribed to Hippocrates himself: umeniami. A tak existuje ve¾a lekárov pod¾a mena, pod¾a svojho
“Omnium artium medicina nobilissima” (Medical art is the nob- pôsobenia existujú však len niektorí“.
lest of all arts). However, the Father of Medicine continues in a less Hippokrates pokladá vecné znalosti a tým odbornú kompeten-
pompous way: “ But because of ignorance of those who perform it ciu za predpoklad lieèenia. „Ten, kto si chce osvoji presné zna-
and those who know physicians only superficially — medicine as losti lekárskeho umenia, potrebuje nasledovné schopnosti a vzde-
an art is valued less than other arts. And thus many physicians lanie: vhodné miesto na vzdelávanie, výuèbu od mladosti,
exist only by name and not by their work, and those who are jud- pracovitos a urèité kvantum èasu, ktoré je na to potrebné“. Mo-
ged by their work are only few.” derne povedané: mladý lekár musí ma prirodzený vzah k medi-
Hippocrates considers the real knowledge, skills and profes- cíne, lebo kde sa vzpiera prirodzenos, je všetko zbytoèné. S vyu-
sional competence the prerequisites of successful medical treat- èovaním v lekárskom umení je to ako s rastlinami rastúcimi zo
ment. “Those who want to achieve attributes of the art of medici- zeme. „Naše prirodzené schopnosti sú ako orná pôda, výuèba ako
ne, need the following: place that suits education, devotion from sejba; uèebni zodpovedá pri rastlinách výživa, ktorú tieto dostá-
young age, hard work and a lot of time — as indispensable requ- vajú z okolitého vzduchu, a usilovnos je porovnate¾ná s prácou
irements.” In modern language: a young physician must have na poli. Nakoniec èas privádza všetko k úplnej zrelosti“. Len od
a true interest in medicine; without such an interest — all is in takto vzdelaného lekára možno oèakáva, že — tak ako znie hlav-
vain. Learning of medical art can be compared to plants growing ná hippokratovská zásada — svojím lekárskym umením bude pro-
from the earth. “Our natural dispositions are like arable soil, le- spieva alebo prinajmenšom neškodi (nil nocere, adiuvare vel nil
arning like sowing, the environment providing nourishment to nocere).
plants like a lecture hall, and learning itself is a hard work like Neskúsenos naproti tomu je pod¾a Hippokrata zlým pokladom
that of the farmer. Eventually, time brings the process to final a zlým klenotom. „Pretože neskúsenos postráda vo dne i v spánku
maturity.” Only from the physician educated in that way it can be bezstarostnos a veselú myse¾. Nedostatok skúseností — to je živná
 Bujalkova M: Hippocrates and his principles of medical ethics 119
expected — consonantly with the main hippocratic principle — pôda pre zbabelos a bezoèivos“. V oboch smeroch sa neistý lekár
that through his medical art he will be beneficial to his patient, previní a zlyhá: oba extrémy majú tú istú príèinu. Zbabelos je zna-
or at least not doing any harm to him (nil nocere, adiuvare vel nil kom neschopnosti, taký èlovek si v nièom nedôveruje. Bezoèivos
nocere). je však znakom neskúsenosti. Lebo Hippokrates hovorí takto: „Po-
On the other hand, lack of experience is in Hippocrates’ eyes znanie a predstava sú dve rôzne veci. Znalos vytvára poznanie,
a false treasure or jewel. “Since inexperience lacks carefree attitu- neznalos predstavu.“ A potom ešte zdôrazòuje: „Poznanie v dô-
de and a pleasant mind in daytime and also in sleep. Lack of expe- sledku toho plodí znalosti, predstava nevedomos“.
rience is a good nursery of cowardice and impudence.” In both Vo vede, ako aj v umení stroskotali mnohí preto, lebo nedoká-
cases, uncertain physician can easily stumble and fail: both extre- zali zjednoti oboje — prirodzené vlohy a praktické uplatnenie.
mes have the same cause. Cowardice is a sign of incapability and Ak si chce niekto osvoji obe z týchto vecí, tak treba pod¾a Hip-
such person loses self-confidence. However, impudence is a sign pokrata prenies filozofiu do lekárskej vedy a lekársku vedu za-
of inexperience. Since Hippocrates argues that: “Knowledge and èleni do filozofie. Lebo lekár, ktorý sa zároveò usiluje o životnú
assumption are two different things. Learning creates knowledge, múdros, sa vyrovná bohu. Hippokrates tým vonkoncom nemieni,
ignorance gives rise to assumptions.” And then he points out: “Le- že lekár by mal študova filozofiu, aby mohol svoj úrad takpove-
arning gives birth to knowledge, and assumption generates igno- diac urobi vznešeným a pozdvihnú ho až do nebies. Hippokra-
rance.” tes chce poveda nieèo úplne elementárne: „filosofos“ nie je pod-
In science as well as in arts many have failed since they ¾a neho ani študent ani profesor filozofie, ale predovšetkým
could not unite these two things — the inherent faculties and „filantropos“ — èlovek, ktorý vie ži, a “antropoplast“ — mudrc,
their practical implementation. If somebody wants to achieve ktorý je inšpirovaný svojím bohom, a preto sa vyrovná bohu. „Roz-
both — in Hippocrates’ view — philosophy should be brought diel medzi medicínou a filozofiou nie je ve¾ký, pretože všetky vlast-
to medicine and medicine should be integrated to philosophy. nosti, ktoré patria k filozofii, sú obsiahnuté aj v lekárskej vede,
Since that physician who tries to achieve the wisdom of life teda: oslobodenie od chamtivosti, oh¾aduplnos, cudnos, skrom-
can be matched with God. However, Hippocrates is far from né obleèenie, dôstojnos, schopnos posudzova, vyrovnanos,
suggesting that a physician should study philosophy — to bring rozhodnos, statoènos, vyjadrovanie sa v sentenciách.“ Toto je
his profession up to heaven. Hippocrates wants to tell us so- návod na spôsob, ako zaobchádza s ¾uïmi.
mething quite elementary: “philosophos” — is neither a stu- V svete prírody je lekár iba služobníkom fysis; nie je tvorcom
dent nor a professor of philosophy, but first of all “philantro- a plánovaèom, ale skôr kormidelníkom, je „kybernetes“, ktorý drží
pos” — a man who knows how to live, and “anthropoplast” — starostlivou rukou kormidlo loïky života a udržuje jej správny
a wise man inspired by his God, and, therefore equal his God. kurz. On sám tiež sedí v loïke; nemôže rozkáza vetru a nie je
“The difference between medicine and philosophy is not too zodpovedný za more. Nemôže niè plánova in toto; nemôže ve¾a
big since all the virtues of philosophy are involved also in me- urobi, ak je v ohrození. Ale práve vtedy môže kormidlova, a tým
dical science, such as: to free oneself from greediness, to achieve pomáha a nakoniec zvráti ažkú situáciu. Kormidlova zname-
tactfulness, chastity, modesty in clothing, balance of mind, ná vždy len toto: udrža takú rovnováhu, ktorá kolíše v urèitej
prompt decisions, honesty, logical and concise speech. “These tolerancii okolo stredu, naráža pritom na hranice, aby sa znova
are general rules how to approach people. dostala do labilného stavu vyváženosti. Kormidlova ïalej zna-
In natural world physician is a mere servant of “physis”; he is mená vies, èím sa urèuje smer ïalšieho pohybu vpred bez toho,
neither a creator nor a designer but rather a steerman, a ”kybernetes” aby sme zabúdali súèasne na kolísajúcu rovnováhu.
who holds in his careful hand the steer of a boat of life and keeps Po dlhé stároèia sa antickí a stredovekí lekári podrobovali sláv-
her on the right course. He himself is bound to the boat; he cannot nostnému s¾ubu, hoci pochádzal zo staroveku. Tento s¾ub sa na-
order the wind, neither the sea. He cannot plan anything in toto; chádza v Corpus Hippocraticum ako Horkos (Prísaha). Skladal ju
when in danger he cannot do much. But exactly then and there he každý, kto vstupoval do lekárskeho cechu. Vyznaèuje sa jadrnos-
can steer the boat to safety, and to reverse the troublesome situation. ou a vysokými etickými požiadavkami. Text a zásady tejto prísa-
To steer means no more than to maintain such balance that ranges hy sú významné ešte aj dnes pri vzdelávaní a etickom formovaní
within some tolerance around the middlepoint bouncing at the li- lekára. Mladý lekár v prísahe okrem iného vyjadroval vïaènos
mits only to bring her back to the labile state of equilibrium. To steer svojmu uèite¾ovi a zaväzoval sa, že bude pod¾a svojho najlepšie-
also means to maitain the foreward direction but, at the same time, ho svedomia dba o zdravie a blaho chorého a nikdy sa neprepo-
not to forget about the swinging balance. žièia k nièomu zlému a škodlivému.
For ages physicians starting their career swore the solemn Èo nám etické kritériá Hippokratovej prísahy a výrok o vzneše-
oath called Hippocratic Oath — involved in “Corpus Hippocra- nosti lekárskeho umenia hovoria dnes? Kde by sme našli záväznú
ticum” as “Horkos” (Oath). It was obligatory for all physicians etickú normu a pod¾a akých kritérií sa má riadi mravné správanie
before embarking upon their medical careers. It is characteristic lekára? Takáto formulácia otázky nás trápi o to viac v dobe, keï
with its racy style and high ethical message. The text and prin- všetka výchova sa nahrádza púhym vzdelávaním. Univerzity si už
ciples of the Oath have not lost their singificance even today, nekladú za svoju prioritnú úlohu vychováva lekárov. Študent me-
namely in education and ethical moulding of a physician. Taking dicíny je síce rozsiahle informovaný, ale nikto už neoèakáva, že
the Oath young physician expresses his thankfulness to his mas- z lekárskych fakúlt prídu morálne a eticky zdatní lekári. Naše vzde-
ter, and commits himself to care for the good and welfare of his lávacie inštitúcie sa vyznaèujú tým, že sú èasto bez vnútorného kon-
patients to his best ability and judgement and never do harm to ceptu, bez uceleného výchovného plánu, bez zmysluplnej motivá-
anyone. cie a bez vlastnej adekvátnej vysokoškolskej didaktiky. Lekár sa
 120 Bratisl Lek Listy 2001; 102 (2): 117–120

What is this message of ethical criteria of the Hippocratic Oath pritom èasto degraduje na sociálneho nosite¾a úloh a pod¾a toho sa
and of the words on dignity of medical art for us today? Where správa: prispôsobuje sa grotesknému obchodu, ktorý kvôli pacien-
could the binding ethical norm be found and which criteria should tovi organizuje priemysel, poisovne a zdravotníctvo.
be followed to direct ethical behaviour of a physician? These qu- A èo riadi skutky lekára pod¾a Hippokrata? Hovorí o tom prvý
estions become even more disturbing today when education is being aforizmus: vita brevis, ars longa, occasio celeris, experimentum
replaced by mere teaching. Education seems to be no more a prio- periculosum, iudicium difficile (život je krátky, umenie/veda ob-
rity. Even though the student of medicine is extensively informed siahla, príležitos pominute¾ná, pokus nebezpeèný, úsudok/roz-
in professional field, nobody anymore expects that medical scho- hodnutie ažké.)
ols will release morally and ethically mature physicians. Our edu-
cational institutions are often without any inner conception, integ- Literatúra
ral educational curricula, without any meaningful motivation and
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is often degraded to the position of a social bearer of the duties, her-Universität 1967.
and he also behaves like that: adjusts to the grotesque business 2. Niedermayer A.: Ärztliche Ethik. Wien, Herder 1954.
organized for the sake of patients by industries, insurance compa-
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nies and health services. 1839—1861.
Which are the ideas guiding physician’s work in Hippocrates’
way? They are condensed in his 1st Aphorism: vita brevis, ars 4. Schipperges H.: Moderne Medizin im Spiegel der Geschichte. Stut-
longa, occasio celeris, experimentum periculosum, iudicium diffi- tgart, Georg Thieme 1970.
cile (life is short, art/science vast, opportunity volatile, experiment Received January 20, 2001.
risky, decision difficult). Accepted February 11, 2001.

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