This article appears in the November 2003 edition of the Catholic Medical Quarterly
Return to Nov 2003 Contents Page
Life Issues in Relation to the Hippocratic Oath
Based on a talk given at the Annual Symposium held in Brighton 2003
Victoria Gillick
In 1995 I came across a short piece in the Daily Telegraph by its regular classical contributor, Peter Jones. The article was headed `Oathly Powers' and its opening comment ran : "Many medical schools do not put their young doctors on oath any more, and most that do have abandoned the famous Hippocratic Oath. No wonder the National Health Service is going down the drain."
How true, I thought, as I pinned it to my study wall to cheer thyself up. What bitter irony: a health service going down the drain through a chronic shortage of medical staff, due entirely to medical staff having gone down the drain at the hands of doctors and nurses. Our society has indeed boxed itself in since it launched an offensive against its own children. The reasons why we are doing it are many and various, but at the heart of the conundrum lies the nature of man himself, and the progress and regress of that nature over the aeons of human history. It is to this nature, therefore, that I shall first address myself, before taking a brief and selective peep at `life issues' in Europe during the last two thousand years. This will, I hope, give us some kind of insight into our current outlook on life.
Some while ago, I listened to a radio programme about lions. It was fascinating. It seems that when a young male lion succeeds in taking over a pride of lionesses, his first action before impregnating his new harem is to kill off all their existing cubs. Apparently this is nature's way of ensuring the re-invigoration of the gene pool of lions. This interesting piece of information called to mind the behaviour of some human beings, as when marauding armies slaughter all their enemy's children, disembowel their pregnant women and rape their daughters. Very cruel and very animal-like. But what may be good for lions is no earthly good for humans, for the simple reason that man is not a brute beast, no matter how often he may be brutish and beastly. He is a unique creation: an ensouled being with a free spirit and sublime potential, forever bedevilledby a sadly maladjusted nature. Thus, where animals may safely rely on their `natural instincts'to guide their actions, man's free but fallen nature has acquired powerful `natural inclinations' which are just as likely to lead him into inhuman ways as otherwise. He must therefore use his unique gifts of memory and understanding, an innate awareness of his sublime potential, to steer him along his difficult path. The history of man's evolution is essentially the story of his continuous struggle to recognise and overcome his naturally bad inclinations, and to foster his naturally good ones.
In the earliest of times, men and women would have been quite naturally inclined to love and cherish those whom they chose to love and cherish, and to ignore, reject or even destroy those for whom they did not harbour such kind feelings. Primitive cultures, by definition, are intellectually under-developed and therefore tend to give free rein to every natural inclination (equally). Altruism or philanthropy, caring for and protecting the hopeless, the useless, the unloved and the unwanted, for their own sake, is a relatively late human development and represents the triumph of the intellect over the selfish inclination.
Prior to that development, the weak and the unwanted simply went to the wall Children, being always the weakest and most vulnerable, had a particularly hard time of it at the hands of those who did not want them. Virtually every culture in antiquity was stained with the blood of its innocent unwanted young. According to the centuries old tradition of paterfamilias, the birth of a Roman was not a biological fact. Infants were received into the world only as the family willed. A Roman did not have a child, he took a child. Immediately after the birth, if the family decided not to raise the child - literally, lifting him above the earth - he was simply abandoned. There were special high places or walls outside most Roman cities where the newborn was taken and exposed to die. Abortion was - likewise - commonplace and widespread. Persians developed highly sophisticated surgical curette procedures. Chinese women tied heavy ropes around their waists so excruciatingly tight that they either aborted or passed out. Ancient Hindus and Arabs concocted chemical pessaries - abortifacients that were pushed or pumped directly into the womb through the birth canal. Primitive Canaanites threw their children into great flaming pyres as a sacrifice to their god Moloch. Polynesians subjected their pregnant women to awful tortures - their abdomens were beaten with large stones, or hot coals heaped upon their bodies. Japanese women straddled boiling cauldrons or parricidal brews. Egyptians disposed of their unwanted children by disembowelling and dismembering them shortly after birth - their collagen was then ritually harvested for the manufacture of cosmetic creams. Greeks often gave their pregnant women harsh doses of herbal or medicinal abortifacients. In short, abortion, infanticide, exposure and abandonment were an integral, and often ritualised, part of everyday pagan life.
Against this primitive backdrop Hippocrates practised medicine and formulated his famous Oath, twenty three centuries ago. He may even have foreseen that the advances in medical science might one day tempt the rich and powerful to employ doctors to cause death and destruction on a grand scale. The Oath he formulated was therefore more than just a doctor's self-regulating device for the benefit and protection of his patients; it also offered protection to the Oath-takers themselves, against the pressures of public immorality, and any deadly intention of public authorities. Foresight indeed. Less than three centuries later, God entered human history in the person of Jesus Christ, revealing to one and all what an unfallen and un-maladjusted human nature looked like and bringing to mankind the heart-stopping news that God, the Creator of all things, loved and cherished all human beings equally and unconditionally. Nobody, the message ran, was unwanted by God: every single human being that God chose to create was precious to Him. It followed that what pleased God most was man's corresponding love for his fellow man, especially those whom he was inclined by his fallen nature to despise and reject. God, through His glorified risen son, was enjoining mankind to become pro-life in thought, word and deed, for Christ's sake.
Over the next four centuries, as the Christian Gospel and Christian social welfare spread throughout the Roman Empire, the old pagan ways of life were gradually transformed. For the first time in human history, hospitals were founded, orphanages established, rescue missions were started, almshouses built, soup kitchens were begun, shelters endowed, charitable societies incorporated, and relief agencies commissioned. The barbarous holdovers from paganism - abortion, infanticide, exposure and abandonment - were slowly but systematically rooted out. A cultural reformation of cosmic proportions had begun.
In the reign of the Byzantine Emperor Justinian, pro-life legislation became universally and comprehensively enforced. Julian's code was explicit: "Those who expose children, possibly hoping they would die, and those who use the potion of the abortionist, are subject to the full penalty of the law - both civil and ecclesiastical - for murder" For the first time we see the injunctions of an ancient pagan medical code being given the full weight of the law of universal Christendom. From henceforth, a doctor who broke his Hippocratic Oath and helped procure a woman's abortion, would not only lose forever "... his reputation among all men for his life and for his art...", he could also find himself brought before the civil courts on a charge of complicity to murder an unborn child. This legislative support for sound consistent medical ethics, and an ever-expanding programme of Christian social action, advanced both the welfare of the poorest, and medical research. It continued in medieval Christian Europe for a further seven centuries.
In the middle of the 14th Century, during a protracted European war and growing famine, the continent was overwhelmed by a catastrophe of unprecedented and unimaginable proportions: the outbreak in 1347 of the Black Death. In the space of just three years, one third of the population of Europe was wiped out by the disease. In England, the population of three million was reduced by one million in one single year alone. The majority of the plague's victims were the old and the young. Repeated outbreaks of the disease during the next fifty years further exhausted and depleted the population that was already on the verge of starvation. So great was the impact of this devastating epidemic that its fearful memory is with us still, six centuries later. Historians have long recognised that the de-population wrought by the Black Death changed the whole course of European history. This being so, it must have some relevance to the way we think and behave today. Of particular interest to today's Christian pro-lifers, is the long-term effect that the bubonic holocaust had on the outlook and pattern of behaviour of the general populace, and the intellectual and cultural shift away from Christianity that emerged in the two centuries that followed: a shift that has continued to resonate in secular intellectual circles, right up until the present time. One cannot overestimate the impact that the sudden and colossal scything down of young life had upon the peoples of the latter half of the 14th Century. It was truly a Valley of Death for rich and poor alike. Bereavement on such a scale would have caused a shattering of morale, an all-pervasive sense of desolation and abandonment, and a consequent loss of religious faith. Social disorder and crime would follow, compounding the problems of the millions of starving, fractured families, each of which would have had its own disintegrating effect on the subsequent generations of men, women and children. Nowadays, we have invented a term to describe the sufferings and turmoil experienced after a huge calamity: we call it �collective post-traumatic stress disorder�. If anyone should say that medieval men and women were unlikely to be as sensitive to death as their modern counterparts, then imagine the outcome in Africa today if the AIDS epidemic killed one third of the entire population in just three years. The disarray in the moral and social order was reflected equally in the heart of the Christian Church itself, which went through successive crises in the 15th Century, losing its missionary nerve and progressive edge, and eventually tearing itself apart in the early 16th Century, with the Protestant Reformation in Northern Europe.
The gradual disintegration of medieval Christendom in the aftermath of the de-populating Black Death, and the religious hiatus caused by the schism in the Church, led to an era that has a great many features recognisable today. Having progressed for so many centuries under the mantle of medieval Christian orthodoxy, it was no longer possible for Western societies to live without some ruling set of principles, values, or ethical standards. The alternative they found suited them down to the ground � just as it had suited mankind and his natural inclinations for countless millennia before the coming of Christianity: it is called Paganism.
Despite its many advances in art, music, medicine, science and technology, the Renaissance and Enlightenment were essentially revivals of ancient pagan ideals and values. Every aspect of life began to reflect a newfound fascination with the pre-Christian past. The arts, architecture, music, drama, literature and every other form of popular culture began to portray the dominating ideas of the times, which Christian historians describe as �classical humanism, pregnable naturalism and antinomian individualism�. In other words: godlessness, materialism and hedonism.
They began to extol all those other, primitive, pre-Christian values as well, including abortion, infanticide, exposure and abandonment. By the middle of the epoch one out of every three children was killed or exposed in French, Italian and Spanish cities. In Paris, children known to have been abandoned accounted for between 20 and 30 percent of all registered births, while in London they were between 11 and 22 percent, with comparable rates throughout the rest of Europe, wherever resurrected paganism was extolled. The French philosopher, Jean Jacques Rousseau, for example, boasted that he had abandoned all five of his illegitimate children, and many of the great writers, painters and musicians of those times explored similar ideasin their works.
No surprise then, to find a political economist coming to prominence at the end of the 18th Century with a thoroughly rational and neopagan proposal for eliminating the poor beleaguered peasantry in their thousands, and on a regular basis too. He was Thomas Malthus. "In our towns" he declared in his Essay on the Principle of Population "we should make the streets narrower, crowd more people into houses, and court the return of the plague. In the country, we should build our villages near stagnant pools, and particularly encourage settlement in all marshy and unwholesome situations." (He was evidently thinking of Wisbech and the fens!!!). "But above all," cried this smart little 32 year old economist, in his powdered wig and breeches "we should reprobate specific remedies for ravaging diseases, and restrain those benevolent but much mistaken men, who have thought they were doing a service to mankind by projecting schemes for the total extirpation of particular disorders." That sounds very like a warning shot across the bows of the medical profession. The Hippocratic Oath was under assault and up for review. And, please note, thecall for a change in the code was coming from outside the profession: from a neo-pagan polemicist with a very particular anti-Christian, anti-prolife agenda.
Most followers of Malthus, however, favoured a more modern and scientific approach to down-sizing everyone other than themselves. Rather than discouraging doctors from practising their healing arts among the rising tides of neglected poor, they believed more could be achieved by harnessing the whole of the medical profession in a eugenic programme of selected segregation, sterilization, birth control and abortion.
I don't know what proportion of the medical profession were willing to break their Oath , but it seems that the practice of abortion, and its attendant horrors, had become such an endemic scandal by the turn of the 19th Century that Parliament eventually found it necessary to introduce anti-abortion legislation, incorporating it into the Offences Against the Persons Act of 1803. This piece of legislation became typical of the new Victorian age: a dynamic period, full of optimistic self-confidence, rising prosperity, industrial and trading aspiration, and staggering social and economic reforms in favour of the poor and unwanted. The Christian faith may not have been as deep-seated among the higher echelons and thinkers of the day, but Christian pro-lifers in the 19th Century stand among the greatest in history. The number of precious souls in England increased six-fold between 1800 and 1900, so they must have been doing something right.
It was certainly not an age in which the frightmeisters of Malthus and the later German philosopher Friedrich Nietzsche, were likely to be very popular. With what glee the public must have read Charles Dickens' stern rebuttal of mean-spirited Malthusianism, in his hugely popular tale 'A Christmas Carol', in which the Ghost upbraids the odious and loveless miser, Mr. Scrooge, for his misanthropic suggestion that the poor should be encouraged to die so as to 'decrease the surplus population'. "Forbear that wicked cant", cries the Ghost. "Will you decide what men shall live, what men shall die? It may be that in the sight of Heaven you are more worthless and less fit to love than millions like this poor man's child. O God! To hear the Insect on the leaf pronouncing on the too much life among his hungry brothers in the dust!"
But the germ of a new idea, such as Malthus and Nietzsche had conceived, having once entered into the minds of men, would not leave it willingly, even if obliged to remain quiescent and untested for half a century. Eventually a time would come when a change in the moral climate would enable the idea to be regenerated into a highly contagious ideology. The change came in the early decades of the next century, in the turbulent, confused years between the First and the Second World Wars.
If the ravages of the Black Death - an opportunistic pathogen - had demoralised and destabilised Europeans in the 15th and 15th Centuries, how much more distraught and spiritually depressed were the people of the 1920s and '30s, knowing that the grim reaper who had mown their loved ones down in their millions was none other than man himself? The confident Victorian dreams of unstoppable progress in European civilisation .... suddenly and brutally blown to smithereens in the most horrific internicine war the world had ever known. Chronic and protracted grief in its aftermath was thus exacerbated by an overriding sense of guilt and anger. To cap it all, the same thing happened all over again, just twenty one years later. Is there anyone under the age of ninety willing to dispute that those two world wars, coming so close together and wiping out in a few sharp years the 'flower of youth' and countless millions of civilians, didn't knock all the old moral certainties on the head; didn't leave everyone feeling ashamed, bitter and rebellious ... particularly the youth, so ready to blame the older generation for all those wars of mankind?
Everything about the first half of the 20th Century seems to have a kind of desperation about it. Perhaps that is what it was: despair at man's terrible capacity to be a brute beast, albeit a brave beast. At all events, it was a suitably pessimistic and confused mind-set for the ideas of Malthus and Nietzsche to be given a second public airing. This time they were not only unchallenged by the popular writers and thinkers of the day; they were adamantly embraced, welcomed and blazed abroad by them.
The inter-war years saw the first wave of morally maladjusted academics and a self-styled intellectual elite, writing - as ever- with an elegant detachment and wealth of privilege of the "too much life" among the teeming masses of mankind. Like Nietzsche, their hero and mentor, these would-be pagans " abhorred Christianity with a deadly hatred", especially Christianity's moral values and pro-life ethic, which they well recognised was a bulwark against such bad human inclinations as "getting rid of unwanted people".
The ideas of Nietzsche were given an experimental spin round the block in 1930s Germany, in a secret programme of mass sterilization and euthanasia of handicapped adults and children. Then came the wholesale annihilation of all unwanted people in the gas chambers. Needless to say, Nietzsche's fans were much impressed; but they tended to keep it to themselves after the war. The term 'Radical Hygiene', hovering over pits of emaciated, rotting corpses, had made the whole notion of 'eugenics' stink to high heaven in the public mind. Better to let it rest for a few decades, and then give it a nice, modern, user-friendly name such as - genetic counselling.
Meanwhile, back in the 1950s, Malthusian ideologues - their armbands with pagan insignia judiciously set aside - began creeping out of the post-war bolt holes to begin afresh their grim determination to rid the planet of as many unwanted people as was possible in one lifetime.
While some of these zealots slipped quietly back into the world of academe, others found senior posts in such international bodies as the United Nations and its newly established agency, the World Health Organisation. They were not going to make any mistakes this time around. The nazi experiment had been rejected because it was overtly nasty; the strong pitted against the unwanted weak. A new strategy had therefore to be devised in which the same ends could be achieved, but by voluntary mutual agreement: the unwanted must be induced to will the means to their own demise.
In 1960s Europe the general mood of disquiet among the young, and self-reproach among the rest, was more than conducive to a strategy of generational de-population. Thanks mainly to further advances in medical science and technology, the British population was healthy, energetic and burgeoning. So you tell them in agonised tones that it was burgeoning too much and at a frighteningly dangerous rate. Speak of an imminent population 'explosion' so as to associate it with the nuclear explosions so dreaded at the time. Ban the Bomb ... and Ban the Baby.
A newly affluent society wants to get richer and richer; so wring your hands and cry woe as you warn, with experts at your elbow, of the unsustainability of wealth and progress in an over-populated country. Commandeer the language of philanthropy as you sigh most convincingly over the inevitable prospect of a long fall-back into endemic poverty, unemployment, bad housing and crime, if we don't do something about the 'population crisis'.
Leave the words marriage and motherhood out of your vocabulary and concentrate instead, on the good time. And sex? - Stress choice. And children? - Choice again. Then, you announce, this a dangerous and uncertain world into which to bring children; even worse, if they are unplanned and unwanted. And the unwanted child - what about those? A problem; no problem at all. Your choice again.
It was on the face of it a breathtakingly simple strategy, that succeeded in its aims because it caught the confused and anxious people at a particularly low spiritual ebb, urging a repudiation of the past while provoking alarm at the future, and topping it all with an insistent Siren appeal to over-indulge a natural inclination towards self interest.
It was guaranteed to gain the full support of the multitude of vested interests that would need tobe involved the pharmaceutical industry, medical researchers, science and technology; the sex, pop, film and clothing industries.
But not for very long, one suspects. Already we can hear the note of desperation sounding in the corridors of government and industry at the declining number of profitable 'bums on seats' and hands at the helm.
When one looks with hindsight at all that has happened during the last fifty years or so, one can see that the Hippocratic Oath really didn't stand a chance of surviving in any recognisable pro-life form. Even the World Medical Association's updated version of the Oath in 1947, which was just as explicit in its promise not to assist in abortions, was set to naught by the will of Parliament twenty short years later. Yet the explanation for that betrayal by Parliament lies with the medical profession itself, because doctors had already 'sold the pass' back in the late 1940s, when they agreed to start fitting inter-uterine devices into womens' wombs. Perhaps most doctors at the time truly believed that it acted solely by preventing conception and perhaps most doctors thought the same of the contraceptive Pill.... But to reveal the truth at that time, would demonstrate that doctors were committing an illegal abortion, or at least intending that one should occur.
The fear of being prosecuted prior to the 1967 Act was of course an unreality, since all forms of birth control, by whatever means, were universally welcomed and hailed as a woman's best friend, and the salvation of the planet from over-population. Let pro-life activists and lawyers argue over the illegality of these birth control methods as much as they liked: it was all one to the Malthusians, who were themselves making a very nice living indeed out of the secret and silent deaths of the newly conceived. Not even the Lane Commission in 1974 could find fault with the workings of the Abortion Act, despite protest and ample evidence that its provisions were being grossly and widely ignored. It put the entire Malthusian project in a nutshell when reporting that; "Progress in the emancipation of women, advances in medical research and pressures of a population explosion ... will ensure that further changes will occur."
To be on the safe side Dr. Colin Brewer, fitted an I.U.D. into a woman in the presence of a female journalist, explaining that the device was an abortifacient, and challenging pro-lifers to charge him under the Abortion Act, for breaking the provision allowed under the law. Nobody did so, and for obvious reasons: they would have lost the case.
In 1977 the central core of Malthusians in Britain decided that their stratagem had been well enough tested on the public for it to be exported in its entirety, which included the whole packet of accompanying pagan principles, into the Commonwealth, the third world element of which was not only full to bursting with needy and unwanted people, but was most importantly a fabulous market for the pharmaceutical industry. Many of these countries were rather more religious than Britain, with abortion laws often too restrictive to allow the latest amazing developments in medical child-destruction which we in Britain liked to pretend were contraceptives, although we actually knew they were no such thing. I will not bore you with the convoluted, nit-picking arguments indulged in by the authors of the Commonwealth Secretariat's report, in their attempt to prove that this or that contraceptive method, was or was not an abortion.
Pro-lifers in this country (myself included) have tried time after time to catch the Malthusians out, by recourse to Parliament or the law. But so far, always to no avail. Paganism, whether ancient or modern, is - as we know from history - incredibly difficult to overcome and transform because it is so very appealing, at least initially, to the least worthy of our human inclinations. It is such a difficult task convincing people living in a progressive, high-tec era, surrounded by the material benefits arising from our endless quest for knowledge and self-advancement, that we have simultaneously regressed to a very primitive level in our personal relationships. Or as somebody once described it: an age of technological giants and moral pigmies.
Undoubtedly, the very worst and wickedest thing about the 20th Century Malthusians was the way they turned desire into a weapon of mass destruction. It seems incomprehensible, that sex rather than warfare should be the cause of so much destruction and personal misery today. Sexuality has been designed by our Creator specifically to generate human love and life. The Malthusians targeted our sexual desires in order to pervert them , and create what the Holy Father has rightly described a 'Culture of Death'. The confusion and unhappiness that so many people feel today is precisely because they are struggling to live with the great paradox at the heart of this Culture, which requires men and women to fear and reject life while in the very act of embracing it. Their life giving and life enhancing sexuality turned by contraception into a weapon against itself: a kind of voluntary auto-destruction. Only the devil himself could have devised such a deadly inversion of a natural, and naturally good, human activity. Only a soul at war with itself and its Creator would wish to see such a diabolical plan succeed.
Although the paradox at the heart of the Culture of Death is potentially lethal, it is not ... an incurable condition. There is, and always has been for Christians, an antidote to it: spiritual immunisation and strong antibiotics in the form of sound, orthodox Christian teaching, the Sacraments, and plenty of tender loving pro-life care of the weak and vulnerable young and their adult counterparts.
I can never resist quoting that marvellous pro-life champion of the poor and unwanted, Josephine Butler, who declared with absolute conviction, and truth, that:
"There is no evil in the world so great that God cannot raise up to meet it a corresponding beauty and glory that will blaze it out of countenance".
Mrs. Victoria Gillick is a Pro-life campaigner, Life Pregnancy Counsellor and former plaintiff in a cause celebre.