Passage - General Questions

[Administrator]

Passage Discussion

In the fi rst paragraph the author discusses the function of the Hippocratic oath and then reviews
criticisms of the oath. The second paragraph dismisses some of those criticisms, reaffi rms some
of the core principles of the oath, and fi nally acknowledges that some revisions of the oath are
desirable.

Paragraph 1 Overview

Since this passage consists of two long paragraphs, you should realize that a reasonable map of
passage development will assist you, and may possibly be necessary.

The author begins by introducing the Hippocratic oath. The author does not clearly defi ne the oath,
but does describe some of its facets in lines 1-12:

1. Physicians usually affi rm the oath before entering the medical practice.
2. The oath is traditionally seen as a universal, immutable code.
3. The oath involves promises such as:
i. A promise to act in the patient’s benefi t.
ii. A promise to preserve confi dence.
4. Elements of the oath have, until recently, seemed impervious to scientifi c and societal forces.

You should at least take note of the presence of this description, even if you do not remember every
detail of it. For example, you could bracket lines 1-12, and note in the margin “oath description.”
That would provide an adequate cue for passage reference.

Also, remember to read aggressively and consider the direction the author will take later in the
passage. Notably, given that the states that the oath has “long been” considered immutable, and
uses phrases such as “until very recently,” you should realize that the passage will probably discuss
possible changes to the oath. In fact, in line 13, which ideally ought to begin a new paragraph, the
author introduces some criticisms of the oath. You absolutely must make note of these critiques, and
might want to bracket lines 13-33 and note in the margin “critics of oath,” or something similar.

You should also note that the author’s language does not imply total agreement with the critics of
the oath. For example, the author probably would not include phrases such as “they say” in line 14,
or “some critics believe” in lines 21-22 unless the author wanted some distance from those claims.
In any case, you should notice the author’s disagreement when you reach the second paragraph;
however, the passage will probably make more sense if early on you pick up on the author’s
language and sense that he or she does not agree with all the claims of the critics.

The author mentions a few criticisms that others make:

1. The fi xed moral code of the oath is incompatible with fl exible modern ethics.
2. The code encourages an authoritarian attitude.
3. The emphasis on the individual frustrates the physician’s role as gatekeeper for managed
care plans, and restricts the effect of competitive market forces.
4. The oath does not cover some contemporary issues.
5. The authorship of the oath is doubtful in any case.

You should be sure to underline or note some brief portion of each of those critiques.

Paragraph 2 Overview

The author uses the second paragraph to evaluate the various complaints of the critics. You must be
careful to separate the critiques one from the other.

Immediately, the author discards as entirely irrelevant point that the authorship of the oath is
uncertain. The author argues that those who assess and adopt the oath are, in a practical sense, the
current authors, but does not immediately explain why.

The author then points out that, more importantly, patients need assurance that physicians will
pursue appropriate goals, so the core value of benefi cence (acting for the benefi t of the individual
patient) should be retained, while adjusting other portions of the oath to refl ect benefi cence in
modern situations. As an example, the author points out that physicians already re-interpret part of
the oath. At the time of the oath’s inception, surgery was probably more likely to harm the patient
than to help, but today the provision against “cutting for the stone” is not interpreted to disallow
surgery. Instead, the broader intent of the oath is considered—a physician who acts in accordance
with benefi cence will not attempt procedures outside of his or her capabilities. The author’s strongly
implied argument is that the provisions in the oath follow from the desire to benefi t the patient, and
that the provisions are not a collection of arbitrary rules, so it is reasonable to adjust the oath to
modern capabilities while retaining the core value of benefi cence, which supports the author’s strong
statement of main point from lines 47-52.

Passage Summary

The author’s main point, most clearly stated in lines 47-52, is that the Hippocratic oath should be
preserved at its core with some surface modifi cation.

The structure of the passage is as follows:

Paragraph 1: Introduce the Hippocratic oath and some criticisms of it.
Paragraph 2: Defend the Hippocratic oath against some of those criticisms and suggest a
method of modifi cation for the oath.

Note that the two paragraph format is probably used to intentionally confuse test takers. This passage
would readily lend itself to partition into more paragraphs, and a greater number of paragraphs
would lend clarity to the different sub-topics.

[pacemaker]

Hippocratic Oath Passage

I somehow missed the point that the critics wanted to completely abandon the oath and I am wondering why I missed this point.

I know that the critics argued that the oath was outdated and they gave several reasons for this. The author on the other hand says that the care for patients is still key which the current oath is stating but he also acknowledges the need to some reform based on the reasons that one group of critics have given while the author dismissed the other group of critics point on the unknown origin and authorship of the oath.

So, I have read the passage twice and what I got from the passage was that the author was suggesting to keep the current points on patients welfare in the oath and to make other revisions around it. But I still thought that when the critics say "outdated" - to me, this meant it needs to be updated (i.e. revised) and the author was suggesting in general what kind of revisions to make - I don't see where they are saying that the current oath needs to be abandoned and a new one formed?

I missed a couple of questions because of this misunderstanding.

[David Boyle]

Hippocratic Oath Passage

I somehow missed the point that the critics wanted to completely abandon the oath and I am wondering why I missed this point.

I know that the critics argued that the oath was outdated and they gave several reasons for this. The author on the other hand says that the care for patients is still key which the current oath is stating but he also acknowledges the need to some reform based on the reasons that one group of critics have given while the author dismissed the other group of critics point on the unknown origin and authorship of the oath.

So, I have read the passage twice and what I got from the passage was that the author was suggesting to keep the current points on patients welfare in the oath and to make other revisions around it. But I still thought that when the critics say "outdated" - to me, this meant it needs to be updated (i.e. revised) and the author was suggesting in general what kind of revisions to make - I don't see where they are saying that the current oath needs to be abandoned and a new one formed?

I missed a couple of questions because of this misunderstanding.

Hello pacemaker,

While the passage does not say, "Some critics demand that the Hippocratic oath be burned up and completely abandoned", the word "outdated" implies that there is some serious hostility/lack of respect towards the oath. (Note that the critics didn't say "Parts of the oath are outdated"; they just said the oath is outdated, period.) So there is the strong implication that some critics don't want the oath at all.

Hope this helps,
David

[abhola]

Hi Powerscore,

Could you please help me understand the following bit of the explanation?

4. Elements of the oath have, until recently, seemed impervious to scientifi c and societal forces.

What does it mean to say "element of oath seemed impervious to certain forced." I was not able to make amy sense of this sentence.

[Adam Tyson]

That line references this text from the first paragraph, ahola:

Until very recently the promises expressed in that oath—for example to act primarily for the benefit and not the harm of patients and to conform to various standards of professional conduct including the preservation of patients’ confidences—even seemed impervious to the powerful scientific and societal forces challenging it.

And that line itself it a continuation of the description of the oath as being seen as an " immutable bedrock of medical ethics" that physicians "standardly affirm."

In other words, the oath hasn't changed even under all sorts of pressure, including pressure from changes to society over time and of scientific developments that might require reevaluating the oath. It has been inflexible and unyielding, even though there may be powerful reasons to make changes to it. That's the background that the author provides about the oath as it currently exists, which then leads into a discussion of criticism (some folks think it should be changed to adapt to those social and scientific pressures) and ultimately to the author's defense of the oath (if it needs to change at all, it's just at the periphery, while the core should stay the same and we should instead adjust our interpretation and understanding of what it requires).