First-year medical student Sean Sweat "didn't want to tiptoe around" issues of race when she sat down with 11 of her classmates to write a new version of the medical profession's venerable Hippocratic oath.
"We start our medical journey amidst the COVID-19 pandemic, and a national civil rights movement reinvigorated by the killings of Breonna Taylor, George Floyd and Ahmaud Arbery," begins the alternate version of the oath, rewritten for the class of 2024 at the University of Pittsburgh School of Medicine.
It continues: "We honor the 700,000-plus lives lost to COVID-19, despite the sacrifices of health care workers."
Sweat and the other incoming first-year medical students recited this newly penned pledge, along with a traditional version of the Hippocratic oath, as part of orientation activities during their first week of medical school this fall.
The earliest known version of the Hippocratic oath dates back to the fifth century B.C. Many iterations exist, and in many U.S. medical schools it has become customary for incoming medical students to write and even recite their own versions; many of the variants include language that prohibits discrimination or bias in the practice of medicine.
What's distinctive about the University of Pittsburgh version is that it specifically names people who have died recently at the hands of police and thereby addresses events that are still unfolding.
"Our oath can be both timely and timeless," Sweat says.
Increasingly, medical professionals are joining protests for racial justice and acknowledging racism's impact on public health. For example, Black residents of Allegheny County, where Pittsburgh is the county seat, have been disproportionately hurt by the coronavirus, as have Blacks in other parts of the United States. Though 13% of Allegheny County is Black, Black residents make up nearly 19% of cases and 30% of COVID-19 hospitalizations.
"This pandemic has wreaked havoc on minority populations," Sweat says. "It has revealed the many gaps within the medical field. ... A lot of those gaps that this pandemic has revealed, those are things we need to go after to fix."
Bioethicist Laura Guidry-Grimes agrees this year has been a "paradigm-shifting time" that has brought a "reckoning" for medicine; she says she likes that the University of Pittsburgh version of the Hippocratic oath discusses COVID-19.
"[It acknowledges] that we have been challenged and learned the hard way ... that what we've been doing is not enough," says , an assistant professor in the department of Medical Humanities and Bioethics at the University of Arkansas.
The new oath asks physicians to eliminate their personal biases, combat disinformation to improve health literacy and be an ally to minorities and other underserved groups in society.
It also calls on each doctor to pledge to learn about the social determinants of health "to use my voice as a physician to advocate for a more equitable health care system from the local to the global level."
Some doctors have said they worry that the proliferation of different versions of physician oaths could weaken their intended effect on the profession. A 2004 paper in Academic Medicine suggested that the trend might even lead to "fragmentation and confusion about the ethical values of the medical profession."
But Guidry-Grimes says she thinks that concern is misplaced. If anything, she worries that physician oaths have lost relevance: "My fear is that too often the oath-taking is a ritual for the sake of ritual," she says. "You have words washing over everything without meaning or impact." If that is the case, exercises such as rewriting the oaths are helpful in that they may spur medical students to consider more deeply professional ethics and their sense of mission.
For Sweat, the oath she helped write has meaning and will continue to guide her as she launches her career. "Patients entrust us to take care of their health," she says. "In my opinion we're more than just physicians. We're leaders in this society. With that comes a responsibility."
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