Abstract: It has been debated whether the Hippocratic Oath’s commitment referring to not administering poisonous/ deadly drugs prohibits: euthanasia, assisted suicide or murder. The first goal was to analyze if the prohibition of administering poisonous/deadly drugs was kept and how it changed in medical oaths of Hippocratic stemma of different time periods and religious orientations. The second aim was discern what is forbidden: euthanasia, assisted suicide or murder. Seventeen medical oaths: 4 Medieval, 2 Modern and 11 Contemporary oaths were studied and divided into those expressing the commitment like the original, those that may include it depending on the interpretation and those that do not mention it. Medieval and Modern oaths express it similarly to the Hippocratic Oath, possibly due to religious and Hippocratic/Galenic influences. What they forbid cannot be inferred. Contemporary oaths maintaining the commitment tend to include phrases regarding active euthanasia and assisted suicide. Other contemporary oaths may generalize it. It would be advisable that medical oaths would contain clear and specific premises regarding this commitment depending on the country, school and the student body’s idiosyncrasies.

Resumen: Ha sido debatido qué es lo que prohíbe el compromiso del Juramento Hipocrático de no administrar drogas venenosas/mortales: la eutanasia, el suicidio asistido o el asesinato. El primer objetivo fue analizar si la prohibición de administrar drogas venenosas/mortales se mantuvo y cómo cambió en juramentos médicos de stemma hipocrática en diferentes tiempos y con distinta orientación religiosa. El segundo objetivo fue discernir qué se prohíbe: si la eutanasia, el suicidio asistido o el asesinato. Se analizaron 17 juramentos médicos: 4 medievales, 2 modernos y 11 contemporáneos. Se dividieron en aquellos que expresan el compromiso como el original, aquellos que podrían incluirlo o no dependiendo de la interpretación y aquellos que no mencionan nada al respecto. Los juramentos medievales y modernos expresan el compromiso de manera similar al Juramento Hipocrático, posiblemente por influencias religiosas e hipocrático/galénicas. Qué es lo que prohíben no puede ser inferido. Los juramentos contemporáneos que mantienen el compromiso suelen incluir frases en relación a la eutanasia activa y al suicidio asistido. Otros juramentos contemporáneos lo generalizarían. Sería recomendable que los juramentos incorporaran compromisos claros dependiendo de la idiosincrasia de los países, instituciones y cuerpo estudiantil.

Resumo: Tem sido debatido se o compromisso do juramento de Hipócrates, referindo-se a não administrção de drogas venenosas/mortais, proíbe: a eutanásia, o suicídio assistido ou o assassinato. O primeiro objetivo foi analisar se a proibição de administrar drogas venenosas/mortais foi mantida e como isso mudou em juramentos médicos de Hippocratic stemma em diferentes períodos de tempo e orientações religiosas. O segundo objetivo foi discernir o que é proibido: eutanásia, suicídio assistido ou assassinato. Dezessete juramentos médicos: 4 medievais, 2 modernos e 11 juramentos contemporâneos foram estudados e divididos naqueles que expressavam o compromisso semelhante ao original, aqueles que podem incluir, consoante a interpretação e aqueles que não o mencionam. Os juramentos medievais e modernos expressam da mesma forma que o juramento de Hipócrates, possivelmente devido a influência religiosa e de Hipócrates/galênica. O que eles proíbem não podem ser inferido. Os juramentos contemporâneos, mantendo o compromisso tendem a incluir frases sobre eutanásia ativa e suicídio assistido. Outros juramentos contemporâneos podem generalizá-lo. Seria aconselhável que os juramentos médicos conteria premissas claras e específicas sobre este compromisso dependendo do país, a escola e as idiossincrasias do corpo estudantil.

Background The relationship teacher-student might determine the link between the student and the patient. Currently, this relationship has been spoilt by causes typical of the institution and of the education in general, but also by the lack of honesty among students and by teachers' abuse. The students may consider abuse as a morally incorrect incident, but they may take into account other actions. Objective To analyze which incidents are considered morally incorrect by final year medical students. Material and Methods A semi-structured survey was conducted on students of the final year of the School of Medicine, with closed items (variables: student's gender and age; aspects: teacher's position and gender, cycle and instance) and an opened item: reporting the incident. Categories were constructed for the latter item. The significance of the relation between variables and aspects was analyzed using the chi square test (p <0.05). Results The survey was responded by 80 students; 6 did not report any incident. Average age was 26.83 years (MSE 0.47); 59.4% were women. The greatest number of incidents occurred during the clinical cycle, in oral examinations and with male professors. We found a significant relation between student's age and teacher´s gender on the one hand, and cycle (basic and clinical) and instance (teaching-learning and evaluation) on the other. Abuse and unfair evaluation criteria were the categories most frequently mentioned. Conclusions Unlike the studies analyzing abuse, this study asked the students about a general concept; however, abuse was the morally incorrect incident most reported, together with unfair evaluation criteria. These aspects show the lack of moral commitments among teachers: respect and justice.

Introducción La relación docente-alumno en medicina podría determinar el vínculo que entable el estudiante con el paciente. En la actualidad se encuentra deteriorada por causas propias de la institución y de la educación en general, pero también por la falta de honestidad de alumnos y maltrato de docentes. Los estudiantes pueden considerar el maltrato como un incidente moralmente incorrecto, pero pueden tener en cuenta otras acciones. Objetivo Analizar qué consideraban los alumnos del último año de medicina como incidentes moralmente incorrectos. Material y métodos Se efectuó una encuesta semiestructurada a alumnos del último año de medicina, con ítems cerrados (variables: sexo y edad del alumno; aspectos: cargo y sexo del docente, ciclo e instancia) y abierto: narrar el incidente. Se construyeron categorías para este último. Se comprobó si existía una relación significativa entre variables y aspectos con la prueba de chi cuadrado (p < 0,05). Resultados Completaron la encuesta 80 alumnos; 6 no manifestaron incidentes. El promedio de edad fue de 26,83 años (EEM 0,47). El 59,4% eran mujeres. El mayor número de incidentes se produjo en el ciclo clínico, en evaluaciones orales y con profesores hombres. Se encontró una relación significativa entre edad de alumno y sexo del docente, por un lado, y ciclo (básico y clínico) e instancia (enseñanza-aprendizaje y evaluación), por otro. Las categorías más mencionadas fueron maltrato y criterios de evaluación injustos. Conclusiones A diferencia de los estudios que analizan el maltrato, se interrogó a los estudiantes sobre un concepto general, pero a pesar de ello el incidente moralmente incorrecto más indicado fue el maltrato. A diferencia también, señalaron la evaluación como conflictiva. Estos aspectos indican la falta de compromisos morales por parte de los docentes: respeto y justicia.

OBJETIVO: Determinar se os Juramentos Médicos de diferentes épocas expressam o compromisso do médico de solicitar uma remuneração justa pelo atendimento e serviços prestados na recuperação da saúde de pacientes. MÉTODOS: Foram analisados 50 Juramentos Médicos editados em artigos e publicações, segundo duas épocas diferentes, 12 juramentos da época antiga e medieval e 38 juramentos da época moderna e contemporânea. RESULTADOS: Somente três textos de juramento, entre os 50 selecionados, contêm expressamente explícito o compromisso de remuneração justa dos honorários médicos. Dois deles são da época medieval e pertencem à Escola de Medicina de Montpellier, e apenas um da época moderna (Juramento de Amato Lusitano). Quatro fórmulas indicam votos com a atenção dos pobres e 11 assinalam indiretamente não obter ganhos de outras atividades ou relações. CONCLUSÕES: Os Juramentos mais antigos são os que enfatizam a justa remuneração dos serviços médicos, a atenção médica sem discriminar o atendimento em função da possibilidade de pagamento do paciente e a obtenção de ganhos por meios honestos. Os textos de juramentos atuais não expressam estes aspectos, sendo poucos os que se referem somente a não exercer a profissão para proveito material. Apesar destas evidências, os médicos devem respeitar os limites de suas obrigações e estarem comprometidos no sentido de atender pacientes sem discriminar, especialmente sem levar em conta as possibilidades financeiras dos pacientes e, ao mesmo tempo, não exigir honorários que não estejam de acordo com os serviços prestados.

BACKGROUND: to determine if Medical Oaths from different times include the statement of the physician to request from patients a fair retribution for his/her medical services. METHODS: Fifty Medical Oaths found in articles and publications were analyzed. In accordance with their corresponding dates, the Oaths were grouped as ancient /medieval (12), and modern/contemporary (38). RESULTS: Of the fifty, only three specifically included the statement of fair retribution. Two of the three were medieval and belonged to the School of Medicine of Montpellier. The other text was modern (Amato Lusitano's Oath). Four writings showed statements regarding medical assistance to the poor. Eleven pledges indirectly stated that no earnings from other activities and/or relations were obtained. CONCLUSIONS: Ancient oaths emphasize fair retribution, no discrimination in medical assistance based on payment possibilities, and gain of honest earnings. Modern oaths generally do not include these topics and very few mention that the medical profession should not be exercised merely for material purposes. Despite the above, physicians should respect the limits of their obligations and should be committed to assist without discriminating, particularly without taking into consideration their patient's financial possibilities. Therefore their fees should not be excessive for the services rendered.

Background: All humans have the right to receive a thorough medical attention, and should not be discriminated. Aims: To determine if there is a significant relationship between Medical Oaths that commit to the principle of no discrimination in health care and the time, origin and source of the modifications to the Hippocratic Oath. To specify which are the conditions for no discrimination. Materials and Methods: Fifty Oaths found in different articles and publications were analyzed and selected considering their historical context. Results: Of the fifty Oaths that were analyzed, nineteen express a commitment towards no discrimination, whereas one of the texts is discriminatory. The only significant relationship found was the origin and source of the texts. The most frequently discriminating factors found are social class, religion, nationality and race. At present, other factors can be found such as ideology, moral, aptitude, sex and political and sexual preferences. Conclusions: The commitment towards no discrimination is not widely found in Medical Oaths of all times (30/50). According to the bioethics principle of justice, physicians should find the limit of their obligation as doctors in providing medical assistance to everyone alike, wealthy or poor; Christians, Hebrews or Muslims; men or women; children, adults or old; with or without infectious diseases. Non discrimination should be a vow that physicians must be willing to take despite any of the factors that could influence health care (Rev Méd Chile 2003; 131: 799-807)