Controversy over medical pledge uncalled for

MUCH controversy has been generated by the recommendation of the National Medical Commission (NMC) to initiate medical graduates with the ‘Charak Shapath’, in place of the ‘Hippocratic oath’ which has, till now, been used for this purpose. So much so, that the dean of a medical college in Tamil Nadu was removed from his post for using the ‘Charak Shapath’ rather than the ‘Hippocratic oath’. Macbeth immediately springs to mind, for the entire episode is nothing more than sound and fury, signifying nothing. Unsurprisingly, the real issue, to which I shall presently advert, is lost in the dust and din of hollow political discourse.

But first, a few words about the two competing professional pledges. The ‘Hippocratic oath’ is attributed to the Greek physician Hippocrates, and dates back to around 4 or 5 BC. The ‘Charak Shapath’ is attributed to Charak, the Indian physician whose composition ‘Charak Samhita’ is considered the foundational text of ancient Indian medicine, and dates back to the first or second century AD. It is widely believed that the Indian system of medicine was quite superior to the Greek system, around that point in time. There should then be no occasion for anyone to take umbrage to the use of the ‘Charak Shapath’. It is as if the mere invocation of the name ‘Charak’ is unacceptable. Unfortunately, it appears to be fashionable in some quarters to demean or belittle our rich historical and cultural traditions, rather than celebrating them and unifying around them.

As a medical doctor, I have experienced first-hand the sublime scientific splendour of the allopathic system. Despite its current limitations, it remains the foremost medical system in the world, and never ceases to fascinate the interested observer with its relentless evolution and advancement. Nonetheless, we cannot degrade our own past contributions. The WHO has recognised the contribution of the Indian systems of medicine to humankind. It is worth mentioning that the definition of the term ‘health’, as adopted by the WHO in 1948, was a “state of complete physical, mental and social well-being”, and not merely the absence of disease. To this was added “spiritual health”, based on the suggestions of Indian professionals. Again, thanks to the efforts of India and its political leadership, the United Nations has begun to celebrate International Yoga Day, on June 21 each year. The health benefits of the regulated practice of yoga are also now well accepted. This international recognition should instil in us a sense of pride and inspire us to live up to the best in our own traditions.

I have come across writings which point to certain portions of the complete ‘Charak Shapath’ as being incompatible with present day mores and egalitarian beliefs. While these portions may have no relevance in modern society, what is missed unfortunately, is that none of these portions are included in the version of the ‘Shapath’ recommended by the NMC.

I should point out that no less an institution than the AIIMS in New Delhi, the premier medical institution and college in the country, where I also had the privilege of serving for about 25 years, has been using a version of the ‘Charak Shapath’ for many years. The pledge, as recited at each convocation in AIIMS, includes the following statement: “Not for the self, not for the fulfilment of any worldly material desire or gain, but solely for the good of suffering humanity, I will treat my patient and excel all.”

It is impossible, in my view, to identify anything objectionable in these words. For the sake of comparison, let me refer to the pledge each graduate doctor is expected to recite at the commencement of the post-graduate residency training at the PGIMER at Chandigarh. The PGIMER, apart from being my own alma mater, is an institution of national importance, just like AIIMS. The pledge at PGIMER contains a portion from the ‘Hippocratic oath’, to the following effect: “I charge you to make yourself a trustworthy physician who will practice medicine with excellence, integrity and devotion to your patients. I commit you to a life that will bring honour to yourself and your family, the profession, the institute, and your country.”

It is difficult for me to detect any material difference between these words and the words recited at AIIMS.

Quite apart, it is also disturbing that a decision taken by the NMC should be subjected to such doubt and criticism. The NMC is a professional body, with around 30 members. All members of the NMC, except one or two, are medical professionals. Surely, the recommendation was made after due deliberation and internal debate. Moreover, what could a body like the NMC stand to gain by making its recommendation? And how could the dean of a medical college have been removed from his post merely for following a recommendation of the NMC? Any honest and fair assessment of the unnecessary controversy and the events leading to it must address these questions.

Interestingly, nearly four years ago, while addressing the convocation of the Rajiv Gandhi Health University in Bengaluru, Vice-President Venkaiah Naidu, as per press reports, spoke about the ‘Hippocratic oath’ and the ‘Charak shapath’. As per reports, he mentioned that the ‘Hippocratic oath’ includes a statement that ‘there is an art of medicine as well as a science’, and that the warmth, sympathy and understanding may outweigh the surgeon’s knife or the chemist’s drug. He advised students to master both the art and science of medicine, while emphasising that the ideal medical student has been described in the ‘Charak Samhita’ as one who is of mild disposition, never mean in his acts, humble, thoughtful and compassionate, seeking the good of all.

This brings me to the real issue. What should concern us is not the title or the authorship of the pledge taken by medical professionals, but the actual adherence to the solemn undertakings embodied in the pledge. The spirit of the ‘Hippocratic oath’ as well as the ‘Charak shapath’, as recommended by the NMC, is indistinguishable. The words may differ, but what they embody and convey is hardly different. The real challenge lies in being able to live up to these ideals. Instances of unethical conduct must be handled firmly by the medical councils. It is only when we are driven by the ideals of service to humanity that we can truly call ourselves a noble profession. Otherwise, any convocation pledge will ring hollow.