Volume 9, Issue 1 - January 2026

Dear Yvonne,

This first issue of The Academy for 2026 highlights the length and breadth of topics impacting important discussions of health professionalism. As those in some locales – due to changing governmental regulations, policies, and programs – have seen the road to becoming a health professional made much, much bumpier, we consider topics in both of historical- and forwarding- natures, as well as work in professionalism-adjacent spaces.

In “Prescriptions Fade, but the Spirit Remains: A Legacy of the Hippocratic Oath,” Guy Stein reflects on the influence of the Hippocratic Oath, arguably the single most important document to the profession that he holds most dear. Whether the Oath is appropriately applicable in modern professionalism contexts is an important question to consider for future physicians, as well as for all health professionals whose work is impacted or whose profession’s core values have been influenced by the content of the Oath. Gazing back in our first article, we look forward in our final article, by Milan Kharel. Dr. Kharel examines the National Health Service’s Virtual Wards, which raise interesting and timely questions about the application of health professionalism in novel spaces. These questions call out for answers, and so we invite those who are thinking about the application of professionalism in new spaces, to share their thoughts (to be considered for publication in the Letters to the Editor section of our February issue). Bridging the gap between the past and the future is our second article, penned by Tom Koch. Koch reflects on professionalism and the philosophies of care through a critical examination of the intersection of the field of bioethics and professionalism. There are lessons to be drawn from his historically informed work, and - as with our final piece - we invite readers, especially those with interests in bioethics, to write to us with any reactions to Koch’s arguments. His pithy title, “After Bioethics: The Professional and Philosophies of Care,” harkens back to work in the discipline of philosophy, like Alasdair MacIntyre’s After Virtue: A Study in Moral Theory, as well as work in bioethics, such as H. Tristram Engelhardt’s After God: Morality and Bioethics, and it will not disappoint the reader interested in a critical evaluation of a field so impactful on health professionalism.

Also included in our monthly publication are important updates about future professionalism conversations, most noteworthy the APHC’s upcoming conference, as well as our usual set of announcements both from members and about professionalism-related opportunities.

Bryan Pilkington, PhD, is Professor of Bioethics, in the Department of Medical Sciences, at Hackensack Meridian School of Medicine, and the Editor-in-Chief of The Academy: A Forum for Conversations about Health Care Professionalism.

1. APHC Call for Abstracts:

2. Prescriptions Fade, but the Spirit Remains: A Legacy of the Hippocratic Oath

3. After Bioethics: The Professional and Philosophies of Care

4. The National Health Service’s New Virtual Wards

5. APHC Roundtable

6. Healthcare Professionalism: Education, Research & Resources Podcast

7. APHC Member Announcements

8. APHC Member Benefits

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In Western culture, the Hippocratic Oath is often regarded as a foundational text of the medical profession. Since its inception more than 2,000 years ago, the medical profession has changed dramatically and in turn so has the oath that most physicians may take today. One of the most common iterations of taking the oath these days is doing so in medical school ceremonies. Some institutions have changed the Oath to reflect their values, while others use popular updated versions. A 2009 survey found that one-third of U.S. and Canadian schools used Dr. Louis Lasagna’s modernized version, while only 11% retained the original.¹ In a 2016 survey, 70% of physicians over age 65 found the oath meaningful, compared with just 39% of those under 34.² This generational divide raises the question: why does the oath resonate less with younger physicians?

First, the original text is bound to its historical context. It references Greek gods, forbids sexual acts with slaves, and other elements which are irrelevant to modern medicine. More significantly, the oath embodies a paternalistic model of the patient–physician relationship. While it prohibits harm through malpractice, sexual misconduct, or breaches of confidentiality, it never acknowledges patient autonomy. Modern medicine, however, is grounded in shared decision-making, with autonomy considered a central ethical principle. The importance of this principle is even more prevalent in younger physicians, and the oath’s silence on this point undermines its relevance.

Second, the oath ignores preventive medicine, a cornerstone of modern practice. Screening tests, vaccinations, and lifestyle interventions are widely regarded as essential to reducing disease burden on both the individual and the general population. Physicians strongly support prevention, yet the oath reflects only treatment of disease, not proactive care. Since the time of Hippocrates, medicine has expanded to include population health alongside individual patient care. This evolution is evident in public health campaigns that keep both communities and individuals healthier while reducing the overall burden on healthcare systems. The omission of prevention from the oath further distances it from modern medical professional values.

Third, the oath’s stance on abortion and end-of-life care underscores how opinions in medicine have changed. The original bans abortion outright, while modern versions omit this restriction.³ Lasagna’s version even acknowledges a physician’s potential role in ending life, tempered by humility: “Above all, I must not play at God”.¹ This reflects evolving debates around abortion and medical assistance in dying. While not all physicians agree with such practices, the acknowledgment of these responsibilities marks a significant departure from the Hippocratic prohibition. The diversity of views on these issues illustrates the ethical complexity of modern medicine and the inherent limitation of any single oath to capture the full spectrum of opinions. Together, these omissions and revisions explain why younger physicians, who are trained in a profession centered on autonomy, prevention, and contested practices like assisted dying, see the original oath as outdated.

Still, the oath’s influence persists. Even revised versions retain the original spirit and structure. The original emphasized obligations to teachers and colleagues, fostering camaraderie and continuity within the profession. While the specifics (such as offering free education to one’s teacher’s children) no longer apply, the modern oath echoes this sentiment: “I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow”.¹ Mentorship and collegiality remain pillars of medical life, setting medicine apart from many other professions.

Most importantly, the oath enshrines the ethic of doing good for patients and avoiding harm. Though approaches to achieving this have changed, the central ideal remains constant. Hippocrates’ specific prescriptions may have faded, but the oath codified an enduring professional identity.

As I enter the fourth year of my medical training, I find that the spirit of the oath still resonates with me. When I took the oath during my first year of medical school I found the wording to be obvious, and the content to be straightforward. I thought to myself: how could we need to take this oath (the revised version) when anyone who knows anything about medicine would assume these values? Yet, as I reflect on those initial impressions, I realize that the apparent obviousness of the oath is a testament to its ubiquity in the modern consciousness regarding what it truly means to be a physician.

In short, the Hippocratic Oath is no longer directly applicable as a literal guide for practice. Its content reflects an ancient worldview far removed from contemporary medicine. Yet its legacy endures: it established the expectation that physicians articulate and commit to an ethical framework beyond technical skill. For that reason, even if younger physicians find the oath’s literal wording outdated, they remain heirs to its lasting spirit.

REFERENCES 

1. Hajar R. The Physician's Oath: Historical Perspectives. Heart Views. 2017;18(4):154-159. doi:10.4103/HEARTVIEWS.HEARTVIEWS_131_17
2. Meskó B, Spiegel B. A Revised Hippocratic Oath for the Era of Digital Health. J Med Internet Res. 2022;24(9):e39177. Published 2022 Sep 7. doi:10.2196/39177
3. T.A. Cavanaugh. Hippocrates’ Oath and Asclepius’ Snake : The Birth of a Medical Profession. Oxford University Press; 2018. Accessed September 12, 2025. https://research.ebsco.com/linkprocessor/plink?id=f87ee42f-d7bf-3ad0-b21a-7dcbdf51a0a4

Guy Stein is a current fourth year medical student at the Hackensack Meridian School of Medicine with an interest in Internal Medicine.

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Bioethics came on the scene in the 1970s like a slick, television campaigner announcing answers for a problem nobody knew existed. Medicinal advances, its promoters declared, required a new ethic and moral philosophers had the answer (Beauchamp and Childress 1979,1).

All that was needed was “philosophical reflection on morality and ethics … that affords some distance from assumptions still evident in the biomedical sciences and healthcare”. Forget the old, Hippocratic tradition. Founding bioethicists would set forth a limited series of general principles to govern medicine in the future. With their application it would all work out.

At the recent meetings of the American Society for Bioethics and the Humanities (ASBH) there was talk of AI and ethics, clinical ethics, genomic ethics, global healthcare, neuroethics and religious ethics—everything but Bioethics and its principles that were supposed to provide answers to every query.

Certainly, an ethics of practice with a social vision of health care is needed. Bioethics was a grand ideal (Koch 2008) that failed to provide either in three essential ways.  In thinking about medical ethics today it’s useful to remember that there were at least three other potential ethical systems that might have served at least as well, or better. Here they are reviewed as a palliative to Bioethics failures.

The Failure

First, was the perhaps arrogant assumption that moral philosophers with neither medical experience or training in socioeconomic practice might craft a simple set of principles that could govern the complexities of clinical practice and health policy.

“Philosophy cannot do its job well unless it is informed by fact and experience” (Nussbaum 1998). Moral philosophers had neither. Little wonder that, as Hastings Centre cofounder Daniel Callahan later admitted, “We felt most like the wizard [of Oz], pulling levers behind a screen and talking in a way that projected a wisdom about large moral puzzles we did not yet have” (Callahan 2012, 77).

Second, Bioethicists ceded questions of medical organization and governance to a commercial vision in which medicine was less an ethical good than a product, embracing a traditional view that the market encompasses most desired transactions (Radin 1996, 36).

 And so for bioethicists, “The market was treated as a moral, not just an efficiency value … little interested in the common good” (Callahan 2012, 132-33).

That fit nicely with the neoliberal, Regan-Thatcher economics of the day. It was “the sell,” perhaps heart-felt but also practical and self-serving. As former ASBH director Mark Kuczewski admitted, “Ethicists have been a guest in the house of medicine,’ and in order to survive in that environment have had to align themselves with money and power” (Kuzczewski 2010, 4).

The result has been, as Callahan eventually admitted, “devastating” (Callahan 2012, 127).

Third, for Bioethics to succeed it needed to push religion as a value system and practitioners as ethical experts (CALLAHAN 1993, S8-9). Robert Veatch (2912) insisted medical professionals were merely technicians with no more moral understanding than a store clerk recommending, say, a new pair of shoes. That was consistent with the patient-as-consumer view “turning professionals into sellers”(Mol 2002, 167).

Fourth, Bioethicists advanced “autonomy” as its governing principle. That dismissed the traditional, relational ethic of medicine as a shared endeavour between practitioners and patients with practitioners serving as active agents for a caring healthy environment.

The Bioethical vision was wrapped into that of Professionalism as a mostly silent, powerless partner in an unwritten, unnegotiated contract with business and government. The result has been to limit their role as ethicists and citizens focused on justice and care even as in practice they remain Hippocratic in their duties to patients. It is no wonder either that the result has been diminished respect for the practitioner in a commercialized environment that is less amenable to fulfilling ideals of equality and justice.

Alternatives

Any corrective to Bioethics would require, first, a move back toward a relational and communal ethic of care (Elliott 2021). Certainly any such move would revive the focus on the medical practitioner-patient relationship. The Hippocratic injunctions in its Oath included benevolence, nonmalevolence … and justice as practical duties:

“Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bond or free” (Jones 1923).

That vision would have been embraced by the post World War II existentialists like Jean-Paul Sarte and Simon de Beauvior. Moral philosophers, they rejected the abstract for the practical and immediate with Husserl’s battle cry: “To the Things themselves”. 

For them, the patient in relation was the phoneme of ethical human endeavour, one including social engagement and justice.

As Bioethics dismissed the practically relational another ethic was developing in the 1980s. Like the existential and the Hippocratic, it, too, was grounded in the realities of interpersonal caring. Feminist ethics “calls upon us to take responsibility while liberal individualistic morality focuses on how we should each leave each other alone” (Held 2006, 4-5).

Conclusion

One cannot un-ring the bell. Bioethics remains a broad forum for all sorts of topics. But for professionals requiring an ethics of care, a new ethic is required, one that like the traditional Hippocratic ethic, the existential turn and feminism, one that is relational from the start. That ethics of medicine would embrace the activism Bioethics ignored (“bioethics has not turned out many Ralph Naders”, Callahan 1993) and a sense of both life and care as essential goods.

REFERENCES

Callahan D. 1992. Why America accepted bioethics. The Hastings Center Report 23: S8-9.

Callahan D. 2012. In Search of the Good: A Life in Bioethics. Cambridge, MA. MIT Press.

Elliott C. 2021. Sisyphus Gets a Prescription. Hedgehog Review 23 (3). https://hedgehogreview.com/issues/authenticity/articles/Sisyphus-gets-a-prescription.

Held V. 2006. The Ethics of Care: Personal, Political, and Global. NY: Oxford University Press.

Jones W.H.S. 1923. “The Oath.” Hippocrates of Cos. Loeb Classical Library. 147: 298–299.

Koch T. 2008. Bioethics? A Grand Idea. J. of the Canadian Medical Association 178.1, 116.

Kuczewski M. G. 2010. Taking it Personally: Reflections on Living Bioethics and Medical Humanities. ASBH Reader (Summer-Autumn): 4.

Lasagna l. 1991. Mortal Decisions: The Search for an Ethical Policy on Allocating Health Care. Science 120 (3114): 43-44.199.

Nussbaum M. 1998. Public Philosophy and international Feminism. Ethics 108: 762-68.

Radin M. A. 1996. Contested Commodities: The Trouble with Trade in Sex, Children, Body Parts, and Other Things. Cambridge, MA: Harvard University Press.

Veatch R. 2012. Hippocratic, Religious and Secular Medical Ethics: The Points of Conflict. Washington, DC: Georgetown University Press.

Tom Koch (http://kochworks.com) is a medical ethicist, gerontologist, geographer and historian. He is the author of more than 200 articles and Thieves of Virtue: When Bioethics Stole Medicine (2012) and recently Seeking Medicine’s Moral Centre (2024).

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More info to come

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Roundtables are for APHC Members only.
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Over 125 podcast episodes have been released with over 17,000 downloads.

Released every other Saturday morning, recent episodes include Rachel Pittmann discussing Telehealth Etiquette and Amal Khidir talking about Designing the Faculty Development Professionalism Program with Multi-cultural Perspectives.

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APHC Member Sofica Bistriceanu was recently named in the top 50 Disruptor List, CEO Scoop., Jan 2026.  Read article here ➜

Michelle Schmude, EdD, MBA, APHC President and Geisinger Professor of Medical Education and her colleagues Dr. Andrea DiMattia, Andrea Mulrine, and Stephen Hoover had “Recommendations and Action Steps to Deploy AI in Medical Education: A Practical Guide for Responsible Integration Using the Josiah Macy Jr. Foundation Framework” published in AAMC Advancing AI Across Academic Medicine Resource Collection. Recommendations and Action Steps to Deploy AI in Medical Education: A Practical Guide for Responsible Integration Using the Josiah Macy Jr. Foundation Framework | AAMC

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Editor-in-Chief: Bryan Pilkington | Managing Editor: Yvonne Kriss

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