The Politics of Oaths

Hippocratic Oath or Charak Shapath ?

In August 2018, India’s Hindu nationalist Bhartiya Janata Party (BJP) government renamed the historic Mughalsarai Junction Railway Station in the state of Uttar Pradesh after the right-wing Hindu ideologue Deen Dayal Upadhyaya, most likely because the existing name referred to the Indian Muslim Mughal dynasty. Three years earlier, in May 2015, the ruling BJP officially changed the name of the Aurangzeb Road to A P J Abdul Kalam, a pro-BJP ex-president of India.  In April 2016, the BJP government in Haryana renamed the city of Gurgaon as Gurugram, after Guru Dronacharya, an upper-caste Hindu figure from the epic Mahabharata, who is viewed as a villain by India’s Dalits. The Rashtriya Swayamsevak Sangh (RSS), the ideological parent of the BJP, also demands many other places with Muslim names, including the cities of Ahmedabad, Hyderabad, and Aurangabad, be renamed.

Naming and renaming of public spaces are complicated and political businesses in most countries. After Independence, we saw a flurry of name changes as India sought to physically erase markers of the colonial legacy. In Delhi, the names of landmark roads were changed — Kingsway to Rajpath and Queensway to Janpath, for instance. India also renamed several cities long before the BJP took power. In 1995, it restored the names of the cities of Bombay, Bangalore, and Calcutta to their indigenous versions – Mumbai, Bengaluru, and Kolkata respectively – to emphasise its independence from Britain and reject the linguistic symbols leftover from the colonial era. The names of the cities Cawnpore and Jubblepore were also changed to Kanpur and Jabalpur to reflect traditional spelling and pronunciation.  Although renaming has been practised widely across the world, in many cases it has been socially and politically controversial. This is because renaming is a lot more than simply changing a word on a map or a street sign. Place names are an important element of a country’s cultural landscape, as they naturally document and reflect a locality’s heritage and identity. Changing them is often seen as a re-writing of history. Renaming, therefore, is always a hotly debated issue.

The latest name change attempt which came to light earlier this month is more than just a name change. The National Medical Commission has suggested to medical colleges that the traditional Hippocratic Oath should be replaced by a “Charak Shapath”. Named after the founder of Ayurveda, the Shapath or oath lays down a code of conduct for healers in ancient Indian medicines. The proposal has been circulated to medical colleges for their feedback.  The proposal has drawn flak from the influential Indian Medical Association which has said that the NMC is trying to erase the identity of modern medicine and replace it with the identity and legacy of a different system of medicine which is a betrayal of the profession.

The Hippocratic oath as such is not much used anymore. The ‘original’ oath is from a 2,500-year-old text called the Corpus of Hippocrates, from Greece. The classic text oath says, “I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant….” However, the pledges taken now are mostly versions of the physicians’ pledge of the World Medical Association (WMA), of which the Indian Medical Association (IMA) is a part. The pledge was published in 1948 at the Declaration of Geneva (which is the human rights declaration of the world) post the atrocities of the second world war. It has been amended five times over the last seven decades, (the last in 2017) to keep it relevant to the present context of healthcare and society.

The pledge was developed to codify and emphasise the ethical values that should be inherent in the practice of medicine, and which had been abandoned by some physicians during and preceding the second world war. Physicians had been involved in the torture, incarceration, and eugenic studies of millions of people, particularly in the concentration camps of Nazi Germany. Hence, the emphasis and importance of these lines in the pledge, “I will maintain the utmost respect for human life. I will not use my medical knowledge to violate human rights and civil liberties, even under threat. I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing, or any other factor to intervene between my duty and my patient.”

The Charak Shapath, possibly about the same antiquity as the Hippocratic corpus, starts with these lines: “The teacher then should instruct the disciple in the presence of the sacred fire, Brahmanas [Brahmins] and physicians.” It goes on to say that, “….thou shalt pray for the welfare of all creatures beginning with the cows and Brahmanas.” A modified version doing the rounds starts with, “O Dwij [twice born]! Facing the east in the presence of holy fire…” One of the codes of the Charak Shapath says: “I (especially a male doctor) shall treat a woman only in the presence of her husband or a near relative.” The other codes include “my dress ought to be decent yet impressive and personality confidence-inspiring. I shall always use sweet, pure, appropriate, pleasant, truthful, beneficial, and polite words, and using my past experience, I shall keep in mind the time and the place.” The regressive and casteist vocabulary is in your face.

Replacement of the Hippocratic Oath has been a long-standing demand of the Rashtriya Swayamsewak Sangh (RSS). The RSS has also held programmes in the past where it has administered the oath to medical students. the National Medicos Organisation, affiliated with the RSS, has been informally administering the indigenous oath to students in Gujarat and some other states for many years. There is no doubt that Maharishi Charaka is a deserving role model for Indian doctors. It may even be possibly acceptable with ease among the fraternity of Ayurvedic physicians. But at the end of the day, changing an oath is easier than reforming medical education just as changing a city’s name is easier than improving its creaking infrastructure. Governance is all about changing names and symbols; not the substance.