USA Today

In a sweeping global statement published in two medical journals, a committee of doctors from the USA and Europe has attempted to update the 2,500 year old Hippocratic oath. Almost every graduating medical student swears to some form of the ancient code of conduct-a code that has been translated and revised over the ages.

The Hippocratic oath basically tells doctors to exercise their art solely for the cure of their patients. The modern version tells doctors to do no harm. But today's medical profession is under intense pressure. Medical errors claim as many as 98,000 lives each year. Health costs are soaring. Doctors who get less money from struggling insurance companies may be tempted by drug or medical-device makers who sometimes use gifts to sell more goods."We are concerned about what is an increasing mercantile environment," says Harry Kimball, one of the authors of the new code."That trend has accelerated over the last few years." Authors hope the new codes, which include three guiding principles and 10 professional responsibilities, will lead doctors through modern issues ranging from empowering patients to reducing medical errors. The principles:

* Primacy of patient welfare. "Altruism contributes to the trust that is central to the physician-patient relationship. Market forces, societal pressures, and administrative exigencies must not compromise this principle."

* Patient autonomy."Physicians must be honest with their patients and empower them to make informed decisions about their treatment. Patient's decisions about their care must be paramount, as long as those decisions are in keeping with ethical practice and do not lead to demands for inappropriate care."

* Social justice. Doctors "must promote justice in the health care system, including the fair distribution of health care resources. Physicians should work actively to eliminate discrimination in health care, whether based on race, gender, socioeconomic status, ethnicity, religion, or any other social category."

The new codes appear in the British medical journal The Lancet and the USA's Annals of Internal Medicine. They were written by doctors from the American Board of Internal Medicine, the American College of Physicians, American Society of Internal Medicine, and the European Federation of Internal Medicine. The American Medical Association is expected soon to release its own version. Art Caplan, a bioethicist at the University of Pennsylvania, says new codes are needed. "Today, the practice is pulled every day to be more of a business," he says."That is the wrong ethic."

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