Doctors' new oath looks to rationing

SIR KENNETH Calman, the Government's Chief Medical Officer, has proposed a new version of the Hippocratic oath which would require doctors to accept responsibility for health- care rationing for the first time.

The updated version of the oath which has provided an ethical touchstone for 2,500 years would commit doctors to serving "individual patients and the community", acknowledging the tension between their needs.

In a key passage it says: "I will recognise that the decisions I make will have consequences for the patient, the community and for resources."

Until now, a pillar of the medical relationship has been the assumption that doctors would do their best for each patient that came before them, regardless of the cost.

Sir Kenneth's version, which he describes as a "very personal re-interpretation" of the original, is at odds with ministerial pronouncements which have sought to distance the Government from any mention of rationing.

Frank Dobson, the Secretary of State for Health, has repeatedly insisted that the task facing the National Health Service is to prioritise cases and iron out inequities in care, not to ration resources.

Yesterday, Sir Kenneth said: "The idea that doctors should be concerned with resources at all used to be greeted with real hostility. That has changed. There is now a much clearer recognition that doctors have responsibility for resources."

Asked if this meant doctors had to be involved in rationing, he said: "I wouldn't interpret it that way. It is the responsibility of doctors to use the resources they have wisely and that is bound to lead to tensions between the needs of individual patients and the good of the population as a whole."

Last night, leading doctors rejected this view. Dr Peter Holden, a GP and member of the British Medical Association's council said: "The Chief Medical Officer is an agent of the Government and my worry is that he is trying to bounce us into taking responsibility for rationing.

"Rationing has to be a whole community decision. We could never swear an oath that put us at the mercy and whim of whatever government happened to be in power."

Dr Holden said that doctors should always tell patients if the NHS could not afford to provide all the options for treatment rather than choosing the less expensive one on their behalf.

"We must tell patients the whole truth. We must never be led into subterfuge," he said.

The original Hippocratic oath, which was last updated in 1948, says that doctors must respect life, keep patients' confidences and refrain from sex with them, but it disallows abortion. Beginning "I swear by Apollo the physician...", it is widely recognised to be outdated, but attempts to improve it have failed.

The BMA drew up a new version last year, at the request of the World Medical Association, but it was voted down by the association's annual meeting for being too long and boring.

Sir Kenneth's version appears in The Potential for Health, a collection of his writings published this month by Oxford University Press.

He says that the new oath "identifies one of the crucial tensions - care for the patient versus responsibility for the community."

He adds in an earlier section: "A doctor who spends two hours with one patient cannot spend these hours with another. Similarly, if a sum of money is spent on one patient it will not be available for another. Resources are, and always have been, finite.

"The classical dilemma for the doctor is how to do the best for one patient without disadvantaging another. The fact that this is difficult must not mean that doctors abrogate their responsibilities."