Ancient Greek Medicine vs the Tory Privatisation of the NHS

As with so much of western culture, western medicine has its basis in that of ancient Greece. One of the greatest of the ancient Greek medical texts is the Hippocratic Corpus, the bulk of which were written sometime between 430 and 330 BC. The authors of these treatises were not only concerned with the physical, technical aspects of their profession – the structure of the human body, the nature of disease, and methods of healing. They were also concerned with moral status of the doctor and correct ethical practice. Until a few decades ago, doctors were bound by the Hippocratic oath, which amongst other things forbade them from practising surgery, performing abortions, administering poisons and using their position as a doctor for sexual exploitation. They were required to be chaste and religious, and to do no harm.

‘I will use my power to help the sick to the best of my ability and judgment; I will abstain by harming or wronging any man by it.’

Although there was no state provision of health care in the ancient world, and doctors charged fees for their services, nevertheless the Hippocratic authors condemned greed and stated that there should be occasions when the doctor should be required to treat patients for free. Furthermore, the doctor should not withhold treatment simply because he has not agreed a fee with the patient, nor to upset his patient by discussing the cost of treatment before treating him or her.

The Hippocratic Oath itself contains the pledge

I will pay the same respect to my master in the Science as to my parents and share my life with him and pay all my debts to him. I will regard his sons as my brothers and teach them the Science, if they desire to learn it, without fee or contract. I will had on precepts, lectures and all other learning to my sons, to those of my master and to those pupils duly apprenticed and sworn and to none other.

Thus there is the beginning of the notion that medical education should be free.

In his introduction to the Penguin Classics edition of the Hippocratic writings, G.E.R. Lloyd writes

Several of the Hippocratic treatises that deal with questions of medical etiquette and ethics warn the doctor against avarice. Precepts (Ch.6) recommends that the doctor should consider the patients’ means in fixing fees and, as already noted, suggests that the doctor should be prepared, on occasion, to treat a patient for nothing. The same work also says (ch.4) that the doctor should not begin a consultation by discussing fees with his patient. This may well cause the patient anxiety, for he may believe that the doctor will abandon him if no agreement over fees is reached. As the writer puts it; ‘It is better to reproach patients you have saved than to extort money from those in danger of dying.’ Decorum (ch5), too, mentions lack of the love of money as one of the qualities a good doctor should show.

This contradicts the spirit of the Tory privatisation of the NHS, as this is very much driven by the greed of private contractors, a fair number of whom employ or are headed by Tory MPs, and their desire to exploit the sick for their own profit. Indeed, Private Eye ran a detailed article on the origins of Private Finance Initiative a little while ago, showing that it had its origins in a scheme by Peter Lilley under John Major to allow private industry access to income from the N.H.S.

Yesterday I posted a piece about Mike’s article, over at Vox Political, on Keith Willett’s suggestion at a conference by one of the private health contractors, Urgent UK, that the government should pay doctors to sign clients back to work early. Yet in the sections ‘Aphorisms’, the very first piece of advice in Chapter 1 is

Life is short, science is long; opportunity is elusive, experiment is dangerous, judgment is difficult. It is not enough for the physician to do what is necessary, but the patient and the attendants must do their part as well, and circumstances must be favourable.

This suggests, amongst other things, that regardless of the skill of the doctor, the healing process will take as long as it takes. It can’t be forced. Which clearly goes against Willett’s apparent view that with a bit more money, doctors could force people back to work earlier. Presumably before they had got properly well.

The Tories are, of course, trying to introduce the American system of private medical care, and so make it fee paying. As I said, medicine in ancient Greece was private, although some doctors were employed by a few of the ancient Greek city states, probably in order to keep them there, as well as receiving fees from their patients. However, the sheer greed behind the Tories’ reforms contradicts much of the ethical spirit behind ancient Greek medicine. They are not just dragging us back to the period before the foundation of the NHS, but even into the most rapacious aspects of medicine in the ancient world.

Source

G.E.R. Lloyd, ed., and J. Chadwick, W.N. Mann, I.M. Lonie and E.T. Withington, trans, Hippocratic Writings (Harmondsworth: Penguin 1973)

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