Explained: New row over Charak Shapath; what is it, and what does it say?

While some medical practitioners welcomed the proposal, the Indian Medical Association (IMA), the national representative platform of doctors of modern medicine, took up the matter with Health Minister Mansukh Mandaviya.

In a letter published in IMA News, the IMA’s official publication, the association’s national president Dr Sahajanand Prasad Singh said that at an “interactive meeting” with an IMA delegation on February 21, Mandaviya had “assured that Charak Shapath will be optional and will not be forced to replace the Hippocratic Oath”.

Subsequently, on March 29, replying to an unstarred question by several MPs on “whether Government intends to replace the Hippocratic Oath with the Charak Shapath”, “whether it is a fact that the National Medical Commission has proposed replacing the Hippocratic Oath with Charak Shapath”, and “whether Government has met with the representatives of the Indian Medical Association (IMA) to discuss their opposition to this proposal”, Minister of State for Health and Family Welfare Dr Bharati Pravin Pawar told Rajya Sabha: “As informed by the National Medical Commission (NMC), there is no proposal of replacement of Hippocratic Oath with Charak Shapath.”

Days later, however, on March 31, the NMC issued a circular on “Implementation of new Competency Based Medical Education for Undergraduate Course Curriculum”, in which it said: “Modified ‘Maharshi Charak Shapath’ is recommended when a candidate is introduced to medical education”.

Interestingly, as The Indian Express reported in February, undergraduates at the country’s premier health institute, AIIMS, have been taking the Charak Oath during their annual convocation for several years now.

Dr M C Misra, former director of AIIMS, had told The Indian Express earlier that the Charak Shapath was already part of the annual convocation when he took charge in the post in 2013.

The AIIMS Charak Shapath is: “Not for the self; Not for the fulfilment of any worldly material desire or gain, but solely for the good of suffering humanity, I will treat my patient and excel well.”

What is the Hippocratic Oath that the Charak Shapath would replace?

The Hippocratic Oath is attributed to Hippocrates of the island of Kos, a Greek physician of the classical period (4th-5th centuries BC), broadly corresponding to the period from the death of the Buddha (486 BC) to the rise of the Mauryas (321 BC) in India.

Among the great contemporaries of Hippocrates, the so-called “father of modern medicine”, were the Athenian philosopher Plato and his teacher Socrates, and Plato’s student and a tutor of Alexander the Great, Aristotle.

The Oath is a charter of ethical principles that physicians over the ages have sworn to uphold in the practice of their profession. The earliest available fragments of what is understood to be the original oath date back to the late 3rd century AD, and a millennium-old version is kept in the library of the Holy See.

To Hippocrates is attributed a collection of 70 books on medicine called ‘The Corpus Hippocraticum’; most scholars, however, agree that the Hippocratic Oath itself may not have been the work of the individual identified as the historical Hippocrates.

What does the Hippocratic Oath say?

Two translations of the pagan oath from the Greek original, by WHS Jones (‘The Doctor’s Oath’, Cambridge University Press, 1924) and Ludwig Edelstein (‘The Hippocratic Oath: Text, Translation, and Interpretation’, Johns Hopkins Press, 1943), are popular with scholars. According to extracts published in the BMJ, October 1998, the Oath says:

“I will use treatment to help the sick according to my ability and judgment, but I will never use it to injure or wrong them.

I will not give poison to anyone though asked to do so, nor will I suggest such a plan. Similarly I will not give a pessary to a woman to cause abortion. But in purity and in holiness I will guard my life and my art.

I will not use the knife either on sufferers from stone, but I will give place to such as are craftsmen therein.

Into whatsoever houses I enter, I will do so to help the sick, keeping myself free from all intentional wrongdoing and harm, especially from fornication with woman or man, bond or free.

Whatsoever in the course of practice I see or hear (or even outside my practice in social intercourse) that ought never to be published abroad, I will not divulge, but consider such things to be holy secrets.”

So is there one universally accepted version of the physician’s Oath?

There isn’t. Modern codes of medical ethics such as those formulated by the American Medical Association (AMA) and the British Medical Association (BMA) are broadly rooted in the Hippocratic Oath, but they draw heavily from other sources as well.

Many medical schools around the world hold a ceremony in which graduating doctors swear to a broad charter of ethics that are sometimes customised by individual institutions.

A version of the ‘physician’s code of ethics’ is commonly displayed in hospitals or clinics in most places, including India.

The AMA describes its Code of Medical Ethics as a living document that has evolved as medicine and society have changed. The AMA’s Code was adopted in 1847, and underwent updates in 1903, 1949, 1957, and 2008.

The World Medical Association (WMA) adopted an international code of medical ethics in 1949, which was amended in 1968, 1983, and 2006. In May last year, the WMA published a proposed modernised version of the international code, “outlining physicians’ duties towards their patients, other physicians, health professionals and society as a whole”, according to the WMA website.

According to the WMA, some of the duties of physicians in general are to:

* always exercise his/her independent professional judgment and maintain the highest standards of professional conduct;

* respect a competent patient’s right to accept or refuse treatment;

* not allow his/her judgment to be influenced by personal profit or unfair discrimination;

* be dedicated to providing competent medical service in full professional and moral independence, with compassion and respect for human dignity;

* deal honestly with patients and colleagues, and report to the appropriate authorities those physicians who practice unethically or incompetently or who engage in fraud or deception;

* certify only that which he/she has personally verified;

* respect the local and national codes of ethics.

Who was Charaka and what is the Charak Samhita?

Like several other sages mentioned in the literature of ancient India, the historicity of Charaka is uncertain. The compendium of medicine that carries his name is unlikely to have been the work of a single individual, and not all of it is likely to have been written at the same time.

The Charak Samhita is a medical pharmacopoeia and collection of commentaries and discussions on medical practices that is historically dated to the 1st-2nd centuries AD.

Along with the compendium of Susruta (c. 4th century AD), which is about surgery, the Charak Samhita is considered the foundational text of ancient Indian medicine, which was an evolved system of understanding and treating disease that was in several ways ahead of the Greeks.

The ancient Indian interest in physiology is understood to have drawn from yoga and mysticism, and to have been enriched by the growth and spread of Buddhism to new lands, the arrival of the first Christian missionaries, and the contact with Hellenic practitioners of medicine.

And what are the medical ethics of the sage Charaka?

The physician was an important and respected member of ancient Indian society, and medical practice followed rules of professional conduct and ethical principles.

A L Basham (‘The Wonder That Was India’, 1954) quotes from a part of the sermon that Charaka instructs a physician to preach to his pupils at a ceremony at the end of their apprenticeship.

“…You must strive with all your soul for the health of the sick. You must not betray your patients, even at the cost of your own life… You must not get drunk, or commit evil, or have evil companions… You must be pleasant of speech…and thoughtful, always striving to improve your knowledge.

“When you go to the home of a patient you should direct your words, mind, intellect, and senses nowhere but to your patient and his treatment… Nothing that happens in the house of the sick man must be told outside, nor must the patient’s condition be told to anyone who might do harm by that knowledge to the patient or to another.”

This ethical code of Charaka is universal, and remains just as relevant and applicable today.

What else does the Charak Samhita say?

The Charak Samhita underlines the importance of the physician praying, “every day on rising and going to bed for the welfare of all beings”, (Basham) and that of debate and discussion among the learned.

A passage in the Charak Samhita, quoted in Wendy Doniger (‘On Hinduism’, ‘The Hindus’) describes a debate among sages who were invited by a king to determine the origin of disease. The sages put forward their theories, which were in several cases the essence of major philosophical and medical traditions of ancient India.

One said that the individual is born from the soul, so disease too must come from the soul; a second said that the mind, when overwhelmed by energy and torpor, gives rise to both the body and the pathological changes in it; a third said that creatures and disease both come from rasa; a fourth argued that since the individual is created from the six material elements of earth, water, fire, wind, space, and soul, disease too is born of these same elements; a fifth submitted that just as an individual must have a father and mother, so too must disease; but the sixth rebutted that while a blind person isn’t necessarily born of another blind person, all creatures are the product of karma, and so is disease.

As the sages argued, one of them advised the rest not to take rigid positions — typical, Doniger says, of the way all of the shastras strive to be open minded and inclusive. “Not until you shake off the torpor of factionalism from what you want to know will true knowledge emerge.”

Newsletter | Click to get the day’s best explainers in your inbox