Was Hippocratic Medicine Authoritarian?
Author: Hélio Angotti Neto
KEYWORDS: Hippocrates, Medical Ethics, History of Medicine, Paternalism, Authoritarianism, Physician-Patient Relationship.
I. Introduction
Hippocratic Medicine became a taboo in our times. The Hippocratic tradition, rich and complex as it can be, receive accusations of irresponsibility toward social issues. In addition, physicians that worked or, allegedly, work under such an inspiration are seen as paternalists and authoritarians by many authors, professors, and even common folk. This article searches for an answer for the following questions: (1) Did the Hippocratic physicians of old were really paternalists in the strong sense of the term (all knowing and authoritarians, undermining the autonomy of the patient and their families)? (2) If not, how they practiced medicine considering their patients, their families and their colleagues?
II. Hippocrates and the authoritarian origins of medicine
The contemporary vision of Hippocratic ethical tradition is one of authoritarianism, paternalism, forceful beneficence and disrespectful stance, with an arrogance that cannot stand the autonomy of the patient. To some critics, the ancient model remained until very recently, perpetuating paternalism in some kind similar to a Dark Age of medical ethics, now enlightened by modern bioethics.
In a publication of the Regional Medical Council of São Paulo (Siqueira 2005, p.14) we can read:
(…) traditional medical ethics, as conceived in the Hippocratic model, has a strong paternalist appeal (…). Only in the sixties, medical ethical codes started to acknowledge the infirm as an autonomous agent.
Even in the probably most important book of bioethics in the world (Beauchamp & Childress 2013, p.1), they present the Hippocratic tradition as:
(…) not well equipped to address problems such as informed consent, privacy, access to health care, communal and public health responsibilities, and research involving humans subjects as these appeared in the modern context, and its paternalistic orientation provoked resistance from advocates of patient’s rights.
The judgement of what was good for the patient, according to many critics, was an exclusivity of the physician, who reduced the patient to a complete vulnerable and dependent state (Cascais 2006, p. 1011). Only the physician retained the scientific knowledge; therefore, only he decided, without any concern for the patient’s will or participation (Ligiera 2005, p. 410-427).
This conception of an inadequate old medicine when someone evokes Hippocrates is commonplace in contemporary Academy. In the New England Journal of Medicine (Kapp 1999, p. 821), one can read that:
Gone are the days of medical paternalism, when arrogant health care professionals misused their power to force particular treatments on dependent patients who blindly trusted them.
This excerpt, from one of the most important medical journals in the world, is given as common knowledge, without any original text to justify it, and is referred directly by other authors (Silva & Nunes 2015, p.475) as proof for what they say in other article, as shown in the following excerpt:
Authority and responsibility, once an exclusive domain of the physician in medicine, are now shared with the patient, who is given, as a mentally and emotionally capable individual, the freedom to choose from several options. The risks and benefits related to those options should be explained in advance.
What, perhaps, was something accepted in the Academy with some valid justification is now reproduced inside the Academy itself without none, except for the repetition of many precious opinions.
Even if the justification for this authoritarian image of traditional medicine was adequate, the reproduction of such conclusion without adequate sources can turn common knowledge into prejudice. We fear that such can be the case with the Hippocratic moral tradition in medicine.
Resuming all the accusations:
(1) Traditional Hippocratic physicians took for themselves all the authority and responsibility over the patient, disregarding patient’s autonomy to choose;
(2) Physicians were arrogant and imposed their treatments on their patients;
(3) Patients blindly trusted their physicians.
Searching in the Hippocratic originals, we will see if we can consider valid each one of these accusations.
If the answer is positive - the accusations are valid and, therefore, just -, academic literature concerning Hippocrates is mostly right, and, perhaps, the accusations of romantic idealization directed to some defenders of Hippocratic tradition is adequate.
If the answer is negative, and the original texts of Hippocrates and philosophers of his time could deny the accusations, we can assume that a great historic injustice has been committed against traditional Hippocratic medicine.
In addition, to assume that traditional Hippocratic medicine is not textually and systematically authoritarian is not the same as assuming that no physician was authoritarian, and vice-versa.
Considering the word “paternalist”, I will prefer, instead, the use of “authoritarian”, for the previous word carries a strong emotional rejection and can arise many wrong prejudices that will only confuse the exposition, and risk an incorrect interpretation, disregarding the many subtleties of the concept, varying from a strong to an weak form. The word “paternalism”, probably since the publication of the “Authoritarian Personality” (Adorno et al. 1950), became something almost as terrible as Nazi or sexist, and it could rightly be interpreted as a Hateful Labeling, a traditional eristic stratagem, according to Schopenhauer (2003). To use authoritarian, we want to approach paternalism in the strongest sense possible, as we seen in many accusations nowadays.
III. The answer of the Hippocratic corpus and other classic texts
Accusation (1): Traditional Hippocratic physicians took for themselves all the authority and responsibility over the patient, disregarding patient’s autonomy to choose.
Many excerpts from the Hippocratic tradition completely deny this accusation.
I. Life is short, the Art long, opportunity fleeting, experiment treacherous, and judgment difficult. The physician must be ready, not only to do his duty himself, but also to secure the co-operation of the patient, of the attendants and of externals (Hippocrates & Heracleitus 1931).[1]
The first aphorism explicitly shows that the physician must search for the co-operation of other people, including the patient and his family. The good was not a duty only for the physician. It was something that should be accomplished by everyone surrounding the patient, and the patient himself.
LXIX. Such is my advice to the great mass of mankind, who of necessity live a haphazard life without the chance of neglecting everything to concentrate on taking care of their health. (Hippocrates & Heracleitus 1931).[2]
This passage shows that the Hippocratic writings were primarily educational instruments. Some of the Hippocratic authors expected that their writings could reach many hands and educate the “great mass of humanity”. To share knowledge hardly is compatible with an authoritarian accumulation of responsibility and power. Neither is compatible the understanding that the patient should co-operate: “The physician is the servant of the art. The patient must co-operate with the physician in combating the disease” (Hippocrates 1923a).[3]
This excerpt from Epidemics Ialso emphasizes the importance that the patient has in the therapeutic act, sharing responsibility with the Hippocratic doctor:“Do not hesitate to inquire of laymen, if thereby there seems likely to result any improvement in treatment” (Hippocrates 1923a).[4]
In the work Precepts, teamwork is remembered in the following situation:
VIII. So much for such recommendations. For remission and aggravation of a disease require respectively less or more medical assistance. A physician does not violate etiquette even if, being in difficulties on occasion over a patient and in the dark through inexperience, he should urge the calling in of others, in order to learn by consultation the truth about the case, and in order that there may be fellow-workers to afford abundant help. For when a diseased condition is stubborn and the evil grows, in the perplexity of the moment most things go wrong (Hippocrates 1923a).[5]
This clear prescription of humility and teamwork for the physician do not resemble an authoritarian, all-knowing, professional. In fact, it shows only a physician truly devoted to the patient’s good, ready to call for help if needed, be such help from other physicians, from the patient, or from their families. A very “contemporary” demand on medicine, indeed.
The disposition to educate the patient is clearly demonstrated. Why teach someone if not to expect an active role of the patient in the therapeutic act?
IX. A wise man should consider that health is the greatest of human blessings, and learn how by his own thought to derive benefit in his illnesses. (Hippocrates & Heracleitus 1931).[6]
The physician was rightly acknowledged as an authority in healthcare matters. The wise man urged everyone to heed physicians’ counsels. In the following passage, Plato shows that choosing to whom one should listen is a common happening:
7. Socrates. Come then, what used we to say about this? If a man is an athlete and makes that his business, does he pay attention to every man’s praise and blame and opinion or to those of one man only who is a physician or a trainer?
Crito. To those of one man only (Plato 1914).[7]
To choose a physician is not an imposition. It appears to be the most reasonable thing to do. However, the possibility of acting in an irrational way is not excluded. It is the patient who chooses, it is him who invites the physician to enter his house, under the vow of silence.
soc. And whether their mentor be poor or rich will make no difference to the Athenians when they deliberate for the health of the citizens; all that they require of their counsellor is that he be a physician (Plato 1927).[8]
The excerpt above, from Alcibiades I, shows that the ruling citizens of the Poliscalled physicians to listen to their counsels. Again, the physician act as an invited counselor, as the one who shows the way to achieve better health. The possibility of denying what the physician counsels is present, thus, the initiative of the patient or collectivity is present somehow.
Accusation (2): Physicians were arrogant and imposed their treatments on their patients.
One image comes to mind when I read some commentaries from nowadays bioethicists: an imposing and almost violent doctor forcing bad tasting medicine down the throats of helpless patients. This is a strong image, but false, at least when we appeal to ancient descriptions of medical-patient relationships.
Someone can argue that the selection of Hippocratic works only is not sufficient, and more testimonies are necessary. However, even when those descriptions come from other sources than the Hippocratic writings, the aspects that were observed in Hippocratic texts are still present. In the work of Plato we can read:
str. Suppose a physician who has right knowledge of his profession does not persuade, but forces, his patient, whether man, woman, or child, to do the better thing, though it be contrary to the written precepts, what will such violence be called? The last name in the world to call it would be “unscientific and baneful error,” as the phrase is, would it not? And the patient so forced might rightly say anything else rather than that he had been treated in a baneful or unscientific way by the physicians who used force upon him.
y. soc. Very true (Plato 1925b).[9]
It may be surprising for some to see the expression violence linked to the disrespectful act against patient’s autonomy at that ancient period, but it is described as such in the work The statesmanfrom Plato. To describe this act of imposing treatment as violence presupposes the choice of the therapy by the patient before it starts as a parameter, it presupposes patient’s agreement.
Accusation (3): Patients blindly trusted their physicians.
Patients appear to have a very active role in the medical-patient relationship, deciding if they would allow or not the physician to do his work, and even sometimes, distrusting the physician and denying treatment, which is something very far from a blind-trusting patient. In the famous dialogue Gorgias, Plato describes a physician requiring help to persuade a patient.
Gorg. Ah yes, if you knew all, Socrates,—how it comprises in itself practically all powers at once! And I will tell you a striking proof of this: many and many a time have I gone with my brother or other doctors to visit one of their patients, and found him unwilling either to take medicine or submit to the surgeon’s knife or cautery; and when the doctor failed to persuade him I succeeded, by no other art than that of rhetoric (Plato 1925a).[10]
This passage of Gorgias reveals that patients could deny their physicians prescriptions, and shows a physician very different from the imposing figure described sometimes. The physician appears to ask compliance from the patient, knowing that he is an invited person, and has only the authority that the patient gives to him.
XII. On entering bear in mind your manner of sitting, reserve, arrangement of dress, decisive utterance, brevity of speech, composure, bedside manners, care, replies to objections, calm self-control to meet the troubles that occur, rebuke of disturbance, readiness to do what has to be done. In addition to these things be careful of your first preparation. Failing this, make no further mistake in the matters wherefrom instructions are given for readiness (Hippocrates 1923b).[11]
In this Hippocratic text, the physician deals with the possibility of objection from the patient. Again, an image very different from the accusation of docile patients, blindly trusting in their doctors.
IV. Conclusions and Discussion
There are many other references to the relation between physicians and patients or laypeople present in the works of ancient Greece physicians and philosophers, but for now, we believe these samples can answer our main questions.
(1) Did the Hippocratic physicians of old were authoritarian?
After revising many ancient texts close to the time of Hippocrates, one cannot affirm that physicians were authoritarian because they followed Hippocratic morality. Therefore, the contemporary references to the authoritarianism – or very strong paternalism - of Hippocratic medicine should be better analyzed, and the true historical root of the authority problem ought to be searched. This conclusion does not affirm that no physician of old was authoritarian. Even today, in times of patient autonomy rising over other principles of action, one may encounter an authoritarian physician who has nothing of Hippocratic per se.
(2) If not, how they practiced medicine considering their patients, their families and their colleagues?
Considering these original texts - a small but representative sample -, one can conclude that Hippocratic physicians were generally used to: (a) expect some collaboration from the patients and their families; (b) divide responsibility with other physicians and even layman, according to the situation; (c) try to convince their patients of the adequate treatment; (d) educate layman using written texts and, probably, oral learning; and (e) depend on their patients consent.
This historic frame differs much from the authoritarian figure evoked by many contemporary bioethicists and researches. Although the majority of the Academy appears to disavow traditional Hippocratic ethics, some researchers judge better the essential aspects of this tradition, and reach more equilibrated conclusions.
The great humanist physician, Pedro Laín Entralgo, for example, recognizes in his classic work “La Medicina Hipocrática” that the objectives of the Hippocratic physician included education of the patient, among many others.
As an expert in medicine and in the knowledge of human nature, the Hippocratic physician feels himself obligated to teach the profane. Primarily, to allow that this one, enlightened by the physician, could live in a more salutary way when healthy and could better help the physician when diseased.
Second, because the physician’s experience could be greater and deeper if his patients received certain information about diseases and their treatments.
Finally, because the formation of the learned man, thepaideia, demands the learning from those who truly knew, and the physician is, among all, the most qualified knower of the man’s physiology. The Hippocratic writer wants to intervene in the education of his people, especially of those citizens who, because of their social status in the polis, had the duty to possess culture” (Lain-Entralgo 1970).[12]
Actual researches, like Fabrice Joterrand, also examine the Hippocratic tradition with less prejudice, concluding that the Hippocratic Oath, for example, is a particularistic vision of the universal aspects of medical morality, and that can be used, even today, with some caution (Joterrand 2005).
Beier and Ianotti conclude, in a much adequate way, after analyzing many Hippocratic writings, that:
The Hippocratism is considered, not a few times, strongly paternalist, in the medical-patient relationship. However, after the close study of many passages in some Hippocratic works, one must admit the possibility that such paternalism was not strong, but moderate” (Beier & Ianotti 2010).[13]
It may be that the modern physician’s authoritarian character perceived by many patients, scholars and even physicians themselves is a product of Illuminist ideology, with its mechanicism and naturalism, in which the physician assumes the cold and powerful role of a technocrat. However, this hypothesis is to be discussed in another opportunity.
Concluding, the Hippocratic medical tradition cannot be termed as authoritarian – or strongly paternalist -, as many scholars affirm today. The Bioethics discourse may be influenced by some ideological biasin its judgement of past moral traditions, and Academy must review the way it refers to Hippocratic tradition if it wants to remain true to history and written legacies from the past. We should at least acknowledge the complexity and richness of the Hippocratic tradition and its developments in western civilization, avoiding simple generalizations that can undermine our capacity to understand our cultural roots.
In a remarkable conference at the UNESCO International Symposium “Forms and Dynamics of Exclusion”, in Paris, 1997, the Brazilian philosopher Olavo de Carvalho remembered us that:
To reengage the dialogue with the past is to reconquer de sense of human unity. To try to reintegrate into humankind this or that group that remains today among the excluded and discriminated without revoking before the discrimination against all humanity that preceded us would be an insanity (Carvalho 1997).[14]
If we do not understand our past and find the universal connections that link human experiences along the centuries, we would hardly be prepared to face our present and our future.
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Hélio Angotti Neto is a Medical Doctor graduated at the Federal University of Espírito Santo, and has a Medical Residency in Ophthalmology and a PhD in Sciences from the Faculty of Medicine of the University of São Paulo. He acts as Professor and Coordinator of the Medicine Course of the University Center of Espírito Santo. He is President of the Chapter of History of Medicine of the Brazilian Society of Clinical Medicine (Triennium 2017-2020), member of the Brazilian Council of Ophthalmology and Delegate of the Regional Council of Medicine in the city of Colatina, at Espírito Santo, Brazil (2018-2023). He was a Global Scholar of the Center for Bioethics and Human Dignity of Trinity International University in 2016 (Illinois, USA) and is the Editorial Director of Mirabilia Medicinae, a publication in Medical Humanities hosted by the Institut d'Estudis Medievals of the Autonomous University of Barcelona. He published several books: The Death of Medicine; The Tradition of Medicine; Dysbioethics Volume 1: Reflections on a strange ethics; Dysbioethics Volume 2: New Reflections on a Strange Ethics; Dysbioethics Volume 3: The Extermination of Tomorrow; Medical Art: From Hippocrates to Christ; besides several chapters of books and articles in Ophthalmology, Bioethics, Politics and Medical Humanities. Creator and Coordinator of the Seminar of Philosophy Applied on Medicine. He is Presbyter of the 3rd Presbyterian Church of Colatina. Married to Joan and father to Arthur, Hector and Andrew.
[1]I. Ὁβίοςβραχύς, ἡδὲτέχνημακρή, ὁδὲ καιρὸςὀξύς, ἡδὲπεῖρασφαλερή, ἡδὲκρίσιςχαλεπή. δεῖδὲοὐμόνονἑωυτὸνπαρέχειντὰδέονταποιέοντα, ἀλλὰκαὶτὸννοσέοντα καὶτοὺςπαρεόνταςκαὶτὰἔξωθεν. Hippocrates, Heracleitus. Nature of Man. Regimen in Health. Humours. Aphorisms. Regimen 1-3. Dreams. Heracleitus: On the Universe. Translated by W. H. S. Jones. Loeb Classical Library 150. Cambridge, MA: Harvard University Press, 1931, p. 98-99.
[2]LXIX. Ταῦταμὲνπαραινέωτῷπλήθειτῶνἀνθρώπων, ὁκόσοισινἐξἀνάγκηςεἰκῆτὸνβίονδιατελεῖνἐστί, μηδ᾿ὑπάρχειαὐτοῖσιτῶνἄλλωνἀμελήσασιτῆςὑγιείηςἐπιμελεῖσθαι·Hippocrates, Heracleitus. Nature of Man. Regimen in Health. Humours. Aphorisms. Regimen 1-3. Dreams. Heracleitus: On the Universe. Translated by W. H. S. Jones. Loeb Classical Library 150. Cambridge, MA: Harvard University Press, 1931, p. 366-367.
[3]ἡτέχνηδιὰτριῶν, τὸνόσημακαὶὁνοσέωνκαὶὁἰητρός·ὁἰητρὸςὑπηρέτηςτῆςτέχνης·ὑπεναντιοῦσθαιτῷνοσήματιτὸννοσέοντα μετὰτοῦἰητροῦ.Hippocrates. Ancient Medicine. Airs, Waters, Places. Epidemics 1 and 3. The Oath. Precepts. Nutriment. Translated by W. H. S. Jones. Loeb Classical Library 147. Cambridge, MA: Harvard University Press, 1923, p. 146-147.
[4]μὴὀκνεῖνδὲπαρὰ ἰδιωτέωνἱστορεῖν, ἤντιδοκῇσυνοίσεινἐςκαιρὸνθεραπείης.Hippocrates. Ancient Medicine. Airs, Waters, Places. Epidemics 1 and 3. The Oath. Precepts. Nutriment. Translated by W. H. S. Jones. Loeb Classical Library 147. Cambridge, MA: Harvard University Press, 1923, p. 312-313.
[5]VIII. Περὶσημασίηςτοιαύτηςἅλιςἔστω·ἄνεσιςγὰρκαὶἐπίτασιςνοσέοντοςἐπινέμησινἰητρικὴνκέχρηνται. οὐκἀσχήμων δέ, οὐδ᾿ἤντιςἰητρὸςστενοχωρέωντῷπαρεόντι ἐπίτινινοσέοντικαὶἐπισκοτεόμενοςτῇἀπειρίῃκελεύῃκαὶἑτέρουςἐσάγειν, εἵνεκατοῦἐκκοινολογίηςἱστορῆσαιτὰπερὶτὸννοσέοντα, καὶσυνεργοὺςγενέσθαιἐςεὐπορίηνβοηθήσιος. ἐνγὰρκακοπαθείηςπαρεδρίῃἐπιτείνοντοςτοῦπάθεος, δι᾿10ἀπορίηντὰπλεῖσταἐκκλίνουσιτῷπαρέοντι. Hippocrates. Ancient Medicine. Airs, Waters, Places. Epidemics 1 and 3. The Oath. Precepts. Nutriment. Translated by W. H. S. Jones. Loeb Classical Library 147. Cambridge, MA: Harvard University Press, 1923, p. 312-313.
[6]IX. Ἄνδραδὲ χρή. ὅς ἐστισυνετός, λογισάμενονὅτιτοῖσινἀνθρώποισιπλείστουἄξιόνἐστινἡὑγιείη, ἐπίστασθαιἐκ τῆςἑωυτοῦγνώμηςἐντῇσινούσοισινὠφελεῖσθαι. Hippocrates, Heracleitus. Nature of Man. Regimen in Health. Humours. Aphorisms. Regimen 1-3. Dreams. Heracleitus: On the Universe. Translated by W. H. S. Jones. Loeb Classical Library 150. Cambridge, MA: Harvard University Press, 1931, p. 58-59.
[7]7. ΣΩΚΡΑΤΗΣ. Φέρεδή, πῶςαὖτὰτοιαῦτα Bἐλέγετο; γυμναζόμενοςἀνὴρκαὶτοῦτοπράττωνπότερονπαντὸςἀνδρὸςἐπαίνῳκαὶψόγῳκαὶδόξῃτὸννοῦνπροσέχει, ἢἑνὸςμόνουἐκείνου, ὃςἄντυγχάνῃἰατρὸςἢπαιδοτρίβηςὤν;
ΚΡΙΤΩΝ. Ἑνὸςμόνου.
Plato. Euthyphro. Apology. Crito. Phaedo. Phaedrus. Translated by Harold North Fowler. Loeb Classical Library 36. Cambridge, MA: Harvard University Press, 1914, p. 162-165.
[8]ΣΩ. Ἀλλ᾿ἐάντεπένηςἐάντεπλούσιοςᾖὁπαραινῶν, οὐδὲνδιοίσειἈθηναίοις, ὅτανπερὶτῶν ἐντῇπόλειβουλεύωνται, πῶςἂνὑγιαίνοιεν, ἀλλὰζητοῦσινἰατρὸνεἶναιτὸνσύμβουλον.Plato. Charmides. Alcibiades I and II. Hipparchus. The Lovers. Theages. Minos. Epinomis. Translated by W. R. M. Lamb. Loeb Classical Library 201. Cambridge, MA: Harvard University Press, 1927, p. 110-111.
[9]ΞΕ. Ἄντιςἄραμὴπείθωντὸνἰατρευόμενον, ἔχωνδὲὀρθῶςτὴντέχνην, παρὰτὰγεγραμμένατὸβέλτιονἀναγκάζῃδρᾶνπαῖδαἤτιναἄνδραἢκαὶγυναῖκα, τίτοὔνοματῆςβίαςἔσταιταύτης; ἆρ᾿οὐπᾶνμᾶλλονἢτὸπαρὰτὴντέχνηνλεγόμενονἁμάρτημαCτὸνοσῶδες; καὶπάνταὀρθῶςεἰπεῖνἔστιπρότεροντῷβιασθέντιπερὶτὸτοιοῦτον, πλὴνὅτινοσώδηκαὶἄτεχναπέπονθενὑπὸτῶνβιασαμένωνἰατρῶν;
ΝΕ. ΣΩ. Ἀληθέσταταλέγεις.
Plato. Statesman. Philebus. Ion. Translated by Harold North Fowler, W. R. M. Lamb. Loeb Classical Library 164. Cambridge, MA: Harvard University Press, 1925, p. 140-141.
[10]ΓΟΡΓ. Εἰπάνταγεεἰδείης, ὦΣώκρατες, ὅτιὡςἔποςεἰπεῖνἁπάσαςτὰςδυνάμειςσυλλαβοῦσαὑφ᾿ Bαὑτῇἔχει. μέγαδέσοιτεκμήριονἐρῶ·πολλάκιςγὰρἤδηἔγωγεμετὰτοῦἀδελφοῦκαὶμετὰτῶνἄλλωνἰατρῶνεἰσελθὼνπαράτινατῶνκαμνόντωνοὐχὶἐθέλονταἢφάρμακονπιεῖνἢτεμεῖνἢκαῦσαιπαρασχεῖντῷἰατρῷ, οὐδυναμένουτοῦἰατροῦπεῖσαι, ἐγὼἔπεισα, οὐκἄλλῃτέχνῃἢτῇῥητορικῇ. Plato. Lysis. Symposium. Gorgias. Translated by W. R. M. Lamb. Loeb Classical Library 166. Cambridge, MA: Harvard University Press, 1925, p. 290-291.
[11]XII. Ἐνδὲτῇἐσόδῳμεμνῆσθαικαὶκαθέδρης, καὶκαταστολῆς, περιστολῆς, ἀνακυριώσιος, βραχυλογίης, ἀταρακτοποιησίης, προσεδρίης, ἐπιμελείης, ἀντιλέξιοςπρὸςτὰἀπαντώμενα, πρὸςτοὺςὄχλουςτοὺςἐπιγινομένουςεὐσταθείηςτῆςἐνἑωυτῷ, πρὸςτοὺςθορύβουςἐπιπλήξιος, πρὸςτὰςὑπουργίαςἑτοιμασίης. ἐπὶτούτοισιμέμνησοπαρασκευῆςτῆςπρώτης·εἰδὲμή, τὰκατ᾿ἄλλαἀδιάπτωτον, ἐξὧνπαραγγέλλεταιἐς ἑτοιμασίην.Hippocrates. Prognostic. Regimen in Acute Diseases. The Sacred Disease. The Art. Breaths. Law. Decorum. Physician (Ch. 1). Dentition. Translated by W. H. S. Jones. Loeb Classical Library 148. Cambridge, MA: Harvard University Press, 1923, p. 294-295.
[12]Como experto en medicina y en el conocimiento de la naturaliza humana, el médico hipocrático se siente en el deber de enseñar al profano (idiotes, dèmótés). Ante todo, para que éste, así ilustrado, viva de un modo más salubre cuando está sano y colabore mejor con el médico cuando llegue a enfermar.
En segundo lugar, porque la experiência del médico podrá ser más amplia y profunda si sus pacientes han recibido cierta información acerca de las enfermedades y su tratamiento.
Y por fin, porque la formación del hombre culto, la paideia, exige aprender de los que real y verdaderamente saben, y el médico es, entre todos ellos, el más calificado conocedor de la physiología del hombre. El tratadista hipocrático quiere intervenir en la educación de su pueblo, y muy especialmente en la de los ciudadanos que por su situación social en la polis tienen el deber de la cultura.
Lain-Entralgo, P. La Medicina Hipocrática. Madrid, Sp: Ediciones de la Revista del Occidente, 1970, p. 367.
[13]Não poucas vezes, considera-se que o hipocratismo se assenta sobre um paternalismo forte na relação médico-paciente. Entretanto, o estudo atento de passagens diversas em alguns dos livros do CH, levam a possibilidade de se admitir que esse paternalismo não era forte, mas moderado. Beier M; Ianotti GC. Paternalism and the hippocratic oath. Revista Brasileira de Saúde Materno Infantil, Recife, 10 (Supl. 2): S383-S389 dez, 2010.
[14]Reencontrar o diálogo com o passado é reconquistar o sentido da unidade da espécie humana, e seria loucura pretender reintegrar na humanidade este ou aquele grupo que estejam hoje entre os excluídos e os discriminados, sem antes revogar a discriminação de toda a humanidade que nos precedeu. “Les plus exclus des exclus: Le Silence des morts comme modèle des vivants defendus de parler”, Conferece at the UNESCO International Symposium “Forms and Dynamics of Exclusion, Paris, June 22-26, 1997. In: Olavo de Carvalho, O Futuro do Pensamento Brasileiro: Estudos sobre o nosso lugar no mundo, 2a. edição, Rio de Janeiro, Faculdade da Cidade Editora, 1997, pp. 82-111. Internet, http://www.olavodecarvalho.org/textos/mais_excluidos.htm#nota1