Kita telah membahas asal sumpah dokter dan bagaimana barisan kata yang tertulis pada dokumen tua itu menjadi sebuah panduan etik para penyembuh. Bila belum membaca, silakan klik Sejarah Sumpah Dokter satu dan dua. Kali ini, kita akan membahas tentang beberapa sumber kode etikomedik dunia.

Sumpah Hippocrates Modern
Derasnya perubahan sosial ekonomi, politik, dan tentunya moral, membuat banyak kalangan pesimis akan berlakunya Sumpah Hippocrates. Adanya keragu-raguan itu akhirnya berujung pada modifikasi sumpah agar lebih sesuai dengan tuntutan jaman. Dan yang mencengangkan, dunia memiliki empat sumber kode etikomedik dalam membingkai profesi para penyembuh. Keempatnya adalah the Declaration of Geneva, the Prayer of Maimonides, the Oath of Lasagna, dan the Reinstatement of Hippocratic Oath. Msskipun keempatnya berbeda dalam diksi dan isi, pemaknaan utamanya tetaplah sama – merawat pasien dengan kemampuan terbaik, jangan melakukan kesalahan yang disengaja, dan membina kepercayaan pasien. Dan tidak ada satu pun di antara keempatnya yang menyebutkan hukuman bagi yang melanggar sumpah, kecuali Reinstatement of Hippocratic.

Mari kita bahas satu per satu.

The Prayer of Maimonides

Marcus (Markus) Herz (January 17, 1747 – January 19, 1803), was a Jewish German physician and lecturer on philosophy

The Prayer of Maimonides diperkirakan dilahirkan dan ditulis sekitar abad ke-12 oleh seorang dokter yang juga seorang ahli filsafat Moses Maimonides. Namun bukti-bukti lain menyatakan bahwa barisan doa (prayer) ini pertama kali ditulis pada 1793 oleh dokter berkebangsaan Jerman, Marcus Herz, yang ternyata merupakan murid dari filsuf Jerman Immanuel Kant dan murid dari dokter Inggris Moses Mendelssohn.

“The eternal providence has appointed me to watch over the life and health of Thy creatures. May the love for my art actuate me at all time; may neither avarice nor miserliness, nor thirst for glory or for a great reputation engage my mind; for the enemies of truth and philanthropy could easily deceive me and make me forgetful of my lofty aim of doing good to Thy children.
May I never see in the patient anything but a fellow creature in pain.
Grant me the strength, time and opportunity always to correct what I have acquired, always to extend its domain; for knowledge is immense and the spirit of man can extend indefinitely to enrich itself daily with new requirements.
Today he can discover his errors of yesterday and tomorrow he can obtain a new light on what he thinks himself sure of today. Oh, God, Thou has appointed me to watch over the life and death of Thy creatures; here am I ready for my vocation and now I turn unto my calling.”

Meskipun barisan doa ini ditujukan kepada Tuhan sebagai saksi dan pembimbing, dan bukan dewa-dewi Yunani, namun inti dari barisan doa ini ternyata sama dengan Sumoah Hippocrates – mendedikasikan diri untuk merawat pasien dengan sebaik-baik kemampuan manusia.

The Oath of Lasagna

Louis Lasagna (1923-2003) was an American physician and professor of medicine

The Oath of Lasagna ditulis pada tahun 1964 oleh Louis Lasagna, Dekan Akademik Fakultas Kedokteran Universitas Tufts. Sumpah ini diklaim menjadi sumpah yang digunakan mayoritas fakultas kedokteran. Dan masih sama dengan sumpah-sumpah lain, Sumpah Lasagna menekankan pentingnya memeperlakukan pasien selayak mungkin sebagai manusia, bukan memandangnya sebagai kasus medis. Semenarik apapun kasus medis pasien, kita tidak boleh melupakan bahwa ia adalah manusia dengan segala atributnya. Saat ini berbagai sumber menyebutkan modifikasi Sumpah Hippocrates a la Lasagna sebagai Sumpah Hippocrates versi Modern.

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.

I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

—Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, and used in many medical schools today.

Reinstatement of Hippocratic Oath
The Reinstatement of Hippocratic Oath diperkenalkan pada bulan Juni tahun 1995 oleh The Value of Life Committee, Inc. Dr Joseph R Stanton, yang merupakan anggota komite menegaskan:

It is the hope of the signers and endorsers of this 1995 Restatement that upcoming generations of young physicians in increasing numbers will embrace the Oath’s principles in their personal and professional lives. In taking this pledge, they will stand shoulder to shoulder with the giants who have pledged it in the past and contributed so profoundly to advances in the art and science of medicine while leading exemplary and principled lives.

Meskipun sulit mendapatkan bagaimana redaksionalnya, namun beberapa sumber mengatakan bahwa banyak kemiripan dengan Barisan Doa Maimonides yang menegaskan kesaksian di depan Tuhan. Dan isi dan inti tetaplah sama dengan sumpah Hippocrates – termasuk bunyi sumpah “should the physician transgress from the oath, then he will readily be punished for it.”

The Declaration of Geneva
The Declaration of Geneva berasal dari the General Assembly of the World Medical Association di Jenewa pada 1948. Dan sebagian besar telah kita bahas pada Sejarah Sumpah Dokter (2). Kongres asosiasi medis dunia tersebut dipicu insiden Nazi Jerman dan akhirnya melahirkan Deklarasi Jenewa. Deklarasi Jenewa didedikasikan untuk membela kemanusiaan di tengah gencarnya penelitian demi inovasi medis. Dan Deklarasi Jenewa lah yang pertama kali menyebutkan tentang merawat manusia secara sama, tanpa memperhitungkan ras, agama, kedudukan sosial, dan afiliasi politik. Berikut perubahannya:

I will practice my profession with conscience and dignity; the health of my patient will be my first consideration

I will maintain the utmost respect for human life from the time of conception, even under threat, I will not use my medical knowledge contrary to the laws of humanity

Deklarasi Jenewa telah berulang-ulang ditinjau kembali selama bertahun-tahun. Naskah terakhir yang bisa saya dapatkan berasal dari amandemen Deklarasi Jenewa pada tahun 2006.

Declaration of Geneva – 2006
October 2006
Adopted by the 2nd General Assembly of the World Medical Association, Geneva, Switzerland, September 1948
and amended by the 22nd World Medical Assembly, Sydney, Australia, August 1968
and the 35th World Medical Assembly, Venice, Italy, October 1983
and the 46th WMA General Assembly, Stockholm, Sweden, September 1994
and editorially revised at the 170th Council Session, Divonne-les-Bains, France, May 2005 and the 173rd Council Session, Divonne-les-Bains, France, May 2006

At the time of being admitted as a member of the medical profession:
I solemnly pledge to consecrate my life to the service of humanity;
I will give to my teachers the respect and gratitude that is their due;
I will practise my profession with conscience and dignity;
The health of my patient will be my first consideration;
I will respect the secrets that are confided in me, even after the patient has died;
I will maintain, by all the means in my power, the honour and the noble traditions of the medical profession;
My colleagues will be my sisters and brothers;
I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;
I will maintain the utmost respect for human life;
I will not use my medical knowledge to violate human rights and civil liberties, even under threat;
I make these promises solemnly, freely and upon my honour.

Inilah naskah terakhir dari Deklarasi Jenewa. Dan mungkin paling mungkin menjadi sumber adaptasi Sumpah Dokter di Indonesia.

Selanjutnya pada edisi berikutnya akan kita bahas kontroversi dari sumpah Hippocrates pada jaman modern. Tunggu edisi berikutnya.

Link:

Sejarah Sumpah Dokter (1)

Sejarah Sumpah Dokter (2)

Sejarah Sumpah Dokter (4)