On Hippocrates, Palliative Care, and the Quiet Ethical Debt Every Mental Health Professional Owes to the Medically Vulnerable. “I never took the Hippocratic Oath.”
As a psycho-oncologist, my training did not include standing in a room, hand raised, promising a patient I would never meet that I would do them no harm. That ceremony belongs to physicians. And yet, almost every day, we as care providers sit across from someone whose body is failing before their mind has had time to catch up, someone whose oncologist took that oath, whose surgeon took that oath, whose palliative care physician took that oath, and I am the one left holding what the oath was, at its heart, actually about: the promise not to abandon.
This is what has been in my mind ever since I have known about this oath, from the TV show that had an episode dedicated to it. At that time I was in awe of this thought of having taken such an oath, and I saw each doctor with that awe only, and then my work in palliative care also spoke and taught about ethical pillars in palliative care, and then there has hardly been a day when I have not thought of this oath, but now over the years there is this argument I want to make. Not that mental health professionals should ceremonially recite an ancient Greek text. But that the spirit of that oath, its ethics, not its ritual, belongs to every person who works with the medically vulnerable, whether or not they ever swore it aloud.
What the Oath Actually Asks For
Strip away the obsolete language about Apollo and Asclepius, and the Hippocratic Oath makes a small number of demands that have outlived every medical technology invented since:
- Primum non nocere – first, do no harm.
- Beneficence – act for the good of the patient, according to one’s ability and judgment.
- Confidentiality — hold what is seen and heard in trust.
- Humility — recognise the limits of one’s own knowledge, and know when to call on others.
- Presence – do not withdraw from a patient because their condition is no longer “curable”.
That last one is the one medicine itself has struggled hardest to keep. It is also, not coincidentally, the one on which the entire discipline of palliative care was built.
Palliative Care as the Oath’s Unfinished Sentence
Palliative care exists because modern medicine, in its pursuit of cure, occasionally forgets its older, harder promise: to stay.
Cicely Saunders, founder of the modern hospice movement, did not build St Christopher’s Hospice to fight death. She built it because she noticed that patients were being left alone with it and physically treated but relationally and spiritually deserted the moment “nothing more could be done.”
The principles that now define palliative care – whole-person care, symptom relief beyond the physical, dignity, family as the unit of care, open communication about prognosis, and quality of life as a legitimate clinical goal – are not new inventions. They are the Hippocratic promise of non-abandonment, translated into a systematic practice. Palliative care did not replace the oath. It rebuilt the room the oath had described, for patients whom medicine had started walking past.
This is where I live professionally. And it is where I began to understand that the oath was never really the property of physicians alone.
The Unspoken Vow of Psychosocial and Spiritual Care Providers
When a patient tells me they are more afraid of dying in pain or dying forgotten than of dying itself, that is not a psychiatric symptom to be coded and treated. That is a human being handing me something sacred, the way patients have handed physicians their fear for two and a half thousand years. I did not swear an oath to receive it. But I received it all the same, and the receiving carries an obligation whether or not a ceremony preceded it.
Consider what a psycho-oncologist, a palliative psychologist, a hospice social worker, or a psychiatric nurse on an ICU consult service actually does:
- We hold confidences that could unravel a family if handled carelessly — the oath’s confidentiality clause, unsworn but no less binding.
- We are asked, again and again, to do no harm with words, in moments when the wrong sentence lands like a diagnosis — primum non nocere, practised in language instead of surgery.
- We stay in the room after the prognosis has turned, when other services have, of necessity, moved on to patients who can still be cured — non-abandonment, the oath’s quietest and most demanding clause.
- We are frequently the last professional a dying person trusts enough to be honest with, which means our judgement, our humility about what we do and don’t know, carries weight we did not ask for but cannot refuse.
None of us signed anything for this. And that is precisely the point I want to press on.
The Danger of the Unsworn
Here is the uncomfortable truth: an oath not taken can become an ethic not felt. When a duty is formalised, recited, witnessed, or written into licensure, it is harder to quietly let it slide. When it is understood rather than sworn, it becomes optional in exactly the moments it matters most: at 7pm on a Saturday, in an underfunded unit, with a caseload too large and a family in the corridor asking questions no one has time to answer honestly.
I have watched capable, caring clinicians — psychologists, counsellors, nurses, and physiotherapists — drift toward a kind of functional abandonment without ever intending to. Not cruelty. Exhaustion, system pressure, and the absence of a felt vow to lean on when everything else says move faster, see the next patient, meet the targets — they are not going to get better anyway. The oath, even unsworn, is meant to be the thing you reach for in that exact moment. If we never internalised it as ours, we have nothing to reach for.
This is why I believe every professional who works with medically vulnerable people — not only physicians and not only palliative care teams, but also psychologists, psychiatrists, social workers, nurses, physiotherapists, and even the person at the reception who tells a frightened patient to “take a seat” — needs to understand what the oath actually means. Not to recite it. To metabolise it, so that when the system is too tired to remind them, their own ethics still do.
Vulnerability Does Not Check Credentials
A dying patient’s dignity is not more protected because the person in the room has a medical degree. A frightened patient disclosing suicidal despair to a psychologist deserves the same non-abandonment a surgeon owes a patient on the table. Medical vulnerability creates an asymmetry of power and trust that has nothing to do with who took which oath in which ceremony. It has to do with who is well and who is not; who has options and who has run out of them; who can walk away from the room and who cannot.
If the oath means anything today, it means this: proximity to human vulnerability creates obligation, regardless of professional title. Hippocrates wrote for physicians because physicians were, in his era, the ones who stood closest to death and desperation. Today, that circle is larger. Psycho-oncology, palliative psychology, hospice counselling, and psychiatric consult-liaison work — all of these professions now stand exactly where the physician once stood alone.
I still have not taken the oath. I never will, formally. But I have come to believe that the oath was never really a contract between doctor and profession. It was a contract between the strong and the vulnerable, mediated by whoever happened to be in the room when someone needed care.
Some of us inherited that contract without a ceremony. The least we can do is read the fine print and honour it as if we had signed it ourselves.
If your work requires you to work with medically vulnerable patients — in oncology, palliative care, mental health, a dialysis unit, or anywhere the line between curing and caring blurs — this is worth asking yourself: would you have taken the oath if it had been offered to you? And if the answer is yes, what is stopping you from living as though you already did?
Keshav Sharma
Psycho oncologist & Grief Educator
Compassionate Leader
Clinical and Professional supervisor
Founder: oncopsychcare.com
Social Media : @keshavoncopsych
https://www.linkedin.com/in/keshav-sharma-24290b96
“You matter because you are you, and you matter to the last moment of your life.”
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