How Medical School Oaths and Professional Codes of Ethics Affect Physicians' PracticeHow Oaths and Codes of Ethics Affect Physician Practice

Abstract

Objectives: Most US medical students recite a physician's oath, yet the influence of oaths and similar ethical codes on physicians' professional practice remains unknown. We sought to describe the prevalence and perceived impact of having taken an oath during medical school compared with the influence of the AMA Code of Ethics and other sources of moral medical guidance. We also examined the distinguishing characteristics of physicians who reported oaths and the AMA code having a significant influence on their practices. Design: Mailed survey of 2000 practicing US physicians. Results: Fifty-four percent of eligible respondents (1032 of 1895) completed the questionnaire. Most reported participating in a medical school oath ceremony (79%). However, most (61%) believed oaths had a limited influence on their professional lives; only 1 in 4 (26%) believed that oaths had influenced them “a lot.” Few physicians (16%) cited the AMA Code of Ethics as having a significant influence on their practice. Other notable sources of moral guidance reported were personal sense of right and wrong (92%), great moral teachers (35%), and specific traditions (28%). In multivariable models controlling for age, sex, race, region, and specialty, physicians' religious characteristics were independently associated with oaths influencing their practice “a lot”(odds ratio, 1.8; 95% confidence interval, 1.4-2.5) and reporting that the AMA Code of Ethics “significantly” influenced their practice (odds ratio, 2.2; 95% confidence interval, 1.0-4.7). Conclusion: Medical school oaths and other professional codes, such as the AMA code of ethics, appear to have only modest effects on the self-conscious practices of most US physicians.