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As with so much from the Classical setting, the conditions in which the Hippocratic Oath was conceived in Greece are fundamentally different from what the modern doctor faces. The presence of money and economic well- being is something that the healer in the Greek setting did not have to necessarily wrestle with as today's doctor does. This helps to explain why there is tension. It does not remove responsibility or seek to alleviate the pressure on the doctor for abandoning a patient due to health costs, but it offers clarification. I think that this is one reason why it is difficult to judge the modern doctor who recognizes the constraints of economics on the treatment of a patient. The modern configuration of business related entities in the field of medicine such as the Health Management Organization or the Accounts Payable department at the hospital have occupied a larger role in the field of administering medicine than at any other time in the history of the field. If one were to examine in the strictest interpretation the Oath and the doctor that abandons their patient for economic costs, obviously that doctor would fail the Oath. The Oath is fairly specific in that it was made as a promise to the Gods. There is little room for negotiation in that light. The doctor who abandons their patient for non- payment has failed that patient. Over time, the Hippocratic Oath has been substituted by different versions. One such modern version addresses the reality of economics, in an open manner:
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.
The "family and economic stability" is part of the modern doctor's understanding in treating patients. In the end, doctors will have to make the choices that they must live by, and must adhere. Regrettably, medicine has been relegated to a business and doctors are covered by accounting practices and financial realities if they choose to not care for a patient who cannot pay. In a highly financially driven industry, there is more than enough cover for a doctor who operates as a business person. However, they must accept the fact that in following this path, they stray from the Hippocratic Oath which has been the guiding spirit of medicine for centuries. This becomes an issue for the doctor and their conscience, the implications of which can cast a shadow for some time over their work and how they do it.
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