The oath recommended for medical students is adopted from an ancient text on Ayurveda that tells physicians to not treat people hated by the king, ‘extremely abnormal’ people, and women unattended by husbands or guardians.

Representative image of a doctor treating a patient: The Charaka Shapath controversy and why it has no place in modern medicine Image for representation/PTI
news Education Tuesday, May 03, 2022 - 13:44

On April 30, several future doctors who were starting their medical education at the Madurai Medical College took an oath of ethics, which is required of new physicians, swearing to adhere to certain ethical standards while practising medicine. But instead of the conventional Hippocratic oath, they took ‘Maharshi Charak Shapath’, an altered version of an oath borrowed from an ancient Vedic medicine text. This oath has been heavily criticised for being deeply regressive and casteist and irrelevant to practise of modern medicine and ethics.

The original form of this oath of initiation requires physicians to refrain from eating meat, needs them to grow a beard, and repeatedly tells them to give importance to Brahmins. People who hate the king or are hated by him, ‘extremely abnormal’ people, and also women unattended by husbands or guardians, shall not receive treatment, it says. 

The modified ‘Maharshi Charak Shapath’, recommended by the National Medical Council (NMC) in a circular issued on March 31, discards many of these ideas. However, according to Tamil Nadu Finance Minister Palanivel Thiaga Rajan, who was present at the oath-taking ceremony in Madurai, the version read out by the students, which led to stringent action by the government, was a little closer to the original, discriminatory version. 

Watch our Let Me Explain episode on Charaka Shapath

In a firm response, the state government removed the Dean of the college Dr A Rathinavel from the post, initiated a departmental inquiry into the matter, and said it would advise heads of all state-run medical colleges to always follow the Hippocratic oath without fail. With the debate over the Charaka oath replacing the conventional Hippocratic oath being reignited, here’s an explainer on where the Charaka oath comes from, what it originally said, and why many people are opposed to it in any form. 

What is the Charaka Shapath?  

The oath is borrowed from a Sanskrit text on Ayurveda called ‘Charaka Samhita’. While it is unclear if it was written by one or many individuals, the text is attributed to a ‘sage’ named Charaka. Some sources date it as far back as the second century BC. The text is a collection of commentaries on the physiological and psychological behaviour of human beings, illnesses and their treatment. 

According to an English translation of the oath from Sanskrit, the teacher must administer the oath, in nine parts, to disciples in the presence of the sacred fire, Brahmins and physicians. “Thou shalt lead the life of a celibate, grow thy hair and beard, speak only the truth, eat no meat, eat only pure articles of food, be free from envy and carry no arms,” the oath says. It says that if the student desires success, wealth and fame as a physician and heaven after death, they shall pray for the welfare of all creatures “beginning with the cows and Brahmins.”

While the Hippocratic oath requires physicians to treat patients regardless of their gender or political position, the Charaka oath isn’t so egalitarian. “No persons, who are hated by the king or who are haters of the king or who are hated by the public or who are haters of the public, shall receive treatment. Similarly, those who are extremely abnormal, wicked, and of miserable character and conduct, those who have not vindicated their honour, those who are on the point of death, and similarly women who are unattended by their husbands or guardians shall not receive treatment,” it says. 

It also demands absolute obedience from the disciple toward the teacher. “Thou shalt dedicate thyself to me and regard me as thy chief … Thou shalt serve and dwell with me like a son or a slave or a supplicant,” the teacher tells students. The oath also asks the physicians to endeavour for patients’ relief with heart and soul, to keep certain details about the patient confidential, and to not be boastful of their knowledge. 

The updated version the Indian government wants students to take

When the news of NMC mulling replacement of Hippocratic oath with Charaka oath was reported in February, it was opposed by many quarters, including doctors’ bodies. A group of doctors from Karnataka wrote to the NMC expressing concerns that the Charaka oath was completely out of sync with modern scientific medicine, modern social practices, and modern socio-political values. Later on March 25, when a question was posed in the Lok Sabha over the matter, the response from Union Minister of State for Health and Family Welfare Dr Bharati Pravin Pawar was: “As informed by the National Medical Commission (NMC), there is no proposal of replacement of Hippocratic Oath with Charak Shapath.”

Yet, the NMC issued a circular a week later on March 31, which had a modified ‘Maharshi Charak Shapath’ with eight points. It appeared relatively innocuous, with statements like – ‘During the period of study, I shall live a disciplined life with my teachers and peers’ and ‘I shall always be ready to serve patients, even if I am extremely busy and tired’. 

The oath also talked about dressing well, appropriate conduct, confidentiality, and humility. However, the sixth statement read: “I shall treat patients of gender other than mine in presence of relatives or attendants.” It also included a statement that says the physician will not entertain a desire for lust, greed or wealth. “Immorality shall not emerge even in my thoughts,” it says. 

'Maharshi Charak Shapath' as published in a circular issued by NMC on March 31

But according to the version shared by Minister PTR, which he said was administered at the Madurai Medical College, the oath talks about students practising self-control and piety, submitting themselves to their ‘guru’, acting like a son/daughter for the teacher’s welfare and happiness. “I shall aim my full efforts and ability towards the desired goal of my Guru,” it says, sounding a lot more similar to the original oath from Charaka Samhita which asks students to serve teachers “like a slave.” The Madurai college version also said, “I (especially a male doctor) shall treat a woman only in the presence of her husband or a near relative.”

Why the Charaka Shapath is being opposed 

From the time it was proposed, many doctors, as well as political parties like Congress, have criticised the move to replace the Hippocratic oath with Charaka oath as an attempt to saffronise medical education. The move has also been a long-standing demand of the Rashtriya Swayamsevak Sangh (RSS) according to reports. The medical wing of RSS has administered the Charaka oath to many medical students in Gujarat in the past, claiming that it is rooted in ‘Indian values’ and is a matter of ‘pride in India’s medical legacy.’ 

Speaking to TNM, Dr Amalorpavanathan Joseph, member, Tamil Nadu State Planning Commission and former Director of Institute of Vascular Surgery at Madras Medical College questions the rationale behind replacing the existing Hippocratic oath, asked what it lacked and why the Charaka oath was needed as a replacement. “Medical ethics is constantly evolving. Even in the modern oath, doctors swear confidentiality but at the same time, they are compelled to share patient details with insurance providers. So it makes sense to have a more evolved oath rather than replacing an old-fashioned one with a much more outdated oath,” says Dr Joseph.

While the oath currently in use is merely called the Hippocratic oath, it is an evolved modern oath updated for modern scientific medicine, he says. “For example, the original Hippocratic oath says physicians will not use a knife, as the mortality rate in that case was 100% at the time. But that is not practical for modern medicine,” he says, adding that if a replacement is deemed necessary, the NMC could consider the International Code of Medical Ethics adopted by the World Medical Association (WMA), which was last updated in 2017. 

The Karnataka group of doctors who had earlier opposed the Charaka oath had also said that it was not only unnecessary to adopt it, but many aspects of it would be impossible to implement or even lead to ridiculous situations. 

The part of the oath about male doctors only treating women patients if accompanied by a husband or relative, for instance, cannot be used to deny treatment to women who visit a doctor by themselves, says Dr Joseph. “It is advisable to have a female attendant present if a male doctor is treating a female patient, to make the patient feel comfortable and also in the event that there are allegations of sexual harassment. If a woman patient visits alone, we would call a female staff member to be present, but can never deny treatment to her,” he says. 

Doctors have also criticised the NMC’s move to make yoga compulsory for ten days in all medical colleges. “The NMC can advise exercise in general but it doesn’t make sense to impose yoga in particular, instead of letting students choose their preferred form of exercise,” says Dr Joseph. 

He also points out that while the modern oath in use applies to all fields of medicine, the Charaka Samhita pertains specifically to Ayurveda. “Even if it is an important text, it still is pertinent to one particular medicine system. There are other practices like Siddha and Unani, as well as modern medicine. One field’s principles cannot be imposed on practitioners of all forms of medicine,” he says.

Watch our Let Me Explain episode on Charaka Shapath

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