Member Care and the Hippocratic Oath, Part 10—Summary

Hippocrates as Historical Precedent:

Roots and Responsibilities

The Hippocratic Oath in Greek and Latin.

La saeta lanza

fasta un cierto fito,

y la letra alcanza

desde Burgos a Egipto.

Sem Tob, 14th century, Spain

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Translation:

Darts hit their mark when carefully thrown

Writings go far when skilfully sown.

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This is our 10th and final discussion of the Hippocratic Oath. As the above moral proverb indicates (and many thanks to you Sem Tob for your universally-wise rhymes!), the truth in skilfully written words, such as those in the Hippocratic Oath, span across continents, generations, centuries, and health disciplines. The ethical core for health practitioners in the Oath, arguably, is unprecedented as a historical foundation of good practice.

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Just one case in point among many is the current version of the American Psychology’s Ethical Principles for Psychologists and Code of Conduct (2002). This code like its “cousin codes” in related health sciences, is replete with what can only be called by this point in our discussions, "hippocratisms.” Smile. Meander through the Introduction and the Preamble, and then on to the General Principles and then Ethical Standards sections and you will quickly bump into such familiar concepts/commitments as doing no harm, responsibility, competence, confidentiality, and yes, even not having sex with clients etc. Check it out at: http://www.apa.org/ethics/code2002.html  The Hippocratic foundation is there (along with other items such as justice, integrity, and rights along with more specific, contemporary standards involving things like psychological testing, court testimony, etc.).

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Final Application

We want to summarize the 10 core principles that we have covered over the past three plus months. These principles are commitments that are explicitly embedded in the Hippocratic Oath (HO). We want to remember our roots and our responsibilties. These core priciples could be likened to being the 10 commandments for healthcare practitioners. But let’s just call it the “10 HO Commitments”. We also list the first draft of the newly condensed version (10 items now) of the “15 Commitments for Member Care Workers” (from the 2006 article “Five Stones for Member Care: Upgrading Ethical Practice).”

http://www.fuller.edu/academics/school-of-psychology/integration-symposium-2009.aspx.

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Well, if this does not have your head spinning yet, then this may well do the trick: The 10 Commitments in the Hippocratic Oath will then be referenced to the 10 MCW Commitments (in parentheses)--although note there is definitely not a one-to-one correspondence. Here we go!

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10 HO Commitments (for health care workers)

1. Foundational Principle: Accountability to a Higher Power

2. High Standards: Agapeoath for Trans-Practitioners

3. Professional Obligations to Respect, Relate, and Reproduce

4. Hippocratic Heart: Dong Good and Doing No Harm

5. Respecting Human Life: Conception through Completion

6. Growing in Character and Competence

7. Prudence: No Sex with Clients

8. Confidentiality as a Lifestyle

9. Consequences of Good vs Poor Practice

10. Historical Precedents: Roots and Responsibilities

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10 MCW Commitments (for member care workers)

1. Ongoing training, personal growth, and self-care. (HO6)

2. Ongoing accountability for my personal/work life, including consulting/supervision. (HO1)

3. Recognizing my strengths/limits and representing my skills/ background accurately. (HO6)

4. Understanding/respecting felt needs, culture, and diversity of those with whom I work. (H03)

5. Working with other colleagues, and making referrals when needed. (HO3)

6. Preventing problems and offering supportive/restorative and at times pro bono services.(HO5)

7. Having high standards in my services and embracing specific ethical guidelines. (HO2)

8. Not imposing my disciplinary/regulatory norms on other MCWs. (H03)

9. Abiding by any legal requirements for offering member care where I reside/practice. (HO9)

10. Growing in my relationship to Christ, the Good Practitioner. (HO1)

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Reflection and Discussion

We hope these 10 entries since June have stimulated your thinking about new, old, and creative ways to understand member care. Take some time to identify/review three meaningful concepts for you in particular.

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I especially enjoyed the challenge of trying to relate the moral proverbs of Sem Tob and the indigenous artwork of Diego Rivera with member care thinking and the Hippocratic Oath. Perhaps you would like to have a go at some integrative member care work that includes the arts, sciences, and history etc. too.

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It has personally been a lot of work and I was not always sure where we would end up. Perhaps the same is true for you. Are you OK for example with the summary in the 10 HO Commitments?
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I am tempted to close with yet another gem from the Jewish rabbi Sem Tob in 14th century Spain. However  I want to finish now with something from an anonymous Christian monk in 8th century Ireland. This excerpt from the poem Pangur Ban (White Cat) aptly describes what this integrative journey into "Member Care and the Hippocratic Oath" has been like for me. Like the monk in this poem, I have been hunting at length for the right words to convey my thoughts and I have been keenly aware of how small my wisdom really is. Maybe you have a proverb or short poem that reflects your experience too.

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I and Pangur Ban my cat

‘Tis a like task we are at

Hunting mice is his delight

Hunting words I sit all night.

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Against the wall he sets his eye

Full and fierce and sharp and sly

Against the wall of knowledge I

All my little wisdom try.

Member Care and the Hippocratic Oath, Part 9

Should Member Care Practitioners Be Disciplined?

An impeached and disgraced President Nixon,

leaving the White House and US Presidency

some 35 years ago--August 9, 1974.

***

Tórnase sin tardar

la mar mansa muy brava;

el mundo hoy despreciar

al que ayer honraba.

Por ende el grande estado

al hombre que ha saber,

face venir cuitado

y tristezas haber.

Sem Tob, 14th century, Spain

***
Translation:

Just as placid seas quickly turn fierce in a storm

so honor today can become tomorrow’s scorn.

Therefore remember our exalted state

can suddenly turn to sadness by fate.

***
If I keep this oath faithfully,

may I enjoy my life and practice my art,

respected by all men and in all times;

but if I swerve from it or violate it,

may the reverse be my lot.

Hippocratic Oath

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According to the final part of the Oath, practitioners freely invoke/embrace the consequences of good practice vs poor practice. One’s keeping of this Oath will result in three outcomes:

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1. Enjoying life vs not enjoying life

2. Practicing health care vs not being able or allowed to practice health care

3. Being respected by people always vs never being respected by people.

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It is not clear however in the Oath who or what is relegating the consequences for the quality of one’s practice. A god? Fate? Some type of Hellenistic karma? Or is it just the acknowledgement that one does not deserve good things from life if one deviates from properly caring for his/her clients/patients, with the word properly being defined by the general parameters of the Oath? Whatever the case, this is serious business and obviously one should never take such a life-impacting oath lightly.

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Applications

So should there be consequences for member care practitioners who fail to practice ethically and competently? Yes, of course. This is especially true if they consistently practice unethically and incompetently in ways that hurt others.

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But what should the consequences be, especially in a field like international member care that is largely unregulated? Should poor practitioners who make serious errors or who are consistently negligent be disciplined or otherwise removed from practice? Probably. But the modus for such action is hazy at best. Perhaps receiving informal or even formal correctives from one’s peers or organizational affiliations are the most we can hope for.
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In the Hippocratic Oath, there are no specific external referents to regulatory bodies such as a licensing board, a professional ethics committee, or civil law. For many member care practitioners, the same is true: there is no regulatory body to monitor member care practice and to receive any client complaints. This of course is not the case for professional caregivers in member care who are legally certified in a special field and part of a professional association.

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On the More Positive Side:

Good self-care and good social support are the core safeguards to help one continue to practice well and to avoid impairment in judgement, inferior services, and even burnout. In addition having different interests outside of one’s work, an ability to maintain perspective in difficult times, having fun, and being self-aware are also important qualities to promote well being and foster good practice. Know your limits, know your strengths, and know your relevant ethics codes!

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Bennett et al in Assessing and Managing Risk in Psychological Practice (2006) remind psychologists [and for our purposes member care practitioners] that good practice is “hard work.” We are encouraged to “Strive for excellence but not perfection” and to know that:

**"You will make mistakes.

**You cannot help everyone.

**You will not know everything.

**You cannot go it alone.

**It is helpful to have a proper mix of confidence and humility.” (p.5)

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Reflection and Discussion

We are entrusted to help foster the well-being of individuals, couples, children, families, teams, organizations etc. Again, it's serious business for sure! This serious and final part of the Hippocratic Oath reminds me of an admonition in Deuteronomy 28: 1-2, 15, attributed by many to Moses.

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“Now it shall be, if you diligently obey the LORD your God, being careful to do all His commandments which I command you today, the LORD your God will set you high above all the nations of the earth. And all these blessings will come upon you and overtake you if you obey the LORD your God…But it shall come about, if you do not obey the LORD your God, to observe to do all His commandments and His statutes with which I charge you today, that all these curses will come upon you and overtake you…”

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Comment on this final declaration of the Hippocratic Oath in light of this portion of Jewish-Christian Scripture (which may have preceded Hippocrates by up to 10 centuries!) and in light of these assertions:

1. There are pros and cons for member care practitioners who say that they are accountable to a Higher Being--God.

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2. Regardless of one’s profession in life, acting ethically will have certain consequences and acting unethically with have certain consequences.

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3. Learning and growth do not occur without making mistakes regardless of one’s level of experience.

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4. “Keep this oath faithfully” (Hippocrates) and “Diligently obey the Lord” (Moses). Both can be easily harmonized and can be done simultaneously.

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5. Discipline can be misapplied and good practitioners can be seriously hurt by people who are misinformed, overly spiritual, who have political agendas, and in some cases by those who have serious problems themselves. On the other end of the "discipline continuum" are poor practitioners who can essentially do whatever they want with impunity. Both extremes involve serious errors in discipline/accountability with the end result being that people get hurt. The Hippocratic heart (as described in Part 4 of this series) of "doing good and doing no harm" can thus sadly be broken.

Member Care and the Hippocratic Oath, Part 8

Confidentiality as a Lifestyle

Diego Rivera, Women combing each others’ hair, 1957

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Si fuese el fablar

de plata figurado,

debe ser el callar

de oro afinado.

Sem Tob, 14th century, Spain

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Translation:

If speech is silver

then silence is gold.

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All that may come to my knowledge

in the exercise of my profession

or in daily commerce with men,

which ought not to be spread abroad,

I will keep secret and will never reveal.

Hippocratic Oath

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Keeping confidences is not just a member care practice or a professional standard (e.g., confidentiality is a serious part of “the exercise of my profession” Hippocratic Oath). It is also part of our lifestyle and commitment to integrity in our relationships (e.g., confidentiality is also explicitly included in our “daily commerce with men” Hippocratic Oath).
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Have you ever wondered when it is OK to share information with another person? Can you tell one friend what another friend told you privately? What if there was no explicit stipulation that you need to keep this information to yourself? Or what if your friend "would not mind" if you told someone else--or so you think/rationalise? Is it just a matter of your discretion to determine, in the terms of the Hippocratic oath “what ought not to be spread abroad?”

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Likewise when is it OK for us to share private information with a “consultant” in order to get “input”. Who and what constitutes a person being a “consultant” anyway? When might such consultancy be or lapse into more of a thin veneer for a juicy round of gossip or for affecting some unidisclosed manipulative end?

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The list of questions and situations involving private communications and disclosures is seemingly endless, both in our private lives as well as in our member care work. The adage “when in doubt, don’t” is not a bad place to begin. The counter to all of this however is not to create some culture of secrecy where simply sharing news with each other is somehow hindered or viewed with suspicion.

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The following material can help give us all some more clarity as member care practitioners. It is from the 2009 article, “Ethics and Human Rights in Member Care: Developing Guidelines for Good Practice” by Kelly O’Donnell

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When is information considered “confidential”?

The basic consensus among professional codes of ethics is that any information shared during the course of professional services is considered to be "privileged" information. This means that only the "client" (the person asking for help/receiving services) can determine when and how this information can be shared by the helper/member care worker. There are a few important exceptions however when there is a danger to self/others (see below).

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Confidentiality is a core part of the helping relationship, and a foundation for trust and good practice. It is not just a matter of member care workers (MCWs) simply being “discrete”—which can be interpreted in many different ways—and relying on one’s own “good” judgment concerning disclosures. Rather the MCW abides by a strict standard that honours the client’s rights.

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Here are three confidentiality examples to consider. The third one was added to this blog entry. It is a a short prosaic piece (indicting almost all of us I'm afraid) on the common practice of ‘indulging in idle talk and rumours about others, especially the private affairs of others, often while feigning noble motives for such improprietous disclosures.’

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Example One: Member Care Associates

Confidentiality (from Service Agreement)

We want you to know that what you share with us is confidential. The only exception, in compliance with most laws (e.g., American and European), is when: a) you or someone's life may be in danger (e.g., child/elder abuse, suicidal/homicidal threat, gravely disabled); or b) explicit written permission by you has been given to waive confidentiality.
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Other types of personal struggles can significantly interfere with one's work role and/or credibility of one/s organization (e.g., abusive leadership, addictions, major depression, moral failure, serious marital conflict.) In such cases we usually encourage you to inform a leader whom you trust within your organization(s). We see such struggles as being larger than the helping relationship, and thus usually best handled with the involvement and support of others.
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Note for group or debriefing services: The material shared by others during the group/debriefing sessions will be kept strictly confidential by the participants.

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Example Two: American Association for Marriage and Family Therapy (AAMFT)

Confidentiality (Code of Ethics, July 2001)

www.aamft.org/resources/lrm_plan/Ethics/ethicscode2001.asp

Marriage and family counselors/therapists often work with more than one person in a family. It is important to guard each client’s confidence but it can be challenging at times. The AAMFT has developed six points relating to confidentiality. The main ideas in each point are listed below. Be sure to see the full code at the

AAMFT site listed above.

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1. Discuss the nature of confidentiality to clients and any others involved in the case

2. Do not disclose information without written authorization or when required by the law.

3. Confidentiality is protected when using examples for teaching, writing, research ,etc.

4. Clarity about how to safeguard and destroy records of clients

5. Clarity about how to deal with client records when closing a practice, moving, or dying

6. When/how to disclose information if one consults with colleagues about a case

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Example Three: The Snake That Poisons Everybody

Author Unknown (1980s)

It topples governments, wrecks marriages, ruins careers, busts reputations, causes heartaches, nightmares, indigestion, spawns suspicion, generates grief, dispatches innocent people to cry in their pillows.

Even it's name hisses.

It's called gossip.

Office gossip. Shop gossip. Party gossip.

It makes headlines and headaches.

Before you repeat a story, ask yourself:

Is it true? Is if fair? Is it necessary?

If not, shut up!

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Reflection and Discussion

1. In what ways are the above “standards” relevant to member care workers who provide more "informal" services, or who do not have a "professional" certification, or who are not therapists, or who come from different countries?

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2. How thorough and how specific should such standards be, for different settings in which different types of member care are provided, including counselling, team meetings, or internet communications?

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3. Confidentiality sometimes leads to misunderstandings. For example, it can be seen as being secretive and withholding important information from an organization about its staff. How can this be minimized?

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4. Can you think of additional ways to put into personal practice the third example above, on “gossip”?

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5. How might the above standards apply to protecting information in written and digital form?

Member Care and the Hippocratic Oath, Part 7

Member Care Never Includes Sex

Diego Rivera, Dance of Tehuantapec, 1928

Como el pez en el río,
vicioso y riendo,
non piensa el sandío
la red quel’ van teniendo.

Sem Tob, 14th cnetury, Spain

Translation:

Imprudent people like careless fish get
trapped in their folly and caught in a net.

*****
In every house where I come
I will enter only for the good of my patients,
keeping myself far from all intentional ill-doing and all seduction
and especially from the pleasures of love with women or with men,
be they free or slaves.
Hippocratic Oath
*****

As member care providers and those with member care responsibility, we are committed to the good of those with whom we work. We do good and do no harm. We enter into many types of houses so to speak (the term used in the Hippocrates Oath) during the course of our work. Houses can be literal as well as represent peoples’ lives, organizations, countries, and cultures. We are trusted guests. No matter how helpful or beautiful or fun or anything one might wish to frame such an experience:

There is no ethical context
for having member care sex.

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So chill out. Take a cold shower. Stay accountable to colleagues. Because having sexual relationships with people who receive our services–-regardless of our world views or spiritual leanings--is a no go. Just don’t do it. And don’t even think about it. But do think about and stay in touch with your own sexuality.
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The same goes for romance, as you will note in the examples below of professional principles, codes, and laws. Remember there are millions of other foxes in the lea and fish in sea besides that "irresistible" person you are trying to “help.”
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Sexual Purity in Missions (p. 249-250)
Dr. Ken Williams in Doing Member Care Well, 2002
[Note: This article is also available in Chinese, Arabic, Spanish, Portuguese, and Korean. The article also includes two helpful self-assessment tools. The English and Chinese versions are available in Section Five (Special Issues) at http://www.chinamembercare.com/]
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Being sexual and sane these days is no easy thing …We need to be just as concerned about understanding the normal and healthy aspects of human sexuality as we are about its potential dangers and downside. What a powerful and lovely gift we have from the Creator!
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Professional Therapy Never Includes Sex, 2004, (p. 5)
California Department of Consumer Affairs
http://www.psychboard.ca.gov/formspubs/proftherapy.pdf
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Professional psychotherapy never includes sex. It also never includes verbal sexual advances or any other kind of sexual contact or behavior. Sexual contact of any kind between a therapist and a patient is unethical and illegal in the state of California. Additionally, with regard to former patients, sexual contact within two years after termination of therapy is also illegal and unethical.
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Sexual contact between a therapist and a patient can also be harmful to the patient. Harm may arise from the therapist’s exploitation of the patient to fulfill his or her own needs or desires, and from the therapist’s loss of the objectivity necessary for effective therapy. All therapists are trained and educated to know that this kind of behavior is inappropriate and can result in the revocation of their professional license.
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Therapists are trusted and respected, and it is common for patients to admire and feel attracted to them. However, a therapist who accepts or encourages these normal feelings in a sexual way — or tells a patient that sexual involvement is part of therapy — is using the trusting therapy relationship to take advantage of the patient. And once sexual involvement begins, therapy for the patient ends. The original issues that brought the patient to therapy are postponed, neglected, and sometimes lost.

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Many people who endure this kind of abusive behavior from therapists suffer harmful, long-lasting emotional and psychological effects. Family life and friendships are often disrupted, or sometimes ruined.
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Ethical Principles of Psychologists and Code of Conduct, 2002
American Psychological Association
http://www.apa.org/ethics/code2002.html
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Principle A: Beneficence and Nonmaleficence. Psychologists strive to benefit those with whom they work and take care to do no harm…Because psychologists' scientific and professional judgments and actions may affect the lives of others, they are alert to and guard against personal, financial, social, organizational, or political factors that might lead to misuse of their influence. Psychologists strive to be aware of the possible effect of their own physical and mental health on their ability to help those with whom they work.
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3.02 Sexual Harassment. Psychologists do not engage in sexual harassment. Sexual harassment is sexual solicitation, physical advances, or verbal or nonverbal conduct that is sexual in nature, that occurs in connection with the psychologist's activities or roles as a psychologist, and that either (1) is unwelcome, is offensive, or creates a hostile workplace or educational environment, and the psychologist knows or is told this or (2) is sufficiently severe or intense to be abusive to a reasonable person in the context. Sexual harassment can consist of a single intense or severe act or of multiple persistent or pervasive acts.
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10.05 Sexual Intimacies With Current Therapy Clients/Patients. Psychologists do not engage in sexual intimacies with current therapy clients/patients.
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10.06 Sexual Intimacies With Relatives or Significant Others of Current Therapy Clients/Patients. Psychologists do not engage in sexual intimacies with individuals they know to be close relatives, guardians, or significant others of current clients/patients. Psychologists do not terminate therapy to circumvent this standard.
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10.07 Therapy With Former Sexual Partners. Psychologists do not accept as therapy clients/patients persons with whom they have engaged in sexual intimacies.

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10.08 Sexual Intimacies With Former Therapy Clients/Patients.

(a) Psychologists do not engage in sexual intimacies with former clients/patients for at least two years after cessation or termination of therapy.

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(b) Psychologists do not engage in sexual intimacies with former clients/patients even after a two-year interval except in the most unusual circumstances. Psychologists who engage in such activity after the two years following cessation or termination of therapy and of having no sexual contact with the former client/patient bear the burden of demonstrating that there has been no exploitation, in light of all relevant factors, including (1) the amount of time that has passed since therapy terminated; (2) the nature, duration, and intensity of the therapy; (3) the circumstances of termination; (4) the client's/patient's personal history; (5) the client's/patient's current mental status; (6) the likelihood of adverse impact on the client/patient; and (7) any statements or actions made by the therapist during the course of therapy suggesting or inviting the possibility of a posttermination sexual or romantic relationship with the client/patient. (See also Standard 3.05, Multiple Relationships.)
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Reflection and Discussion
1. To what extent do the above principles and codes (from the USA) apply to member caregivers with various backgrounds and in other countries? Can the above standards and caveats be written (or are they alredy written) in such a way as to be universal?
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2. What are some of the safeguards you and those in your setting have to avoid sexual intimicies with the people you are trying to help?
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3. What is the best way to handle a situation in which you are infatuated with a person (client, student, colleague, neighbour) and having a sexual or romantic relationship is likely although clearly not appropriate (due to marriage, the nature of your member care relationship, values, etc.).
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4. Condoms are currently handed out freely all over the globe. So will the  day ever come when it will be seen as OK or even "ethical" to give condoms to clients when they walk into our member care offices--and lives? Just in case something happens between helper and helpee?
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5. How should we respond to member caregivers who have sexual intimicies with those that they are trying to help?

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Note: This entry did not get into the topic of "intentional ill-doing" as stated in this part of the Hippocratic Oath. What would such "ill-doing" involve? Probably the exploitation of others for one's own selfish ends (e.g., overcharging, spreading gossip about a person, deceiving someone concerning credentials and qualifications, not admitting errors etc.).

Member Care and the Hippocratic Oath, Part 6

Character and Competence

La Era (garden), Diego Rivera, 1904
*****
El sabio, con corona,
como leon semeja;
la verdad es leona
la mentira es gulpeja.
Sem Tob, 14th century, Spain

Translation :
Wise people are like lions:
Crowned in truth they hold their ground.
But lying foxes run around.
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But I will preserve the purity of my life and my arts.
I will not cut for stone,

even for patients in whom the disease is manifest;
I will leave this operation to be performed by practitioners,

specialists in this art.

Hippoctratic Oath
*****

For member care practitioners, and all of us with member care responsibility, character and competence are inseparable in our lives. Said another way, we want to extol and develop both virtue and skill. And we want to help others–-fellow practitioners, organizations, clients, etc—to do the same.
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The notion of character, broadly speaking, is embodied in the Hippocratic commitment to “preserve the purity of my life and arts”. It necessitates practicing ethically and living ethically.
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The notion of competence—or more specifically working within one’s sphere of competency—is seen in the commitment to “not cut for stone”. Apparently this refers to the surgical removal of things like gall stones or kidney stones. Such practices at that time in 4th century Greece were not part of the purview of medical practitioners.
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It bears mentioning that during our work in member care we are often stretched both:

**ethically (not everything in our work of course is black and white—and we cannot always know the consequences of our interventions) and

**experientially (not everything we do fits neatly into our training backgrounds—and we cannot always know what the “best practice” will be).
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I appreciate the simile of the lion cited above from Rabbi Sem Tob’s heptasyllabic quartet (that sounds serious—well, what I mean is that it is a short poem written in a certain manner :-) Tob's creative gem states that our crowning wisdom is demonstrated through our courage and clarity in speaking/acting truthfully (holding our ground with the truth, not being distracted from our course, and being open to input when the truth is not clear).

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By “truth” I mean the conformity of mind to reality, as the Scholastics would say (e.g., Thomas Aquinas et al). Of course we could then ask what is mind and what is reality! But I will leave that for others to deal with who are far more learned than I am.

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What I am really getting at here via the blend of Sem Tob's morality poem, Hippocrates' oath, and Rivera's painting, is that we are committed in the member care field to work knowledgeably and ethically within our "gardens"--that is, our spheres of influence. Knowledge and ethics are all part of the character/competency core.
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Here are three related items--resources--that you will hopefully find helpful. (from Kelly O’Donnell)
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1. Some Suggested Ethical Guidelines for the Delivery of Mental Health Services in Mission Settings, Helping Missionaries Grow, (1988) p. 469
**MHPs [mental health practitioners in missions] are dedicated to high standards of competence in the interest of the individuals and mission agencies which they serve. They recognize the limits of their training, experience, and skills, and endeavor to develop and maintain professional competencies. MHPs keep abreast with current professional information and scientific research related to their work in mission settings.
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2. Upgrading Member Care: Five Stones for Ethical Practice (2009)
**MCWs are committed to provide the best services possible in the best interests of the people whom they serve…. Character, competence, and compassion are necessary to practice member care well.
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**[Character] refers to moral virtue, emotional stability, and overall maturity. Basically, the qualifications for leaders in Timothy and Titus reflect the types of character traits needed for MCWs. Those in member care ministry have positions of trust and responsibility, and work with people who are often in a vulnerable place. Therefore they need to model godly characteristics as they minister responsibly—to protect/provide for those who receive their services…

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**[Competence] refers to having the necessary skills to help well (via life experience and training). I have found that competence is not necessarily based on degrees or certification, although the systematic training that is required to get these “validations” is a very important consideration. Others without such institutional validation are also capable of doing member care well (usually via more supportive than specialized care), and indeed in many places they are the primary service providers (e.g., peers, team leaders). Note that MCWs, like others in the health care fields, can be “stretched” at times to work in ways that may go beyond their skill level. And many services can be in ambiguous, complex, and difficult settings, with the outcomes (positive or negative) not easy to predict. Caution and consultation with others are needed in such cases…
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**[Compassion] refers to our core motivation for member care work. It is the love of Christ that compels us. We value people for their inherent worth, and just for their “important” work.
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3. Member Care Involvement Grid—Strengths and Preferences (2003, adapted)
This grid helps us to identify the “fit” and practice parameters for ourselves and colleagues. This grid is a continuum. It could also be used as part of a simple/informal team building exercise as a way to get to know other MCWs and understand their strengths and preferences. Note that there are many other items that cold be included on this grid. What would you include?

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Administration focus/involvement-----People focus/involvement
Working by oneself mostly-----Working as part of a group mostly
Mostly provide member care-----Mostly develop member care
Working groups that Talk/think-----Work groups that “Task”/do
Services as needed/requested-----Systematic/planned services
Local geographic focus-----International geographic focus
One main ministry focus-----Multiple ministry focus
One specialty-----Many specialities
One organization focus------Interagency focus
Connection in a sector-----Connection in many sectors
Additional
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Reflection and Discussion (apologies for the “leading questions”!)
1. Should the member care field be regulated to better ensure the quality of services and qualifications of service providers? If so, how?
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2. How do we measure competence in member care practitioners?
What could be some specific behavioural criteria to consider (so not just academic degrees, titles, job descriptions, time living in another culture etc.)?
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3. How could the member care sector build program evaluation/outcome studies/research into the member care field in order to empirically measure the effectiveness of the various types of services/interventions that we provide? Is it appropriate—ethical--to continue providing and developing services without assessing their effectiveness?

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4. How relevant is the notion of developing evidence-based, expert-consensus guidelines for member care practice? What are the criteria for "evidence"--"expert"--"consensus"?!

Member Care and the Hippocratic Oath, Part 5

Respecting Human Life—From Conception to Completion

Diego Rivera, Flower Day

No tengas por vil hombre
por pequeño que lo veas,
nin escribas tu nombre
en carta que non leas.
Sem Tob, 14th century, Spain

*

Translation:
Don’t look down on people because they may be small
Don’t sign a document unless you’ve read it all.
*
There are an estimated 42 million abortions each year worldwide.
Over 80% take place in the “developed” world.
http://www.abortionno.org/Resources/fastfacts.html

*****

Hippocrates Then and Hypocrisy Now?
I will not give a woman a pessary to cause an abortion.
But I will preserve the purity of my life and arts.
Hippocratic Oath, circa 400 BC

Didache Then and Deadkids Now?
There are two ways, one of life and one of death, but a great difference between the two ways…you shall not murder a child by abortion nor kill that which is born.
Didache—The Teaching of The Twelve, circa 100 AD

Conception Then and Concession Now?
I solemnly pledge myself to consecrate my life to the service of humanity…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...
Declaration of Geneva, adopted by the General Assembly of the World Medical Association, Geneva, Switzerland, September 1948.

The current amended version of the Declaration of Geneva excludes “conception” and says:
"...I will maintain the utmost respect for human life..."

Humans Then and Non-Humans Now?
Quotes from Physicians for Life web site:
http://www.physiciansforlife.org/

*

American Medical Association. For 125 years, the American Medical Association took a firm anti-abortion position, declaring in 1859 that abortion is the "unwarranted destruction of human life." In 1871, the AMA denounced doctors who would perform abortions as "false to their professions, false to principle, false to honor, false to humanity, false to God." But, in 1989, the AMA called abortion a "fundamental right," to be decided "free of state interference" in the absence of compelling justification.
*

The United Nations. The United Nations Declaration on the Rights of the Child, adopted by the General Assembly in 1959, stated that a child "needs special safeguards and care, including appropriate legal protection, before as well as after birth." This is reaffirmed in the 1990 United Nations Convention on the Rights of the Child.
*
Planned Parenthood. In 1963, Planned Parenthood insisted that the organization's birth control campaign did not support abortion, stating: "An abortion kills the life of a baby after it has begun."
*
California Medical Association. The California Medical Association, in 1970, declared abortion to be "killing" and referred to "the scientific fact, which everyone really knows, that human life begins at conception and is continuous whether intra- or extra-uterine until death."

Reflection and Discussion
1. Physicians for Life says that “Until the 1970s, medical professionals, human rights groups, and birth control providers traditionally understood human life to begin at conception/fertilization.” If this is accurate, then what has changed and why?

2. Should unborn humans be considered to be an unreached people group (UPG)? If so to what extent is this understanding being incorporated into mainstream missiological thinking and practice?

3. What is the place of member care, broadly speaking, for prenatal humans? How could member care practitioners also help in the areas of human sexuality and reproductive health on behalf of postnatal humans?

4. The American Psychological Association has emphasised and supported research that looks at the mental health effects of abortion on mothers/parents. We are wondering if psychologists have explored the mental health effects of abortion on unborn humans--you know the luckless recipients of abortion. Any ideas for “research”? Who knows. Perhaps the dismembered and/or scorched mass of previable fetal parts could actually score quite well on a standardized Mental Health Exam. It might even be oriented for (non)person, place, and placenta, inspite of having a relatively low APGAR score.

My God and my fellow post-natal humans:

this is rubbish and it has to stop!

5. Here’s a short video expressing the beauty and humanness of prenatal life, accompanied by a song from the musician Joe Cocker (You Are So Beautiful).
http://www.youtube.com/watch?v=LdxWFr_UjqQ&feature=PlayList&p=D0E2770173A13165&index=5

**Note 1: To see the Rivera painting that we preferred to put here, go to this web site and click on the second grouping in the gallery (thumbnails) and then click on the last (eigth) painting):

http://www.diegorivera.com/gallery/index.php

**Note 2: It is important to confirm the sources, context, and accuracy of the above quotes for the web site of Physicians for Life. We have not yet been able to do so, but the quotes do fit with the predominant medical/ethical thinking of the times indicated.

**Note 3: This has been the most difficult (saddest and emotionally draining) weblog entry we have done to date.

Member Care and the Hippocratic Oath, Part 4

The "Hippocratic Heart":

Doing Good and Avoiding Harm

Diego Rivera, The Vendor of Lillies

Non hay tan buen tesoro
como el bien facer
nin tan precioso oro
nin tan dulce placer.
Sem Tob, 14th century, Spain

Translation:

Doing good is the greatest treasure,
Better than gold, better than pleasure.

*****
“I will prescribe regimens for the good of my patients
according to my ability and my judgment
and never do harm to anyone.”
Hippocrates, 4th century, Greece
*****

This portion of the Hippocratic Oath can be summarized in two words and also in two phrases: Benevolence—Do good and Nonmaleficence—Do no harm. So much of helpful and ethical health care practice is founded upon these timeless principles.
*
Applications for the "Hippocratic Heart"
1. Memorize. A suggestion: Do you know other languages besides English? If so, get an accurate translation of these two words and two phrases, especially in your heart language. Memorize them.
*
2. Competency. We practice within our level of competency (“ability and judgement”). We also acknowledge that we will be “stretched” at times in our practice, and may be called upon to help in ways that are not fully within our experiential, training, and certainly comfort zones. Is this OK? Consult with colleagues as much as possible in such situations. In addition and in general, get supervision as needed. Participate in peer supervision and group case consultations. These all help us in doing good (good practice) and avoiding ham (poor practice).
*
3. Love. The foundational principles of benevolence and nonmaleficence are clearly reflected throughout the New Testament. They can be seen as core principles founded upon the bedrock of “love”. Here are some quotes.
*
**Let love be without hypocrisy. Abhor what is evil; cling to what is good.
Romans 12:9
*
*Love works no evil to a neighbour. Love therefore is the fulfillment of the law.
Romans 13:10
*
**Let us not lose heart in doing good…let us do good to all people, especially those who are of the household of the faith.
Galatians 6:9,10
*
Reflection and Discussion
1. Primum non nocere--first, do no harm. Sometimes this principle is used without the accompanying principle of “doing good” What are your thoughts about the possible sufficiency of nonmaleficence?
*
2. Sometimes we are in situations when we are not sure of the best course of action or the best intervention/treatment. Nor are we able to foresee the consequences of our work. A classic example is if we help one person in a dysfunctional system, will that lead to positive change in the overall system as hoped or will it lead to greater problems for the healthier person and the system—e.g., the person may have to still reamain part of the dysfunctional system and may be dependent on the system as he/she tries to effect healthy change. Comment on such situations and give any examples in your life, practice, current international events, history.
*
3. It is helpful to make organizational applications of the principles of Benevolence—Do good and Nonmaleficence—Do no harm. For example, what practices can organizations put into place to make sure that leaders, staff, the ethos, policies etc. do in fact reflect these core Hippocratic principles?

Member Care and the Hippocratic Oath, Part 3

Some Ideas for Responsible Practice:

Respect, Relate, Reproduce

*****

Diego Reivera, The Flower Carrier, 1935

*****

Non hay tan dulce cosa

como la fidelidad

nin miel tan sabrosa

como la buena amistad.

Tem Tob, 14th century, Spain

*

Translation:

Good, faithful friends are sweeter than anything.

*

“To consider dear to me, as my parents,

him who taught me this art;

To live in common with him and, if necessary,

to share my goods with him;

To look upon his children as my own brothers,

to teach them this art.”
*

This second section of the Oath, quoted above, might not seem too applicable for us in the member care field. The type of close teacher-student relationship described here is not exactly the same today as it was 2400 years ago in Greece. But let’s look into it more closely. I would like to suggest that we extract three broad principles from this section that are relevant for member care practitioners.
*

Applications
1. Respecting Senior Colleagues.
We show respect to (and “consider dear”) the senior practitioners in our field. For me, this applies to people whose proven character and proven contributions are sustained over time. It especially applies to those aged 70+ who were working in the pre-member care field in the 1970s and even 1960s. We show respect by listening carefully to their input and honouring them in our gatherings.
*
Personally I so enjoy learning more about our roots as a field and the efforts of those who trail blazed so long ago. Often these folks were not even aware that they were blazing anything but rather thought that they were just doing their job. These folks in their steadfastness and depth inspire me: Stringham, Lindquist, Foyle, Narramore the Grossmans and surely many more! As Tolkien says of Aragorn, a “senior (Ranger) practitioner” in the Lord of the Rings, “the old that is strong does not wither, deep roots are not reached by the frost.”
*
The Oath indicates that the teachers and the students have a close personal and working relationship. They may even “live in common”. I likewise want to encourage member care workers and senior practitioners to connect closely together for personal and professional learning. Would it ever be possible for practitioners and senior practitioners to “live in common” in some sense? Now that is quite an idea! Perhaps the closest thing that I am aware of is sharing a room together at a conference for a week, or working on a field-based project for a few weeks, or working on staff together as part of a course or school for a few months. And maybe there are additional types of relationships that we can creatively consider. Why not?
*
The Oath also mentions providing practical support for teachers/senior practitioners as needed. The labourer is worthy of her/his wages. Note that there is no clear requirement for remuneration in the Oath, and perhaps this is not mentioned so that senior practitioners would not be tempted to exploit underlings for money. Perhaps the default arrangement as much as possible was pro bono instruction. Paul the Apostle gets into this point in 2 Corinthians 11 regarding his status as a senior (apostolic) practitioner. He reminds the Corinthians (as he did the Thessalonians and other churches, e.g., I Thes. 2:9) that he served them freely and was not a financial burden to them even though he could have honourably and ethically asked them to help meet his needs. Bottom line: keep our financial relationships clear, and don’t exploit anyone who needs our services or whose services (such as training) that we ourselves need.
*
2. Relating Closely with Colleagues.
Our relationships with the family members of teachers/senior practitioners is the next broad principle. Apparently priority was to be given to children (sons) of the medical teachers. There seems to be a sense of duty to look after the teacher’s children as well as a strategic sense that the children will be in a good place to continue the medical profession, having watched and learned from their parent who is a physician.
*
How to apply this? Well, I like the idea of getting to know the families of senior colleagues and also the families of a few close colleagues. Many family members and others can benefit beyond the dyadic teacher-student relationship. And maybe we will be seeing second or even third biological generations of member care practitioners. Again I say, why not? But consider these caveats: let’s avoid any type of nepotism or favouritism in the member care community. And let’s not confuse professional roles and responsibilities with personal preferences and gain that produce conflicts of interest, not to mention envy and resentment.
*
3. Reproducing Knowledge/Skills.
We provide services but we also try to multiply our services reesponsibly. In fact, as member care practitioners we try to multiply ourselves—our competencies as well as our character. Training in many contexts can thus also involve "imparting our own lives" (I Thes. 2: 8). This is a special privlege and responsibility to be taken very seriously. It also requires accountability. “Let not many of you become teachers knowing that as such you shall receive a stricter judgement” (James 3:1).

*
One additional application is to mention that it is especially challenging to offer instruction well in light of the diversity of the member care world and mission/aid settings. One example among many: how to intervene in a “troubled” family/team setting in which the parent/team leader is seen as being rigid and authoritarian by some members and as exercising firm, caring authority by others? These types of sitautions certainly "stretch" our own experiential and practice boundaries. Good member care practice often requires going beyond the familiar (or with reference to the Oath, we go beyond the family of our senior teachers) in order to embrace the diverse. We have to cross sectors and disciplines, genders and generations, in addition to crossing cultures. Have a look at the material from the World Federation of Mental Health, prepared for World Mental Health Day 2007: Mental Health in a Changing World: The Impact of Culture and Diversity

http://wfmh.org/COVERS/2007WMHDAY.jpg
*
Final Thought
An important part of our member care practice involves responsibly: a) respecting other practitioners, b) relating to other practitioners, and c) reproducing other practitioners. Can we really read all of these responsibilities into the second section of the Hippocratic Oath? Well, yes, in a general way. Without overstepping our interpretive bounds, we can build upon our Greek predecessors. We can use this part of the Oath as a further springboard to help us consider how we want to practice responsibly.
*
Reflection and Discussion
1. Is there a senior colleague with whom you regularly relate? Do you have any special type of agreed-upon relationship?
*
2. Are there member care workers who look to you as being something like a senior colleague, and consult with you for help?
*
3. Who are your closest colleagues? How close are you to their family members?
*
4. What are the pros and cons of member care workers who link personal and professional relationships together?
*
5. In what ways are you reproducing your knowledge and skills within your sphere of influence? What thoughts do you have about training (i.e. responsible multiplication) in light of the diversity of caregivers/settings?

Member Care and the Hippocratic Oath, Part 2

Should Member Care Practitioners Take an Oath Too?

*****

*****

Face rico los hombres

con su prometimiento;

después fállanse pobres

odres llenos de viento.

Sem Tob, 14th century, Spain

Translation:

You might get rich by false promises tried

But you'll end up poor and empty inside.

*****

Many medical practitioners, health care professionals, politicians, and others have historically taken “oaths”. These oaths have been solemn commitments by people with important responsibilities, who are recognized for having mastered a certain body of knowledge and skill sets, and thus able to competently and ethically practice a profession. How might taking such an oath be relevant for the very diverse and largely unregulated member care field?

*

Commitments and Agapeoath

The Hippocratic Oath begins with: “I swear…to keep according to my ability and my judgment, the following Oath and agreement.” See the previous entry to view the full Hippocratic Oath. I personally can imagine member care practitioners taking some type of an oath as part of their commitment to practice member care competently and ethically. Such an oath would lbe volunatary, likely brief, and include wording that would give it universal appeal and relevance for faith-based pratitioners from a variety of backgrounds.

*

I would like to propose something called an agapeoath (agapeo + oath = agapeoath; pronounced uh-gah-PAY-oath). This term embodies the essence of sacrificial love (agapeo) and a serious promise (oath). It would be a solemn commitment to practice true love in a member care context as we endeavor to do good/do no harm to those who receive our services and as we pursue ongoing healthy relationships (aka "relational resiliency") with fellow workers.

*

This commitment is sustained in spite of work/life's difficulties "come hell or high water." It is tough love that perseveres and does not "sell" one's integrity, principles, or colleagues for thirty pieces of anything when the going gets tough. It is practical and observable not simply idealistic or ethereal. It is love which "swears to one's own hurt"-- that is, keeping your word even when it may cost you things like your reputation and finances (Psalm 15: 4).
*

Commitments and Trans-Practitioners

What also makes much sense to me is embracing a series of commitments to practice member care responsibly. These commitments would be founded upon agapeo per the previously mentioned foundational oath of agapeo--agapeoath. Is this moving in a direction that the diversity of member care practitioners could embrace? I think so, but it is something to be discussed broadly.
*

I would like to introduce another term: trans-practitioner. This term refers to member care workers who intentionally cross cultures, disciplines, sectors, organizations, genders, generations, and other "borders" for the sake of mutual learning and good practice. Trans-pracitioners seek and use core concepts which are relevant in many settings. One example is the set of “15 Commitments for Member Care Workers” that promotes high standards for character and competency and that aim to be applicable to the diversity of member care workers. These commitments are discussed earlier on this blog (see April 29, 2007) and in the article Ethics and Human Rights in Member Care (2009): http://www.fuller.edu/academics/school-of-psychology/integration-symposium-2009.aspx
*

Taking the High RoadThe member care field is fairly loose. Not surprisingly, some unfortunate and clearly erroneous practices have occurred. We probably all know of cases where people receiving services have been negatively impacted; where there have been unresolved relationship struggles that have not been dealt with adequately and which have seriously injured people and disrupted mission/aid work; and where unchecked personal/systemic dysfunction have put wedges within different commiunities including the practitioner community.

*

We can change these problem areas. But to do so we must not be afraid to admit them, discuss them, work through them, learn from them, and put appropriate safeguards in place. Such actions will require courage--a courage that seeks mutual transparency, accountability and the welfare of all. It will require integrity: an integrity which is not just based on living harmoniously with one’s own internal norms but based on the fuller integrity which arises from living congruently with externally-referenced norms/high standards such as the 15 commitments mentioned above.

*

Maybe it is time to adjust our course as a field in a way that will help sustain us through the dark days and intense challenges in this world. Maybe it is time to take the higher road, a road demarcated by trans-practitioner commitments founded upon a solemn oath of agapeo.
*
Final Thoughts

Hippocrates was not just on the right road. He helped forge the right road. He took his professional responsibility seriously as well as that of his colleagues and his students. He made a serious, public commitment to practice competently and ethically. Member care workers would do well to do the same.
*

Reflection and Discussion
1. Should every member care practitioner have a clear set of commitments to which she/he is accountable? Consider this question in light of the above comments and in light of this quote: (context is exploring the relevance and lack of relevance of ethical codes for member care workers)

*
“Many types of professional ethical codes exist that can relate to the practice of member care. For some practitioners, these codes are essential and are a good “fit.” But one size does not fit all! For example, as a psychologist and as an international affiliate of the American Psychological Association (APA), I abide by the APA’s Ethical Principles of Psychologists and Code of Conduct (2002). But a skilled Nigerian pastor providing trauma training/care in Sudan may not find this code so helpful. Such ethical codes are primarily relevant for the disciplines and countries for which they were intended. Yet many MCWs enter the member care field via a combination of their life experiences and informal training, and are not part of a professional association with a written ethics code. Common sense and one’s moral convictions only go so far. Further, appealing to another country or discipline’s ethical code can result in a rather cumbersome mismatch between the person and the code.” Ethics and Human Rights in Member Care (2009), Kelly O’Donnell
*

2. How could a set of commitments help keep member care practitioners working together competently and with good relationships? Consider this question in light of the above comments and in light of this quote:

(context is a description of how the growing "darkness" has surrounded the woodland kingdom of the elves , and the consequences to relationships to peoples of good will in Middle Earth)
*

"Indeed in nothing is the power of the Dark Lord more clearly shown than in the estrangement that divides all those who still oppose him...We live now upon an island amid many perils, and our hands are more often upon on the bowstring than the harp." The Fellowship of the Ring (1954), J.R.R. Tolkien
*

3. Love is all you need, right? Consider this question in light of the above comments and in light of this quote:

(context is identifying some of the essential future directions for the member care field)
*

"Above all, the core of E2MC [that is, Ethne to Ethne Member Care—providing/developing member care for/from all people groups] involves the trans-ethnê, New Testament practice of fervently loving one another—like encouraging one another each day; bearing one another’s burdens; and forgiving one another from the heart. By this all people will know that we are His disciples (John 13:35). The Great Commission and the Great Commandment are inseparable. Our love is the final apologetic. It is the ultimate measure of the effectiveness of our member care.” God in the Global Office, 2009, Kelly O’Donnell

Member Care and the Hippocratic Oath, Part 1

Hippocrates and Higher Powers

Non hay lanza que pase 
todas las armaduras,

nin que tanto traspase

como las escrituras.
Sem Tob, 14th century, Spain

***
Translation:

No spear can pierce all armour in a fight

Nothing penetrates like words that we write.

***

This is the first of 10 brief discussions about the Hippocratic Oath and its relevance for member care. As the above 14th century proverb suggests, the written word--in this case the Hippocratic Oath--has adeptly penetrated practitioner hearts, human history, and the health sciences themselves.
*

I really enjoyed studying Greek mythology and life in ancient Greece as a boy. It was thrilling to read over and over again about the heroic feats of Achilles at Troy; the decade-long wanderings of courageous Odysseus; the harrowing foot race along the sea between peerless Atlanta and love-struck Hippomenes; the atoning descent into treacherous Hades by Heracles; satyrs, naiads, centaurs, tritons, and many other mostly delightful mythical creatures. So intentionally meandering now into the ancient Greek world has both a familiar and fascinating feel to it!

*

Hippocrates lived in the fourth century BC (circa 460-370 BC). He is considered to be the "father" of western medicine and is credited with helping to further develop and establish the practice of medicine in Greece at a time when Greek civilization was flourishing under Pericles.
*

The Hippocratic Oath (reproduced below, translation by the National Institute of Health in the USA) is attributed to Hippocrates and pertains to the ethical practice of medicine. What were the core principles to embrace which would guide specific medical interventions? The Oath summarizes these key principles. Physicians in his day and beyond swore this oath or some variation of it. The principles of "doing good and doing no harm" for example, are still widely accepted and a usefulwayto summarize the Oath itself.

*

The Oath is relevant in so many ways for member care practitioners and the member care field. The first application we propose is to look at the opening salvo and consider our work, as Hippocrates et al did, in light of Higher Powers and accountabilty.

*

A Foundational Application

By Jove, by the gods above, by Apollo, or by Whoever or Whatever, we humans are not alone in our health care activities. Hippocrates appealed to a Higher Power (gods) to whom all humans and physicians were ultimately accountable and in some sense dependent upon. The specific gods listed by Hippocrates were apparently linked to healing in Greek religion/mythology (Apollo, Asclepius, Hygieia, and Panacea).

*

Member care practice likewise starts with a Higher Power--God--who sees all, knows all, is the source of healing, and who holds us accountable for our personal and professsional actions. It is not ultimately good practice codes or professional standards to which we are accountable, but a Creator. We also note for reference that "Master Care"--care for and care by God the Master--is placed at the center (beginning) of the international/macro member care model (Doing Member Care Well, 2002, chapter one).

*

Further, we as member care practitioners facilitate healing because being made in the image of God, we emulate the Creator who heals. In the Judeo-Christian tradition, this is YHWH-Rapha, a special name for God which means the Lord that Heals. So perhaps we might see Hippocrates et al as getting their theology wrong, but they were certainly on the right track as they began with and appealed to Higher Powers as being the "first principle" to consider for their healing arts.

*

In short: Member care starts with God. Member caregivers are accountable to God. Simple.

*

Hippocratic Oath (other translations/versions are slightly longer but essentially the same)

I swear by Apollo, the healer, Asclepius, Hygieia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath and agreement:

*

To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art.
*

I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.
*

I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.

*

But I will preserve the purity of my life and my arts.
*

I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.
*

In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.

*

All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.
*

If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot.

*

Reflection and Discussion

Member care should not be ahistorical.

Comment on this assertion

*

Member care also has some roots outside of the Judeo-Christian tradition and which pre-date the New Testament.

Comment on this assertion.

*

Member care, like any of the helping professions/healing arts, must philosophically and ethically start with a First Principle, a Higher Power.

Comment on this assertion.

Note: During these 10 discussions of the Hippocratic Oath we will introduce two additional items into the integrative mix: a special proverb and a special work of art. Our goal is to broaden our understanding of member care in some new and creative ways.These two items are:
a. a related proverb in Spanish from Sem Tob, a relatively unknown 12th century Rabbi in the court of Peter I in Castilla, Spain. The English translations are courtesy Kelly O'Donnell.
b. a related piece of art from Diego Rivera, the widely-known 20th century Mexican artist who created large murals depicting various social themes as well as paintings depicting indigenous life in Mexico.