Explained: Will 'Charak Shapath' Replace Hippocratic Oath for MBBS Students?

Newly inducted MBBS students should take the Maharashi Charak Shapath, India’s medical education regulator has said.

Students who have taken admission into India's MBBS courses this year should take the Maharashi Charak Shapath, India’s apex medical education regulator National Medical Commission (NMC) said on Thursday, 31 January.

(Photo: iStock)

(This story was first published on 2 April 2022 and has been republished with minor updates.)

The Tamil Nadu government has removed the Dean of the Madurai Medical College Dr A Rathinavel from his post after first-year students on Saturday, 30 April, were made to take the ‘Maharshi Charak Shapath (oath)’ instead of the Hippocratic oath that is conventionally administered at the induction ceremony.

Earlier, in March, India’s apex medical education regulator National Medical Commission (NMC) said students who have taken admission into India's MBBS courses this year should take the Maharshi Charak Shapath.

The new oath, seated in the ancient practice of Ayurveda, will possibly replace the long-standing tradition of the Hippocratic Oath – a ceremonial vow undertaken by medical students worldwide, as they are ushered into the momentous responsibilities that come with their field of study.

The decision was announced merely a few days after the government denied any change towards replacing the Hippocratic Oath with the Charak Shapath.

So, what's the difference between the Hippocratic Oath and the Charak Shapath? What do the NMC's new guidelines say? And what do doctors and the government have to say about this? Here's what we know.

What Is the Hippocratic Oath?

The Hippocratic Oath is an oath of ethics traditionally taken by medical graduates around the world. The oath, which is held sacred by doctors, is named after its writer and Greek philosopher Hippocrates (circa 400 BC), who is also given the sobriquet of the 'Father of Medicine.'

The ‘original’ Hippocratic oath is from a 2,500-year-old text called the Corpus of Hippocrates. The pledges taken now are mostly versions of the physicians’ pledge of the World Medical Association (WMA), of which the Indian Medical Association (IMA) is a part.

The pledge was published in 1948 at the Declaration of Geneva post the atrocities of the second world war. It has been amended five times over the last seven decades, (last in 2017) to keep it relevant to the present context of healthcare and society.

The taker of the ceremonial vow, generally a new physician, swears by a number of healing gods to uphold specific ethical standards. The oath contains two primary tenets: Duty to the ill, and protecting patients against personal and social injustice.

One who takes the pledge affirms that they will "benefit (their) patients according to (their) greatest ability and judgement," and will not cause any form of harm to those under their care.

Here's the full text of the oath:

"I swear by Apollo the physician, and Asclepius, and Hygieia and Panacea and all the gods and goddesses as my witnesses, that, according to my ability and judgement, I will keep this Oath and this contract:

To hold him who taught me this art equally dear to me as my parents, to be a partner in life with him, and to fulfill his needs when required; to look upon his offspring as equals to my own siblings, and to teach them this art, if they shall wish to learn it, without fee or contract; and that by the set rules, lectures, and every other mode of instruction, I will impart a knowledge of the art to my own sons, and those of my teachers, and to students bound by this contract and having sworn this Oath to the law of medicine, but to no others.

I will use those dietary regimens which will benefit my patients according to my greatest ability and judgement, and I will do no harm or injustice to them.

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.

In purity and according to divine law will I carry out my life and my art.

I will not use the knife, even upon those suffering from stones, but I will leave this to those who are trained in this craft.

Into whatever homes I go, I will enter them for the benefit of the sick, avoiding any voluntary act of impropriety or corruption, including the seduction of women or men, whether they are free men or slaves.

Whatever I see or hear in the lives of my patients, whether in connection with my professional practice or not, which ought not to be spoken of outside, I will keep secret, as considering all such things to be private.

So long as I maintain this Oath faithfully and without corruption, may it be granted to me to partake of life fully and the practice of my art, gaining the respect of all men for all time. However, should I transgress this Oath and violate it, may the opposite be my fate."

(Source: National Institutes of Health (NIH), the United States)

What Is the Charak Shapath?

The Charak Shapath is a passage of text in the Charaka Samhita, a Sanskrit text on Ayurveda (Indian traditional medicine) believed to have been composed between 100 BCE and 200 CE.

The Shapath is written in the form of instructions delineated by a teacher to prospective students of medicine. According to the Charaka Samhita, the unconditional agreement to abide by these instructions is a necessary precondition to be eligible to study medicine.

The passage prescribes the ideal conduct to be practised by a doctor with their patient and their teacher, and forbids the swearer from entertaining thoughts of "lust, greed, or wealth."

A translation of the ancient Indian vow, as provided within the new guidelines of the National Medical Commission, also carries a statement that prescribes a gendered treatment of patients:

"I shall threat patient of gender other than mine in presence of relatives or attendants."

The Shapath further preaches that a doctor should always be ready to serve their patients, even when "extremely busy and tired."

(Source: National Medical Commission)

Has the Hippocratic Oath Been Replaced by the Charak Shapath for MBBS Students?

The National Medical Commission's new guidelines for the Undergraduate Medical Education Board introduce a "Competency Based Medical Education for Undergraduate Course Curriculum" for the current batch of MBBS students, admitted in the months of February-March 2022.

The revised guidelines state:

"Modified 'Maharshi Charak Shapath' is recommended when a candidate is introduced to medical education."

The circular does not clarify whether the Hippocratic Oath will be scrapped in order for the Shapath to take its place for Indian MBBS students. However, notably, the guidelines make no mention of the Hippocratic Oath.

The previous curriculum guidelines, which had been release in August 2019, did make a note of the importance of the Hippocratic Oath.

"The White Coat Ceremony is a rite of passage, welcoming the new medical students into the medical profession... The white coat reminds physicians of their professional duties, as prescribed by Hippocrates, to lead their lives and practice their art in uprightness and honour," a detailed circular on the older guidelines states.

The new guidelines also recommend a ten-day yoga “foundation course," beginning on 12 June and culminating on the International Yoga Day June 21. “Yoga module will be made available to all colleges… however colleges may adopt their own modules. Yoga unit may be inducted under PMR department or any other department of all colleges at their discretion,” as per the circular.

What Has the Government Said About This?

Merely a few days before the publication of the NMC's revised guidelines on 31 March, the central government had informed the Parliament that no plans were underway to implement the Charak Shapath instead of the Hippocratic Oath.

"As informed by the National Medical Commission (NMC), there is no proposal of replacement of Hippocratic Oath with Charak Shapath," Minister of State for Health and Family Welfare Bharati Pravin Pawar had stated in a written reply in the Lok Sabha on 25 March.

(Source: Lok Sabha website)

The government's statement had come after a proposal to replace the Hippocratic Oath with the Charak Shapath was reportedly discussed at a the NMC’s Undergraduate Board meeting on 7 February.

What Do Doctors Say About This?

A number of doctors have raised concerns about the introduction of the Charak Shapath as a possible replacement for the Hippocratic Oath.

Writing for The Quint, Dr Sumit Ray, a senior consultant in critical care medicine, explains why the Charak Shapath is an unnecessary and an unwelcome change to the medical curriculum.

Read Dr Ray's piece here.