Whatever houses I may visit, I will come for the benefit of the sick.
— The Hippocratic Oath, translation from the original Greek by Ludwig Edelstein (1943).
I will apply, for the benefit of the sick, all measures which are required.
— Modern adaption of the Hippocratic Oath, by Louis Lasagna, former Academic Dean of the School of Medicine, Tufts University (Tyson, 2001)
The Oath of Hippocrates, estimated to be written in 400 BCE, is one of the earliest known declarations of medical ethics. Historical scholars believe that it was originally used as part of an initiation ceremony into a medical apprenticeship (Miles, 2005). Much of the historical oath is now anachronistic, and modern versions of the oath or other statements of medical ethics substantially depart from it. Nevertheless, a central tenet that has been preserved from the original oath through the ages, as exemplified in the two quotes above, is a concept that one might refer to as beneficience, which, plainly stated, means that a physician should act with the primary objective of delivering care that benefits the patient.
The purpose of this chapter is to introduce and discuss an important issue that can impede both physicians and healthcare delivery organizations in their efforts to fulfill this primary objective. Specifically, this chapter focuses on competing interests in healthcare, which we will define ...