An oath at Columbia University’s “white coat” ceremony for medical students. Is it compelled speech?

February 16, 2023 • 9:15 am

If you think wokeism (or whatever you want to call it) is abating, realize that this kind of add-on to the traditional Hippocratic Oath is proliferating, and these oaths are written by the med students themselves—sometimes with the help of the faculty.  The pledges are recited during the “White Coat Ceremony”—the occasion during which new medical students get their white doctor coats. The ceremony actually has existed only since 1993, and we’ve already seen several that include a student-written oath. (Remember, this is a student-inspired add-on to the traditional Hippocratic Oath (see Greek original and translation here). These days, if students produce add-ons, you know what they’re going to be.

The two I’ve posted about include one at the University of Pittsburgh and the other at the University of Minnesota, with the latter including a land acknowledgment and pledging to honor “all Indigenous ways of healing that have been historically marginalized by Western medicine.” (Some of those ways of healing, of course, are useless and shouldn’t be “honored” in any sense.) FIRE has a list five such med-school ceremonies (see below).

Well, this is a ceremony that cannot help but spread, for students can’t help but inject their ideology (debatable ideologies, as you can see below) into nearly everything. This one took place at Columbia University’s  Irving Medical Center in August of 2021 for students of the class of 2025, and was shown and reported on by the Medical Center itself:

For the first time in the medical school’s 254-year history, the incoming MD students recited their own Class Oath, updating the Hippocratic Oath to better reflect the values they wish to uphold as they enter their medical training. The Class Oath includes a commitment to “acknowledge and embrace the diversity that exists within all communities, and the formative influence that the Washington Heights community will have on my future as a physician.” This year’s ceremony at the Armory was convened in person with limited faculty and guests and was also watched virtually via Zoom.

The idea for a new Oath came up a year ago, shortly before the White Coat Ceremony for the VP&S Class of 2024 but with little time for students to write the content. With this in mind, the rising second-year medical students asked to help members of the VP&S Class of 2025 write their own Class Oath. The writing took place over many weeks this summer. Current MD students were trained by the VP&S Office of Medical Education as writing facilitators to work with the incoming students and collaborating faculty members. Going forward, each incoming MD class will have the opportunity to create its own Oath.

As you see, this ideological oath will continue in perpetuity. Not at all ideological, you say? Well, not entirely, but surely in part. Listen to the recitation and then read the text below.


Here’s the text from another Columbia Medicine website (bolding is not mine, but from the original)

Class of 2025 Oath

“We enter the profession of medicine with appreciation for the opportunity to build on the scientific and humanistic achievements of the past. We also recognize the acts and systems of oppression effected in the name of medicine. We take this oath of service to begin building a future grounded in truth, restoration, and equity to fulfill medicine’s capacity to liberate.

I make this pledge to myself, my classmates and future colleagues, and the individuals and communities I will serve.

I acknowledge that my role is to inform my patients, accompany them in moments of wellness and vulnerability, and respect their privacy and autonomy while empowering them to flourish.

I promise to take care of my future patients by engaging in dialogue, listening to their lived experience, and tailoring my recommendations to their unique circumstances.

I commit to honor the relationship formed between patient and physician by maintaining confidentiality at all times.

I vow to contribute to the field of medicine through ethical study and equitable evidence-based care, and to treat my patients and represent my profession with compassion, humility, and equanimity.

I acknowledge the past and present failures of medicine to abide by its obligation to do no harm and affirm the need to address systemic issues in the institutions I uphold. 

I promise to critically examine the systems and experiences that impact every person’s health and ability to receive care.

I vow to use this knowledge to uplift my patients and disrupt the injustices that harm them as I forge the future of medicine.

I acknowledge the background and experiences that enrich my perspectives while recognizing the limitations, shortcomings, and biases that I bring to each encounter with patients and colleagues. 

I promise to self-reflect diligently, to confront unconscious prejudices, and to develop the skills, knowledge, and character necessary to engender an inclusive, equitable field of medicine.

I commit to fostering empathy and a culture of care, not just for our patients but for ourselves and our colleagues in healthcare.

I vow to remember the humanity and fallibility of myself and every member of the care team, and to call upon my colleagues for assistance in recognition of the limits of my knowledge and skills.

I acknowledge and embrace the diversity that exists within all communities, and the formative influence that the Washington Heights community will have on my future as a physician. 

I promise to respect, regardless of identity or socioeconomic status, the fundamental dignity of all patients, colleagues, and community members, and their right to quality care.

I vow to restore trust where it has been broken and to inspire and nurture trust in the relationships I build with patients, through collaborative effort with my classmates, colleagues, and communities.

Let us bow our heads in recognition of the gravity of this oath; we swear to faithfully engage with these ideals and obligations for the ongoing betterment of medicine and humanity.”

Note that while a lot of it is traditional and appropriate, there are also tropes about confronting unconscious bias (a contentious claim) and pledges to confront “systemic issues,” and to “disrupt injustices”. It’s as much aboout self-flagellation of the students as it is about their promises for the future.  Note as well that the pledge to abide by “evidence-based care” conflicts with Minnesota’s pledge to to honor “all Indigenous ways of healing that have been historically marginalized by Western medicine.” I guess “honoring” is different from “employing”.

I will leave you to comment on this or the issues it raises, but I’ll just add that FIRE (the Foundation for Individual Rights and Expression) has written about its concern with these ceremonies, noting this about the Minnesota oath in particular and these oaths in general:

Similar student-authored oaths were adopted in recent years at medical schools like HarvardColumbiaWashUPitt Med, and the Icahn School of Medicine.

. . .Again, while universities, students, and faculty are free to encourage or promote DEI-type values, forcing others to say they believe in these concepts is not only contrary to many universities’ legal obligations — but violates their moral obligations, too.

Consider: Even students or faculty who broadly agree with a university’s stance on DEI may believe, for example, that land acknowledgements are merely performative. Or a faculty member who studies race and gender may have highly nuanced views on DEI not reflected by the university’s stance. Students, likewise, may disagree with other aspects of a given DEI pledge.

Medical students possibly being made to read verbatim from ideological pledges if they wish to become physicians would be a new low.

Why not law students, engineers, and business-school students, too?

I’m not sure that a lawsuit is in the offing (though FIRE’s article notes it’s looking for students forced to recite one of these oaths, ergo someone with standing to sue), but even so this comes pretty close to compelled speech. So far nobody’s been punished for not mouthing the words (though they may all have to stand up), but surely a substantial proportion of students don’t agree with the pledges they’re forced to recite, and would probably prefer to refrain from doing so. They’re in med school to become doctors, not social engineers.

h/t: Wayne

16 thoughts on “An oath at Columbia University’s “white coat” ceremony for medical students. Is it compelled speech?

  1. ” “all Indigenous ways of healing that have been historically marginalized by Western medicine.” ”

    Oh, so they arrive at the podium to take the medical degree but then refuse the medical degree! That’s awesome! Wow! Now _that_ really says something, they’d earn the degree, but then give the finger to “Western medicine.”

    Bravo, I say – BRAVO!!!

  2. Reciting a pledge is a long-standing tradition. My class of 1984 recited a WHO pledge in place of the traditional Hippocratic Oath.

  3. Well, if it’s a requirement to graduate or if non-participation results in disciplinary measures, then it’s compelled speech.

  4. The 2025 Columbia oath is nowhere near as bad as I was expecting. Much of it is good. The “lived experience” phrase is something I noticed immediately. I generally regard that phrase as a license to ignore actual knowledge and reason, but here it’s just thrown out there but not elaborated upon. It’s noteworthy that in this case the phrase carries no implication that lived experience trumps the Enlightenment. That’s a good sign that, for these students, reason still prevails.

    One good thing is that none of what I read in the Columbia oath will do any actual harm to evidence-based scientific medicine. Much will be helpful.

    I’m not so sure about the Minnesota and Pittsburgh oaths that honor Indigenous ways of healing, but I too immediately noticed that “honoring” does not mean “implementing.” Even here it seems that the students are giving themselves wiggle room to actually practice real medicine.

    It remains to be seen if the land acknowledgements and other nods to social justice really have any substantive impact on the practice of medicine. The nods that emphasize compassion and understanding might have a positive impact, but the ones that I’d be most concerned about seem mostly to be pro forma lip-service and not serious.

    Hope springs eternal that this stuff will eventually go away.

    1. Or, if they don’t go away, that they will remain vague enough that even conservatives and classic liberals can interpret them in a way they find positive and inspirational.

  5. Why on earth are they all wearing masks?? Who do they think they are? Surgeons? Is it so the ones who don’t want to swear to this guff can’t be outed by video analysis of lip non-movements?

    Hippocratic Oath recitations go back a long way (obviously) and were being criticized at least as long ago as the 1970s. I think they make most sense for graduating medical students (as we did), not for incoming students who really know nothing at all about medicine yet.

    The original Hippocratic Oath has as its core the precept that a doctor must see the patient as all times as an individual and strive always to do what’s good for the patient, no matter the pressure that might be put on him to treat him as a means to some other end. This applies no matter what group he can be characterized as belonging to, even the wounded soldier of an army that is invading one’s country and carrying out unspeakable atrocities (as Dr. Norman Bethune wrote about eloquently in his war diaries as a surgeon for Mao’s army fighting the Japanese in Manchuria.: “In this community of pain there are only brothers.”) It is an explicitly non-ideological commitment. Even Bethune’s Chinese colleagues “got” this.

    The obligation to keep secrets that patients tell us originates with Hippocrates.

    Parts of the original oath seem antiquated and at odds with modern views. We stopped swearing to Apollo, and then not to God. Giving poison is now OK as long as the request is coming from the patient and not the family for foul motives. Not giving a pessary to procure abortion is an ambiguous reference that seems to mean not doing things that are likely to kill the mother, and not a prohibition of abortion as a moral issue per se.. (This is my own view, fwiw.) But we dropped that just to be on the safe side because medical abortion is not dangerous anymore. Not cutting for stone seems to mean, “Leave surgery to surgeons”, always good advice or, more broadly, know what you don’t know.

    Teaching the art only to the sons of those who taught us and keeping the skills a secret seems unthinkable today and so we of course don’t. One corollary of this section, though, is that we can’t accept payment for teaching medical students. Administrators are only too happy to hold us to this, no matter what they don’t like about the original Oath. (Nonetheless it is an honour to be asked to teach med students no matter whose kids they are.)

    So yes, things have been dropped from the Oath (and its various non-Hippocratic formulations adopted in the name of “relevance”.) You don’t want doctors swearing to violate modern public policy. Someone who couldn’t swear to what remains of the core Hippocratic tradition probably can’t be trusted to be self-governing. The oath is to reassure the public that graduating doctors understand their obligations, no to make leftists in medical schools feel good about their own virtue (and power.)

    All these ideological add-ons are unwise. They are compelled speech in support of specific political positions that have nothing to do with the fundamental mission of medicine, which is to do always and only what is in the best interests of the patient.

    The subservience of the individual to the group as the mission of medicine has been noticed in Canada, too. The rot has infiltrated not just into performative oaths but into certifying and regulatory bodies as well, much more dangerous. An anonymous Canadian physician writes here:

    1. I was always told the ‘shall not give a pessary to woman’ was certainly a reference to the ancient Arab practice of inserting pebbles in camel’s vaginas (sorry, Jerry!) to discourage pregnancy. When I qualified in 1981, no medical school in the UK used the Hippocratic Oath as far as I know. It was a historical thing, and a bit of a joke. I believe it has come back in some places (sans pessary) as a bit of theatre, but still not considered a binding oath in any way. The rules of the General Medical Council or whatever it calls itself these days are far more strict and frightening.

      1. Were the pebbles to deter pregnancy or just to deter male camels?
        We didn’t do the H.O. either. The Declaration of Geneva, I think, where we pledged not to commit war crimes was about it. Yes, it’s a bit of theatre that goes nicely with graduation ceremony. A separate white-coat ceremony for people who were liberal arts or chemistry students last week seems pretentious to me, too much like being inducted into a priesthood or a cult.

    1. Thanks for the link, Jon.

      A fourth-year Yale medical student describes how the specter of Step One affected his priorities. In his first two years of medical school, the student had “immersed” himself, as he describes it, in a student-led committee focused on diversity, inclusion, and social justice. The student ran a podcast about health disparities. All that political work was made possible by Yale’s pass-fail grading system, which meant that he didn’t feel compelled to put studying ahead of diversity concerns. Then, as he tells it, Step One “reared its ugly head.” Getting an actual grade on an exam might prove to “whoever might have thought it before that I didn’t deserve a seat at Yale as a Black medical student,” the student worried.

      The solution to such academic pressure was obvious: abolish Step One grades. Since January 2022, Step One has been graded on a pass-fail basis. The fourth-year Yale student can now go back to his diversity activism, without worrying about what a graded exam might reveal. Whether his future patients will appreciate his chosen focus is unclear.

      That final sentence highlights the important thing that is being overlooked with all this nonsense.

  6. First do no harm – unless the patient has gender dysphoria, in which case “gender-affirming” rules apply so feel free to hack off perfectly healthy body parts unquestioningly…

  7. Strikes me as the woke equivalent of “ceremonial deism,” the bs legal doctrine that allows the US congress to hire chaplains and to open its sessions with prayer and that permits the US Treasury to plaster “In God We Trust” on our legal tender.

  8. I remember taking the Oath 30 years ago to treat all humans as equals
    Do we need this woke verbiage to explain EQUAL

  9. “I acknowledge that my role is to inform my patients, accompany them in moments of wellness and vulnerability, and respect their privacy and autonomy while empowering them to flourish.”

    I trust that that includes residents showing up on time for daily rounds.

  10. In the 1960s, Lysenkoism was weakened and finally repudiated in the USSR when it gradually became apparent that Lysenko’s experimental claims about “vernalization” were false, and that his model farm (with model cows that gave model milk) in the Lenin Hills outside Moscow was a scam. Acolytes of the DEI cult have not, in general, made the mistake of proposing falsifiable propositions. As a result, we can expect their effects in the US academic world to be longer-lasting than the effects of the Lysenkovshchina were in that galaxy far away. Perhaps if increased numbers of patients start dying under the care of physicians who have studied DEI more intensely than anatomy (if this outcome is not hushed up), then a gradual reevaluation might< come to pass.

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