“First, do no harm” is a phrase often associated with the Hippocratic Oath or in recent times more often a variant of the Declaration of Geneva which in one way or another is pledged by most medical professionals.
Similar oaths have also been discussed for scientists in general. But even with some schools offering ethical training as part of their curricula no Hippocratic Oath for Scientists has emerged to be pledged by scientists. With the rise of data science, also oaths for data scientists have been discussed.
This posts does not intend to open the particular debate of whether one should be adopted, but instead explores the aforementioned oaths/pledges to discuss what there might be learned when adapting them to HPC practitioners. Most notable is a different and far less direct dynamic when it comes to assessing the impact for decisions made when working as a HPC practitioners.
Hippocratic Oath
Attributed to the Greek physician Hippocrates (460-370 BC), the Hippocratic Oath is an oath to uphold certain ethical standards. In its classical form, many elements of greek culture and religion are embedded so that as a result of medical progress and historical events various revised variants have been adopted by practitioners and institutions over time.
In this section, we will not consider the classical form but instead review a modern version of the Hippocratic Oath written in 1964 by Louis Lasagna, at the time Academic Dean of the School of Medicine at Tufts University, which is still used in many medical schools today.
| Modern Hippocratic (1964, Lasagna) | Adaption from an HPC perspective | Discussion |
|---|---|---|
| I swear to fulfill, to the best of my ability and judgment, this covenant: | 1) I swear to fulfill, to the best of my ability and judgment, this covenant: | |
| I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow. | 2) I will respect the hard-won scientific gains of those scientists in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow. | |
| I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism. | 3) I will apply, for the benefit of my mandator/humanity/the environment, all measures [that] are required, avoiding the traps of over-engineering and model uncertainty. | In HPC there is not such a clear definition of a mandator: It could be an individual, a company or large organization or a government. The idea of a twin trap in HPC does not seem adequate. Depending on the scientific domain different challenges exist. |
| I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug. | 4) I will remember that there is art to HPC as well as science, and that warmth, sympathy and understanding may outweigh an algorithm or a technical solution. | Not every solutions needs/can to be of technical nature? |
| I will not be ashamed to say “I know not”, nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery. | 5) I will not be shamed to say “I know not”, nor will I fail to call in my colleagues when the skills of another are needed. | The time criticality when it comes to decision making in an medical emergency follows a very different dynamic for HPC problems. So seeking second opinions or independent verification should certainly be embraced also by HPC practitioners. |
| I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God. | 6) I will respect the privacy of my mandator/individuals, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God. | The impact on life and death is usually far more indirect. HPC typically informs a design decision instead of directly being a mechanism of intervention. Also instead of targeting an individual insight many HPC applications have an impact on society at large. Privacy can also be a concern for HPC workloads. For example, various data science applications may handle personal or other sensitive information. |
| I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick. | 7) I will remember that I am not playing a game, but impact society/an individual, which may affect (her) families and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick. | Motivation for HPC practitioners may vary widely, and for many the intellectual challenge may actually have been a large factor in their career choice. At the same time, there are consequences to society and individuals within it. In addition, resources are often limited and one should be conservative about using them, this may become increasingly important as many machine learning workloads for example generously accept exploring large parameters spaces just shy of brute force. |
| I will prevent disease whenever I can, for prevention is preferable to cure. | 8) I will prevent side effects whenever I can, for prevention is preferable to corrective action. | Anticipating impacts and side effects is not possible for many technological advancements, especially if they are only emerging from interactions with society. Yet, many consequences are being raised by concerned scientists, have been discussed in science-fiction, or even have historical analogies. |
| I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm. | 9) I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm. | |
| If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help. | 10) If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help. |
Declaration of Geneva
First adopted in 1948, and revised multiple times last in 2017 (also in 1968, 1983, 1994, 2005, 2006), the Declaration of Geneva by the World Medical Association serves as a pledge by physicians to dedicating their medical expertise to humanitarian goals. This was particularly relevant given the historical context and horrific medical crimes committed across a German-occupied Europe.
The Declaration of Geneva in that sense was also intended as a revision to and modern interpretation of the moral truths as suggested in the Hippocratic Oath. Interestingly, the first two revisions from 1948 and 1968 include a summary of the international code of medical ethics.
| Declartion of Geneva (2017, WMA) | Adaption from an HPC Perspective | Discussion |
|---|---|---|
| AS A MEMBER OF THE MEDICAL PROFESSION: | AS A HPC PRACTIONER: | |
| I SOLEMNLY PLEDGE to dedicate my life to the service of humanity; | 1) I SOLEMNLY PLEDGE to dedicate my life to the service of humanity; | |
| THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration; | 2) THE WELL-BEING OF my mandator/humanity/the environment will be my first consideration; | Here shows a critical difference, HPC practitioners lack a clear analogy to a mandator or a patient. Often impact on society or individuals or the environment are hard to predict. At the same time the mandate of HPC practitioners may most directly correspond with an organization, such as a research institute or a company, or a country. HPC is less often directly benefiting individuals, although this may change with applications in precision medicine. |
| I WILL RESPECT the autonomy and dignity of my patient; [2017] | 3) I WILL RESPECT the autonomy and dignity of my mandator; | This may be most likely be infringed on by making decisions for a client from a position of technical expertise not verifiable by the client. |
| I WILL MAINTAIN the utmost respect for human life; | 4) I WILL MAINTAIN the utmost respect for human life; | |
| I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient; | 5) I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my mandator; | |
| I WILL RESPECT the secrets that are confided in me, even after the patient has died; | 6) I WILL RESPECT the secrets that are confided in me, even after the mandator has died; | |
| I WILL PRACTICE my profession with conscience and dignity and in accordance with good medical practice; | 7) I WILL PRACTICE my profession with conscience and dignity and in accordance with good HPC practice; | It is not really established what “good HPC practice” may actually entail. |
| I WILL FOSTER the honour and noble traditions of the medical profession; | 8) I WILL FOSTER the honour and noble traditions of HPC practitioners; | |
| I WILL GIVE to my teachers, colleagues, and students the respect and gratitude that is their due; | 9) I WILL GIVE to my teachers, colleagues, and students the respect and gratitude that is their due; | |
| I WILL SHARE my medical knowledge for the benefit of the patient and the advancement of healthcare; [2017] | 10) I WILL SHARE my knowledge for the benefit of the mandator and the advancement of humanity; | |
| I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard; [2017] | 11) I WILL ATTEND TO my own health, well-being, and abilities in order to provide advice of the highest standard; | |
| I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat; | 12) I WILL NOT USE my knowledge to violate human rights and civil liberties, even under threat; | |
| I MAKE THESE PROMISES solemnly, freely and upon my honour. | 13) I MAKE THESE PROMISES solemnly, freely and upon my honour. |
Interestingly, many aspects of the Declaration of Geneva seem also applicable to HPC practitioners while only introducing minor changes. Most noteably, a HPC practitioner is less certain about whom they actually benefit. At the same time, respect for human life, non discrimination, or respecting confided secrets as well as sharing knowledge also apply for HPC practitioners.
Hippocratic Oath for Scientists
An Hippocratic oath for scientists has been debated extensively throughout but especially in the last quarter of the 20th century, and finds many proponents but also many opponents. As of today, no such oath is widely sworn by scientists. It is, however, increasingly common to find code of conducts documents collected by organizations, events but also many communities and projects.
Proponents see utility in such an oath to provide guidance to new scientists and remind them of the social and moral responsibilities, but also to ensure public trust in scientists and protect them from discrimination by employers when researchers find truth that is in conflict to economical or political interest.
Opponents see code of conducts as more suitable devices or fear that that an oath might be used to suppress research in certain areas (e.g., gene editing).
Summing Up
Rewording existing pledges from other domains to fit to the HPC context highlights a number of challenges which are quite unique to the HPC and consequently should be developed by the HPC community itself. Most notable is the lack of a clearly defined boundary when it comes to assessing the impact an HPC practitioner on individuals and society at large as it applies to many HPC applications which perform fundamental science which typically benefits humanity at large. At the same time, it becomes more plausible that workloads that benefit individuals may become more common as well.
This article serves as a brief exploration into the adoption and evolution of ethical standards in the medical field, as well as into attempts to extend the concept to other scientific domains as well. The discussion here is meant as a teaser but actually deserves more depth as many matters such as historical context, the debates and discourse that preceded the successful adoption of such a standard by international committees are not documented as well or are not as easy to find as the resulting statements agreed on published declarations. In addition, various other frameworks are connected to, for example, the declaration of Geneva such as the Declarations of Helsinki, Tokyo, Teipei, Malta, Lisbon and Ottawa, which cover the research with human subjects, the prevention of torture, implications of medical databases, dealing with patients in hunger strikes, patient rights, and children’s health. All of these are motivated in part also by historic events that called for guidance. Most of the guiding principles identified in these declarations are also found in the International Code of Medical Ethics which deserves an article of its own.