Why doctors won't cop legislated silence

Two Australian doctors have taken to the pages of the prestigious journal, the BMJ to make their international colleagues aware of the extraordinary assault on medical ethics contained in the recently enacted Border Force Act 2015. I have also received an email on behalf on the President of the Royal Australasian College of Physicians Laureate Professor Nick Talley to all members of the College and its Chapters and Faculties calling the Act “unacceptable to physicians”. They join the AMA and other peak health organisations in publicly warning the Government about trying to prevent doctors advocating for vulnerable patients.

The essence of opposition from medical groups in not political, but ethical. The paramilitary nature of the Border Force that has been created is reinforced by the grotesque oath pledging loyalty to the organisation’s interests. Doctors regard themselves as having loyalty first and foremost to their professional ethics, and not to any employer. When I was a military medical officer, I was subject to the Official Secrets Act but also to the Geneva protocols regarding my obligation to remain a non-combatant and provide medical care based on need rather than political allegiance.

If I was witness to any war crimes or other unconscionable acts, I would have felt obliged to speak out on behalf of the victims, even if that meant I might have to answer for a security breach.

Drawing attention to the condition of detainees in immigration detention does not affect national security in the same way as military matters. Publicising the plight of patients suffering permanent harm in immigration detention cannot give comfort or operational intelligence to an enemy.

Prof Talley is correct to point out that punishing whistleblowers with a gaol term is placing them in ‘an impossible position’ ethically. He adds that the Act ‘fails to understand…that the contribution made by health professionals who speak out about healthcare in situations such as detention centres is invaluable.’

I’ll repeat that. It is regarded by the RACP as invaluable. Not illegal. Not seditious. Invaluable.

Invaluable because the Immigration Health Advisory Group (IHAG) which oversaw these issues has been disbanded by the Government. There is nobody to report substandard care to any more.

When experts in paediatrics and psychiatry have lined up to condemn the failure of successive Governments to provide even the barest mental and physical health care to asylum seekers, the politicians should take note. They have been told by the profession that what they are doing is reckless with the lives of these benighted people.

This is not political point-scoring. It is the caring profession using its advocacy to protect the vulnerable to who we owe a duty of care that transcends partisan politics. Some humanitarian and civic duties transcend the party system. Surely there must be some within the major parties who agree that doctors must be free of intimidation to advocate for their patients. Such a law is unprecedented in Australian medicine.

This Government has attempted to roll over doctors' concerns about vulnerable patients previously, with the ill-conceived GP tax. This mandatory silence is a direct attack upon the ancient obligation of medical practitioners to speak out on behalf of their patients. A situation where doctors are required by law to report suspected child abuse in routine practice, but are now apparently forbidden to report proven child abuse in detention cannot be allowed to stand.

Instead, the Border Force Act 2015 seeks to make it illegal to voice discontent at disgraceful health outcomes, and legislates compulsory non-disclosure for any health worker who is compassionate and courageous enough to want to work in the face of such hamfisted intimidation.

That sinister oath would stick in the throat of any decent doctor.

If the Government insists on refusing doctors the freedom to advocate on behalf of their patients, I expect they will face an organised campaign from the profession. The signs are that they will. It is unusual for such a conservative body as the RACP to take such public steps in disagreeing with a political policy. There is widespread incredulity in the profession that this is being attempted. This will turn to anger soon enough, if our warnings are ignored. And not just doctors, but nurses and paramedical staff would feel exactly the same.

The Abbott Government would surely not be foolish enough to pick a fight over ethics with the whole healthcare workforce.