GPFUQ #219 : Are the Doctors who take Non-violent Direct Action to Raise Public Awareness about the Climate Emergency Radical Activists, Rightminded Professionals, or Reluctant Whistleblowers?This article argues that these doctors are right minded professionals and may also be reluctant whistleblowers.
To cite this article: Terry Kemple (2020): The Climate Emergency: Are the Doctors who take Nonviolent Direct Action to Raise Public Awareness Radical Activists, Rightminded Professionals, or Reluctant Whistleblowers?, The New Bioethics, DOI: 10.1080/20502877.2020.1775390
To link to this article: https://doi.org/10.1080/20502877.2020.1775390
When doctors become aware of a threat to public health, they have a professional duty to try to mitigate the threat. Climate change is a recognized major threat to planetary and public health that requires actions to both mitigate, and adapt to, climate change. The limited time and resources available tochange what humankind are doing and protect planetary health add urgency to the threat. Some doctors take non-violent direct actions if their governments fail to take the effective actions needed. Professional regulatory organizations like the UK’s General Medical Council (GMC) are charged with protecting the health of patients by setting standards for, giving ethical advice about, and supervising the behaviour of doctors. This article examines the conflict between climate activist doctors and the GMC interpretation of a doctor’s duty of care when there is threat to public health from climate change.
David Roberts recently remarked, ‘For five decades now, [climate models] have warned us that we are marching toward ruin, and we have, for the most part, ignored them. We cannot claim that we did not know what we were doing’ (2019).
Humankind is waking up to the consequences of living unsustainably. Medicine mostly uses the lens of its discipline to zoom in on the most specialized studies of the human body or zoom out to get the bigger picture in public health. Yet, if physicians want to help people to stay healthy, the lens must zoom out beyond public health to view the health of the planet and try to understand and manage its complex natural systems. Planetary health links the disruptions of the Earth’s natural systems caused by humans with the resulting impacts on public health and then develops and evaluates evidence-based solutions to maintain a world that is healthy and sustainable for everyone. Anticipating and avoiding futures that can cause worse public health should be possible from understanding threats like climate change and reacting
fast enough by switching away from environmentally damaging ways of living to sustainable ways.
The extra challenge of climate change for humankind is that there is limited time and resources to change what is being done and protect planetary health. Most governments (UNFCC 2015) have acknowledged the problem of climate change and made pledges to mitigate it but there is a widespread consensus that not enough is being done; governments are failing to fulfil their existing pledges to take the necessary actions (Carbon Brief 2019).
As public awareness of the enormity of the threats to planetary health increases, social movements like Extinction Rebellion (XR), which demand urgent action, are growing. These movements may include non-violent direct actions as part of their protests. This article examines the ethical dilemma for doctors in the UK who consider climate change a major threat to public health threat and take non-violent direct actions to raise awareness and influence government but then come into conflict
with the government and its professional regulator of doctors in the UK – the General Medical Council.
Ethical foundations: the Golden rule or Kant’s categorical Imperative
The principle of treating others as you want to be treated yourself is a common, but not universal, maxim of reciprocity. As a moral duty if it is accepted, it becomes the foundation for other often-cited advice about human interactions. The principle is widespread – in philosophy it is recognized in Kant’s categorical imperative (Kant and Paton 2009) and in religion and culture it is often known as the Golden rule. In this article, the concept will be referred to as the Golden rule. The variations in the application of the Golden rule are how humans can reasonably expect to be treated by all others, and how much humans can extend these expectations to others. The latter may be applicable to those who are
distant in place and time, such as inhabitants of far off countries and the future unborn generations.
Society’s expectation for acceptable behaviours can react with the issues of the time so humans must be prepared to change how they interpret and adhere to the Golden rule. For example: those who were brought up in a Roman Catholic household in the UK in the mid-twentieth century were expected to follow the rules described in a pocket-sized book called the ‘Catechism.’ This was also known as
the Penny Catechism. It provided the elementary structure of the Catholic Faith for generations of people until the 1960s. Catholic children were given this small book to study in the early years at school. The catechism included the Jewish ‘Ten Commandments’ and other doctrines of the Catholic church. Children learned about the so-called ‘Golden rule’.
Today’s version of the small pocket-sized catechism, The Catechism of the Catholic Church (Catechism of the Catholic Church 2019). was introduced in the 1990s. It is an oversize book with 900+ pages. It is still changing. In November 2019, following through on a proposal made at the Synod of Bishops for the Amazon, Pope Francis said there are plans to include a definition of ecological sins in the church’s official teaching. ‘We should be introducing – we were thinking – in the Catechism of the Catholic Church the sin against ecology, ecological sin against the common home’ (Catholicnews.com 2019). This language of ecological sin was unthinkable a century ago, or even a decade ago.
Currently, the awareness and acceptance of the threat from climate change and its impact on the planet varies among people. Most individuals need to be more aware about the threats to health on the planet and then act to reduce the risks of climate change. However, learning and accepting the essential information about climate
change and then the next steps of appropriately changing behaviours, either as well informed citizens or dutiful doctors, does not always occur. The reactions to climate change can include a call to action, but also denial, environmental grief, climate depression, eco-anxiety, futilitarianism, or becoming a ‘doomer’. This different
awareness, and then acceptance of, these threats and impacts by individuals and organizations inevitably cause problems applying the Golden rule consistently.
The interval between becoming aware of a threat and taking action can undermine the efficacy of the Golden rule. If the outcome of a rule does not work out as expected, thoughtful people should ask the question whether it was conceptual failure or implementation failure. There
are only trivial reasons to believe the Golden rule is flawed and the concept wrong, thus eliminating conceptual failure. The poor outcome of the Golden rule must be an implementation failure; humans have been unable to deliver on our self-chosen principles.
The problem of implementation of the Golden rule
Falsehood flies and the truth comes limping after it. Jonathan Swift (1710)
There are many different explanations for the human behaviour responsible for implementation failure of the Golden rule. Once each is identified, perhaps they can be mitigated. These explanations include mechanisms like the following and are applicable to individuals and organizations like the General Medical Council (GMC).
First, there are the familiar processes of normal and accepted psychological reactions. For example, the adaptive behaviour that humans can feel around experiences like loss and grief. The stages of this process include shock and denial, pain and guilt,
anger and bargaining, depression and reflection. All are common in the context of personal reactions about climate changes.
Second, are the less familiar cognitive phenomena of heuristics and biases described by Kahneman (2011). Individuals cope with uncertainty and complexity by using a small number of general-purpose heuristics for simplifying judgments and making decisions. This can lead to suboptimal decision-making.
Third, humans, as individuals, follow a unique mix of rules rooted in personal truths, deceits, biases from upbringing, family mores, religious rules, the dominant culture, generational norms and the laws of the land. Professions like medicine add another set of rules. These can all be influenced by false rules and fake news, for example, the mistaken belief that repetition is a form of validation. The character of the Bellman by Lewis Carroll in ‘The Hunting of the Snark’ says ‘What I tell you three times is true’ (1876). This Bellman-like deceit is apparent
in scientific research in the continued presentation of discredited data, or the disregard of data from a study which comes to a different conclusion. A modern example is the antivaxxer belief that autism is caused by the Mumps, Measles and Rubella (MMR) combined immunization in childhood. Despite subsequent retraction by the publishing journal of the fraudulent research that started this false finding, the paper is still widely cited and believed (Suelzer et al. 2019). The Bellman-like deceit is a common and widely applied mistake, perhaps because humans often look either for confirmation of an existing bias, or are disinclined
to challenge the false information. Fourth, in addition to conscious biases, humans also have unconscious biases. Self-Tests can measure implicit attitudes and beliefs and reveal unconscious bias.
These Implicit Association Tests (Greenwald et al. 1998) are widely available on-line and usually reveal a bias that people are either unwilling or unable to report.
Fifth, the outcomes of all these psychological processes, heuristics, rules and biases make us who we are and manifests through phenomena like conscience, ‘common sense’ and ‘gut reactions’. Conscience can warn that something is wrong, or suggest that something is right. Expert intuition in any profession is a specialized
gut reaction recognition of patterns. The individual expert may not be consciously aware that something that does not fit in the expected pattern, but the mind can process information more quickly than one can comprehend it (Reason 2009).
There is a great danger in leaping to the wrong conclusions when there is insufficient information. This creates the ‘strong but wrong’ reaction in the mind. Given these and other obstacles, a few strategies can mitigate the implementation failure of the Golden rule. Individuals and organizations can learn to recognize and ignore many of the obstacles to implementation. Individuals can expect to get wiser if they can learn from their mistakes. Although it may be not be possible to discover
any great truth, it is possible to recognize mistakes earlier and more often. The opposite of wisdom is the stupidity of making the same mistake over and over. Only the wisest and stupidest never change.
The ethical codes given to doctors
Ethical codes are given to doctors at graduation from their medical school and after graduation from medical organizations. Doctors refer to these codes throughout their practice and use them to protect and defend them from those outside of the profession. Many are based in a deontological ethics, which reflects the Golden rule.
Initial secular pledges at graduation
Many medical schools expect their student to take an oath or pledge at their graduation. This has its origins in the earliest expression of medical ethics in the western world: the Hippocratic oath (Edelstein 1943). In 1948, the World Medical Association (WMA) was concerned over the state of medical ethics and drafted a pledge – the Declaration of Geneva (wma.net 1948) – so that the oath’s moral code could be passed on in a modern way. In the 1960s, the Hippocratic Oath itself was changed to make it a more contemporary and secular obligation (Lasagna 1964).
There are various versions of these pledges and there are always pressures to update their contents. For example, in many countries campaigns to allow legal assisted-dying is a common call for change in the pledges. There is also pressure from doctors concerned about planetary health to require ‘protection of the environment
which sustains us’ and extend the focus of care for doctors from the individual to the community and the ecosystem. In 2008, Dr Margaret Chan, the director of the World Health Organisation stated, ‘in the face of this challenge, the WHO is committed to do everything it can to ensure all is done to protect human health from climate change’ (Chan 2008).
Continuing national professional regulators and influencers after
graduation
In addition to, or in the absence of, oaths and pledges upon their qualification, doctors are expected to follow the rules of their national professional regulatory authority that each publish, and police their versions of the rights and responsibilities – the duties – of a doctor. In the UK, the General Medical Council provides a comprehensive overview of the obligations and professional behaviour of a doctor
to their patients and wider society (gmc-uk.org 2013). Doctors who violate these codes may be subjected to disciplinary proceedings, including the loss of their licence to practice medicine (gmc-uk.org 2020a). The General Medical council was created by an Act of Parliament in 1858 entitled ‘An Act to Regulate the Qualifications
of Practitioners in Medicine and Surgery’ (Legislation.gov.uk 1858). It
was the first to regulate the practice of doctors in the UK.
At its start, the General Medical Council was a body of doctors who self-regulated their profession. This model allowed doctors themselves to decide what was best for patients. Its disciplinary powers were exercised only in cases of criminal behaviour or poor professional conduct for the time, often summarized as the ‘3 A’s’: addiction, adultery and advertising. Modern regulations are less rigid about some of these conducts. Scandals regarding patient safety, and some disquiet that the organization was self-serving, prompted the reform of the GMC into an independent regulator (legislation. gov.uk 1978).
The GMC published the first edition of its Good Medical Practice (gmc-uk.org 2013) in 1995. This gave the first explicit statements about the standards of care patients should expect and doctors should provide. Although the original self regulated GMC was an inadequate safeguard for patients, its successor – the independent regulator GMC – is not safe from censure. High-quality organizations usually have robust governance that allows a constant process of feedback to challenge and improve practice. There may be guardians in charge of the rules and their interpretation in an organization, but there should not be anonymous rule makers and enforcers who cannot be challenged. There
should be identifiable people with roles. The British politician Tony Benn suggested that you should be able to search out the named people in charge and then ask:‘What power have you got? Where did you get it from? In whose interests do you exercise it? To whom are you accountable? And how can we get rid of you?’ (Benn 2001). Organizations with insufficient feedback, quality improvement, and
assurance in the processes of regulation can preserve flawed processes and outcomes. The GMC has an implicit duty to take appropriate actions to identify and reduce the risks when there are threats to the public’s health. The GMC already accepts and follows its public duty and holds financial investments only through fund managers
who demonstrate the strongest environmental, social and governance credentials and specifically excludes investment in companies that derive more than 10% of their revenue from: tobacco, alcohol, gambling, pornography, high-interest rate lending, cluster munitions and landmines, and the extraction of thermal coal or oil sands (Gmc-uk.org 2018a). Whilst more and more medical organizations are
divesting from energy companies that rely on fossil fuels and investing in companies generating energy from renewable sources, the GMC continues to permit its own investments in the fossil fuel industry.
The GMC has declared, ‘doctors in particular have a duty to act when they believe patients’ safety is at risk, or that patients’ care or dignity are being compromised.’ (gmc-uk.org 2013). Doctors themselves have a professional duty to report themselves to the GMC when they are charged with, or found guilty of, a criminal offence. The GMC then usually refers the doctor to a medical practitioner’s publicly held tribunal that conducts an investigation and makes a judgement.
Some specific and less serious convictions like parking and speeding
offences do not have to be referred for investigation (gmc-uk.org 2020b).
Although speeding has a known association with risks of harm to other people it has not been recognized as an important offence, perhaps because it is a highly prevalent offence.
If the tribunal judges that a doctor’s fitness to practise is impaired, it has a few options. First, it can take no action. Second it can agree to undertakings offered by the doctor at the hearing. Third, it can put conditions on the doctor’s registration, which restricts what a doctor is allowed to do. Fourth, it can stop a doctor from working as a doctor for a set period of time (suspension). Fifth, it can remove the
doctor from the medical register to stop them practising (erasure) (mpts-uk.org 2020). Regardless of the final outcome, the tribunal process is usually slow, long, and stressful for the doctor who is being investigated and judged.
Other softer, but important, influencers in professional behaviour are the predetermined performance pathways, such as guidelines, and payments for performance that are used to attempt to link various aspects of doctors’ work, including effort, achievement, values, purpose, and self-understanding, to measures and comparisons of output and outcomes.
All these regulations and guidelines can be like satellite navigation on car journeys: authoritative and useful, but prone to major errors at difficult junctions. Although they can seem obligatory, they are in reality just informed advice and not a guarantee of the best outcome.
The ethical codes used by doctors
The secular pledges and professional regulations usually set only the basic and minimally acceptable standards for doctors. Importantly, there are other sets of standards that also apply. Integrity, moral duty and quality are words that can express the nature and importance of these higher standards. Doctors learn these higher standards through lifelong learning experiences. Humans are influenced by many things, including the Golden rule itself, positive and negative roles models, peer
group pressure, the breadth and depth of personal experience, and feedback from others. All knowledge is formed by information with experience, context, interpretation, and reflection.
Professional judgement, like any practical wisdom, is a form of knowledge that is not formally taught, but is acquired through experience. Explicit knowledge for physicians typically uses the evidence-base of medicine. Tacit knowledge however is based on personal know-how. Greater wisdom can develop through continuing
critical deliberation about the best thing to do in practice. This is more than learning from simple reflection. In medicine, wisdom is the use of a clinician’s professional judgement that helps individuals manage the uncertainties and risk in their lives. Professional judgement is important when doctors decide not to follow published guidelines for care. A
dilemma of modern health care is that doctors are trained and expected to use their judgement for the best interests of their patients, but well-intentioned prescriptive regulations and guidelines may hinder them from using their best judgement. Many doctors continue to aspire to higher standards to provide ‘quality’ care for their patients. ‘Quality’ often describes a specific vagueness in performance in medicine and it is not always clear what quality means for most people. Lewis Carroll’s
Humpty Dumpty ‘understood’ the words he used. ‘When I use a word, it means just what I choose it to mean – neither more nor less’ (Carroll 1871). Quality, like many concepts, is often used without a shared understanding and it will frequently mean different things to different people at different times. Quality may often describe more of a journey of aspiration for greater achievement with milestones on the way rather than a fixed destination or accomplishment.
The problem with the quality journey is that, although there is a direction to take, the final destination may change. Quality is a higher aspiration than even the Golden rule – to treat others even better than you expect to be treated yourself.
When doctors treat other doctors they often try to provide the highest of standards, because if they themselves become patients, they often expect the highest of standards.
There are informal and formal accreditation systems for quality standards in most countries. Although self-assessment of quality can often be considered an inadequate safeguard of minimum standards, the state-regulated quality assessments can become bureaucratic obstructions to quality improvement and learning by promoting caution and conformity. To assure quality the GMC introduced the mandatory relicensing of doctors every 5 years, through a process called revalidation and a list of requirements that aim to reduce unacceptable variations in the care by doctors.
Regulators can set arbitrary and inappropriate standards and may have little tolerance for contrary ideas or opinions. The list of requirements can become more valued than the purpose of the process.
Adherents to any dogma run the risk of increasing their efforts to obey, and unwillingness to change the rules and thereby risk undermining the Golden rule.
The desired outcome of quality assurance becomes a casualty of the bureaucracy. Such may be the case when physicians are obligated to act only on guidance that is broadcast from the top down, rather than mastered from the bottom up.
Physician activism
The UK’s General Medical Council tells doctors that they do have a duty ‘to act when they believe patients’ safety is at risk’ (gmc-uk.org 2013). The GMC also assures them they will be protected if they follow a process that results in their whistleblowing (gmc-uk.org 2018c). Doctors who believe climate change is the major
threat to the health of the majority of people on the planet may become frustrated that governments and other responsible organizations like the GMC are not responding sufficiently to mitigate the threat. Any non-violent actions that doctors may take to raise awareness can conflict with the laws of the land and the rulings of the national regulators of doctors who determine the standards of care that patients should expect and the behaviour that doctors should follow. Despite their duty to act and the GMC’s assurance of support, if doctors attempt to raise awareness about the threat of climate change and the government’s failure to
mitigate climate change, i.e. ‘whistleblow’ and then get arrested after taking nonviolent actions, they make themselves liable to be disciplined for unprofessional conduct by the GMC and labelled as radical activists by the popular media. For example, in April 2019 Dr DianaWarner was one of six people in the original ‘Extinction Rebellion’ (XR) movement who staged a protest on a train at a London station by using a super glue to attach herself to a train window. She was arrested and charged under the Malicious Damage Act of 1861 but a scheduled Crown court jury trial in May 2020 was postponed due to the Covid-19 pandemic.
Following the outcome of the court appearance she would await a judgement about her behaviour by the GMC (Mahase 2019).
Doctors for Extinction Rebellion
Extinction Rebellion was started in the UK in May 2018, but it quickly became an influential environmental mass movement. With the stated aim to be a global movement that uses non-violent civil disobedience in an attempt to halt mass extinction and minimize the risk of social collapse, XR has three demands: First, tell the truth. Governments must tell the truth by declaring a climate and ecological emergency,
working with other institutions to communicate the urgency for change.
Second, act now. Governments must act now to halt biodiversity loss and reduce greenhouse gas emissions to net zero by 2025. Third, go beyond politics. Governments must create and be led by the decisions of a Citizens’ Assembly on climate and ecological justice (Extinction Rebellion 2018). Extinction Rebellion has explicit principles and values, but the organization is decentralized, meaning that there is no requirement for each local XR group to ask for permission from a central group or authority. Arguably, this has helped it to be both a faster growing, and faster learning, organization. In May 2019, a new special interest XR group called ‘Doctors for Extinction Rebellion’ (Mahase 2019) formed in the UK to fight climate change and promote planetary and public health. Many doctors who are concerned about their government’s failure to acknowledge the climate emergency and failure to defend life are taking part in non-violent direct action, such as demonstrations that occasionally result in arrests for offences such as obstruction of a police officer, breach of the public order act, breach of the peace, obstruction of the highway, aggravated trespassing, criminal damage and theft, violent disorder, and affray. These arrests are often used by police to clear away a demonstration and those arrested
are subsequently released without any charge or criminal record. Any arrests of physicians that result in being charged with a crime, or being convicted, can trigger referral by the GMC to the Medical Practitioners Tribunal Service. TheTribunal will make an investigation and give a public hearing. These protestors may be viewed in different ways – as radical activists, right-minded professionals, or reluctant whistleblowers.
Radical activists?
In an ideal world, scientists would report on science and the government would act on it. Unfortunately, this has not happened with climate change. So, to get this critical message out, some doctors are resorting to civil disruption to get in the press and inform the public to pressure government to act on the science. Dr Chris Newman, a General Practitioner and a co-founder of Doctors for Extinction
Rebellion remarks, there is a deep sense that we as healthcare professionals must become advocates for the ecosystem as a vital part of health, and that to do this most effectively we must step out of
our traditional roles. We are held in high regard by the public, and we must honour their faith by acting in a manner that matches the magnitude of the problem. (Mahase 2019) If, in the course of these non-violent direct actions, doctors are arrested, charged and appear in the courts, they can then use that platform to further raise awareness
of the major threats to public health. Although this has been shown to be effective, these doctors are often dismissed as radical activists by naysayers and the media. Labelling others with false descriptors by ‘name calling’ that which society generally deems negative, alienates the activists and discredits their message. It can create a strong – but wrong – reaction to them and their message. When this does happen,
reframing the problem can make it easier to understand and interpret. To change thought processes, awareness of the current framing must be developed, consequences considered, an alternative frame devised, and the consequences of alternative innovative thinking considered.
In challenging the description of Extinction Rebellion as a radical environmentalist movement, Scott Fraser reframed the argument: ‘Extinction Rebellion has rightly sought to bring to wider attention the imminent breakdown of our climate and the
catastrophe this will herald if we do not change our behaviour very soon. I can’t see how this would be described as radical: we don’t label smoking cessation practitioners as ‘radical anti-cancers’ or school crossing patrols as ‘radical anti-accident activists’ (Fraser 2019).
Right minded professionals doing their duty?
The climate emergency is like no other in recorded history. Dr Chris Newman, questions,why do we spend billions of pounds every year reducing small—yet statistically significant—(health) risks to small groups of people, yet spend so little on unimaginable risks to everyone? What happens when our duty to safeguard public health directly conflicts
with the authority of government? (Mahase 2019) Dr Newman called on the General Medical Council to support doctors taking direct action against climate change and was himself was one of several doctors
who was arrested after scaling and then gluing themselves to a government building in London in September 2019. They carried out the act of ‘peaceful civil disobedience’ to deliver an ‘urgent health warning’ about the severity of the climate and ecological crisis, and to prompt government action on the matter (Iacobucci 2019). Newman explained climate and ecological breakdown pose one of the greatest threats to public health theworld has ever faced. Yet the government is failing to take meaningful steps to protect its citizens. Non-violent peaceful protests like today are essential public health interventions
for getting the government to take immediate action. Following the code of self-reporting, Newman wrote to the GMC after his arrest
and urged the UK’s regulator to declare a climate and environmental emergency and support doctors taking action, stating, We do still expect you to hold doctors to account for their actions as part of protest groups, but if and only if they are deemed to be wholly excessive. There should be no ‘carte blanche’ for protestors, but fear of giving this does not justify the prolonged
delay thus far in making your climate declaration.
In a statement related to doctors who protest about climate change the GMC responded, ‘like all citizens, doctors are entitled to their own political opinions, and there is nothing in the standards that we set that prevents them from exercising their rights to lobby government or campaign’ (Iacobucci 2019). By this statement the GMC seems to muddle the scientific facts about the threats to health from climate change with political opinions about what governments should do.
The GMC went on to write: If we were to receive a complaint or a self-referral about the actions of a doctor involved in a protest, we would have a legal duty to consider the matter raised. However, as with
all complaints, we would make our decision based on the specific facts of the case. Our focus would be on whether the doctor’s actions may have fallen seriously or persistently below the standards we set or put patients or the public confidence in the profession at risk. Doctors must always be prepared to justify their decisions and actions. The GMC added: ‘We understand the strength of the concerns that doctors are
raising about the impact of climate change. However, our role is set out in the Medical Act, which provides us with no powers to declare a climate emergency’ (Iacobucci 2019).
Climate change will affect most people and may cause a great transformation all over the world. What should any right-minded doctors do when they become aware of the threat to human health from climate change and the need to mitigate and adapt to climate change? Each person should consider their moral duty informed by the Golden rule, then follow their own conscience.
Reluctant whistleblowers?
‘Quis custodiet ipsos custodes?’ (Translation: ‘Who will guard the guards themselves’?) is generally used to consider the embodiment of the philosophical question as to how those in power can be held to account. Although the GMC may view physicians who take non-violent direct actions as political activists, perhaps a more useful way to view physician activism – including those who take non-violent direct actions – is that of whistleblowers doing their professional duty. In doing
so, doctors may be following the Golden rule and prompting others, including the GMC, to do the same and change their behaviour.
According to the GMC, ‘whistleblowing’ is where an employee, former employee or member of an organization raises concerns to people who have the power and presumed willingness to take corrective action’ (gmc-uk.org 2018c). A broader definition might recognize that a whistleblower is usually someone who exposes information or activity that is deemed illegal, unethical or incorrect within a private or public organization. Discussions on whistleblowing usually consider attempts to
define whistleblowing more precisely, with debates about whether and when whistleblowing is permissible, and debates about whether and when one has an obligation to blow the whistle.
In the UK, whistleblowers are protected by law and should not be treated
unfairly because of whistleblowing. The law specifically protects whistleblowers who report that someone’s health and safety is in danger, report risk or actual damage to the environment, or report if someone is suspected of covering up wrongdoing. Anna Rowland, the Assistant Director of Policy, Business Transformation and Safeguarding GMC claims, ‘we want whistleblowers to feel confident in raising their concerns to us and so we have improved the process by which disclosures can be made, giving people the option to do so anonymously’ (gmc-uk.org 2018b). It is in the best interests of the public for physicians to safeguard the future of patients’ health by speaking out about the damaging consequences to public health of climate change. A physician who raises awareness about climate change and threats to health, and exposes the lack of sufficient actions by government
and other organizations, including the GMC, to mitigate climate change seems to be acting – knowingly or unknowingly – as a whistleblower. Whistleblowers risk reprisal and retaliation from those who are accused or alleged of wrongdoing. Doctors can be concerned that the General Medical Council does not acknowledge the whistleblowing nature of their actions and does not protect them. Rita Issa, a co-founder of Doctors for Extinction Rebellion remarks, as a doctor, I’m bound by good clinical practice to hold human life with the utmost respect, to practise from a scientific evidence base, and to act promptly when patient safety may be
compromised…and I’m supporting Extinction Rebellion ... out of duty to this ethical code, and out of respect to the evidence that the climate crisis is, as the Lancet called it, ‘the greatest threat to human health of the 21st century. (Moberly 2019) The GMC has a duty to support whistleblowers, even when the GMC is the organization being accused of the wrongdoing.
Conclusion
The GMC, and UK Government, should acknowledge the grave threat to the environment and public health of climate change and take appropriate actions to identify and reduce threats to public health. The concept of the Golden rule and its implementation are a measure of the quality of health care. Medical pledges, regulatory authorities and Government policies should be aligned to support the actions of doctors attempting to implement the Golden rule. When this alignment is missing, then the quality assurance of health care may be failing, and the root causes of that failure should be sought. Being open to feedback – including whistleblowing – is essential to correct misalignments and the ability to tackle urgent issues like climate change.
References
Benn, T. 2001. House of commons hansard debates for 22 Mar 2001 (pt 13). [online].
Publications.parliament.uk. Available from: https://publications.parliament.uk/pa/cm200001/cmhansrd/
vo010322/debtext/10322-13.htm [Accessed 3 March 2020].
Carbon Brief. 2019. COP25: Key outcomes agreed at the UN climate talks in Madrid | Carbon Brief [online].
Available from: https://www.carbonbrief.org/cop25-key-outcomes-agreed-at-the-un-climate-talks-in-madrid
[Accessed 3 March 2020].
Carroll, L., 1871. Through the looking-glass. London: MacMillan.
———., 1876. The hunting of the snark. London: Macmillan Publishers.
Catechism of the Catholic Church. 2019. Vatican City: Libreria Editrice Vaticana.
Catholicnews.com. 2019. Catechism will be updated to include ecological sins, pope says [online]. Available
from: https://www.catholicnews.com/services/englishnews/2019/catechism-will-be-updated-to-include-ecolo
gical-sins-pope-says.cfm [Accessed 3 March 2020].
Chan, M., 2008. WHO | Message from WHO Director-General [online] Who.int. Available from: https://www.
who.int/world-health-day/dg_message/en/ [Accessed 3 March 2020]
Edelstein, L., 1943. The hippocratic oath, text, translation and interpretation. Baltimore: Johns Hopkins Press.
Extinction Rebellion. (2018). Our demands – extinction rebellion [online] Available from: https://rebellion.
earth/the-truth/demands/ [Accessed 3 March 2020].
Fraser, S., 2019. Extinction rebellion: who is the BMJ calling radical environmentalists? BMJ, 365, l2256.
Gmc-uk.org. 2013. Good medical practice [online]. Available from: https://www.gmc-uk.org/ethical-guidance/
ethical-guidance-for-doctors/good-medical-practice [Accessed 3 March 2020].
———.. 2018a. Annual report [online]. Available from: https://www.gmc-uk.org/-/media/documents/annualreport-
2018-english_pdf-80413921.pdf [Accessed 3 March 2020].
———.. 2018b. First regulators whistleblowing report published [online]. Available from: https://www.gmc-uk.
org/news/news-archive/first-regulators-whistleblowing-report-published [Accessed 3 March 2020].
———.. 2018c. GMC policy on whistleblowing [online]. Available from: https://www.gmc-uk.org/-/media/
documents/DC5900_Whistleblowing_guidance.pdf_57107304.pdf [Accessed 3 March 2020].
———.. 2020a. Reasons for licence withdrawal [online]. Available from: https://www.gmc-uk.org/registrationand-
licensing/managing-your-registration/revalidation/revalidation-resources/revalidation-licence-topractise-
withdrawing-giving-up-restoring-appeals/reasons-for-licence-withdrawal [Accessed 3 March 2020].
———.. 2020b. Referral for a hearing at the MPTS [online]. Available from: https://www.gmc-uk.org/concerns/
information-for-doctors-under-investigation/our-sanctions/referral-for-a-hearing-at-the-mpts [Accessed 3
March 2020].
Greenwald, A., McGhee, D., and Schwartz, J.,
Greenwald, A., McGhee, D., and Schwartz, J., 1998. Measuring individual differences in implicit cognition: The
implicit Association Test. Journal of personality and social psychology, 74, 1464–1480.
Iacobucci, G. 2019. Campaign group urges GMC to support doctors taking direct action against climate change.
The BMJ [online]. Available from: https://www.bmj.com/content/366/bmj.l5785/related [Accessed 3 March
2020].
Kahneman, D., 2011. Thinking, fast and slow. New York: Farrar, Strauss and Giroux.
Kant, I., and Paton, H., 2009. Groundwork of the metaphysic of morals. New York: Harper Perennial Modern
Thought.
Lasagna, L. 1964. NOVA doctors’ diaries, the hippocratic oath: modern version PBS [online]. Pbs.org. Available
from: https://www.pbs.org/wgbh/nova/doctors/oath_modern.html [Accessed 3 March. 2020].
Legislation.gov.uk. 1858. Medical Act 1858 [online]. Available from: http://www.legislation.gov.uk/ukpga/Vict/
21-22/90/enacted [Accessed 3 Mar. 2020].
———.. 1978. The Medical Act 1978 (Commencement No.4) Order 1980 [online] Available from: http://www.
legislation.gov.uk/uksi/1980/1524/made [Accessed 3 March 2020].
Mahase, E., 2019. Doctors for Extinction Rebellion: new group fights for planetary and public health. BMJ,
365, l2364.
Moberly, T., 2019. Doctors join Extinction Rebellion demonstrations. BMJ, 367, l6037.
