Recently the code of practice of doctors proposed to restrict freedom of speech for doctors. Of course, such terms were not directly used in the proposition of the code, but in the newly introduced section of professionalism it stated that:
“Community trust in the medical profession is essential. Every doctor has a responsibility to behave ethically to justify this trust. The boundary between a doctor’s personal and public profile can be blurred. As a doctor, you need to acknowledge and consider the effect of your comments and actions outside work, including online, on your professional standing and on the reputation of the profession. If making public comment, you should acknowledge the profession’s generally accepted views and indicate when your personal opinion differs. Behaviour which could undermine community trust in the profession is at odds with good medical practice and may be considered unprofessional”
Where are the limitations in such a statement? And when is that possible, on twitter?!
When say, on twitter when discussing politics, or the finer principles of knitting or ironing – or football – can we deliver the professions ‘generally accepted views’, and, why should we?
Who gets to determine the professions ‘generally accepted views’? And who should?
And since when does having a medical degree mean that you are no longer allowed to contribute to or participate in public debate unless it is ‘profession sanctified and sanctioned’?
Are we to now as professionals seek written permission from the board for any opinions that we have and espouse in public? On any topic? This is madness! And this is exactly what the wording of this section entails.
Freedom of speech is a fundamental human right that is available to everyone, and it is there for a reason.
Suppression of the free discussion of ideas, has been associated with every dark age where those in power sought to impose their beliefs and ideals on the public. The ages of the Catholic Inquisition is a case in point where those in the church sought to impose their belief system on the public ‘in their own good’ and ‘in the public interest’. Their use of torture and suppression and public murder is legendary, and their actions brought about control through fear.
We do not have public immolations and no actual torture rooms any more, but what we do have in society and what we see applied to our profession is fundamental suppression of true freedom of speech.
Freedom of speech is NOT freedom to abuse, demean, lie about or vilify another anymore than freedom to move means freedom to hit, accost, assault rape or murder anyone you like.
Freedom of speech is the freedom to espouse an idea, an opinion in respectful dialogue. This allows the fostering of an open culture of discussion which can lead to the discovery of a deeper truth collectively.
Suppression of the speech and opinion of anyone through any means, such as proposed by the board, does not foster this culture and instead fosters the beliefs of a minority who hold power over the masses. And this is exactly what the upholding of fundamental human rights is for. To uphold the dignity of each individual for the benefit of the all.
Doctors are people too. We are deserving of the same fundamental human rights as everyone. Are we not?!
If we are to have a code of conduct which suppresses our public expression, then our fundamental human rights are being violated.
It is utterly outrageous that there can be a situation where because of the publication of an opinion that a doctor can be called before the board for ‘bringing the profession into disrepute’ or being ‘unprofessional’.
Recently a woman lost her job with the Cricket Board of Australia for having an opinion on abortion and daring to be public with it. Wow. I don’t know what is more shocking – the fact that she dared as a woman to have an opinion on abortion *eye rolling*, or, losing her job for it.
Recently a doctor was also called to answer to the medical board for apparently 2 tweets. I mean. Seriously.
Where does this end? And what does this make of us as a society? Certainly, not an Enlightened one. One that is fearful of ideas and opinions, not lies.
Are we to accept this? And partake of this as a profession?
If people are abusive towards others, harass others and behave in a manner of conduct that is not decent, then yes those are standards of behaviour that need addressing, but not by an inquisition.
The terms of the current code of conduct as proposed are sufficiently loose to allow anyone with an opinion that is different from anyone in a position of power in the medical board or AHPRA to be brought before the board for what is effectively an inquisition and a consideration as to whether they have brought the profession into disrepute. This is extreme. And a vast waste of resources. There are frankly bigger issues that the medical board can be spending their time with rather than policing the opinions of members of the profession via tribunal. Imagine the cases that they are going to be taking years to assess. We all know how long it takes for ‘an investigation to be done’. Imagine taking 2 years to investigate one tweet….. I mean, seriously. Its beyond ridiculous and we need to see it as such. I mean, will I be ‘investigated’ for publishing this blog?! Will others? Dare we speak? Having an opinion that is not that of the board and thus being ‘unprofessional’?! That is absurd!! (**disclaimer ** on that note, to be clear, for all who are reading, I here state that my opinions on freedom of speech are clearly not that of the medical board. They may possibly be the generally held opinions of the profession but it’s hard to say, because I haven’t spoken to everyone in the profession, yet. There are quite a few of us. Just sayin’, you know, to be clear, that because I have a title of doctor, I may or may not be representing the silent views of those in the profession. Please let me know when a poll is done so I can update my disclaimer, thank you)
Freedom of expression within medicine is just as vital in medicine as it is outside of medicine.
Advances in medical understanding have come from those who have challenged the status quo. Think Semelweiss who discovered that lack of handwashing by doctors caused post puerperal death. He was hounded in his day and only later was it found out that he was correct. Think of those who discovered that stomach ulcers were caused by a bacterium: they were ruthlessly hounded and under current code provisions could easily have been prosecuted for ‘bringing the profession into disrepute’ by those who opposed them and for being ‘unprofessional’ for making their view public that were ‘not the profession’s generally accepted views’. These people and many others had ideas which changed medical understanding for the good. Were Marshall to have been silenced we would not have revolutionised the treatment of peptic ulcer.
If we have in place such restrictions as the board are proposing with ‘good intentions’ we will have a situation where freedom of ideas will be prohibited and those publicly challenging the status quo are at risk of being brought before the board for daring to have ideas which differ with those of the so called ‘ruling elite’.
Freedom of speech exists exactly such that the ruling elite can be challenged.
Progress comes from challenging the status quo not blindly adhering to it.
We cannot assume that that which we hold true today will be true tomorrow. Why persecute those for challenging something that we are told is the norm when the very act of challenging it may bring about the needed change that is truly in the greater good?
Even if they are wrong, there is nothing wrong with debate and discussion. Discussion which doesn’t seek to defend a particular viewpoint but seeks to further expand collective understanding.
We are on a slippery slope as a profession when we allow terms in our very code of practice that infringe on true freedom of speech and ideas.
As a profession we are a group of people, not just ‘doctors’ and we too are equally part of society and thus are deserving of freedom of speech. We need such measures to be utterly honoured in our codes of conduct and our daily practice. Our wellbeing, and the wellbeing of the public depend on this.
What’s your opinion on this?
Dr Maxine Szramka is a Rheumatologist in Sydney active in professional affairs, advocating for the health and well-being of the medical profession and for health care reform.