Brexit: Doctors’ first duty in no-deal planning is to speak up about the risks to patients

Doctors have a duty to tell the public if a policy puts them at risk

Tomorrow, parliament returns from its summer recess. MPs will sit for a few short days before parliament is “prorogued”—which stops all business, including select committee meetings—for the longest period since 1945. Most commentators believe this is happening so that the government can avoid any scrutiny over Brexit, in order to either push through a “no-deal” Brexit, or to bully parliament into accepting a dreadful deal to avoid a no-deal.

The BMA has detailed the likely consequences of Brexit, in a series of Brexit briefings, most recently today [02 Sep 2019]. All of the briefings warn of the harm that Brexit could do.

BMA policy is to oppose Brexit in any form, because it is bad for patients, bad for the NHS, and catastrophic for public health. Crashing out of the EU without a deal multiplies the harm many times. 

Vast sums of public money have been spent on “no-deal Brexit planning”. A further £100m has just been announced for a public Get Ready for Brexit campaign. But no amount of no-deal planning will do any more than very slightly mitigate the immediate consequence, as a recent article in The BMJ concluded.

This supports our impression from involvement with emergency planning. Many doctors have been involved in no-deal planning. Our fear is that the message to the public of no-deal planning is “this is something we can plan for; and by planning for it, we can ensure it isn’t harmful.”  In our view, no deal planning is propaganda to make crashing out of the EU sound less damaging, and therefore makes this outcome more likely—with inevitable harm to the population.

No-deal planning will, at the very most, make a tiny difference to how bad the outcome of crashing out of the EU will be: it will still be catastrophic. 

To compare it to a medical intervention, it is like giving a treatment that has a small unknown chance of a tiny clinical benefit, and a big known chance of catastrophic effects. 

Given that no-deal Brexit planning makes a no-deal Brexit more likely, many doctors may consider it unethical for them to be involved in no-deal Brexit planning. Doctors should not put their jobs or careers at risk by refusing to undertake no-deal planning if instructed to do so by their employers; but they may choose to make it clear that they are participating under protest.

We understand that people participating in no-deal Brexit planning are frequently required to sign “non-disclosure agreements”. The purported reason for this is that it would scare the population if they knew how bad, and how impossible to adequately mitigate the consequences of a no-deal Brexit would be, which might give opponents of a no-deal Brexit further ammunition. 

Doctors may also be told, by their employers, that anything they learn through their employment is confidential, and may not be divulged to the public. A doctor’s first duty is to the population or patients they serve. It would be wrong to withhold from the public information that they need to know, and the BMA will continue to publicise the adverse effects where and when these affect patients and the health of the public. Doctors have a duty to blow the whistle when systems in hospitals are dangerous. We also have a duty to tell the public—as neurologist David Nicholl has done—if a policy puts them at risk, so that members of the public know about them and can choose whether to take action. Doctors involved in no-deal planning should explain this duty to their employers and to any partner organisations, seek assurances that any risks will be put into the public domain, and explain that if such risks are not made public, they will have a duty to do so which overrides any duty of confidentiality. That is their first duty if involved in no-deal Brexit planning.

Peter M B English, chair, BMA Public Health Medicine Committee. COIs: none declared. Twitter: @petermbenglish

Alan Woodall, Founder, GP Survival and GPC Wales member. COIs: none declared

Bharat Pankhania, senior clinical lecturer, University of Exeter, School of Medicine and Health. Member of BMA: Public Health Medicine Committee and BMA SW Regional Council. COIs: I am an elected Lib Dems Councillor for Bath and North East Somerset. Twitter: @DoctorShaib

Cristina Costache, BMA Council and BMA JDC Education & Training Subcommittee. COIs: none declared.

David Irwin, Public Health Physician, BMA member. COIs: none declared.

Emma Pearce, Chair, Public Health Medicine Registrar Subcommittee. COIs: none declared. Twitter: @empearce89

Mary McCarthy, Vice-President European Union of General Practitioners, BMA Council. COIs: none declared.

Mary E Black, Public health specialist, Senior Consultant and Technology Entrepreneur. COIs: none declared. Twitter: @DrMaryBlack

Kailash Chand, BMA council member, Former deputy chair BMA council. COIs: none declared. Twitter: @kailashchandobe

Lewis Morrison, chairman BMA Scotland, COIs: none declared.

Peter Curry, medical reviewer, Healthcare Improvement Scotland, Elected member of Scottish Council, UK Council and other BMA Committees. COIs: I take long term medication as a patient that is currently manufactured in Europe. My expression of support is personal and does not represent the views of my employer or the agreed views of any BMA Committee or Council of which I am a member.

Ben Rush, member of Public Health Medicine Committee. Twitter: @bazyr