By Rammina Yassaie.
On 7 January this year, Bristol GP Patrick Hart, was jailed for 12 months for damaging petrol pump screens, which he describes as “an act of care” in protest against continued fossil fuel extraction; the environmental consequences of which are considered to be the greatest health threat of the 21st century.
Hart’s prison sentence was handed down in the same week the world looked on in horror at apocalyptic scenes of uncontrollable fires in California, which were undoubtedly exacerbated by climate change. As a result of his custodial sentence, Hart may become the first practicing doctor convicted for climate protest related offences to face suspension by the General Medical Council. Two clinically retired doctors, Sarah Benn and Diana Warner, have already been suspended.
The GMC’s primary duties are to protect and promote the health and wellbeing of the public, whilst maintaining confidence and trust in the medical profession and upholding standards of practice.
Maintaining confidence and trust
The decision to suspend Benn and Warner has largely hinged on the assumption that their actions may impact confidence and trust in the profession. For Hart, this unevidenced assumption could cost him his livelihood as a doctor.
Is it not right that the burden of proof ought to lie with the GMC to prove that such actions do in fact hinder public trust, rather than relying on speculation about how the public may or may not react?
And is it really true that trust in the profession would falter as a result of doctors acting in good faith, undertaking nonviolent direct action to sound the alarm on the threats of climate change to health?
Notably, the GMC’s own research commissioned in 2019 found the public have “relaxed” views about criminal acts if undertaken in a non-work context. More specifically, that the GMC should base its regulatory response on whether: the behaviour impacts the doctor’s clinical ability to practice safely; the doctor behaved dishonestly; and/or whether a pattern of behaviour exists.
It cannot reasonably be argued that climate protest impacts one’s ability to practice medicine safely, and as with Benn and Warner, Hart has been consistently honest with the regulator and others, about his actions to date. The GMC expects these activists to express remorse for their actions, which none, including Hart, feel morally able to do. Surely their refusal to demonstrate remorse for their actions only reinforces their honesty and integrity as if they were to change their behaviours (which they have argued to be based on conscience), due to the personal and professional consequences they have faced – the public may, in fact, look down on that.
More recent evidence also falls in favour of these doctors, rather than against them. This includes a public petition (with rising signatures) demanding they receive job protection, an open letter from health, law and scientific communities calling on the GMC to reverse the existing suspensions, along with a (soon-to-be published) survey exploring public attitudes on this topic. This, along with supportive statements from the British Medical Association and the UK Health Alliance on Climate Change, who represent over 1 million health professionals, powerfully challenge the GMC’s position that these actions are viewed as “deplorable” by patients and peers.
Upholding standards
Good Medical Practice sets out the standards of professional behaviours expected by UK doctors. While the latest standards do state that doctors “must follow the law”, they also state that doctors “must act promptly if you think patient safety is, or may be seriously compromised” which these activists would argue they are doing.
The complexities of following potentially conflicting standards are acknowledged within the document itself, with a clear admission that Good Medical Practice is not a set of rules. Rather, that doctors should use their “professional judgement” to apply the standards and, notably, that if doctors “act in good faith and in the interests of patients, you’ll be able to explain and justify your decisions and actions”.
Yet, in reality, the GMC do not appear concerned with these doctors’ justifications or motivations for their actions and instead seem fixated on whether their actions broke the law. I have already argued why this position is problematic in a ‘head-to-head’ with the GMC themselves.
With the GMC positioned as an ethical compass, it is concerning that they appear to be overlooking their own commissioned research, and the wording within the standards they have produced themselves.
Promoting and protecting public health
Crucially, the GMC hold a duty to promote and protect public health, yet they themselves have been slow to act on the climate emergency; having been criticised for failing to embed environmental sustainability more meaningfully into Good Medical Practice, and for being slow to divest from fossil fuels. Most concernedly, their failure to truly appreciate the climate crisis as a health emergency, is clear by their painting of climate activists as basing their actions on ‘personal opinion’ rather than on evidenced-based facts.
With climate breakdown looming and rises in global temperatures already surpassing safe levels, the health consequences of this escalating crisis are clear to anyone who has been paying attention.
Thankfully, Hart’s case provides the GMC with an opportune moment to re-evaluate its position on the climate emergency along with its treatment of whistleblowing climate protesters.
To suspend a practicing GP who cares so deeply about patient health that he is willing to risk his own personal and professional freedoms to sound the alarm on the grave threats to public health would help no one, whilst harming everyone.
It would also demonstrate a profound failure by the GMC to meet its own primary duties which are in service to the patients it exists to protect.
Author: Rammina Yassaie
Affiliations: Medical Doctor and Senior Lecturer in Leadership, Sheffield Hallam University
Competing interests: None declared