{"id":2539,"date":"2013-07-26T16:16:27","date_gmt":"2013-07-26T15:16:27","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=2539"},"modified":"2013-07-26T19:16:44","modified_gmt":"2013-07-26T18:16:44","slug":"fitness-to-practise-revisited","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2013\/07\/26\/fitness-to-practise-revisited\/","title":{"rendered":"Fitness to Practise Revisited"},"content":{"rendered":"

***UPDATE: Important codicil at the end***<\/strong><\/p>\n

Back in March, I posted something<\/span><\/a><\/span><\/span> about what I took to be a slightly odd Fitness to Practise decision by the GMC in respect of one Mohammed Al-Byati.\u00a0 Via the BMJ<\/em>, here’s another case<\/span><\/a><\/span><\/span> that seems a bit strange:<\/p>\n

A doctor who abducted her six year old daughter from her estranged husband nearly two years ago and took her to Pakistan has been struck off by a panel of the Medical Practitioners Tribunal Service (MPTS).<\/p>\n

[…]<\/p>\n

The MPTS panel, sitting in Manchester, acknowledged that Dar\u2019s conduct did not relate to her medical practice<\/strong>.\u00a0 But panel chairman Michael Whitehouse said that misconduct could also involve conduct \u201cof a morally culpable or otherwise disgraceful kind,\u201d which could prejudice the reputation of the profession.<\/p>\n<\/blockquote>\n

The emphasis is mine, though it’s the stuff about the “reputation of the profession” that intrigues me.\u00a0 If Dar has breached a court order, or is a kidnapping suspect, then fine – but that’s a matter for the courts.\u00a0 She perhaps wouldn’t be able to practice if found guilty and imprisoned, but that’s a different matter. \u00a0It’s not obviously the GMC’s business.<\/p>\n

Now, sometimes a profession might have an interest in disciplining people who misuse their association with it.\u00a0 For example, the reputation of bankers or journalists may be tarnished by the things that some people do in their capacity\u00a0as bankers or journalists<\/em>.\u00a0 And there may, to that extent, be at least some limited warrant for a public perception that bankers or journalists are bastards.\u00a0 Limited, because the great majority probably aren’t and so we never hear about them, but there. \u00a0And so whatever the equivalent of the GMC for those professions is might be able to say that it has something to say on the matter.<\/p>\n

But in this case, Dar’s conduct seems to have nothing to do with her being a doctor (as the MPTS panel acknowledges).\u00a0 For this reason, it’s very hard to see what the rationale is for striking her off, beyond a public perception that is ex hypothesi<\/em> baseless.\u00a0 It’s hard to see that that should be determinative.<\/p>\n

Here’s what the GMC itself says<\/span><\/a><\/span><\/span> about such things:<\/p>\n

\n

[T]he public is entitled to expect that their doctor is fit to practise, and follows the GMC\u2019s principles of good practice described in Good m<\/em>edical practice<\/em>. This guidance sets out the standards of competence, care and conduct expected of doctors.<\/p>\n<\/blockquote>\n

The gloss on this is mostly to do with medics’ relationships with patients – which seems appropriate.\u00a0 The exception comes towars the bottom of the page, where it’s asserted that fitness to practise is likely to be questioned if a medic has<\/p>\n

behaved dishonestly, fraudulently or in a way designed to mislead or harm others [and t]he doctor\u2019s behaviour was such that public confidence in doctors generally might be undermined if the GMC did not take action<\/strong>.<\/p><\/blockquote>\n

Again, the emphasis is added.\u00a0 The worry here is that public confidence in doctors might justifiably be dented by some<\/em> behaviour – but the way seems to be open for the GMC to intervene if enough people were to tut, not so much because the tutting is warranted, as because there’s a lot of them.\u00a0 What’s been (allegedly) done is potentially less important than public reactions.<\/p>\n

It’s a strange thing.\u00a0 If someone could explain the public perception aspect, that’d be really appreciated.\u00a0 Do it well, and I’ll give you a guest post.\u00a0 Deal?<\/p>\n

Incidentally: the minutes of the March case are available online<\/span><\/a><\/span><\/span>; they’re rather strange.\u00a0 Pages 10 and 11 seem to me to be the important ones, and it’s worth quoting at length:<\/p>\n

\n

The Panel has noted the evidence of previous good character and that his clinical practice in the UK has not attracted criticism.\u00a0 There have been no concerns in relation to his conduct in the UK. \u00a0The Panel has read the positive testimonials presented on Dr Al-Byati\u2019s behalf.<\/p>\n

The Panel has noted that the facts found proved in Dr Al-Byati\u2019s case relate to his actions approximately 20 years ago.\u00a0 The Panel has borne in mind that there has been no suggestion that Dr Al-Byati has behaved in a similar way before or since. \u00a0The Panel was of the view that the risk of repetition in this case was negligible, as it is unlikely that Dr Al-Byati will find himself in similar circumstances in the future.<\/p>\n

Even having regard to these obvious mitigating factors, the Panel could not lose sight of the nature and gravity of Dr Al-Byati\u2019s misconduct.<\/p>\n

The Panel formed the view that the issue of remediation was of limited relevance in this case, as Dr Al-Byati\u2019s actions were a consequence of his completing his compulsory military service in the dictatorship of Saddam Hussein.<\/p>\n

The Panel has noted that Dr Al-Byati stated that, whilst he accepted that the treatment of prisoners during Saddam\u2019s regime was deplorable, his own conduct was not of a morally culpable or otherwise disgraceful kind, as, in general terms, he was obeying obey orders in a \u2018do or die\u2019 situation.\u00a0 The Panel\u00a0acknowledged that Dr Al-Byati was a junior doctor whose behaviour was being controlled by a dictatorial, totalitarian regime which used systematic, widespread and extremely grave violations of human rights to control the population.<\/p>\n<\/blockquote>\n

So far so good.\u00a0 But then…<\/p>\n

\n

The Panel is concerned that Dr Al-Byati has not shown greater remorse for his actions, or more insight into the gravity of his own acts, but rather appears to be focussed on the position in which he found himself in Iraq.\u00a0 The Panel also considers that his comments demonstrate a lack of understanding into the role of this Panel, which includes its primary responsibility to protect the public interest, in all regards.<\/p>\n

In summary, the Panel has concluded that Dr Al-Byati\u2019s actions, in relation to his involvement in the regime in Iraq between 1992 and 1994, put some of his patients at risk of further harm, have brought the profession into disrepute, and that he has breached a fundamental tenet of the profession, namely his failure to ensure that the welfare of his patients was his first concern.<\/p>\n<\/blockquote>\n

I’m going to assume that the patients put at risk of further harm were the prisoners he treated – in which case my question from March stands: would walking away and leaving them untreated, even if that hadn’t involved putting himself at risk, really have been preferable?\u00a0 Even if were preferable, is it worth disciplinary action that the less-desirable option was chosen?<\/p>\n

And what has a failure to understand the role of the Panel to do with anything?\u00a0 Is that itself culpable?<\/p>\n

But most perplexing is the point about a lack of remorse.\u00a0 If it’s true that Al-Byadi really could not have done anything other than what he did\u00a0– a thesis that seems not to be unreasonable – then it’s not at all clear why he should<\/em> have shown remorse.\u00a0 If ought<\/em> implies can<\/em>, then cannot<\/em> implies not-ought<\/em> – and the idea that one should show remorse for not having done something that is not morally required is difficult to understand… unless the Panel is in the business of disciplining people for not going through the requisite emotional motions.<\/p>\n

\n

UPDATE, 26.vii, 19:15:<\/b>\u00a0Someone who knows more about these things than I has asked me to make clear the distinction\u00a0between the GMC (the regulator, acting as “prosecutor’ in FtP cases) and the MPTS (the quasi-independent tribunal service that runs the panels and hearings). “It is a relatively new separation,” says my correspondent, “but a crucial one in this type of case, in particular as the GMC is currently seeking a legislative change to allow it to appeal MPTS panel rulings where it disagrees with the outcome.”
\nHappy to oblige.<\/p>\n

<\/p>\n","protected":false},"excerpt":{"rendered":"

***UPDATE: Important codicil at the end*** Back in March, I posted something about what I took to be a slightly odd Fitness to Practise decision by the GMC in respect of one Mohammed Al-Byati.\u00a0 Via the BMJ, here’s another case that seems a bit strange: A doctor who abducted her six year old daughter from […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[575,968,2146,511,472],"tags":[],"class_list":["post-2539","post","type-post","status-publish","format-standard","hentry","category-bmj","category-clinical-ethics","category-in-the-courts","category-in-the-news","category-thinking-aloud"],"yoast_head":"\nFitness to Practise Revisited - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2013\/07\/26\/fitness-to-practise-revisited\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Fitness to Practise Revisited - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"***UPDATE: Important codicil at the end*** Back in March, I posted something about what I took to be a slightly odd Fitness to Practise decision by the GMC in respect of one Mohammed Al-Byati.\u00a0 Via the BMJ, here’s another case that seems a bit strange: A doctor who abducted her six year old daughter from [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/medical-ethics\/2013\/07\/26\/fitness-to-practise-revisited\/\" \/>\n<meta property=\"og:site_name\" content=\"Journal of Medical Ethics blog\" \/>\n<meta property=\"article:published_time\" content=\"2013-07-26T15:16:27+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2013-07-26T18:16:44+00:00\" \/>\n<meta name=\"author\" content=\"BMJ\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"BMJ\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"6 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2013\\\/07\\\/26\\\/fitness-to-practise-revisited\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2013\\\/07\\\/26\\\/fitness-to-practise-revisited\\\/\"},\"author\":{\"name\":\"BMJ\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\"},\"headline\":\"Fitness to Practise Revisited\",\"datePublished\":\"2013-07-26T15:16:27+00:00\",\"dateModified\":\"2013-07-26T18:16:44+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2013\\\/07\\\/26\\\/fitness-to-practise-revisited\\\/\"},\"wordCount\":1316,\"commentCount\":1,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#organization\"},\"articleSection\":[\"BMJ\",\"clinical ethics\",\"In the Courts\",\"In the News\",\"Thinking Aloud\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2013\\\/07\\\/26\\\/fitness-to-practise-revisited\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2013\\\/07\\\/26\\\/fitness-to-practise-revisited\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2013\\\/07\\\/26\\\/fitness-to-practise-revisited\\\/\",\"name\":\"Fitness to Practise Revisited - 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