Doctors and civil disobedience

Abstract

Civil disobedience—a public, non-violent action in breach of the law aimed at changing the law or policies of a government—is not a typical tool of the medical trade. But frustration with inaction on the global climate emergency has galvanised doctors and other health professionals to join public protests, some of which have involved breaking the law, thus incurring considerable personal and professional risk. Robin Stott, in an Essay this week, describes his experience of arrest during an Extinction Rebellion protest in London, highlighting how a duty of care can compel one to act disobediently in the clear interest of public health. On this basis, institutions and the public should firmly support the right of health professionals to participate in climate action and to be protected from censure by medical colleges or licensing bodies if such civil action results in arrest or charge. For individual health professionals considering civil disobedience, much needs to be weighed. In a Viewpoint this week, Hayley Bennett and colleagues provide a framework to guide such decisions. Their criteria emphasise the importance of the situation being unjust and a risk to health, and that the action should be a last resort, with a good chance of being effective, and involve minimal harm. Historical examples show how civil disobedience can be successful. But is not without risk to careers and reputations. Health professionals have occupied government buildings to protest nuclear armament and secure patient access to HIV medicines; provided illegal needle exchanges to protect drug users; and defied border security laws by obstructing the detention of asylum seekers. In each case, ethical responsibilities outweighed legal duties, and civil disobedience became a justified means to secure the necessary health action. But what are the red lines for health professionals? Civil disobedience must be strictly non-violent with no harm to other people. And it must be public, fully using the stature and the voice of the health professional to bring attention to and press action for improved health, equity, and human rights. Civil disobedience can be a legitimate health-care practice, and it must be supported. Should health professionals participate in civil disobedience in response to the climate change health emergency?Climate change is a global health emergency and a growing ethical crisis,1,2 and well planned climate action brings opportunities to improve health, equity, and human rights.3–7 In the face of continued inaction, citizens are turning to civil disobedience to persuade governments to act more urgently.8 Civil disobedience is public, non-violent action in breach of the law, which is aimed at changing the law or policies of the government. Such action is an act of conscience, and participants accept possible punishment. Full-Text PDF My arrest in support of Extinction Rebellion: the imperative for actionParliament Square on Oct 31, 2018, was unexpectedly crowded. Together with Charlie Parselle, a lawyer I met on the first day at our secondary school in 1955, I had been pushing for action on global heating for 30 years. Despite the efforts of numerous agencies and individuals, we have seen science ignored and ecological devastation proceed apace. Politicians, in thrall to vested interest, seemed incapable of implementing the requisite transformational action, instead persuading their electorates that growth at all costs is imperative. Full-Text PDF