Canadian doctors have been vocal on a wide range of public policy issues in recent years—from refugee health care to uranium mining to the tar sands, and some have paid a price for that advocacy.
Physicians have many roles. They are entrusted to help their patients stay healthy and to help them make informed decisions about their health when they are unwell. They are confidantes and healers in the office, and they advocate for their patients in many ways.
But do they have a role to advocate outside the four walls of the medical clinic? Should they be commenting publicly about peace, environmental and social justice issues? Or should they restrict their comments to “what they know best”—presumably, issues within the confines of their offices and looking after the medical needs of the citizens of the community.
There are numerous examples of physicians stepping outside their office roles and speaking out on environmental (and sometimes other very political) issues. Dr. John O’Connor, a family physician in Fort Chipewyan in Alberta (a small First Nations community of 1200 which is downwind and downstream from the oil sands), expressed concerns about the potential health effects of the oil industry. In 2006 he noticed a larger than expected rate of unusual cancers in his practice and was accused of misconduct by Health Canada and risked losing his medical licence. These accusations include blocking access to files, billing inconsistencies, and causing “undue alarm”. These allegations were all dropped after almost three years, however the message was clear to other physicians—don’t advocate for your patients and implicate the oil industry, or we will make your life miserable.
Some applaud Dr. O’Connor for speaking out on a health issue he saw that affected his patients. Some criticize him for involving himself in industry and politics, claiming he does not have expertise in these areas.
Another example of physicians advocating for their patients is the group of over twenty physicians in Sept-Īles, where there were plans for uranium exploration and mining close to the town. They threatened to quit en masse unless uranium exploration and mining were banned in the province, as they believed it was a threat to public health. The doctors, knowing the risks of ionizing radiation, and concerned about leaking tailings ponds and health effects, announced that they would all move away, leaving the town without medical services. The province acquiesced and the uranium exploration was put on hold.
Canada saw an unprecedented action from a large group of doctors in May of 2012 when they staged a National Day of Action to protest refugee health care cuts. Thirty doctors in Toronto crowded into the office of Conservative MP and federal cabinet minister Joe Oliver, and dozens more protested on Parliament Hill, all demanding reversal of the cuts. Another day of action is planned by Canadian Doctors for Refugee Care on June 16 this year involving protests by doctors all over the country.
Physicians for Global Survival (the Canadian branch of International Physicians for the Prevention of Nuclear War which won the Nobel Peace prize in 1985) is a Canadian physician group that advocates on all issues of global survival—conflicts around the globe, the threat of nuclear war, militarism, climate change, food security, human rights and many other issues that we may not consider “medical”. But surely dying in a war involves health. Dying of malaria, Lyme disease, heat stroke or in a flood, tornado or tsunami, or starving due to drought, all on the increase due to climate change, are health issues. Ultimately, are not all environmental, social justice, and war and peace issues health issues as well?
Those that criticize health professionals for stepping outside their area of expertise do not recognize that preventive medicine is the best medicine. These physicians are acting in their capacity as health experts to deal with the problems upstream, instead of doing damage control downstream, and patching up the issues without addressing the root cause—whether it be policies causing wars and conflict, environmental degradation or inequality, all of which affect health in a profound manner. Do we really still believe that we exist separately from the environment, and that addressing these issues is not paramount in preventing many of our health woes?
I think not. Many people laud physicians, other health professionals and scientists who speak out on these controversial political issues. According to the CanMEDS roles of Royal College of Physicians and Surgeons of Canada (encompassing six roles—scholar, professional, communicator, collaborator, manager and health advocate), physicians “have the responsibility to advocate public policy that promotes their patients’ health” and that physicians should “responsibly use their expertise and influence to advance the health and well-being of individual patients, communities and populations.” Therefore it is certainly a physician’s role and responsibility to advocate for patients and the community in whatever way is best for their health. This would mean speaking out when health is threatened even if it steps on the toes of politicians and industry representatives.
Arguably this is something that many physicians do not do, do not feel comfortable doing and many do not see as their role. However, there are physicians across the country who speak out publicly on many issues that are not strictly “medical,” conduct and publish research on controversial political topics, educate medical colleagues and the public on these issues and at times draw the ire of politicians and industry representatives that see these doctors as obstructing their goals. Some, such as Dr. O’Connor of Fort Chipewyan pay a hefty price for speaking out. These doctors believe that all issues of social justice, peace and the environment are health issues and therefore doctors have a role to play, and moreover they have a responsibility to act. Doctors’ criticism of industry may also be in conflict with local citizens if the industry provides jobs and livelihood to many people in the area. Many communities become divided because of this. However, it should not deter doctors from speaking out on health issues. Health, after all, is their area of expertise.
Physicians who use their credibility as health experts to comment on health issues caused by environmental degradation, war or social injustices, should be seen as workers doing their job, and recognized as having the courage and tenacity to speak out about these issues, not muzzled and criticized as was Dr. O’Connor. Whether it be approaching politicians to discuss important issues, writing letters to the editor, advocating for compensation for workers harmed by exposures while on the job (such as soldiers who develop cancer after exposure to depleted uranium or Agent Orange), protesting in public or just signing petitions on line, physicians have a role and a responsibility to advocate, not just for the health of their own patients but for the health and ensured survival of the planet.
Cathy Vakil MD, CCFP, FCFP is Assistant Professor, Department of Family Medicine, Queen’s University, Kingston, ON.
Find out more about Physicians for Global Survival at www.pgs.ca or by email at email@example.com.