12 months on (July 2023) and the Robodebt Royal Commission reminds us why supporting free speech for registered health practitioners in Australia is an important counterbalance to government comms
Over 1,600 concerned people co-signed within a few days of this letter being released.
14th July 2022
The Hon. Mark Butler Minister for Health, firstname.lastname@example.org
The Hon. Brad Hazzard Minister for Health, New South Wales, email@example.com
The Hon. Yvette D’Ath Minister for Health, Queensland, firstname.lastname@example.org
The Hon. Chris Picton Minister for Health, South Australia, email@example.com
The Hon. Jeremy Rockliffe Minister for Health, Tasmania, firstname.lastname@example.org
The Hon. Mary-Anne Thomas Minister for Health, Victoria, email@example.com
The Hon. Amber-Jade Sanderson Minister for Health, Western Australia, Minister.Sanderson@dpc.wa.gov.au
The Hon. Rachel Stephen-Smith MLA Minister for Health , Australian Capital Territory
The Hon. Natasha Fyles Minister for Health, Northern Territory
Re Ahpra’s approach to advocacy by doctors, an open letter.
We, the undersigned, being concerned scientists, doctors and citizens of various diverse professional expertise, with a common interest in humanity and the reduction of suffering, disability and death caused by COVID-19, note with concern that Dr David Berger has a public condition placed upon his medical registration.
He is reportedly required to attend education “in relation to behaving professionally and courteously to colleagues and other practitioners”, apparently as a result of a complaint about his effective, scientifically valid and good faith COVID-19 advocacy in the best interests of Australian people.
We would not wish news of this condition placed upon him to be heard without
- reference: to his clear, honest sustained contribution to public health through his personal and corporate advocacy and his unblemished clinical record, working in remote hardship locations, often with indigenous peoples.
- context: that the public health approaches which he has questioned are a legitimate subject of debate in Australia and around the world, and thus remain worthy of being discussed critically despite their implementation by governments.
- consideration: of the effect that such a condition may have on his future good work as an advocate and that of legion other registrants, who may be deterred from speaking truth to power as a result of such action which could have a chilling effect on open political and scientific discussion.
- understanding: that it is critically important for the safety of patients that we speak openly about scientific and clinical matters, and to be polite where possible, but assertive and determined when a message for safety is being ignored by officials or politicians in charge of a health system. The Ahpra policy assumes government policy is always in the best interests of the people of Australia, and that doctors must be subservient to the State over their concerns for patients. This is in breach of our ethical and moral obligations outlined in, for example, the Declaration of Geneva. Governments may formulate public health policies that are not in the best interests of the community, and dissenting doctors may take a position that is for the better interest of population health.
Dr Berger is representative of all of us who take time to think, to care, and to comment in our own diverse way on how to make the public safer, especially to amplify those vulnerable groups such as the very old, very young, or very sick who may not have the resource to be heard. Current public health settings are not infallible, as evidenced by their constant adjustment and wide variation between jurisdictions. The “best available advice” is not always that from government advisors, who by definition are limited in number, diversity and expertise. Even when we might agree with all that these advisors say, it may well not be translated accurately and openly into policy by those in power. The wording of the Ahpra policy on social media is so broad as to potentially permit discretionary outcomes. It could be interpreted one way to target some doctors who do not have support of government, and another to allow other doctors who are government spokespersons to behave as they wish on social media, simply because their views accord with the administration.
We are concerned about the potential for Ahpra to lose its focus on patient safety and become a means to persecute doctors and other registrants for political reasons, in the name of maintaining confidence in public health measures. In fact, it may have the opposite effect if the community distrust a regime that silences medical dissent this way. If the open discussion of public health settings by registered practitioners is stifled by authoritarian implementation of regulation, leaving the rest of the community to discuss these issues without alternative ideas from those who have the best understanding of disease, that will not benefit anyone. Australia must not be a country where reputable scientists and clinicians cannot speak for the public good because they fear reprisal from their government regulator. We stand with David Berger and specifically reject any suggestion that in a democracy we must politely agree with government policy, or stay silent.
We respectfully request the following urgent actions by Health Ministers:
- An independent audit of Ahpra’s handling of social media and public advocacy complaints, focusing on parity of responses and a comparison of complaints that were and were not actioned, and which ones did and did not result in conditions being placed on registrants. The audit should reveal whether the policy is applied consistently.
- We request revocation of the conditions placed on Dr Berger on the basis that it is unreasonable to expect all registrants to always support government public health settings, and to be restricted in their tone of communication by a regulator.
- The 2021 changes to policy that now enable Ahpra to punish doctors for speaking out should be urgently reviewed, along with the remit of Ahpra as a blanket defender of government health policy.
- Removal of the cloak of anonymity from Ahpra complaints where the matter relates to public advocacy rather than clinical practice.
- A statement affirming freedom of speech for doctors, in the public interest, and confirmation that expressing a difference of opinion with government policy does not in itself constitute a breach of Ahpra’s Good Medical Practice Code.
Yours in our private capacities,
Dr Andrew Miller
Professor Raina Macintyre
Professor Kerryn Phelps AM
Distinguished Professor Lidia Morawska
Dr Karina Powers
Ms Anna Davidson
Dr Alan McLean
Dr Lisa Jackson-Pulver AM
A/Professor Donna Green
Scientia Professor Guy Marks AO
Dr Thomas Solano
Professor Geoff Hanmer
Dr Katharine McAlpine
Mrs Kate Cole OAM
Professor Lisa Maher AM
A/Professor Craig Underhill
A/Professor Nada Hamad
Associate Professor David Caldicott
all via firstname.lastname@example.org
and those in accord who subsequently append their signature in agreement online at speakupdoc.com
Signed in support also by:
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