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Doctors and Civil Disobedience

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.