The right to practice medicine without repercussions: ethical issues in times of political strife

Abstract

This commentary examines the incursion on the neutrality of medical personnel now taking place as part of the human rights crises in Bahrain and Syria, and the ethical dilemmas which these incursions place not only in front of physicians practicing in those nations, but in front of the international community as a whole.In Bahrain, physicians have recently received harsh prison terms, apparently for treating demonstrators who clashed with government forces. In Syria, physicians are under the same political pressure to avoid treating political demonstrators or to act as informants against their own patients, turning them in to government authorities. This pressure has been severe, to the point that some physicians have become complicit in the abuse of patients who were also political demonstrators.This paper posits that physicians in certain countries in the Middle East during the “Arab Spring,” specifically Syria and Bahrain, are being used as both political pawns and political weapons in clear violation of Geneva Convention and World Medical Association guidelines, and that this puts them into the most extreme sort of “dual loyalty” dilemma. They are being forced to choose between their own safety and well-being and that of their patients – a negative sum scenario wherein there is no optimal choice. As such, an international call for a United Nations inquiry must be made in order to protect the neutrality of medical care and personnel during times of armed conflict.

Perspectives on Rebuilding Health System Governance in Opposition-Controlled Syria: A Qualitative Study

“…13,18,21 Professionals often stay 24/7 in health facilities to respond to emergencies, causing high stress and burnout. 13,22,23 Financial incentives have largely disappeared as salaries are low and irregular. 13 Limitations are partly overcome by referring some cases to neighbouring countries.…”

Qualitative study exploring surgical team members' perception of patient safety in conflict-ridden Eastern Democratic Republic of Congo

“…HWs sustain socioeconomic losses during direct attacks. As reported in other conflicts, such as in Syria or Bahrain, physicians' neutrality is regularly threatened, 66 and interferes with patient–doctor relationship, preventing the trustful relationship needed for PS. 62 67 68 However, chronic conflict can also be a source of economic resources for health infrastructures and empowerment for HWs, as cited by some study participants who acknowledged the development of skills, resourcefulness and positive impact of aid on hospital resources and PS.…”

“…User fees limit health equity with only ≈4% of the Congolese budget allocated to health from 2006 to 2010 rendering donors' health expenditure of an estimated 300% of the national budget less than effective. 66 This context necessitates a health system approach such as community-based health insurances to overcome national governance disruption, and improve access to safe and equitable surgical and other aspects of healthcare. 79–81 Patients' remain silent about PS, and experienced AEs due to low educational level and cultural beliefs in disease causation.…”

Coercion in the service of society

“…Nürnberg-prosessene etter siste verdenskrig slo fast at ethvert menneske er ansvarlig for konsekvensene av sine egne handlinger (4). I dagens samfunn står kolleger i Syria overfor umenneskelige dilemmaer, der de må balansere ikke bare mellom egen overbevisning og myndighetenes krav, men der også egen helse og sikkerhet legges på vekten (5). Leger som selv deltar i krig, er samtidig forpliktet til å forholde seg til Genève-konvensjonene og menneskerettighetene (6).…”