Upholding the Honour and Integrity of the Medical Profession For the Future of Medicine
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Upholding the Honour and Integrity of the Medical Profession
For the Future of Medicine – Reflections on 56 years
My Colours to the Mast. Will you join me?
The Passion of Medicine.
Which was it?
the thrill of the chase of the elusive diagnosis?
the triumph of solving the puzzle?
the entrée into people’s lives?
the adventure of saving life?
the awe, excitement and responsibility of the birth?
the presence during the last illness?
The passion was the privilege of being there…
And, re transgenders, if we have not even queried whether there are possible contributing factors or stressors in children wishing to transgender – such querying itself labelled as abuse by those who insist on affirming the wish – then we have failed our ethical and professional responsibilities as doctors, and our duty as community leaders and parents.
We have failed the child and we have failed the community. We have failed medicine.
Lachlan Dunjey, December 2020
thinker/student/teacher/general practitioner/advocate/defender/child of God
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The Essential Heart of Medicine
The Heart of Medicine is for good health outcomes working in cooperation with our patients.
To maintain health, to restore health, to heal.
To cure sometimes, to comfort always, to relieve distress until the final breath.
To practice in conscience with compassion.
To ease the way, but never to intentionally kill.
To heal on request even if government forbids it.
To refuse “treatments” and procedures even when government compels it.
Working with our healthcare colleagues in a spirit of collegiality and loyalty, but not at the expense of truth.
To seek, and to speak for, the future of medicine especially in ethical standards and the doctor-patient relationship, being aware of the lessons of history, with active engagement depending on the opportunity. Understanding that it is not enough to evaluate medical or surgical options while ignoring the merits of the purpose for which those techniques are being discussed. Understanding also that there will be ethical divides when it becomes essential for medicine to be decisive and authoritative, when there is no neutral.
To promote physical and mental health in community, helping the disadvantaged, and promoting a global consciousness with respect to all who are at risk. It is also to warn of risk to health of family and community and to engage in such action as is necessary to counter those risks both within Medicine and in Government.
The heart of Medicine demands of its practitioner skill, knowledge, sensitivity, respect for people and their backgrounds to ensure good health outcomes. It involves understanding, assessing what is happening and what is needed, education and explanation, and working respectfully with the patient to ensure the best possible good health outcome.
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November 2020. Condensed from The Heart of Medicine
https://blog.canberradeclaration.org.au/2020/02/14/the-heart-of-medicine/
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The Christian Ethic in Medicine – Loving my Neighbour
I am a doctor. I will use my expertise to heal and to help impartially, regardless of who you are, what you have done, what you do and what you believe.
I do not and will not discriminate.
What I believe does not impede my ability and desire to help.
I may disagree with various aspects of behaviour – particularly involving those that impede or sabotage your own health and that are significant in terms of public health – but that does not impede my ability and desire to help.
You may choose not to be treated by me but that should not and does not mean that I am “not fit” to treat others. That is discriminating against me.
But I will not discriminate against you.
Throughout history it has been the Christian worker that has gone into the epidemic, into the jungle and cannibal tribes, into the refuse pit. Yes, of course there have been others – not necessarily “Christian” – with a deep consciousness of moral truth and eternal values that have done likewise.
How dare you discriminate against my ability to heal by trying to exclude me from my practice of medicine just because you disagree with my belief.
(To the neighbour who objects to me being a doctor simply for what I believe is eternal truth.)
Lachlan Dunjey 24 November 2020
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Appendices:
https://treaties.un.org/doc/publication/unts/volume%20999/volume-999-i-14668-english.pdf International Covenant on Civil and Political Rights (ICCPR) Part 2 Article 3
- Each State Party to the present Covenant undertakes:
(a) To ensure that any person whose rights or freedoms as herein recognized are violated shall have an effective remedy, notwithstanding that the violation has been committed by persons acting in an official capacity;
(b) To ensure that any person claiming such a remedy shall have his right thereto determined by competent judicial, administrative or legislative authorities, or by any other competent authority provided for by the legal system of the State, and to develop the possibilities of judicial remedy;
(c) To ensure that the competent authorities shall enforce such remedies when granted.
See also Rodney Stark’s provocative book For the Glory of God: How Monotheism Led to Reformations, Science, Witch-Hunts, and the End of Slavery in which he argues that, whether we like it or not, people acting for the glory of God have formed our modern culture.
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The Strange Case of Dr Jereth Kok and the Over-reach of the Medical Board of Australia
Dr Jereth Kok
Fact: Dr Kok, a competent GP of 15 years well-respected by his patients, posted comments on social media and at least one article in a Christian newspaper re ethical matters he felt strongly about.
Fact: in August 2019, as a result of a complaint, Dr Kok was suspended from practice under “emergency powers”[1] by the MBA because of these “damaging” statements that might cause patients to lose confidence in the medical profession.
Fact: Dr Kok offered to remove the posts in question but this offer was ignored. It is on record that the current chair of MBA has said that intervention “would require somebody to be unresponsive to requests to take things down”. This did not happen despite Dr Kok’s offer.
Fact: Dr Kok’s explanation of his posts was not listened to and an appeal went through to the Victorian Civil and Administrative Tribunal (VCAT) which stated that the MBA had acted within the rules.
How should this have been handled? Firstly by “the old boy network”[2]. A “talking to”, a metaphorical “rap over the knuckles”, to not post comments that might be regarded by some as “damaging to the profession”.
The MBA’s problem with Dr Kok is that his public stand – as limited as it was – could cause patients to lose confidence in the medical profession. Dr Kok is still under suspension at this time.
Medical Board of Australia
Fact: in October 2018 the MBA released a draft Code of Conduct (COC) for medical doctors for comment.
Fact: this draft COC contained various aspects of medical practice that were considered to be an interference with the practice of good medicine. In short, it was considered by doctors of good standing to be dishonouring to the practice of medicine, even “Orwellian”.
Fact: the draft COC attracted a lot of negative submissions from well-respected doctors across Australia.
Fact: The MBA released a new COC effective from 1 October 2020 having listened to the feedback and removed most of the dishonourable material[3].
A good result but concerns remain – including how the draft code could have been so bad and by what influences.
The MBA has made itself irrelevant in any sense of being an ethical code of conduct.
If such was known more widely it could also have caused loss of confidence in the medical profession as well as the medical profession having lost confidence in the MBA.
In contrast to Dr Kok, the MBA has suffered no penalty and was able to remove the offending material. But for many doctors it will be a long time before confidence in the MBA is restored
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[1] Section 156(1)e of the National Law when the example given relates to a serious criminal offence
(e) the National Board reasonably believes the action is otherwise in the public interest.
Example of when action may be taken in the public interest—
A registered health practitioner is charged with a serious criminal offence, unrelated to the practitioner’s practice, for which immediate action is required to be taken to maintain public confidence in the provision of services by health practitioners.
[2] My experience in complaint resolution is extensive, including 15 yrs of AMA(WA) Colleague of First Contact (now DHAS).
[3] dishonourable material “Medically irrelevant grounds including… gender identity, sexual orientation”
“culturally safe and respectful practice” (not necessarily equating to medically safe)
“only the patient and/or their family can determine whether or not care is culturally safe and respectful”
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Combatting the (transgender) madness. Thoughts at 3am.
The time for politeness on this issue has passed. Biologists and medical professionals need to stand up for the empirical reality of biological sex. When authoritative scientific institutions ignore or deny empirical fact in the name of social accommodation, it is an egregious betrayal to the scientific community they represent. It undermines public trust in science, and it is dangerously harmful to those most vulnerable. Colin Wright and Emma Hilton
We will fight in the kindys, we will fight in the pre-schools, we will fight in the schools and in the curriculum departments. We will fight in the teacher colleges and universities. We will fight in the school literature and in TV production lines, in the movie studios, in Disney Productions. We will fight in athletics and sport. We will fight in every aspect of media that we can access.
We will fight for the intellectual and emotional health of our children and grandchildren.
We will fight in the libraries that allow transvestites to read to our children.
We will fight to promote the healthy aspects of being created male and female.
We will fight for the normal expression of sexual relationships and in particular for monogamy and commitment so well expressed in marriage.
We will fight in our churches and Sunday Schools for Creation teaching. We will not hesitate to teach Creation ordinances out of misplaced respect for the unknown who walk in – we will welcome him or her and surround them with love.
We will fight the insidious propaganda of “only you can tell whether you are a boy or a girl” and “you mustn’t ask what sex the newborn baby is”.
We will fight in the tribunals, and in the courts. We will fight for law that upholds biological truth.
We will fight in our parliaments.
We will fight at election time. As Christians we will fight for a public voice. We will teach our people preferential voting.
We will fight for good science. The time for politeness on this issue has passed.
Even though legislation has gone against us in several states we shall not flag or fail. We shall go on to the end. We shall fight in our courts and in our legislatures, we shall defend the truth, whatever the cost may be. We shall fight in our schools and in our universities, we shall fight for truth around the kitchen table. We shall fight on the beaches, we shall fight in the fields and in the streets, we shall fight in the hills; we shall never surrender.
Lachlan Dunjey. 23 Sept 2020.
(inspired by Sir Winston Churchill: We shall fight on the beaches)
http://www.chooselifeaustralia.org.au/life/combatting-the-transgender-madness/
https://blog.canberradeclaration.org.au/2020/10/23/combatting-the-transgender-madness/
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What is child abuse? the polarisation of medicine and medical defence organisations.
The mutually exclusive “affirming” pathways for children wishing to transgender represent a clear ethical divide in which it is essential for medicine, not activists and not governments, to be decisive and authoritative. There is no neutral.
It is inevitable that at some point there will be consumer legal action for either affirming OR failing to affirm.
Who will decide? Will it be doctors, psychologists or the lawmakers? If doctors, then will it be the psychiatrists or paediatricians who tend to have opposing views? Associations of paediatricians hold very definite opposing views.
Which side of the polarity regarding child abuse will Medical Defence Organisations defend? If they defend surgeons who do transgender mastectomy for a 25 yr-old on the grounds that fully informed consent was given, will they also defend surgeons who have done the same procedure for a 13 yr-old who decides to sue when an adult?
Further, will MDOs defend the surgeon who refuses to do a mastectomy for a 13 yr-old?
And how will MDOs decide? Will different MDOs have different approaches to these matters because their boards have been taken over by people with set ideologies?
Will MDOs simply side with what is legal – if governments declare that affirmation of birth sex or reversal counselling is child abuse and punishable by law?
For the sake of our MDO insurance premiums we need decisions now, rather than a decade from now. It is to be hoped that MDOs will continue their honourable, professional status and be much more than just another insurance company.
This is a clear ethical divide in which it is essential for medicine, not activists and not governments, to be decisive and authoritative. There is no neutral.
A note re affirmation of feelings unsupported by evidence.
“Yes, you must affirm the feelings – progress is not possible unless you do.”
“The evidence doesn’t have to support the feeling – it doesn’t have to be totally true.”
Déjà vu?
Consider “recovered memories syndrome”. After attending a seminar in 1995 on Memories of Abuse, I wrote inter alia the following
If we have not ultimately questioned historical accuracy by using intervention strategies at some point and 20 people are imprisoned as a result of subsequent criminal charges, and it is then found that the memories were not factual, then – despite the existence of disclaimers and contracts – we may be accused of having failed in this wider responsibility. This is equally true even if only 1 person is unjustly imprisoned, and it is also true even if only 1 person is unjustly accused.
And, re transgenders, if we have not even queried whether there are possible contributing factors or stressors in children wishing to transgender – such querying itself labelled as abuse by those who insist on affirming the wish – then we have failed our ethical and professional responsibilities as doctors, and our duty as community leaders and parents.
We have failed the child and we have failed the community. We have failed medicine.
Lachlan Dunjey 28 Oct, 2018. http://www.chooselifeaustralia.org.au/life/what-is-child-abuse-the-polarisation-of-medicine-and-medical-defence-organisations/
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Always be Ready to Quit!
What an astonishing line to hear at a conference of health workers in November 2020!
In the context of a conference on moral injury and the impossible situation of being compelled (coerced/expected) to be complicit in, or carry out, a procedure or pathway that is intrinsically wrong – the consequences of which would be harmful to the third party (physically, mentally) and result in moral injury to the person so compelled (and in fact to the third party as well when seen with retrospective wisdom).
Of course, there will be many interpretations of what is “intrinsically wrong”. How do we measure this? By standards that have become hallowed by history e.g. something that is as fundamental to medicine as the Hippocratic Oath – better still by an adherence to “natural law/moral law” as in ancient literature, especially wisdom literature as in the Hebrew and Christian Bible.
Add to that standards illustrated by our own 20th century history of savagery and barbarism with the subsequent international treaties of the UDHR and ICCPR to combat deterioration of such standards so that they would never, ever, be so compromised again.
So, is quitting ultimately the only option in order to avoid moral injury? Or does one keep going in an occupation where the good outweighs the wrong possibly by a factor of 100:1 but suffering permanent moral injury (“damage”) as a result?
Where do eternal standards fit in this picture and where, in extremis, does “sacrifice” fit (sacrifice of one’s own moral health for the “greater good”? Where do “absolutes” fit? Did Jesus ever compromise for a greater good? Did Paul?
So, what of the Christian physician being involved or complicit in some way? Where do we draw the line – if there is one? If he/she refuses and is sacked – or as in other times and other places even executed – then the problem of choice is resolved but then he is also excluded from doing the good. If he is “just” sacked – his job is terminated – then maybe God will open another pathway, but if his life is terminated then he joins the ranks of martyrs cheering us on. Is that “defeat”?
What about Naaman? Can the compromise of a political leader be compared to compromise of a health worker?
Where does Christian compassion – loving our neighbour – come in to all this?
Ah! If its too hard, become a theologian… Seriously, that may be the path that our loving Lord is directing us to – or somewhere else where our medical qualifications are going to be used more directly for the glory of the Kingdom. Follow the path of Livingstone to darkest Africa.
14 November 2020
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…but it is Christmas. The King of Kings is born in Bethlehem andthe heavens are open to wide-eyed shepherds.
Sing, dance, exchange gifts and good wishes.
Wow! It was so quick. Those of you who dutifully loaded CovidSafe and SafeWA onto your phones are now “registered” by the state and “trackable” by the state. So easy, all in the name of safety and security. So logical. Herod would have loved it. He would not only have known intimate details of the Wise Men from the East but could have tracked them back to their home country. He could have tracked Mary, Joseph and baby Jesus as they fled to Egypt. He needn’t have killed all the baby boys of Bethlehem. Think of the headline spin “Tragedy Averted”. Think of the technology in the wrong hands in our day.
Don’t get me wrong, the safe borders worked to keep we vulnerable elders safe. I am grateful. And during lockdown, when I was limited for 6 months to telephone consulting from home linked to the surgery computer, Lizzie and I had lunch around the picnic table on the grass in the sunshine (most days) – it was wonderful.
It is Christmas! Celebrate!
I didn’t arrange a single hike this year – the first miss since 1984! I hope to do better in 2021…
But sing and dance. Celebrate!
The roll-out of laws in several states that criminalise even prayer and even suggesting that another person could help with counselling when this is requested by a person with unwanted same-sex attraction or a feeling that they are born in the wrong sex has been astonishing in its rapidity.
As I have written elsewhere …if we have not even queried whether there are possible contributing factors or stressors in children wishing to transgender – such querying itself labelled as abuse by those who insist on affirming the wish – then we have failed our ethical and professional responsibilities as doctors, and our duty as community leaders and parents.
We have failed the child and we have failed the community. We have failed medicine.
Can it get worse? Yes, it can. If you need persuading just look at the posts on chooselifeaustralia.org.au over the past 4 weeks.
…the heavens are open to wide-eyed shepherds…
And the wise men from the east did escape. Mary and Joseph and the baby Jesus did escape to Egypt in the middle of the night and return to Nazareth when the despot Herod had died. The love of God rains down on us daily.
Lizzie is having a shoulder replacement in January but it will be a while before she can hang clothes on the line again (how long did you say?!). Family? Once upon a time it was our children fleeing the coop and travelling and working elsewhere – now it is the grandkids, (one) to Narrogin and (another) to Canberra.
I am still working 3-5 hrs/week for the new owners. It is good. More articles on the corrosion of ethics. Once again, the question: was it a waste of time and energy to fight? Despite it being a duty to be a watchman and tell truth, I don’t believe it is ever a “waste”. In all the discussions and presentations of different views some will resonate with that truth and – we pray – consider the great issues of life and their position before God.
It is Christmas! Celebrate!
The Contrasts of Christmas are so evident. Consider the evil of that first Christmas – a time of terror, of tyranny and treachery in high places, a time when evil appeared to be unfettered, a time of uncertainty and a despot ruled. But in the midst of this a baby was born. The angels rejoiced and some very fortunate shepherds witnessed that and came to wonder and worship. And so, once again, it is a time to reflect and rejoice in the wonder and majesty and triumph of the Christ child. Yes, we really can celebrate. Yes!
The King of Kings is born in Bethlehem. Yes!
December 2020.
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Medicine with Morality – a Manifesto of Human Life for the 21st Century.
We, the undersigned medical graduates resident in Australia, affirm the following statement:
We affirm that human life begins when a cell containing human chromosomes first has the ability to replicate and differentiate into individual tissues, as occurs at fertilisation. The genetic pattern of such a cell is uniquely human and determines its adult characteristics.
We deny that any other definition of the beginning of human life is acceptable. We believe this to be a line that must not be crossed.
We affirm that human life has intrinsic value at every stage of life and dependency from its beginning to its natural end and must be protected against experimentation or exploitation.
We deny that concepts of personhood and self-awareness, being arbitrary and capable of varying definition, are acceptable as indicators of the presence or absence of human life.
We affirm further that the human embryo, being human life in the truest sense, has intrinsic value and that the extraction of stem cells from it is unacceptable.
We deny that cloning technology is acceptable whether for so-called therapeutic or reproductive purposes. We also deny that fertilisation attempted between human and non-human cells (to create a ‘chimera’) is acceptable.
We affirm from the evidence of many scientists that stem-cell research on adult tissues and other non-embryonic tissues (e.g. umbilical cord) already has proven benefits and safety as well as increasing promise for the future and that research on embryos is not as necessary as other scientists make out.
We deny that it is acceptable to do harmful research on human life at any stage regardless of impairment or impending death or to terminate such life before its natural end. We further deny that it is acceptable to do destructive research on so-called ‘spare embryos’.
We affirm our right – and indeed obligation – to speak for the future of our society. We hold that ‘natural’ Law is present in the heart of mankind; that this law exhorts us to protect the innocent and helpless and to uphold the sanctity, preciousness and intrinsic value of life at all stages. We further hold that these are eternal and immutable principles.
We assert our right and obligation to practice medicine according to our conscience. We will not engage in or facilitate procedures or practices that we believe are inconsistent with the above manifesto.
2006
http://www.medicinewithmorality.org.au/
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Liberty of Conscience in Medicine – a Declaration
We, the undersigned, seek to maintain the ethical independence of the medical profession and the liberty to practice medicine according to our conscience.
- We believe it is in the patient’s best interests for doctors to adhere to a code of ethics that is independent of any standards set by governments or practices that may be permitted by legislation.
- We believe that as health professionals we have a duty to educate and inform fully so that best management decisions can be made and that such may include a refusal to comply with patient demand where such is inconsistent with good medical practice.
- We further believe there are times when the patient request cannot be complied with because it conflicts with our integrity and ethical stance.
- It is our right and obligation to practice medicine according to our conscience. We will not engage in or facilitate procedures or practices that we believe are in conflict with our conscience.
2010 http://www.conscienceinmedicine.net.au/
Excerpt: When the doctor has met the patient’s point of need as the patient perceives it, intuition helps a doctor to move beyond that to meeting the unexpressed and often unrealised point of need. The ideal doctor/patient relationship enables the doctor to add something to the patient’s life – for the patient to leave the surgery richer than before, not only with more knowledge and understanding and responsibility to their part of the relationship but also strengthened to face another day. The rapport that is established with this kind of personal relationship also gives strength in the patient’s last illness…
http://www.conscienceinmedicine.net.au/why-this-declaration/
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Links to other significant articles
Loving my neighbour. The Christian Underpinning.
http://www.chooselifeaustralia.org.au/life/loving-my-neighbour-the-christian-underpinning/
All of the above – and there’s more – is encompassed within a framework of loving our neighbour and loving our neighbour’s children (the future aspect of that loving) and also establishing “A Safe Place for our Children” within the family, the community and the nation. But it also means how do we prepare, how do we behave, how do we react and adjust when there is no longer a safe place.
The Creation Mandate. Issues of Rebellion against God’s Created Order.
http://www.chooselifeaustralia.org.au/life/the-creation-mandate-issues-of-rebellion-against-gods-created-order/
Therefore, you kings, be wise; be warned, you rulers of the earth. Serve the LORD with fear and celebrate his rule with trembling.
The Fear-of-God builds up confidence, and makes a world safe for your children.
The Descent into Barbarism, Dishonour, and the Whistleblower.
http://www.chooselifeaustralia.org.au/life/the-descent-into-barbarism-dishonour-and-the-whistleblower/
Here, back in the lucky country, consider Jereth Kok, the GP in Victoria who allegedly brought the medical profession into disrepute by his writings in a Christian magazine and on social media. Now into 16 months of suspension of his licence to practice by the Medical Board of Australia – not for being a bad doctor but for what he has said and exposed.
A Critique. Good Medical Practice: A Code of Conduct for Doctors in Australia.
http://www.chooselifeaustralia.org.au/life/a-critique-good-medical-practice-a-code-of-conduct-for-doctors-in-australia/
Governments may legislate to permit certain practices or procedures but governments must never force doctors to violate their conscience by compulsory engagement in such practices or procedures. The Independence of the medical profession is critical – belief in practice as enshrined in the international covenants of the UDHR and ICCPR and non-derogable, that cannot be overridden even in national emergency (article 4 ICCPR).
A dark day in the history of Western Australia 11 Dec, 2019. The passing of the Voluntary Assisted Dying bill.
http://www.chooselifeaustralia.org.au/life/the-sun-rises-on-a-dark-day-in-the-history-of-western-australia-11-dec-2019/
Were we heard? Yes, we were. I think the voices opposing euthanasia, physician assisted suicide, voluntary assisted dying were possibly better prepared and heard more than ever before. We were given time but it made no difference to the outcome.
Orwellian Doublespeak and the NSW Abortion Bill
http://www.chooselifeaustralia.org.au/life/orwellian-doublespeak-and-the-nsw-abortion-bill/
https://blog.canberradeclaration.org.au/2019/09/04/orwellian-doublespeak-the-nsw-reproductive-health-care-reform-bill-2019/
How can it be that Members of Parliament in Australia would vote to give legislative approval to pulling off baby’s arms and legs at a time when nerve pathways have been laid down and the child – no longer safe in what should be the safe-house womb – is screaming and writhing in silent agony.
Human Life as the Imago Dei.
8th World Conference of the World Christian Doctors Network, Brisbane June 11/12, 2011
http://www.medicinewithoutmorality.info/wp-content/uploads/downloads/2011/09/Human-Life-as-the-Imago-Dei.pdf
Add to all this the threat that is already with us that doctors who, for reasons of conscience, will not offer services that are legally permitted should not be doctors
Liberty of Conscience.
8th World Conference of the World Christian Doctors Network, Brisbane June 11/12, 2011
http://www.medicinewithoutmorality.info/wp-content/uploads/downloads/2011/09/Liberty-of-Conscience.pdf
Cognisant of the lessons of history, critical issues like liberty of conscience are defining issues, watersheds if you like, on which each MP must make a decision and should be judged harshly if they fail their responsibility to be guardians for the future of our nation.
Conscience Laws & Healthcare Conference Saturday 25th July 2009
http://www.medicinewithoutmorality.info/wp-content/uploads/downloads/2010/02/TheCoercionofDoctorsMelbourne.pdf
The Coercion of Doctors: What is happening to modern medicine?
Dr Lachlan Dunjey https://vimeo.com/7809169
This is also a challenge to the members of the Parliament of Victoria. Where were the members of integrity when this legislation was passed? Did you not realise the consequences for society, that you have crossed a bridge too far, that you are already on the other side of the Rubicon? Were there not enough of you or were you too suffering from battle fatigue? This is also in a very real sense a challenge for our nation, for our people. It has been said that requiring men to violate and disregard their conscience results in the loss of virtue and undermines the basis for self-government…
Feb 2010 http://www.chooselifeaustralia.org.au/life/the-ethical-crisis-in-our-parliaments/
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