An ethical rebellion?

In this issue of the JRSM, Heather Payne, a paediatrician from Caerphilly, attempts to piece together the jigsaw of child protection (JRSM 2008;101:93-94). She echoes the concerns of many paediatricians about the recent verdict against David Southall when she says that the GMC needs to examine itself to see whether its decisions are justified and really serve children. The trap that the GMC has fallen into, she argues, is one that paediatric trainees are taught to avoid: always listen to the child as well as the parent. Whatever our personal opinions on the Southall verdict, it is easy to understand why the ‘illusion of safe practice’ in child protection has been shattered by recent GMC decisions. Is society prepared to protect parents but place children at greater risk? Shouldn't the balance be in favour of child protection?

These are ethical questions as well as moral and criminal ones, yet doctors are usually ill prepared for ethical dilemmas, especially at the beginning of their careers. In response, Rosalind MacDougall and Daniel Sokol have devised a typology of ethical problems faced by house officers (JRSM 2008;101:67-70). Should a clinician always tell the truth? How do you set an appropriate personal boundary with patients? What can you do about the inappropriate behaviour of others? And how do you manage the limits of your own competence? The issues addressed by the authors, of course, are equally relevant to lowly medical students and grandiose professors. The medical profession has grappled with them for centuries and will continue to do so, except that many of its practitioners now feel besieged, unloved, and exploited. General practitioners are angered by the government's desire to extend working hours; junior doctors face another year of uncertainty over job interviews and career trajectories. This modern discontent has removed the pleasure from one of humanity's greatest professions. Doctors old and young wonder how they were duped and how they might emerge with a sense of job satisfaction. The classic counterargument is that doctors are well paid but, as any cursory glance at the evidence will agree, job satisfaction is more dependent on a sense of control, autonomy, and career development than it is on salary. Doctors might be easily dismissed as well-heeled whingers - a cheap jibe of which the media is fond - but this unhappiness is a symptom of an unhappy profession that feels unfairly victimized.

Indeed, these sentiments are strengthened when medical bodies and organizations are perceived to have deserted their own members. The British Medical Association is yet to recover from the political disaster of MTAS - no trade union can expect to take sides against its membership and flourish. Meanwhile, the General Medical Council continues to be perceived as a self-regulator that fails to fairly serve the interests of its profession. All of this leaves doctors busier discussing the ethics of a strike, revolt or rebellion than debating the ethics of UK's postmortem organ retention crisis -the effects of which on the parents involved are explored by Magi Sque and colleagues (JRSM 2008;101:71-77).