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‘Activist’ doctors must protest and lobby for social change

18 Oct 2022

BY Ruwan Laknath Jayakody An “activist” doctor is, it is observed, supposed to use their professional and social standing and privilege to leverage for social change by being an active participant in organising demonstrations, convening meetings with stakeholders, being a vocal supporter for the issue at hand in the media, and being in dialogue with political leaders, specially at a time of crisis, when the issues are fundamental in nature, and the struggle is for freedom and social justice. These observations were made in a letter to the Editor of the Asian Journal of Internal Medicine titled “Doctor as an activist in the current crisis” which was authored by H. Karunatilake (attached to the National Hospital in Colombo) and published in the Asian Journal of Internal Medicine (1)2 in August, 2022. The economic decline has affected the health system gravely. The lack of essential drugs has made healthcare provision in health institutions challenging. Routine surgical operations have been cancelled, and some critical emergencies are being managed sub-optimally in order to counter the lack of better options. There are protestors to be seen occupying street corners and almost daily, silent vigils, very vocal street-side demonstrations, meetings and processions are held, and these, at times, have led to altercations with the Armed Forces, and the occasional politician. This spontaneous citizen movement has eventually evolved into a significant political force. These non-violent people’s uprisings are not rare in recent times. The people’s non-violent defiance has brought down non-democratic governments and dictatorships the world over. The ultimate aim of the non-violent movement will be a change in the power structure between the rulers and the people who are ruled. French thinker M. Foucault, in a lecture on the “Society Must be Defended” describes power thus: “Do not regard power as a phenomenon of mass and homogeneous domination – the domination of only one individual, group, or class over others – keep it clearly in mind that power is not something that is divided between those who have it and hold it exclusively, and those who do not have it and are subject to it. Power functions only when it is part of a chain. It is never only in the hands of some. They are in a position to both submit to, and exercise this power.” According to American political scientist G. Sharp’s “From dictatorship to democracy: A conceptual framework for liberation”: “Dictators require the assistance of the people that they rule, without which they cannot secure and maintain the sources of political power.” People allow themselves to be ruled with the belief that the regime is legitimate, and that they have a moral duty to obey it. Rulers make sure that sanctions or punishments are threatened or applied, against the disobedient and non-co-operative in order to ensure the submission and co-operation that is needed. Subjects, Sharp notes in “How the non-violent struggle works”, supply the regime with the human resources, skills, and knowledge needed to perform specific actions. Sharp also says that “all governments can rule only as long as they receive the replenishment of the needed sources of their power from the cooperation, submission, and obedience of the population, and the institutions of the society”.  Once the people stop consenting and become disobedient, refuse and stop co-operating, rulers start losing power, and with that, the resources needed to maintain it. That is when power changes hands, Sharp observes. This is the basis of non-violent struggles used to topple dictatorships in the world over the recent past, which have proven to be the most effective way in which dictatorships could be successfully collapsed with minimum loss and suffering to the citizens. Since 1980, dictatorships have collapsed before the predominantly non-violent defiance of people in Estonia, Latvia, Lithuania, Poland, East Germany, Czechoslovakia, Slovenia, Madagascar, Mali, Bolivia, and the Philippines, while the non-violent resistance has furthered the movement toward democratisation in Nepal, Zambia, South Korea, Chile, Argentina, Haiti, Brazil, Uruguay, Malawi, Thailand, Bulgaria, Hungary, and Nigeria. Per Sharp, “negotiations are not a realistic way to remove a strong dictatorship in the absence of a powerful democratic opposition”. When the issues at stake are fundamental, affecting human freedom, affecting the future development of the society, and is a threat to democracy, negotiations do not provide an effective way of reaching a mutually satisfactory solution, Sharp points out. The non-violent struggle is a much more complex and varied means of struggle than violence, Sharp emphasises, that instead od violance, the struggle is fought by psychological, social, economic, and political weapons applied by the population and the institutions of the society. These have been known under various names such as protests, strikes, non-co-operation, boycotts, occupations, silent vigils, and displays of people power including “satyagrahas” and “aragalayas”. “The medical profession cannot be isolated from the events that occur around them. What is the role of a medical professional in this demanding time?” Karunatilake queries. The doctor as a political activist or physician advocacy in politics is not a new concept. In the history of modern medicine, physicians have been political advocates. German physician R.L.C. Virchow served in political office as a civic reformer. Noting the similarities between medicine and politics, he said in his “Collected essays on public health and epidemiology” and as mentioned in T.S. Huddle and K.L. Maletz’s “Physician involvement with politics – Obligation or avocation?” that “Medicine is a social science, and politics is nothing else but medicine on a large scale. The physicians are the natural attorneys of the poor, and social problems fall, to a large extent, within their jurisdiction”. More recently, American radiologist Dr. H.L. Abrams, who won the Nobel Peace Prize for his work with the International Physicians for the Prevention of Nuclear War, termed physician activism in his “Fourth dimension of biomedicine” and as mentioned by Huddle et al., as “the fourth dimension of biomedicine” while patient-care, research, and teaching constituted the first three dimensions. Doctors have been reluctant participants in social and political activities. Sri Lanka has seen its fair share of doctors in politics, and trade unionists actively playing the role of “political activists”. However, what stemmed from their actions, Karunatilake claims, is nothing but empty rhetoric while some trade unionists’ deviations from their role from health advocacy, into non-health themes have led to and precipitated the current crisis. The Covid-19 pandemic saw an upsurge of social activities by doctors and medical associations as groups which were more obligatory rather than voluntary, per Karunatilake, in terms of providing guidance and leadership in the prevention and control of the spread of the pandemic. The Sri Lanka Medical Association, the Ceylon College of Physicians, the Sri Lanka College of Internal Medicine, and inter-collegiate committees were involved in advocacy in many areas related to pandemic control.  These advocacy activities are hardly considered political. However, the measures and decisions taken based on the knowledge provided by medical specialists had far reaching political effects controlling human life. According to Foucault, this is “bio-politics” which he defines as “new knowledge that exerts a positive influence on life, that endeavours to administer, optimise, and multiply it, subjecting it to precise controls and comprehensive regulations”. While engaging in political activism, it is important that physicians maintain medical neutrality, especially in situations of conflict. There are many reasons why doctors are disinclined participants in socio-political activism. First, physicians may view themselves as apolitical and consider intervening in social and political determinants apart from healthcare as being outside their domain of influence. Most unwillingly participate with the belief that activism is beyond the scope of medical practice. Secondly, physicians’ resistance to activism may arise from ideological differences. Finally, as observed in N. Pallok and D.A. Ansell’s “Should clinicians be activists?”, health professionals might feel deterred from practising activism because they do not think that they have the time or the expertise to do so. Being in the medical profession and bound by a finely calibrated work ethic, doctors cannot resort to refusal, non-consent and disobedience while providing healthcare during a protest or a resistance action. Especially in trying times like the present, doctors cannot, Karunatilake argues, be passive onlookers, hiding in their own academic hubris. Karunatilake concluded with a quote: “We don’t choose the times we live in. The only choice we have is how we respond to the times we live in.”  


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