Should Doctors and Other Health Professionals Engage in Advocacy?

Earlier this week, a Navy nurse who refused to force-feed Guantánamo Bay detainees had his security clearance reinstated, allowing him to return to his full professional duties. The decision ended a yearlong effort by the Pentagon to punish him with potential criminal charges, discharge, and loss of retirement and veterans benefits.

Force-feeding at Guantánamo Bay has been deemed medically unnecessary and physically and mentally harmful to detainees. Captives who refuse to drink a nutritional shake are strapped to a restraint chair and fed the shake through a tube forced down the nose and into the stomach.

The nurse’s refusal to participate in force-feeding prisoners and the corresponding reaction from the Pentagon raised an important set of questions: What are health professionals’ responsibilities to individuals and society? Should doctors and other health professionals act as advocates? If so, how far should we go?

Some health professionals worry about being considered advocates – even for their patients – and a few have even suggested that doctors don’t have any business in advocacy.

I disagree with those who suggest that doctors should stay out of advocacy. On the contrary, doctors and other health professionals have a duty to advocate for the rights of patients and other individuals who cannot always advocate for themselves.

There is little I do that doesn’t involve some form of advocacy – whether I’m advocating for individual patients or advocating for policy changes in the areas of human rights and animal protection.

For example, last weekend I helped my colleagues at Physicians for Human Rights conduct a training session for other health professionals on how to conduct forensic medical examinations of torture survivors seeking asylum in the United States. We spent some of that time discussing the importance of remaining objective when evaluating asylum seekers for forensic indications of torture, while continuing to advocate for the ethical principles that underlie human rights.

Two days before – along with veterinarian Heather Rally, neuroscientist Lori Marino, and environmentalist Jean-Michel Cousteau – I spoke at a press conference arranged by People for the Ethical Treatment of Animals about the harmful mental and physical effects of captivity on orcas living at SeaWorld and in other amusement parks. Before that, I had just returned from a conference where I spoke about the ethical implications of my research showing how chimpanzees used in the biomedical research and entertainment industries suffer from posttraumatic stress disorder (PTSD).

In essence, the nurse at the heart of the force-feeding controversy advocated for the rights of the prisoners to be free from torture and ill-treatment, and for the ethical principles to which doctors and nurses are held accountable.

There should be no controversy about the nurse’s refusal to force-feed prisoners against their will. Doctors and other health professionals are bound by a code of ethics that includes respect for autonomy, an obligation to “do no harm” and act beneficently, and duties to justice. We are also obliged to protect the most vulnerable among us.

The American Medical Association and other professional organizations have now recognized that medical professionals should play a role in advocating for patients – and for social, economic, educational, and political change. There is also a growing movement to train medical students on how to be effective social advocates. More and more medical societies recognize that social advocacy is a component of professionalism.

Doctors, nurses, veterinarians, and other health professionals are privileged to have access to knowledge about contributors to pain and suffering – and how to prevent suffering. If we don’t use our knowledge to alleviate suffering in individuals and society, aren’t we guilty of something much more serious?