18th August 2024: HXR statement in response to the GMC’s suspension of Dr Diana Warner for climate protest and its recent protest guidance

Hils - August 18, 2024August 18, 2024

This statement from Health for Extinction Rebellion is in response to the recent suspension of Dr Diana Warner for non violent climate activism (1), and the statement released by the General Medical Council on the 30th July (2), 6 days before Dr Warner’s tribunal commenced.

To the GMC – our understanding is that you published the aforementioned statement to clarify your position and responsibilities, legal and professional, when considering the cases of the doctors referred to the GMC for participating in disruptive protest in breach of the law. Specifically, we understand that this statement is in response to concern voiced by the medical community following the tribunal of Dr Sarah Benn (3), and in anticipation of the tribunal of Dr Diana Warner (1).

We are extremely concerned that not only is much of the statement’s content misleading and ambiguous, but that it also fails to:

1) Acknowledge and accept the broader responsibilities that the General Medical Council has to protect the health of the public in the face of the Climate and Ecological Emergency (CEE) (4);

2) Recognise the difference between the “Rule of Law” and “Rule by Law” (1);

3) Consider the ethical conflicts that arise for doctors in interpreting the GMC’s “good medical practice” guidance (5); and

4) Define and evidence how they assess whether doctors actions “undermine the confidence of the public in the profession”.

We argue that these fundamental ethical and statutory failings, outlined in further detail below, are not only resulting in the persecution of medical whistleblowers, but are also preventing the GMC from recognising and fulfilling its legally mandated role of protecting the public from the greatest health threat of our time – the climate and ecological emergency (CEE) (6).

The Context: The Climate and Ecological Emergency

Before proceeding, It is important to lay out the context within which the GMC is responding to climate activism. The CEE has intensified significantly over the past year alone, with 2023 breaking records for global temperatures, ocean heat, sea level rise and Antarctic sea ice levels (7). This has led United Nations Secretary-General António Guterres to remark that “Sirens are blaring across all major indicators… Some records aren’t just chart-toppling, they’re chart-busting. And changes are speeding-up”(8).

These accelerating changes in our climate are resulting in record health impacts, with excess heat alone estimated to have caused over 47,000 deaths in Europe in 2023 (9), whilst heat inequality and extreme temperatures are responsible for many thousands more unreported deaths amongst poor communities around the world (10).

Beyond the direct effects of heat, the CEE has well documented and widespread health impacts caused by increased extreme weather events, crop failure, migration and conflict, the increasing incidence of water and vector borne diseases (11)(12), and the too often overlooked, but extremely significant, impact on mental health and wellbeing (13). Caroline Hickman, clinical psychologist, and internationally recognised expert on climate distress, spoke on the topic of climate related mental health at Dr Warner’s tribunal, and described how young people in particular are vulnerable, with evidence indicating the majority are concerned, moderately concerned, or extremely concerned about the CEE, and believe their future is frightening (14). She further described how these impacts are exacerbated by climate inaction, and a failure by those in authority to appropriately acknowledge the scale of the crisis.

The World Health Assembly recently passed a landmark report on Climate Change and Health which asserts that “radical action is imperative to safeguard the health of the planet, underscoring the interdependence of environmental sustainability and public health”. The report also urges the global health community to “mobilize on an unprecedented scale”(15). As yet it does not appear the GMC has heard this urgent call to action.

Health for Extinction Rebellion’s position statement in response to the recent suspension of GP Dr Diana Warner for non- violent climate activism and the statement released by the General Medical Council on the 30th July.

Our primary concerns are outlined in detail below, both with specific reference to the GMC’s statement, and also with comment on how these have impacted on Dr Diana Warner’s tribunal hearing. We acknowledge that many of the themes discussed are also voiced by the UK Health Alliance on Climate Change in their response to the same GMC statement (16). We encourage other medical organisations to join this urgent conversation.

In the introductory paragraph to the GMC’s statement (2) they write: “We recognise that some doctors may feel strongly about social or ethical issues such as climate change”. The characterisation by the GMC of the CEE as a “social or ethical issue” is perplexing and deeply concerning. The CEE has long been widely recognised as a major threat to human health with clear statements of the overwhelming scientific evidence issued by the World Health Organisation (17), the United Nations (18), the Intergovernmental Panel on Climate Change (19), and the UK government (20) amongst many others. That the GMC, whose primary responsibility is to protect the health of the public, characterises the CEE as a “social or ethical issue”, without acknowledging the genuine threat it poses, is deeply undermining of their ability to fulfil this responsibility.

The GMC is failing, in both its statement and in its guidance, to acknowledge that the expectations laid out in the current version of Good Medical Practice (GMP) (5) are potentially conflicting. GMP states that doctors should “make the care of patients [their] first concern”, whilst also stating that doctors “…must follow the law, our guidance on professional standards, and other regulations relevant to your work”. It should be clear to the GMC that following the law is not necessarily in the best interest of patients. In her tribunal, Dr Diana Warner also challenged this blind protection by the GMC of “rule by law”, by movingly speaking of her ancestry as the descendant of a holocaust survivor.

The position of the GMC in relation to the law conflicts with the World Medical Association’s International Code of Medical Ethics (21) which states that doctors have responsibilities towards “the health and well-being of the populations the physician serves and society as a whole, including future generations” and that we should “help prevent national or international ethical, legal, organisational, or regulatory requirements that undermine any of the duties set forth in this Code”. The American Medical Association, in its code of medical ethics (22) is also clear that while “ethical values and legal principles are usually closely related,” the “ethical responsibilities usually exceed legal duties.”

During Dr Warner’s recent tribunal, the GMC lawyer repeatedly insisted that the GMC had no role in applying its own logic, conscience or consideration to any sentence or comment laid down by the UK courts. In fact, they frequently referred to comments made by the judge, and the length of sentence he imposed on Dr Warner, as an indicator of the seriousness of her actions. Speaking as an independent legal expert witness to the GMC, Melinda Janki, Commonwealth Rule of Law Lawyer of the year, spoke compellingly to explain the difference between the “rule of law” and “rule by law”(1), and highlighted current international concerns that the “rule of law” in the UK is being undermined by unfair, unequal sentencing and the criminalisation of protest. The fact that the GMC is unwilling to even consider that it should be independently assessing the validity of a doctor’s actions is deeply concerning. The GMC should not rely on others (e.g. courts) to decide whether a doctor’s actions are valid or appropriate, as to do so is in direct conflict with their primary duty to protect the health of the public.

It could be argued that the GMC should apply their conscience in considering the way the law has acted towards doctors. The GMC has made a public apology this year for disciplining and sanctioning doctors under historical homophobic laws criminalising men who had sex with men (23). It has been pointed out that if the law criminalising male homosexuality was reinstated today, the GMC would, under its current self imposed rules, simply make the same mistake again.

In the third paragraph of the GMCs recent statement (2), under the heading “How we handle concerns”, they state; “If a doctor is convicted of a criminal matter and given a custodial sentence, we must refer the case to the Medical Practitioners Tribunal Service (MPTS) for a hearing. This is required in law and we can’t exercise any discretion over this”. We are aware that the GMCs own guidance dictates automatic referral to the MPTS if a custodial (served or suspended) is issued by the courts (24), however, we have reviewed the Medical Act and have not been able to find the direction that supports this statement. We therefore request that the GMC identify the relevant section of the act (and include it as a link within their statement). If however, they have misrepresented the Medical Act, then of course this statement should be amended urgently and a clarifying statement made.

In their statement (2), the GMC state that; “We have a legal duty under the Medical Act 1983 to protect the public. The Act splits public protection into three distinct parts. It says that we must act in a way that:

protects, promotes and maintains the health, safety and wellbeing of the public
promotes and maintains public confidence in the profession
promotes and maintains proper professional standards and conduct for members of the profession.

It goes on to explain that breaking the law may undermine the confidence of the public in the profession, hence the need for the GMC to impose disciplinary action on these doctors. While we of course do not argue with the principle of this statement, we are very concerned that the GMC has successfully sought suspension of two respected GPs on the basis that non violent climate actions in breach of the law “…have the potential to damage her patient’s trust in her, and the public’s trust in the profession”, without providing any evidence to support this claim. Given that the majority of the public (25) are concerned or very concerned about the CEE, and the high level of support climate activism receives both from within the medical community and from the wider public (26), it seems presumptive to issue this ruling without evidence. Moreover, as Melinda Janki observed “How can the public retain confidence in a medical profession which does not use its unique scientific understanding to alert the public and stand up to the institutional systems that are allowing one industry to destroy and damage human life? (1)”.

The GMC states that “...in assessing whether a concern involves a serious breach of their standards or raises any risk to public protection…” it will consider the seriousness of the concern, any relevant context, and how the doctor responds to the concern. It then clarifies that the context does not include “… the merits of a specific cause…” (2). Again, it is concerning and surprising that the GMC is unwilling to consider the fact that the doctors who take part in climate activism are motivated by a desire to fulfil their primary responsibility as a doctor to protect their patients’ health, as relevant context. It appears that individual medical whistleblowers are suffering the consequences of the GMCs wider failure to acknowledge the CEE as the leading threat to population health and its responsibility to act in this domain. We challenge all doctors and medical organisations to call on the GMC to fulfil its primary responsibility under the Medical Act.
In our final specific comment on the recent GMC statement (2), we would like to draw attention to the case examples used. Firstly, the GMC have not made it sufficiently clear that these cases are fictional. A reader would assume that these examples either represent actual cases, or are closely based on actual cases. Within this context, example 3 is especially problematic. It describes a climate protestor “smashing” windows and equipment, and being “verbally abusive to the police officer”. This example misleadingly suggests to readers: 1) That the climate protestors who have been referred to the MPTS were violent and abusive in their actions; and 2) That climate protestors more generally are abusive and violent. Both these suggestions are incorrect and offensive to individuals and a movement that has successfully sought to maintain a non violent campaign of civil disobedience, and which places great emphasis on personal accountability and non-violent communication.

We therefore request that the GMC:

1) Urgently amend the third example given in their statement; and

2) Make completely clear that these examples are not factual.

Both of these actions are necessary as taking the second step alone will still unfairly bias the reader against climate protestors.

In concluding, we would like to draw attention to Commonwealth Rule of Law Lawyer of the year Melinda Janki’s response to the GMC’s statement (2), given during her evidence at Dr Warner’s tribunal hearing: “With respect, the GMC’s statement entirely misses the point…the larger question for the GMC is what steps it will take to perform its obligations under s1A and s1B (of the medical act) to protect the public”.

Dr Warner, similarly made this direct challenge to the tribunal panel in the course of her hearing;

“The (Tribunal) panel are aware that there is precedent for the GMC to act as facilitator and overall regulator to enable wholescale changes in professional activity, such as the safeguarding of children and vulnerable adults from abuse… The panel has heard that climate change is one of several existential threats (27) that are now impacting physical and mental health, and that it is a safeguarding issue. I put it to the panel that I have been acting as a whistleblower and it is necessary for the GMC to respond as they would to a whistleblower calling them out for failing in its overarching duties.”

There is no doubt that the international scientific and medical community support the need for cohesive, urgent and radical action to prevent catastrophic harm to human health as a result of the CEE. We believe that in failing to respond to the climate emergency, it is the GMC who will lose the trust and confidence of patients. We therefore call on all doctors to insist that the GMC take action now in the best interests of the public, by urgently reviewing its position on all the matters outlined above.

Thank you for your attention,

Health for Extinction Rebellion