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Monday, May 12, 2014

Viewpoint: No Sense of Decency

This editorial is a companion piece to EMN’s May Special Report, “EPs a Casualty of Turkish Uprising.

By William T. Durkin Jr., MD, MBA

You notice a person fall to the ground and appear to be in some distress while attending a political rally. You immediately rush to his aid. But as you go toward him, you remember that you need permission from the government before you can provide any assistance. If you proceed without it, you will be subjected to a large fine ($100,000) or imprisoned — or both.

As incredulous as this seems, it is actually the law in Turkey. Enacted in January of this year, the law forbids a physician from administering any sort of first aid without the approval of a bureaucrat. The law has since been amended to state that care could not be given until emergency services arrive. It also bans doctors from practicing outside of state medical institutions, and aims to prevent them from opening private clinics. Signed by President Abdullah Gül, the bill is seen by many as an attempt to criminalize emergency health care and prevent physicians from treating injured protesters.

I couldn’t believe when I first heard this that a country such as Turkey would even consider such heinous legislation. I knew Libya had such restrictions and Bahrain also did for a period of time, but to see this in a democratic, secular government was astonishing. This is a tactic that dissuades political opponents from staging rallies and demonstrations because acute care may not be readily available if someone attending should fall ill or become injured.

Physicians are bound by the Hippocratic Oath and to ignore someone in extremis is inhumane and goes against any sense of decency. Every individual should have unencumbered access to quality emergency care provided by a specialist in emergency medicine. The American Academy of Emergency Medicine, Physicians for Human Rights, the World Medical Association, the German Medical Association, the Committee of European Doctors, and the British Medical Association sent a letter to President Gül asking him to reconsider these provisions that hinder his citizens’ access to emergency medical care. Unfortunately, this law is still in place in Turkey with the predictable decline in political rallies and protests.

Physicians in Turkey are government employees. Their employer has now dictated when, where, and how they may and may not treat patients. The populace is being denied the basic human right of health care by order of the government.

It is very disturbing to see governments of at least three countries enact laws that deny basic emergency care to its citizens, mostly as a means of discouraging political opposition, setting a dangerous precedent. What is to stop an unethical government after an election from denying basic medical care to those who opposed the victors? It is a formal animus to those of us who believe that health care is a basic human right. It suggests a new era, one where governments can leverage their control of health care to manipulate the behavior of its citizenry. Seeing such behavior in a totalitarian regime such as North Korea would be one thing, but it is something else in a modern democratic country — something rougher, darker, more frightening.

It suggests that it might not be such a grand idea for the government to be controlling health care and those who provide it.

It illustrates the need for all members of the medical community to speak up and stand behind the physicians of these lands.

It tells us that it might occur elsewhere.

It tells us it may not be over.

Dr. Durkin is the immediate past president of the American Academy of Emergency Medicine.