Balancing rights & responsibilities

My friend Dr Khor Swee Kheng convinced me to turn one of my previous blog posts into a proper newspaper column, so I did. Below is the article entitled ‘Balancing rights & responsibilities‘, first published in The Star on Wednesday, 23 June 2021:

Balancing rights & responsibilities

The rights and responsibilities of medical students appear straightforward and uncontroversial, but this issue recently surfaced after Universiti Malaya stopped a medical student from taking the second year exams because this student was unvaccinated.

Some reports indicate that this student had previously refused a Covid-19 vaccine for unclear reasons. Fortunately, this student is an extreme outlier and does not represent the vast majority of medical students and doctors.

The exact circumstances of this case do not matter for the purposes of our article, as we want to ask a much broader question with ethical and policy implications: Should a university be allowed to bar a medical student from taking an exam if he or she refuses the Covid-19 jab for no valid reason (such as a history of severe allergies)?

Indeed, this question raises a variety of subsequent questions, like “Should patients be allowed to decline a doctor if the doctor is unvaccinated?” or “Should the Malaysian Medical Council deregister a doctor who is clearly anti-vaccination?”

Let’s answer the original (and simpler) question, as a basis for answering the subsequent (and more complex) questions.

We both agree that Faculties of Medicine in any university can, should and must bar a medical student from exams if they refuse the Covid-19 vaccine.

Highly respected fraternity

There are several reasons why we hold medical students (and doctors) to a higher standard compared to other professions.

One, society is sensitive to a doctor’s influence (for both right and wrong reasons), and this influence must be used in positive and responsible ways.

Two, doctors are frequently the leading proponents of science, evidence and rationality, and they must maintain their leadership in the face of anti-science and anti-truth movements around the world.

Three, medicine is a profession with strict ethical codes and professional standards, and doctors must uphold these codes and standards.

Today’s medical students are tomorrow’s doctors, so they too, must also be held to these higher standards.

To be absolutely clear, we believe that it is equally important to inform and educate people into getting vaccinated, rather than coerce them.

Education, knowledge and information are not mutually exclusive from our hard stance on exam bans for medical students who refuse vaccinations.

We are also firm believers in the benefits of vaccination and call on everyone to register for vaccinations as early as possible.

We are not saying that doctors are the most important members of society – indeed, nurses, pharmacists, paramedics, allied health professionals, technicians and hospital cleaners are arguably more important than doctors, even in a small hospital.

However, for reasons both good and bad, doctors are seen in a different light and therefore have greater responsibilities to society.

Attitude matters

Being a good doctor is not just about securing good grades.

A doctor’s attitude (towards knowledge, his profession and with other people) is far more important than merely good grades.

For example, let’s imagine a doctor who doesn’t believe in the importance of hand hygiene and handwashing.

That disbelief could be a deeply held personal conviction, but is contradictory to science, evidence and professional standards.

Handwashing can be substituted with vaccines or safe childbirth practices, as examples where a doctor’s personal beliefs must be consistent with prevailing science, evidence and professional standards.

In other words, the doctor’s right to personal beliefs must be balanced with his responsibility to follow the science, evidence and professional standards.

A second example is the doctor who refuses to attend to a medical emergency because it will disrupt his sleep.

It may seem preposterous, but this doctor argues that his right to rest overcomes his responsibility to save a life.

Society does not accept this, and indeed the doctor can be sued for criminal negligence.

In other words, the doctor’s right to rest must be balanced with his responsibility to save lives.

The bigger question is, where does the right of a medical student (or a doctor) stop and his responsibilities begin?

Aren’t we impinging on that person’s right to become a doctor simply because his or her beliefs aren’t aligned with those of modern medicine?

Well, society “impinges” on an individual’s professional rights all the time, because professional rights are never absolute and the public interest is more important than personal interest.

For example, anyone can say they want to be a lawyer, accountant, car mechanic, taxi driver or hawker, but societies have agreed that governments can enforce licences, laws, regulations and standards to ensure that society is protected from any incompetence or malice.

In the case of medical students, their right and privilege to practise medicine clearly must be balanced with their responsibilities to look after their patients.

Protection for all

During the Covid-19 pandemic, it is reasonable to expect that healthcare professionals looking after the most vulnerable members of society should be vaccinated.

Vaccines protect them and their patients.

Medical students should also be vaccinated as their clinical training involves direct interactions with patients.

Indeed, some have advocated for medical students to be considered frontliners and to receive the first vaccines.

But what if a doctor refuses to be vaccinated?

It is important to start by understanding the reason(s) for his refusal, and to manage all the reasonable reasons.

But after that, compassion and understanding must have limits, especially when public interest is at stake.

If push comes to shove, Malaysia should consider making it mandatory for all healthcare professionals (HCPs) to be vaccinated to continue delivering clinical services (unless there are valid reasons not to be vaccinated).

This will protect the HCPs, provide psychological comfort that their colleagues are all similarly vaccinated, protect their patients, and perhaps acts as a litmus test to identify HCPs that have unusual beliefs.

However, this is controversial and may have unintended consequences.

Therefore, it is a nuclear option to be deployed only as an extreme last resort.

Nonetheless, it should remain a viable policy option.

To return to the original question concerning rights and responsibilities of medical students (and doctors), we can conclude by saying that any nobleness in being a doctor comes from the emphasis on our public responsibilities over our personal rights.

People who choose to become doctors must perhaps make more than the usual personal sacrifices to help their patients heal.

In the case of medical students who refuse vaccinations for non-valid reasons, they might be better off looking for a new profession.