twrama 1841_august_2.. - AMA WA

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Shades of grey colour mandatory ‘ethics’ by Benjamin Host President, Western Australian Medical Students’ Society OPINION Doctors have many obligations in their practice. Some of these responsibilities are guided by training, accepted best practice, individual morals and the collective ethics of the profession. Others are required by law. The mandatory reporting of infectious diseases, medical conditions, and deaths serve many important roles for the community. Comprehensive data collection and research, reducing the spread of infectious diseases, appropriate follow-up of mismanaged cases, and the regulation of potentially harmful medications – mandatory reporting serves a number of goals. The ethical issues regarding the reporting of these specifics are fairly clear-cut. However, the mandatory reporting of health professionals is far more complex. It is mandatory for any health professional to report suspected “notifiable conduct” of their colleagues – medical students included. Contained in this definition is the requirement that doctors must report a colleague that has an ‘impairment’ that may put the public at risk of harm1. There are many different things that can be considered under the umbrella term ‘impairment’. It is likely that mental illness, such as depression, could be considered to be impairing the ability of a doctor or other health professional to practice. In any case of mental illness, it is of vital importance that the sufferer is able to seek and receive appropriate care and treatment. In the case of doctors, this becomes even more critical in order to ensure that there is no deterioration in the quality of their practice. However, if a medical practitioner knows that they will have to be reported to the Australian Health Practitioner’s Regulation Authority (AHPRA) if they consult a colleague, then this becomes an enormous disincentive to seek treatment. For many doctors, their income, lifestyle and reputation – their very identity – depends upon their ability to practice medicine. As this is the case, it seems likely that practitioners would avoid seeking help in order to prevent placing their careers in jeopardy. This is a huge barrier to care for doctors and students at a time when they need it most. Implicit in the above is the onus that falls on those doctors who may be treating a colleague with an ‘impairment’. Imagine the situation that they face, knowing that they legally must report a colleague who has placed their trust in them. They are condemning them to face the rigmarole of an investigation and, if they do not report, they risk an investigation themselves. Fortunately, this situation has been foreseen in Western Australia and doctors treating other health professionals are exempt from making a mandatory notification if they become aware of notifiable conduct while in the course of providing treatment. Though this amendment has been made to the Act in <strong>WA</strong>, doctors in other states must contend with this issue whenever a colleague seeks their professional help. Through the mandatory and voluntary reporting processes, there is also scope for a disgruntled colleague, patient or other member of the public to make a malicious and facetious report about a doctor. As the system stands, once a report is received and a preliminary assessment carried out, AHPRA can act to impose conditions on, or suspend a doctor or student’s registration, before a formal Continued on page 36 August MEDICUS 35
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