The Health Care Professional Ethical Choice: Ukraine, Iran, and Whether or When to Risk and Resist

What would it take for psychiatrists and other physicians in the United States to collectively resist risks to the public’s health and mental health?

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PSYCHIATRIC VIEWS ON THE DAILY NEWS

Yesterday, we reported on the courageous Swiss psychiatrist who has taken very risky flights in the air to find sustainability alternatives to fossil fuels. Recent news also coveys that physicians in other countries are taking great risk in responding to societal obstacles.

First, I heard of the Iranian physicians in the Washington Post article of November 10, 2022, “Iran’s doctors have jointed the uprising — and are paying the price.”1 Many Iranian doctors early on seemingly questioned the government’s explanation for the death of 22-year-old Masha Amina in mid-September, sparking protests led by other women. Medical personnel were punished for providing care to those injured. On October 26th, hundreds of physicians had gathered outside the Medical Council in Tehran, protesting the misuse of medical equipment and infiltration of hospitals. The riot police reportedly used shotguns with pellets, batons, and tear gas on them.

The past weekend edition of the Wall Street Journal had a frontpage story in the Review section titled, “Ukrainian Hospital Stymied Russians With Defiant Doctors and a Fake Covid Outbreak.”2 When the Russians took over Kherson in early March and came to Tropinka Hospital, Leonid Remiga, MD, reportedly refused to cooperate. Two other physicians were detained. Dr Remiga and staff slowed down the takeover by feigning a COVID crisis. On June 11th, he was detained and suffered a stroke, but as he recovered, he advised other physicians while he was on the run. Then, about a month ago, when the Russians were beginning to retreat from the city, the staff hid equipment the Russians wanted to take.

As if to punctuate the courage of the health care clinicians in Ukraine, as I was writing this column, I read yesterday’s Psychiatric Times article by the President of the National Psychological Association of Ukraine, Valeriia Palii.3 Surely, any psychologists staying and helping in Ukraine are living up to the highest ethical standards.

Taking into account the limited information, it seems that these physicians and psychologists in Iran and Ukraine made the ethical choice to risk their own well-being for the sake of their patients, public, and country. In the United States, we have not had such societal danger, but 2 issues are causing similar ethical dilemmas: the state laws that are prohibiting abortions and the increasing pressure in some states to forbid medical treatment to trans patients.

Our own well-being is increasingly threatened with our epidemic of burnout due to for-profit business obstacles to healing. So far, there seems to have been increasing resilience, but no collective resistance. In the recent Kaiser Northern California mental health workers strike that seems to have had a successful resolution, psychiatrists did not participate.

It makes me wonder: What would it take for psychiatrists like myself and other physicians in the United States to collectively resist risks to the public’s health and mental health?

Dr Moffic is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues related to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric Times™.

References

1. Dehghanpisheh B. Iran’s doctors have joined the uprising — and are paying the price. The Washington Post. November 10, 2022. Accessed November 29, 2022. https://www.washingtonpost.com/world/2022/11/10/iran-protests-mahsa-amini-hijab/

2. Lovett I. Ukrainian hospital stymied Russians with defiant doctors and a fake Covid outbreak. The Wall Street Journal. November 25, 2022. Accessed November 29, 2022. https://www.wsj.com/articles/ukrainian-hospital-stymied-russians-defiant-doctors-fake-covid-11669243198

3. Palii V. Ukraine now: never so difficult, never so easy. Psychiatric Times. November 28, 2022. https://www.psychiatrictimes.com/view/ukraine-now-never-so-difficult-never-so-easy

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