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Opinions of Sunday, 10 May 2009

Columnist: Ama Mills, Cynthia

Hippocratic Oath: does it matter?

By Cynthia Ama Mills


IN 2006 health workers in general embarked on a strike action to press home their demands. A year later doctors joined but doctors of the Komfo Anokye Teaching Hospital (KATH) in Kumasi did not. In fact, they refused to join their colleagues nationwide to embark on a strike action. They did not deem it necessary. They made me so proud then.

On May Day, this year, junior doctors of KATH embarked on a strike action to back their demand for revised salaries and accumulated fuel allowances.

It took about a week for them to resume work in spite of assurances by the Minister of Health, Dr. George Sipa-Adjah Yankey that their grievances would be resolved Thank God the doctors have seen reason now but not after they have been paid all fuel allowances due the doctors.

The management of KATH has paid a total of GH¢250,000.00 to cover 18 months of accumulated fuel allowances of Health workers, who are entitled to fuel allowance, including Junior Doctors at the hospital.

Besides the directive for all health facilities to pay all fuel allowances or face sanctions the government is was working on the revised salaries in direct consultation with the Ghana Medical Association (GMA).

In assessing this issue, one needs to find out whether the accumulation of their fuel and other allowances were as a result of a political decision or administrative lapse.

I have had the occasion to talk about doctors’ strike in previous articles on June 19 and 26, 2006 under this column and I have always maintained that there is no justification in a doctor embarking on a strike action and explanations by the CEO of KATH, Dr. Anthony Nsiah-Asare go to prove this.

He has said that before the doctors embarked on their industrial action on May 1, 2009, they had already been paid the fuel allowances for the first three quarters of 2008 and that subsequent payments were in the offing.

He said he had also paid 10 months of 2006 as well as the first nine months of 2008, indicating that his administration was on course in honouring its responsibilities with regards to payment of outstanding fuel allowances arrears by the end of June 2009 and wondered why the junior doctors cited the fuel allowances as part of their reasons for embarking on the strike action.

Explaining why the hospital stopped the payment of fuel allowances, he said the fuel allowance was stopped at the onset of payment of the Health Sector Salary (HSS) which was later reinstated following negotiations between the Ministry of Health, the Agencies and the Ghana Medical Association GMA). “That explains the reason for the outstanding arrears for the 2nd half of 2006 and 2007,” he said.

He said it was the government that paid the fuel allowances but the burden was later shifted to the health institutions to use part of their Internally Generated Funds (IGF) to pay for that allowance every month.Â

I have always respected doctors for one thing. Besides God they are the group of Homo sapiens that can save life. Their grievances might be reasonable but the Hippocratic Oath does not permit them to destroy life by any means.

My problem with today’s doctors, particularly the junior doctors is their utter disregard for the age old Hippocratic Oath which their seniors (I mean senior and experienced doctors) respect so much.

Any time I hear about doctors going on strike the question that comes to mind is: Is the Hippocratic Oath not relevant now?

My understanding of the Hippocratic Oath which had been in existence since 425 BC

makes it unreasonable and unjustifiable for a doctor, (junior or senior).

Salary negotiations have been stalled the past three years but that is not a licence to down their tools at the expense of precious lives.

The CEO of KATH having explained the circumstances of the accumulation of the fuel allowance and salaries, I dare say that the doctors should have exercised restraint if they had been able to do that all these years without complaint. Whatever their case, these issues should not be politicized. In the end it is their self esteem which is indicted.

The revised Hippocratic Oath is reproduced for the benefit of readers in order to appreciate my position in this article.

“I promise that my medical knowledge will be used to benefit people’s health; patients are my first concern. I will listen to them, and provide the best care I can. I will be honest, respectful and compassionate towards them.

“I will exercise my professional judgment as independently as possible, uninfluenced by political pressure or the social standing of my patient. I will not put personal profit or advancement above my duty to my patient.

“I recognize the special value of human life, but I also know that prolongation of life is not the only aim of healthcare. If I agree to perform abortion, I agree it should take place only within an ethical and legal context.

“I will not provide treatments that are pointless or harmful, or which an informed and competent patient refuses. I will help patients find the information and support they want to make decisions on heir care.

“I will answer as truthfully as I can, and respect patients’ decisions, unless that puts others at risk of substantial harm. If I cannot agree with their requests, I will explain why.

“If my patients have limited mental awareness, I will still encourage them to participate in decisions as much as they feel able. I will do my best to maintain confidentiality about all patients.

“If there are overriding reasons preventing my keeping a patient’s confidentiality I will explain them. I will recognize the limits of my knowledge and seek advice from colleagues as needed. I will acknowledge my mistakes.

“I will do my best to keep myself and my colleagues informed about new developments, and ensure that poor standards or bad practices are exposed to those who can improve them.

“I will show respect for all those with whom I work and be ready to share my knowledge by teaching others what I know. I will use my training and professional standing to improve the community in which I work.

“I will treat patients equitably and support a fair and humane distribution of health resources. I will try to influence positively authorities whose policies harm public health.

“I will oppose policies which breach internationally accepted standards of human rights. I will strive to change laws that are contrary to patients’ interests or to my professional ethics.

“While I continue to keep this oath unviolated, may it be granted to me to enjoy life and the practice of the Art, respected by all in all times.”

It is becoming necessary for the Ghana Medical Association to sanction its members who disregard the Hippocratic Oath. The time when lives are lost through the  selfishness of junior doctors must be seen to be a thing of the past. As the Hippocratic Oath recommends so long as doctors continue to keep the oath unviolated, they shall continue to earn my respect at all times. If not let the reverse be their lot.

Finally, let me commend the management of KATH for taking that crucial  decision to raise monies for the junior doctors. I hope the government would do its utmost best to see to the rest before those who don’t deserve to be called doctors (because they don’t even understand the dictates of the Hippocratic Oath) exploit the tax payer through intimidation and threats in the name of strikes.