The GMC’s finding that Dr Sarah Benn’s fitness to practise is impaired raises subtle ethical questions. She was jailed for 32 days having flouted an injunction to desist from attending non-violent climate demonstrations at Kingsbury oil terminal in 2022. The GMC found that it had no choice, saying ‘The public must be able to trust that doctors will always act within the law.’
There has been an outcry. How can Dr Benn’s decisions and actions relating to climate action impact her ability to practise medicine? She broke the law in an area far removed from her day-to-day job. Many respect her decision to protest. One could argue that her willingness to risk her own freedom for future generations makes her a morally superior doctor.
Although I have not been able to read the transcript of the hearing, this BBC article does reveal details of Dr Benn’s defence. She argued that, “As a doctor, my fundamental duty is to protect health and life.” Moreover, she explained, non-violent demonstration had been proven to be effective over the centuries. Take the suffragettes for an example. Does anyone, anywhere, now think that they were wrong? Of course not. We appreciate their bravery. The law was behind the times. The law was wrong.
This arguments requires the benefit of hindsight. Although most ‘right-thinking’ people agree that we are damaging the environment and that future generations will suffer for it unless we make drastic changes, there remains a lack of consensus. The industries targeted by the demonstrators can mount strong arguments that their activities are essential for the present well-being of society. People blocking their gates harm the economy and the country. But these opinions do not really matter, for the GMC is clear that the rights and wrongs of human driven climate change have nothing to do with them; the GMC is concerned with only one issue – should a ‘criminal’ be allowed to practise medicine?
We have been here before, in a far more clinically based scenario. In 2015, Dr Hadiza Bawa-Garba was found guilty of gross negligence manslaughter. The MPTS, which is a professional assessment body adjacent but separate to the GMC, felt that she deserved a 12 months suspension rather than erasure from the medical register, because there were mitigating circumstances. The GMC disagreed and took the MPTS decision to the High Court. The High Court agreed with the GMC; she should be struck off. And she was. But in 2018 the Court of Appeal reversed this, and the suspension was reinstated. Hadiza Bawa-Garba is now a consultant paediatrician in good standing. History records that the GMC was wrong. But in the moment, when she was officially guilty, was it right to strike her off? The GMC would say yes – how can you have a doctor who has been found guilty of gross negligence free to see more patients. What would patients think, if they found after being treated by them? This is the GMC’s primary concern.
At the time, Dr Gurmit Mahay (a GP and solicitor) made a very good point. As reported in Pulse, he said that the GMC should ‘undertake the exercise to prove that there is a hand in glove relevance’ between a criminal act and a doctor’s ability to practice, and that the GMC’s reflexive policy of erasure was ‘too crude a mechanism to determine this… A sophisticated regulator would want to look at contextuality and the possibility of remediation even in the most difficult of cases.’
Can a criminal be a good and safe doctor? How can we be sure that they will not choose to disobey the law, a regulation, a clinical protocol or Good Medical Practice guidance, in their day-to-day practise. After all, they have already shown that they are prepared to ignore boundaries if they don’t agree with them. When I was training to be a specialty assessor for the GMC, a slide came up showing a car that had been pulled over due to a broken tail-light. What was this meant to demonstrate? Answer: the driver who happily goes around with a broken tail-light is more likely to overlook other issues, meaning that overall, they pose greater risk to the public. Does the same go for a doctor with a criminal record?
For the GMC to have found that Dr Benn’s fitness to practise was unimpaired would have required an extraordinary justification, along the lines of Dr Mahay’s comment above, that the criminality was irrelevant to patient safety. Currently, I don’t think the GMC can adopt such flexibility. Perhaps it’s time it did. Context is key, in my opinion.
One could argue that the GMC’s judgement is part of the sacrifice Dr Benn was prepared to make. She was willing to risk her freedom to influence society, and the subsequent challenge to her professional identity is an extension of that sacrifice. In breaking the law, even if you do not agree with that law, you expose yourself to many disadvantages. You have a criminal record; your ability to find new employment will be affected; you may be barred from working with the vulnerable; you will find it harder to borrow money. The law exacts a broad price if it is crossed. In Dr Benn’s case, an additional disadvantage may be the loss of her right to practise in her chosen profession, despite a blameless clinical record. This consequence, which appears unjustified from a medical perspective, makes the decision to protest even braver*.
Dr Benn’s experience goes to the heart of what we are prepared to do to secure the future of the planet. Who among us cursed when Extinction Rebellion blocked the streets and stopped us getting to work? When I found Lambeth Bridge obstructed by protesters on my way to work, I shrugged and went round them, I did not join them. That is the typical response of someone who is happy to agree in principle with the objectives of climate protesters, but who doesn’t do anything to support them. Activists are different: they live by their principles, they take risks, they suffer the consequences… and some, like Emmeline Pankhurst, are remembered for the difference that they made.
*According to the BBC, she gave up her licence to practise in August 2022, so it seems she does not intend to return to clinical work.
Illusions of Autonomy 
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