Updated 23 October 2013

Whistleblowing as part of healthcare

When is right to disclose secrets, since that defeats the purpose of even maintaining secrecy? This is of particular concern in healthcare, where the focus is directly life-and-death situations.

 Edward Snowden has become the latest, most famous face of whistleblowing. Exposing the incredibly deep, vast and ubiquitous monitoring of United States’ citizens, Snowden has had to seek asylum in various countries, like Russia. Many question his “loyalty”.

But another question concerns the ethics of whistleblowing: When is right to disclose secrets, since that defeats the purpose of even maintaining secrecy? This is of particular concern in healthcare, where the focus is directly life-and-death situations.

The South African Medical Association (SAMA) reaffirmed its stance in regard to medical practitioners for blowing the whistle. Primarily, the concern for practitioners is current health standards, as it is within their working conditions. And, of course, a doctor’s working conditions are hospitals.

A poorly-run, unhygienic, etc., hospital is detrimental to a patient’s health. Sanitation, water, etc. indeed, are known as the “forgotten foundations of health”.  For example, studies in the Public Library of Science Medicine remind us that 

Of course, it’s not merely diarrhoea that is combatted effectively with effective sanitation. “Lack of sanitation contributes to about 10% of the global disease burden,” say the authors.

Doctors themselves can only have so much impact: primarily, health rests with everyone as an individual, in most cases. Yet we, too, are limited: how do we procure clean water, sanitation, etc., if we can’t afford it like the 2.6 billion people who do not have access to a basic toilet or the 884 million people who don’t have access to safe drinking water. This requires a greater force than we as either professional medical practitioners or as patients can muster.

Shedding light on the problem is the first way to dispel the darkness it causes.

As the definition proposed by Princeton University says, a whistle-blower is “an informant who exposes wrongdoing within an organization in the hope of stopping it”. Wrongdoing need not be deliberately or intentionally wrong to be a wrongdoing. Inadequate sanitation, for example, is a wrong, though it’s doubtful any one (or several) individual villainously plotted to make it so.

Rather, inadequate facilities, scarce resources, untrained, absent or non-existent staff, are symptomatic of a larger, endemic and systematised problem. It’s political, it’s economic, and it’s many other reasons.

But whatever the reasons, doctors are in the best position to report wrongdoing or mismanagement.

First, they know how hospitals should be. Their job’s efficiency – and fellow staff – depends on elements that should be in place: enough resources, like beds, etc. A deficiency of these will be apparent and impact the doctor’s ability to do her job. Second, they are not in a mental, emotional or pain-state like patients are. They can more reasonably assess the situation given their position and knowledge. Third, they are on site everyday, able to judge the decline, rise and maintenance of resources.

Of course, whistle-blowing is not the only method to solve mismanagement, but it is one method. Independent accreditation organisations, such as the only one in South Africa, COHSASA, and America’s Joint Commission, are also essential [PDF]. In order to meet accreditation requirements, criteria are managed to prevent misuse, mistakes and danger before it happens preventing the need for whistle-blowing in the first place. Nonetheless, whistleblowing might still be needed, in addition.

SAMA, as we’ve noted, supports whistle-blowing. This has numerous benefits: anonymity is maintained, attention is drawn to the right area and the information can be given to the right authorities. Press coverage can rightfully focus on those in leadership positions not taking actions (or have been seen doing little to prevent such states arising).

In the end, the point is that whistle-blowing should aid in making hospitals better, which therefore aids doctors – which in turn saves lives. Whistle-blowing then is a part of medicine and healthcare and should be considered as such.

- Tauriq Moosa

Tauriq Moosa is a tutor in ethics, bioethics and critical thinking at the University of Cape Town, South Africa. He is currently pursuing a Masters degree at the Centre for Applied Ethics, Stellenbosch University. Read more of his work on his Big Think blog, Against the New Taboo.




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