The Hippocratic Oath can be interpreted in a number of ways, but the basic tenant is this: that all medical professionals have the obligation to value human life, and to give medical care to the best of their ability. It does not matter if the patient is a sworn enemy, has just committed a crime or has no money to pay for treatment: according to the Hippocratic Oath, the physician should treat her patient all the same.
Besides this historic oath, many nations have laws that detail medics’ duty to provide medical care. In the United States, for example, hospitals are bound by law to offer emergency services to anyone in need, and plenty of hospitals around the world are under obligation to do the same.
It’s a policy that makes sense: payment and other legal issues can be sorted out in the future. A hemorrhaging injury, however, demands immediate attention. And yet according to a new law in Turkey, medics cannot provide emergency care without government authorization.
Approved by Turkish President Abdullah Gul on January 18, the law states that unlicensed health services are now illegal – only doctors operating in state hospitals are authorized to treat patients. Doctors may not set up independent health clinics, and anyone without government approval who offers medical care in an emergency situation may be subject to up to US$1 million in fines and three years in prison.
This health bill has received harsh criticism from across the globe. The United Nations urged Turkey’s parliament not to pass the bill, as did the World Medical Association, the British Medical Association and others. Especially outspoken in its denouncements is Physicians for Human Rights (PHR), a U.S. group that advocates for the rights of patients and medics around the world. According to PHR, the Turkish health bill is an attempt by leaders to silence government opposition following the anti-state protests of last summer. During those protests in Istanbul and across the country, many people involved were treated for tear gas and other wounds by make-shift health units – units that are now illegal under the new health care law.
The anti-government protests last year started as an effort to prevent the destruction of a park in Istanbul, but soon, protesters were also accusing the Turkish government (and in particular, Prime Minister Recep Tayyip Erdogan) of authoritarianism and human rights violations. More than 8,000 people were injured during those protests, and at least six died. The Turkish doctor’s association and protestors themselves reported that police and other government forces took multiple steps to keep medics from treating patients wounded while demonstrating in the protests.
But besides the potential to discourage anti-government activism, the Turkish health law could also affect victims of sudden disasters. The United Nations has explained that in the case of a natural disaster, health care workers might be wary of treating victims; afraid that they could be subject to criminal charges for not taking the patients to a state-sanctioned facility. Similarly, a medical student with enough skills to provide some emergency services may choose to step aside rather than face three years in prison. The United Nations has accused the law of “criminalizing [the] provision of medical care,” and of violating international standards of medicine. Because Turkey sits on two major earthquake fault lines and is also prone to flooding, any law that could prevent emergency health services is worrying.
Indeed, the health legislation also violates standards of medicine in Turkey – according to Turkish penal law, all doctors are required to provide medical care if the opportunity to do so arises. If a doctor un-sanctioned by a national health authority is faced with a health care emergency, what is she to do? Treat the patient and risk violating Turkey’s new health care legislation, or ignore the patient and violate not only international health ethics and the Hippocratic Oath, but also Turkish law? The answer is unclear.
Health Minister of Turkey Mehmet Müezzinoğlu has argued that the health bill was in no way created as a reaction to last year’s protests: in fact, the first draft of the bill was submitted before anti-government demonstrations had even begun. Müezzinoğlu has also said that preventing non-authorized personnel from providing health care services is the best way to serve the people of Turkey, so that health regulations and records can be maintained.
In June, Health Minister Müezzinoğlu threatened to launch an official investigation into volunteer physicians who had treated patients injured in the Istanbul protests. In response, the Turkish Medical Association (of which approximately 80 percent of physicians in Turkey are members) crafted a response declaration, arguing that medical personnel are under an ethical obligation to help those in need, without discrimination. The Association said that if criminal charges were levied, it would stand on the side of those medical workers and volunteers who had assisted protesters in need of medical care.
Supporters of Prime Minister Erdogan and the new health care bill continue to argue that the legislation is intended to prevent unlicensed medical care, and that the administration has no interest in using health law to punish those who would demonstrate against the government. Unfortunately for those in favor of the new health legislation, Erdogan’s opponents have international health advocates on their side. But, the Turkish parliament has already signed the bill, and with President Gul’s signature, little can be done to prevent this health care law from taking effect. The Constitutional Court of Turkey could take action to stop the bill, but in the meantime, health care workers may tread carefully in working conditions that could be deemed unauthorized.