Nurses must not refuse to treat racists

In the name of ‘anti-racism’, the UK’s Royal College of Nursing (RCN) has quietly abandoned its commitment to provide universal healthcare and is encouraging its members to violate a core principle of medical ethics.

On 6 August, the RCN issued new guidelines granting medical professionals permission to refuse to treat patients whom they perceive to be racist. The new guidelines are a response to the violent riots that engulfed parts of England and Northern Ireland earlier this month. These erupted after the Southport knife attack in late July, in which three young girls were killed at a dance workshop. The guidelines specifically legitimise denying a patient care if that patient exhibits ‘discriminatory behaviour, including racism’.

Ahead of the publication of the new guidelines, Nicola Ranger, the RCN general secretary and chief executive, issued a statement denouncing the ‘despicable racism’ seen during the riots. ‘As an anti-racist organisation’, she stated, ‘the RCN will take a lead part in tackling this hatred’.

The RCN comprises over 500,000 nurses, midwives and students. It is principally a medical organisation. But it seems its leadership now sees it as a social-justice organisation committed to fighting racism. Its pledge to refuse to treat patients it perceives as racist is the epitome of virtue-signalling. It flies directly in the face of any professional commitment to serve the good of any patient who seeks help.

The quixotic social-justice goal of the RCN took shape this spring when it held its inaugural ‘anti-racist summit’ and promised ‘to transform the RCN into an anti-racist organisation’. It then issued its ‘equity, diversity and inclusion strategy’ to provide ‘mandatory learning and development’ for accredited representatives to ‘enhance their knowledge and understanding of the wider EDI agenda including intersectionality and anti-racism’.

Can the RCN’s leaders really not see this for the tosh that it is? More importantly, don’t they realise that it undermines the principle that is the basis for practising healthcare: putting the needs of the patient first – over and beyond the interests of any third party?

For all the desire of the RCN to create a ‘better’ world, its efforts are a relatively pernicious example of the common psychological phenomenon in medicine of ‘countertransference’. According to Dr Sheldon Rubenfeld, a long-time professor of medicine at Baylor College of Medicine in Texas (whose course was cancelled as a result of an anti-Semitic backlash after the 7 October Hamas terror attack), countertransference occurs ‘when a physician allows his or her feelings to influence a patient’s treatment… [This includes] personal biases that could interfere with good patient care, such as biases against patients with a particular diagnosis, disability, ethnicity, gender, sexual orientation, political-party affiliation, religion, educational level, personal features such as tattoos and so on.’

Countertransference is antithetical to the Hippocratic model of medicine, where the patient represents a vulnerable person in need – the first and only priority of the caregiver. The RCN has even included patients who tell racist jokes as a reason to exclude them from care. It’s not too much of a stretch to one day see the RCN excluding, say, Tories, Trump supporters, climate-change sceptics, perhaps even Jews or Muslims on the grounds they’re too odious to receive the ministrations of its members.

The cornerstone upon which the practice of medicine is built dates back nearly 3,000 years to the era of Hippocrates and Asclepius in Ancient Greece. That cornerstone is the relationship between patient and caregiver, based on the expectation that the obligation of the healthcare professional must always be first and foremost to help the patient. Nurses do not take the Hippocratic Oath, but they are expected to live up to its core tenets.

When other interests, such as wealth or, in this case, ‘social justice’, supersede this obligation, patients and society suffer, and the profession is compromised.

The relationship between the dependent patient and the caregiver is unique. It is not a contract but a covenant and must be pursued with humility, compassion and intellectual integrity. To defend this covenant, self-interest must be abjured and in our current age, excessive self-virtue – a form of hubris – must be renounced as well. That is what should distinguish healthcare givers as a special moral community. Refusing to care for patients has never been part of the covenant.

When I was practising medicine, I and the team I headed had to take care of murderers, thieves and scoundrels of all sorts. We didn’t like it, but our mission was to leave personal feelings outside, lest they compromise our performance. I personally had to care for some unspeakable villains, including John Wayne Gacy and Richard Speck, two of America’s most notorious 20th-century mass murderers. But I was taught, and acted in accordance with, the Oath of Maimonides: ‘May I never see in the patient anything but a fellow creature in pain.’

The RCN should go back to its roots and remember that when a patient – any patient – comes to us, he or she trusts we will act in their best interest, not judge them for their character or their belief system. If we replace serving the patient’s interest with some nebulous poltical programme, then that trust is eroded and along with it, the raison d’être of the profession. Once that happens, when patients look us in the eye they will no longer see trust, but start to see uncertainty – and then, perhaps even fear.

Cory Franklin’s new book, The Covid Diaries 2020-2024: Anatomy of a Contagion As It Happened, is now available on Amazon in Kindle and book form.