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What is our ‘Final Cause’ as medical educators?

The IMC was obliged to assess RCSI Bahrain and is subject to the Standards in Basic Medical Education issued by the World Federation for Medical Education, which stressed the need for a safe clinical environment enjoying academic freedom of expression and freedom of inquiry.

Such freedoms do not exist in Bahrain.

The medical establishment in Bahrain is militarised and under direct control of the military and members of the Al Khalifa family. When Irish-trained orthopaedic surgeons Ali Alekri and Bassim Dhaif defended their right to treat protesters, they were abducted and severely tortured for months. Some 50 other medics shared a similar fate.

When RCSI Bahrain medical students protested for academic and civil freedoms, they were interrogated and forced to sign a pledge of allegiance to the regime; so forced by RCSI Bahrain staff. Subsequently, when Prof Tom Collins, former President of RCSI Bahrain, attempted to organise a multi-stakeholder conference on ‘Medical ethics and dilemmas in situations of political discord or violence’ in association with Médecins Sans Frontières, he was blocked by the monarchy. He subsequently resigned, citing lack of academic freedom as a fundamental reason.

The Al Khalifa regime has become more brutal in its oppression of democratic and academic freedoms.

Juan Mendez, the UN Special Rapporteur on Torture, is still refused entry into Bahrain. When I met him in Geneva he was quite clear in his condemnation of the brutality in Bahrain and expressed outrage at the attacks against medical personnel.

Similarly, Congressman Jim McDermot, whom I met in Washington, was greatly moved by the plight of medical personnel in Bahrain, and as a result introduced the ‘Medical Neutrality Bill’ to the floor of the House of Representatives.

So why is it that all of these international bodies, including the UN Human Rights Council, Amnesty International, Human Rights Watch and Human Rights First, to name but a few, clearly understand and condemn the ongoing oppression of academic and medical freedom in Bahrain but the IMC is of a contrary opinion? Did the IMC purposely choose to ignore its legal obligation to consider all aspects of the clinical environment in RCSI Bahrain? Did the Council speak to Prof Tom Collins and did they include his assessment of the situation, even as a minority report? Did the IMC meet any of the 50 tortured medics in Bahrain before deciding that the clinical environment there was and is safe?

Perhaps the most disturbing aspect of this affair is not the general lack of interest in the cruel and inhumane treatment of our colleagues in Bahrain, but the ongoing influence of the private and privileged medical education business over our health care system. As our public healthcare system withers on the vine, our private medical education business flourishes and expands. Aristotle referenced the ‘Four Causes of a Thing’, the ‘Final Cause’ being the ultimate usefulness and purpose of anything or any system. What is our Final Cause as medical educators? Is it to cultivate moral and ethical doctors with empathy and intelligence and a social conscience, or is it to mass produce a ‘good product’ and satisfy the profit motive above all else?

Yours sincerely,

Prof Damian McCormack,

Children’s University Hospital, Temple St.

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