Offence, Free Speech and a Code of Conduct

I’m offended.

You’re offensive.

I’m offended that you are offended!

Two train wrecks have collided around free speech in medical politics right now.

The first has to do with the politically correct/social justice warrior/virtue signalling/identity politics movement.

Proclaiming personal offence has replaced sticking out one’s tongue in the schoolyard of adult conversation. Signalling solidarity with every oppressed group is the new morality.

Thou shalt show empathy.

Thou shalt not ask rational questions such as, “Why can’t you afford meds, but you upgrade your iPhone every 6 months?

Brace yourself. People will take offence. Listeners will join a mob to signal their own virtue at your malfeasance.

There is only one accepted view. Questions are out. Debate is unwelcome.

The second train wreck has to do with the Summer of 2016. It was a dark and nasty time for doctors in Ontario.

Pushed to the point of despair by government and pressured to accept a terrible tentative contract, doctors acted out.

Some docs used a private Facebook page as a virtual locker room. Conversations got ugly. Someone took screen shots and gave them to an anti-doctor news outlet.

Locker rooms never look good in print.

So we sail between two threats. On one side, free speech is under attack from political correctness. On the other, some doctors bully and use potty talk.

On top of this, doctors fear speaking up at the best of times: see Free Speech in Hospitals and Can Salaried Doctors Advocate for Patients?

Courageously, the OMA has accepted the quest to sail between Scylla and Charybdis.

Can we promote professionalism without pandering to activists?

Can we support debate without promoting bullying and potty talk?

Naturally, many doctors worry that a Code of Conduct might succumb to the zeitgeist to curtail free speech. They have a point. Their ideas fall into 3 themes:

Doctors Value Free Speech

Most people support parliamentary language in debate. Many people sound like sailors in private. We need to clarify appropriate and inappropriate content in heated exchanges.

A Code should be explicit and might provide examples of acceptable, vigorous debate. Debate often includes calling ideas “stupid” and people “ignorant” (or worse).

For example,

Doctor A: “I think we should raise taxes above 50%.”

Doctor B: “That’s stupid. Don’t you know anything about the Laffer curve?”

Doctor A: “Pedantic, ivory tower wonks are naive. Academic dilletantes haven’t seen pain and suffering up close!”

Doctor B: “Who says it will stop the suffering? Ignorant people like you make stupid proposals that harm those they’re trying to help.”

To be clear, this is not a gold standard for debate.  People can get excited and reckless. We should be okay with pointed conversation. (Of course, Canada limits free speech as described here.)

Medicine is Often Politically Incorrect

 Doctors make a living asking socially inappropriate questions. We could never ask in public what we raise at the bedside.

We try to help solve social issues using reason and evidence. It means tackling facts that would ignite a symphony of virtue signalling at a dinner party.

Virtue signalling is just moral bragging. It does not solve clinical problems. And it’s impolite.

Any Code runs the risk of empowering those who take offence at everything they disagree with. This will not help solve the most difficult social issues in clinical care.

Doctors Value Reason

Medicine rests on modernism: Truth is absolute, dosage matters and investigation guides treatment.

Society rests on post-modernism: Oprah says, “Speak your own truth”; observation is subjective and investigation only reveals your biases.

In post-modernism, emotion trumps reason and evidence.

Being offended is not the same as having a valid argument. Being offended means you lost control of your emotions. It does not mean that you raised a valid point.

Being offended is not a good enough reason to attack someone who triggered you. Kids learn that in Kindergarten.

Activists join mobs and swarm those who say things they find offensive.

  • They appeal to authority to punish the offender(s).
  • They do not stop when offered apology; they use apology as evidence of guilt and press their attack.
  • They do not stop until they can parade a crushed offender through the social media streets.
  • They make examples of people they find offensive and ruin careers.

A Code should have zero tolerance for shouting mobs that block rational debate. Life is full of uncomfortable ideas. Mature adults learn to discuss them.

Beyond Offence

A Code might empower those prone to take offence at everything they dislike as a strategy to get their way. Lack of a Code might empower those prone to bullying and unprofessional behaviour.

A good Code would speak to the motivation behind our behaviour. It would touch on things deeper than potty talk or poor taste. It would aim to capture the true, the good and the beautiful. Is this possible in our fractured world?

The team leading the charge, at the OMA, to create a “Code” is wise and cautious.

They have not rushed.

They have listened, revised, and then listened some more.

Dozens of members have offered feedback.

Given all the time and energy put into this process, I am confident they will arrive at something solid and good and will not stop until they create something that doctors support.

We need passionate people.  We need free speech and emotional resilience. And we need to show a better way, refusing to be guided by nonsense.

 

*******

 

BONUS – Check out this 2:44 minute video. I hope it makes you smile and not take offence!

 

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28 Replies to “Offence, Free Speech and a Code of Conduct”

  1. Thanks for the article Shawn, surely it is touchy subject. There is a actually a fourth category of Doctors that feel a Code of Conduct (CoC) through OMA is redundant given each and every doctor in Ontario is already covered by CPSO mandated CoC, that has real consequences http://www.cpso.on.ca/Policies-Publications/The-Practice-Guide-Medical-Professionalism-and-Col/Introduction. As a front line physician I already feel I am policed enough by the CPSO, MOH, media and the Court of Public Opinion. The untold issue is Doctors feel less and less in control of everything in their professional life. We are told when, where and how to practice; our income was recently attacked, our conscientious rights were recently taken away. So when our very own organization even talks about regulating speech it touches a very painful nerve. This is perhaps not the best time to impose more rules and a take away the little speck of control we have left, at least not from our own organization.

    1. Great comments, Plabon!

      You are right. We are over-regulated. We can barely breath in the legislation and micro-management of medicine.

      Most organizations have at least a basic code that members agree to uphold. After the crazy things that happened in 2016, we were forced to develop our own document so that we had something to point to without relying on what other organizations use. I would rather have something that we create and support than use something from other organizations that seem to exist to make our lives difficult.

      I’ve never seen any code, yet, that tackles the current epidemic of offence and outrage being used to advance special interests. It would be a huge win if we would fix this issue.

      Thanks again for reading and sharing a comment!

  2. I witness first hand daily from first responders up the ladder “There is only one accepted view. Questions are out. Debate is unwelcome.” “We need free speech and emotional resilience.”

    Nice quote Plabon Ismail “We are over-regulated. We can barely breath in the legislation and micro-management of medicine.”

    “Fools, said I, you do not know. Silence like a cancer grows” ‘Sounds of Silence’ Paul Simon

    Untold tens of thousands layperson’s taught Ontario response to this code.
    can’t stay awake, walk or talk
    are breathing slowly or not at all
    have a limp body
    not responding to noise or knuckles being rubbed hard on their breastbone
    snoring or gurgling sounds
    pale or blue skin – especially on their nail beds and lips – and they feel cold
    tiny pupils (pinpoint) or their eyes are rolled back
    vomiting

    Protocol
    Shake their shoulders and shout their name.
    Call 911 if they are unresponsive.
    Give chest compressions
    put your hands on top of one another in the middle of the person’s chest
    keep your arms straight
    PUSH FAST, PUSH HARD, with no interruptions, except to give naloxone.
    Inject 1 vial or ampoule (a small glass container) (0.4 mg/1 ml) of naloxone into their upper arm or upper leg.
    Resume chest compressions.
    Continue compressions until the person responds or EMS arrives. If they are not awake after 2-3 minutes, give a second dose of naloxone.
    https://www.ontario.ca/page/get-naloxone-kits-free

    I do not tug the forelock to experts. I did not turn off my brain when I did grade school science.

    “Attention is living, inattention is dying. The attentive never stop, the inattentive are dead already” Buddha

    1. Gary! Thanks for such an interesting string of comments.

      I didn’t catch all your comments on a quick read through, but I promise to slow down and digest them. Thanks so much for taking time to read and share a comment!

  3. I think that code of conduct was what, 5 pages? Obviously worked on some lawyer or lawyer wannabe it reads like legislation. I for one would like to see a different slant on some of shenanigans over the screen shot fiasco. I would like to see an effort to identify the person who took the screen shots and turned them over to the press. There was a code in place against sharing content on the sight but some malcontent decided to take matters into their own hands and got a lot of people upset, including me and I have a very thick skin. We have draconian thought police already in the CPSO, I don’t really see the point of restricting free speech. Sometimes a profanity lace outburst conveys more about the speakers feelings than parliamentary language. After all, when has parliamentary debate actually changed anything in parliament? In government backrooms, people say what they really mean and make their minds up there before polishing it up to go to the sanitized and anaesthetized audience. Personal threats of grievous bodily harm are obviously too far, but a good bare knuckle debate is probably more productive than either extreme of politeness and PC verbiage or life threatening assaults. This is a distraction, the enemies we face are the government and its stooge the CPSO. We should be spending our time fighting them instead of ourselves.

    1. I agree with much of what you said, Ernest. Well said, indeed. [NOTE: When I say “I agree” it never means I agree 100% with 100% of what was communicated. That would mean that I think exactly like the person making the comment. In which case, one of us is useless.]

      We often tell the truth more clearly, in a moment of passion, than we ever could while using the most guarded parliamentary language. Having said that, too many people fly off the handle at everything they disagree with…they have no idea how to debate without getting angry.

      You raise a great point about the people bringing cameras into locker rooms. That’s a heinous act in itself. And I agree completely, we have too many enemies to waste time fighting with each other.

      Thanks again for reading and sharing a comment!

  4. AAARRRRRGGGGGHHHH…enough! I am not paying the OMA to police my F..ing language! I am paying you to bring me a service contract and to defend my position in government. I am begging you to stop this ridiculous fight and do something constructive with my dues. I don’t need you to tell me what I can and cannot say in social media, stop this sanctimonious bullshit and do your damn job!
    I have sat back, calmly reading this blog for some months now, I have read it and replied many times and I have deleted those replies as I have successfully self edited but the rage I feel now at this complete lack of leadership and petty quarrels have brought me to this outburst as I cannot stand the veiled threats and innuendo anymore. Enough! I invite all like minded doctors to stand with me and demand the OMA stop this ridiculous pursuit which is nothing more than a distraction from what I suspect will be near criminal disposal of our rights as doctors in this province. The OMA has proved itself completely ineffectual at it’s only job, which is to act on our behalf to bring us a contract. The time wasted behind closed doors on a negotiation with a government hell bent on destroying our profession and we are told we need a code of conduct?

    1. I love your passion, Sam! Please tell me you are standing for election in some capacity? We need your passion and energy inside the OMA! Fantastic! The opposite of love is not hate….it is indifference. You care deeply. We need that!

      To be clear, council supports having a code that we create and that we all support. Every organization has one. And this is not taking time away from negotiations! The group working on this is not the same group that negotiates.

      Everyone agrees: We need a contract ASAP. More news on this coming this week.

      Again, thank you SO much for sharing a comment. Please please tell me that you are running for election. I really hope you will funnel your energy into working from the inside. We need your help!

      Best regards,

      Shawn

    2. I witness first hand daily from first responders up the ladder “There is only one accepted view. Questions are out. Debate is unwelcome.” “We need free speech and emotional resilience.”

      Nice quote Plabon Ismail “We are over-regulated. We can barely breath in the legislation and micro-management of medicine.”

      “Fools, said I, you do not know. Silence like a cancer grows” ‘Sounds of Silence’ Paul Simon

      Shawn per your reference Scylla and Charybdis Needless gnashing of teeth over this protocol. Chest compression’s only specific to acute respiratory failure taught to untold tens of thousands. Laypersons just following orders increasing morbidity and mortality any respiratory emergency https://www.ontario.ca/page/get-naloxone-kits-free

      I do not tug the forelock to experts. I did not turn off my brain when I did grade school science.

      “Attention is living, inattention is dying. The attentive never stop, the inattentive are dead already” Buddha

  5. Putting ad hominems aside.

    I’m increasingly pissed off by the “I’m offended” crowd, in particular the modern day persistently and easily I’m offended crowd….those who contstantly state that they feel insulted, resentful or annoyed and need safe spaces as a consequence….perceived insults at that, not true / actual insults , but perceived !

    It seems that the easily triggered , politically correct, social warrior post modernist victimhood snowflakes are perpetually offended by everything that they hear or see, to boot, it seems that they think that their infantile whining confers some moral authority and prestige on themselves ….that merely stating the words “ I’m offended” means that they’ve won whatever internal debate that was bouncing around inside their own tiny little minds….more mature non snow flakes , aware of the complexities of the real world, are not so easily traumatized by perceived slights.

    If free speech offends others so be it ….we should be allowed to be offended by free speech, we should fight for it and certainly not be “protected” from it as so many of our own universities have tried to do as at Wilfred Laurier…we certainly should not be protected from it by the OMA and CPSO.

    What’s wrong about being “offended”?

    When did it become wrong ?

    If you are offended….note that no bones were broken….free speech is not “violent ” as the SJWarriors try to claim….indeed they are the ones wielding sticks and throwing stones.

    The introduction of thoughtcrime , illegal thought, illegal perceived thought , should be resisted .

    Free speech today, tomorrow and forever!

    1. Well said, Andris!

      The glory of living in a free country is accepting the right to be offended. We should relish the chance to hear things that grate and irritate. Polite society has supported free speech only to have the new SJWs decide that any speech they do not like should be violently opposed. It undermines a core principle of western society.

      Thanks for taking time to read and share a comment!

      Cheers

  6. My hope is that the OMA’s code of conduct will *protect* us from complaints to the CPSO about things that we don’t even want them to have any of their regulatory clout over.

  7. Really an important topic to address if we are going to make progress. What we say and how we say it matters; it’s respect, words can cut and leave scars, people have egos and jobs to protect, and we have a certain public perception to maintain. I think we should continue towards building trust, allowing for passionate arguments focused ultimately on the greater public good, and forgiving occasional indiscretions where passion is involved. As for an official code of conduct, perhaps it is required by law, but it may give rise to suspicion and mistrust and curtail some otherwise valuable points. Freedom is necessary for passion and passion necessary for change.

    1. Metaphorical cuts and scars…”Sticks and stones will break my bones but words will never hurt me”….preventing free speech for the “public good” is what totalitarians specialize in.

    2. What a gracious comment, Nick!

      You are right. Words matter, and forgiveness matters, too. We will lose our cool now and then.

      This was simply brilliant: “Freedom is necessary for passion and passion necessary for change.”

      Thanks so much for sharing a comment!

      1. Passion closes the minds , it blinds… passion controlled by reason and logic perhaps.

        Words do matter.

        Forgiveness is a virtue amongst the so called pious….it evidently makes them feel happier as they “move on”….for many if not the most, their forgiveness is a self deceptive fake allowing them to feel a sense of false nobility and superiority as they take the “ high ground”.

        It’s one thing to bury the axe…to make peace…but the wise never forget where they buried it.

        1. You always make great points, Andris. Agree: passion – as in rage or blind emotion – does close minds. Passion – as in focussed determination to persevere despite the odds – can change the world.

          You make good comments about forgiveness, too. We often assume forgiveness means ‘forgive and forget’. The deepest cuts may never be forgotten, but we have to move on. A bitter grudge poisons everything. I like your quote about burying the axe…ideally, we forget where we buried it.

          Thanks again!

  8. Things are so ridiculous we now need a taxonomy of political correctness. In the same way as Sackett had his 584 identified research biases, I’m hereby proposing a breakdown of Infuriating Ways We Speak. I invite anyone to add to the list:

    Marketing Euphemisms – Pre-Owned vs. used
    Employment Euphemisms – Downsized vs. fired
    Medical-Marketing Euphemisms – Erectile Dysfunction vs. impotence
    Disability Euphemisms – Visually Impaired vs. blind
    Political-Social Euphemisms – Underprivileged vs. poor, Food Insecure vs. starving
    Cynical Political Marketing – Death Tax vs. estate tax
    Replacement Curse Words – frigging, arse
    Censored Curse Words (verbal) – the N word, s-hole, MF-er
    Censored Curse Words (written) – f**k, @$$hole
    Business Jargon – syngeries, integration, disruption
    Bureaucratic Jargon – consultation, stakeholder engagement
    Bureaucratic Deflection – “take it under advisement” or “table that discussion” rather than no or not now
    Relationship Non-labels – Partner vs. spouse/boy/girlfriend/ husband/wife, Client vs. patient
    Ethnicity as a Prefix
    Complex Gender/Sexuality Nomenclature

    Insofar as what’s now referred to as political correctness/social justice speech, it’s the act taking offense on behalf of other people, whether or not they’re actually offended. And now it’s no longer just a “campus liberal” issue. Witness the manufactured umbrage over the Governor General’s speech to a roomful of scientists as Deeply Offensive to Peoples of Faith.

    It’s all (to use a censored curse word) BS, and we’d be much better off without it.

    1. Well said, Frank!

      Looks like you have the backbone for a blog post on the Flamebroiled Doctor? I loved this line: “…political correctness/social justice speech, it’s the act taking offense on behalf of other people, whether or not they’re actually offended.” Brilliant.

      Thanks so much for posting a comment!

      1. The CPSO policy on physician behaviour in the proffesional environment states one or minor infractions are addressed by referring doctor to PHP. For help. The docs in the news recently were not treated as per policy. The OMA runs the help for disruptive behaviour and now regulates it. This is a conflict of interest. How about getting the CPSO to follow its own bylaw so disruptive behaviours can get help with OMA. Not judgment. Just an idea.

        1. Thanks so much for this comment, Karin.

          I hesitate to say anything about any other organization’s policy or the application of it. But you raise a very interesting point! As you say, “Not judgement. Just an idea.”

          Sure appreciate you taking time to read and share a comment!

          Cheers

  9. Frustrating times for the profession.

    Decreased pay, increased taxes
    Decreased advocacy, increased oversight
    Decreased autonomy, increased regulation
    Decreased resources, increased expectations
    Decreased meaning, increased stress

    Disempowered, disrespected, and increasingly disenfranchised – and in this regard often a direct result of how we treat each other, and how those who purport to represent us behave. Of course we are primed to take offence and risk offending everyone. Eggshells.

    Why do we feel so fragile, so uncertain, so unsupported? For most docs the feeling is that there is nobody in our corner. The OMA needs to step up and unabashedly represent doctors, period. Not source discount car insurance, not throw our own members under the bus for real or imagined slights, not attempt to partner (pander?) with the government to solve every system management crisis, and certainly not judge or further regulate its own members.

    Just lead our tribe. Ethically, consistently, clearly, forcefully, unapologetically.

    I have a lot of respect for you Shawn, but right now I’m not voluntarily paying my OMA dues. The OMA needs to earn my financial support and until they do… they will have to extract money from my OHIP income.

    1. Thanks Matt. Many solid comments here.

      I have one question: Are you standing for election? I sure hope so. You seem passionate and have good ideas. Getting involved will help things improve for everyone.

      Great to hear from you!

      Cheers

      1. I’ve always wanted to know that if someone’s dues are “forcibly” taken by OHIP, is the person actually a member of the OMA, can they vote and are they allowed to hold office?

        I also think that Matt’s skepticism is quite appropriate in view of how many/most physicians feel about how the OMA has represented its members in the past. I look forward to Shawn and Nadia changing how we come to view the OMA’s advocating for Ontario physicians.

        1. Thanks Gerry.

          You have to be a member to vote or hold office. Members pay dues. We haven’t seen the end of this discussion, for sure. In the membership survey we sent out a few weeks ago, we asked members how likely they would be to pay their dues if they didn’t have to under RAND. I think this kind of question is a step in the right direction.

          With exploration of a pooled pension plan in the works, I suspect RAND might become a non-issue…at least for most.

          Cheers

      2. Ok Shawn, I’ll bite…. but if I ran for an OMA position I would definitely have to have frontal lobe augmentation surgery 😉

        I realize it`s one thing to criticize, muse, rant, but another thing to stand up and offer solutions. You`ve thrown down the gauntlet, I`m open to suggestions.

        1. Yah!!!

          You already spend time thinking about it. You might as well get involved and make your ideas heard on the inside. Send me an email. I need to put you in touch with your regional manager to find out what’s available in your area.

          Excellent! Very happy.

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