Long-established pillars of medical ethics, such as to do good and not to intentionally do harm, remain a “daily compass” for clinicians, but “it has never been more onerous to practice ethically than it is today,” said emergency physician Dr Stephen Parnis in the Australian Catholic University’s 2025 Plunkett Lecture.
Medical professionals must be prepared to pay a price for upholding their ethical principles as healthcare is increasingly beset by political and ideological pressures, he warned.
The former vice-president of the Australian Medical Association and honorary clinical fellow of the Plunkett Centre for Ethics passionately defended the right of doctors and healthcare institutions to conscientious objection, including opposition to euthanasia, saying they should not be forced to participate in a practice they regard as harmful, dangerous, or unethical.
“I and my colleagues have a right not to be subjected to moral injury – the consequences of which have led gifted health professionals to stop practising their vocation in healthcare altogether,” Dr Parnis said.
“Doctors are not vending machines and, provided we do not seek to impede a patient’s access to a legal service, we should not be forced to facilitate it.
“As always, the exercise of such conscientious objection must be framed in empathy and respect for the patient or community.
“What applies for the individual healthcare professional in this regard is equally applicable to healthcare institutions.”
His comments came as the NSW parliament considers reforming its ‘voluntary assisted dying’ laws to prevent aged-care providers from being forced to facilitate it on their premises, and, conversely, in Victoria, where Dr Parnis is based, the government is seeking to remove some safeguards to expand its own VAD regime.
In a wide-ranging lecture, Dr Parnis reflected on many ethical challenges facing modern healthcare, from resource scarcity to moral distress and burnout – the latter he experienced during the COVID pandemic.
“If you are harmed in the course of your work, you are far less likely to help others. Caring for ourselves is an ethical obligation,” he said.
He defined ethics as the principles that guide behaviour – in medicine, they are about applying knowledge “safely and wisely.”
He paid tribute to exemplary leaders including (St) Thomas More, Dietrich Bonhoeffer, and the centre’s namesake, John Hubert Plunkett, the 19th-century NSW attorney general renowned for his prosecution of the people responsible for the 1838 Myall Creek massacre.
“He acted on principle, even when it meant confronting powerful interests. His ethical legacy should continue to guide us,” Dr Parnis said.
He also honoured healthcare workers such as Dr Bernard Quinn, who was executed on Nauru in 1943, and Dr Jane Connor, who died in 1998 while serving with Médecins Sans Frontières.
“One has to be prepared to pay a price for upholding ethical principles,” he said.
“If that is not the case, then it really is a form of hypocrisy – that so-called cherished principles are treated more like platitudes, ready to be abandoned in the face of self-interest or potential adversity.”
Recent examples from his own life included facing criticism for St Vincent’s Hospital Melbourne’s efforts to improve Indigenous patient outcomes through its emergency department triage process.
He also spoke about being a target of complaints following his advocacy on social media for health workers in Gaza and Israel and the protection of innocents “particularly children” – as a result he stepped down in August as chair of the board of Medical Insurance Group of Australia, though he still serves as a board member.
Dr Parnis urged universities and professional bodies to prioritise ethics and humanities education and mentorship, and called on employers and regulators to support clinicians who act ethically.
The Plunkett Lecture is an initiative of the Plunkett Centre for Bioethics at ACU led by Dr Xavier Symons and was held this year at the university’s North Sydney campus.
Following the lecture, Dr Parnis told The Catholic Weekly in 2017 – when Victoria introduced its VAD laws – “what were paraded as safeguards in these forms of legislation were very quickly being called impediments and obstacles to access.”
He said “buzz words” like comfort, dignity, and choice were being “thrown around” while alternatives to VAD such as palliative care are being ignored.
“Systemic influences that are pivotal to making truly informed decisions about their quality of life and whether they want to keep living need more attention,” he said.
“On the issue of conscientious objection and its practice by institutions, we are walking down a dangerous path if we are forcing the hand of institutions that have provided humanitarian and excellent care, in some cases for sometimes a century.”
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