If there is one conviction that has guided Dr Stephen Parnis through decades in emergency medicine, it is that the role of the doctor is to protect the vulnerable. And, he says, the uncomfortable truth is that everyone becomes vulnerable eventually – whether from illness, fear, or the erosion of trust in a system meant to heal.
That belief now sits at the heart of his concern for a profession he says is running on moral fatigue. “My wells of compassion and empathy were running dry,” he recalled of his own experience at the height of the pandemic. “My confidence was undermined and my emotions were laboured.”
When he stepped away from the emergency department, he discovered that burnout wasn’t simply exhaustion – it was a test of his own limits and values. “You can’t care for the vulnerable if you ignore your own humanity.”
For Dr Parnis, president of AMA Victoria from 2012 to 2014, and federal vice president for the following two years, self-care is more than a personal necessity; it’s a moral responsibility. “Healthcare workers have an ethical obligation to care for themselves,” he told colleagues in this year’s Plunkett Lecture for the ACU’s Plunkett Centre for Ethics. “There is overwhelming evidence to show that unwell, exhausted, distressed doctors are impaired doctors – they make more errors, face more complaints and are more likely to be harmed themselves. I remind my colleagues that the first letter in basic life support is not ‘A’ for airway; it is ‘D’ for danger. If you are harmed in the course of your work, you are far less likely to be able to help others in need.”
The lecture – part reflection, part warning – explored the ways modern medicine has become “more onerous than ever” to practise ethically. Dr Parnis said clinicians were increasingly being asked to balance patient care with the demands of bureaucracy, policy and politics. “When moral courage is punished,” he said, “self-interest trumps principle and nobody wins.”
He cited one recent episode that brought that tension into sharp focus. Earlier this year, Melbourne’s St Vincent’s Hospital, where Dr Parnis has worked for more than three decades, was targeted with online abuse for introducing triage reforms to improve outcomes for Indigenous patients.
The hospital’s initiative was based on evidence showing that Aboriginal and Torres Strait Islander people waited three times longer to be seen in emergency and were three times more likely to leave without treatment. Using the existing triage tool, clinicians incorporated cultural-safety training and additional resourcing to better assess risk and urgency. It saw immediate results, audience members heard.
“Just as importantly, there has been no compromise to the care of any other group,” Dr Parnis said. “To be on the receiving end of accusations that we are promoting queue-jumping or racism is disappointing, to say the least. But I’m proud that St Vincent’s will stay the course on a practice that is equitable, ethical and effective.”
He said the backlash captured a wider unease in medicine, one where science, compassion and ethics increasingly find themselves at odds with ideology. “Doctors are not vending machines,” he said. “Provided we don’t obstruct a patient’s legal access to care, we must not be forced to facilitate something we believe is harmful or unethical.”
That contradiction, he added, lies at the heart of contemporary healthcare. “We talk a great deal about respect for patient autonomy as a fundamental ethical principle,” he said. “Yet, sadly, we are witnessing the progressive erosion of professional autonomy.”
“I should not be forced to participate in a practice that I regard as harmful, dangerous and unethical,’ he said. ‘I and my colleagues have a right not to be subjected to injury, the consequences of which have led gifted health professionals to stop practising their vocation altogether”.
In his lecture, Dr Parnis addressed one of medicine’s most contested frontiers: voluntary assisted dying. He said his vocal opposition stemmed not from dogma, but from concern for safety and equity. “The push to facilitate a new choice for dying patients,” he said, “is overly dismissive of the new risks imposed on an incredibly vulnerable group – those who may already feel like a burden.”
He warned that legalising assisted dying without ensuring equal access to palliative care risked deepening inequities in end-of-life care. “If a patient is offered a rapid path to lethal drugs but must wait for basic, patchy community support or pain relief, we have failed them. The choice is not free when compassion and care are unequally distributed.”
While acknowledging the sincerity of those who support voluntary assisted dying, he said the hostility directed at clinicians who object – often reduced to claims of religious bias – had chilled open discussion. “If we lose the ability to respectfully disagree,” he said, “we lose something precious, and our collective values and conduct will suffer accordingly.”
Dr Parnis also reflected on the professional risks of ethical advocacy. In recent years he has spoken publicly about protecting healthcare workers and children caught in the Gaza conflict – advocacy that prompted multiple complaints to the Medical Board – all of which have gone on to be dismissed – but which ultimately led to his resignation as board chair of a company he helped lead.
“I stand by every word I have said in the public domain on Gaza,” he said. “My lifelong commitment is to the protection of the vulnerable – and that includes doctors, nurses and children on both sides of the conflict.”
He acknowledged that taking a stand can come at great personal cost. “I believe that 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. Those so-called cherished principles become platitudes – ready to be abandoned in the face of self-interest or potential adversity.”
He said the cancellations of hospital grand rounds and conferences exploring humanitarian medicine represented a “disturbing new form of self-censorship”. “We are witnessing direct clashes between the interests of those we care for and the interests of those who employ us,” he said.
Despite this, his message was ultimately one of humility and persistence. Ethical practice, he said, depends not on perfect systems but on imperfect people who are willing to learn from mistakes.
“[One] lesson I have learned is a simple one – the need for humility, and to acknowledge our humanity,” he said. “The only safe and effective healthcare professional is the one who acknowledges their limitations and who is willing to learn from their experience, which will inevitably include making mistakes.”
He reflected on how easily confidence can shade into complacency, and how cognitive bias remains an enduring threat to patient care. “We like to think that as doctors, nurses and allied health workers, we are the products of excellent training and that we provide the kind of care we would want for our own families,” he said. “But we’re all susceptible to human error” he said, citing anchoring bias – clinging to initial information – and confirmation bias – where a doctor seeks evidence to support a pre-existing belief, both of which undermine good medicine.
Such biases, he added, can have real-world consequences. “We have all been guilty at some point of not taking a patient’s stated concerns as seriously as we should have. It has been acknowledged in my profession that such shortcomings in the assessment of abdominal pain in women has resulted in serious misdiagnoses, provision of less pain relief and increased patient distrust”.
He credited mentors such as the late emergency physician Dr Andrew Dent and general-practice leader Professor John Murtagh AO, whose quiet courage and moral clarity shaped his own career.
“Ethical literacy isn’t learned from textbooks,” he said. “It’s learned from people who live it.”
His closing plea was directed as much to policymakers as to peers. “Governments, regulators and hospitals rightly demand excellence,” he said. “But our primary duty will always be to our patients. If you support ethical clinicians, their influence will flourish. If you don’t, you encourage a culture where self-interest trumps principle. In that scenario, nobody wins.”
For Dr Parnis, the challenge of modern medicine is not just the science of healing but the endurance of conscience – ethical medicine, he says, is rarely comfortable, but it’s what keeps the profession worthy of the trust it demands.