Intended for healthcare professionals

The Inhumanity And Humanity Of Medicine

The price of truth

BMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6970.1700 (Published 24 December 1994) Cite this as: BMJ 1994;309:1700

Why whistleblowing 'heroes' such as Pink undermine the practice of whistleblowing

Justifiable whistleblowing by health care professionals should not be
considered morally wrong. If hospital authorities fail to take action over
legitimate reported concerns, whistleblowing is likely to be the only
means available to the individual to protect patients at risk of harm.
Some individuals believe it is their professional duty to whistleblow.
However, whistleblowing is not always praiseworthy – it depends on the
motive, on the alternative remedies available, and on how serious the
matter is.

In 1989, Charge Nurse Graham Pink blew the whistle over staff
shortages leading to an alleged reduction in standards of care at a
Stockport hospital. Over the next four years, Pink persisted with his
campaign. Professor Gerald Vinten’s account of the affair notes that apart
from the main concern over alleged staff shortages, many of Pink’s
complaints to his managers referred to the: ‘ inadequacies of his day-
shift colleagues in failing to achieve his own perceived standards in such
areas as filling in drug and nursing kardexes,[nursing records] and name
bands, giving handover reports, washing medicine glasses and removing
teacups from lockers at the end of a shift.’
Pink’s campaign finally ended in settlement only after costing the N.H.S.
Trust thousands of pounds defending their right to dismiss Pink over his
breaching of patient confidentiality. Professor Vinten quotes the opinions
of a ward sister and former colleague of Pink: ‘ In view of the numerous
occasions that Mr. Pink has now violated the most precious rights still
left to the elderly (namely dignity, privacy and above all
confidentiality) by his articles in the press, I would be grateful if you
would consider removing him from this ward, therefore ensuring that the
‘most vulnerable members of our society’ [Mr. Pink’s own phrase] are
indeed afforded the respect they deserve instead of being pawns in his
campaign.’

One may perceive staff shortages as a moral wrong if it might
compromise patient safety. But hospital wards are routinely and adequately
staffed by a fixed number of trained staff. There may be extremely rare
occasions when an unusually large number of patients on the same ward
require attention at the same time. Does this mean ward-staffing levels
should be permanently increased? Would anything be gained in permanently
doubling a ward’s nursing staff, thus diverting resources from elsewhere
merely to cope with a rare and unlikely event? Does it justify
whistleblowing as a means to achieve change? It is noted that in Hunt and
Shailer’s survey of 30 whistleblowers, the vast majority blew for
arguably, semi-serious reasons such as staff shortages and alleged unfair
treatment of staff.

In common with these other whistleblowers, Pink’s intentions may have
been sincere. However, in his case, the question is whether his
whistleblowing strategy was appropriate in the circumstances. Pink was
convinced that the public ought to be aware that some patients were
suffering a degree of harm because of staff shortages. But it could be
argued that one result of his action may have been to undermine the
confidence and trust of patients. This might have been a short- term
regrettable consequence, to be weighed against the possibility that
publicity would result in needed reforms. However, staff shortages are
more of a political issue. Acting heroically whilst facing impossible odds
in taking on a government department, it would suggest that Pink’s
persistent action may have been somewhat ill- advised.

Pink ignored the option not to whistleblow despite the repercussions
on his career. With the odds of success against him, his action was
undoubtedly supererogatory and heroic. But it is 'heroic' whistleblowers
such as Pink who undermine the practice of whistleblowing. Doctors or
nurses who do hold compelling evidence of serious malpractice may have had
their decision not to whistleblow influenced by the fate suffered by
somewhat naïve or perhaps over zealous whistleblowers.(1)

1, Bulletin of Medical Ethics

Editor, Dr. Richard Nicholson, No. 170 AUGUST 2001 pp. 13-17

Competing interests:
None declared

Competing interests: No competing interests

22 November 2007
ANTHONY T FRAIS
researcher
LEEDS LS17 8EB