Complicity vs. protest: a doctor's choice

We are trained to move quickly. To respond before thinking. To act before doubting. To rise at three in the morning because someone’s life might depend on it. That is how we learn ethics, not in seminar rooms, but in corridors that smell of antiseptic and coffee, under fluorescent light, beside stretchers with failing hearts.

And so, somewhere along the way, we begin to believe that morality lives in the moment. In urgency. In the capacity to do something now.

But not all harm arrives that way. Some kinds of harm do not crash through the door. They drift in. Quietly. Over the years. They settle into policy. They do not scream. They accumulate.

And when doctors strike, when they withdraw labor, delay procedures, interrupt what feels like a sacred order, it can feel like a violation of our oath. Not just professionally, but personally. It runs against everything we have practiced. Show up. Do not abandon. Never let them down.

But time teaches another lesson, if you are willing to listen. Sometimes the greater harm is in continuing.

We tend to see harm as what is visible: the canceled surgery, the rebooked patient, the mother in the waiting room whose child’s appointment disappears. These moments matter. Of course they do. But they are not the whole story.

There is also the patient who no longer calls because Medicaid always says no.

The resident who learns to swallow mistreatment because speaking up might end their career.

The attending who spends nearly half the day feeding software instead of using their judgment.

And the quiet knowledge, shared by all of us, that entire communities remain sicker than they should be, not because of some rare disease, but because neglect has become routine.

These are not isolated events. They are built into the system. Over time, we have come to accept them as normal. None of it makes headlines. At least not until someone interrupts it. Not until a physician says, out loud, what many have quietly tolerated.

This is not new.

In the 1960s, some New York doctors refused to keep working under a system that paid them so little they could no longer treat the poor ethically. In the 1980s, physicians in Israel walked away, not impulsively, but because conditions had degraded to the point where staying felt irresponsible. Then, in 2023, junior doctors in the United Kingdom made the same difficult choice. It was not about politics or protest. For many, it was a matter of survival. Their work had been devalued for too long. Their pay eroded. Their ability to continue, simply to stay, had quietly disappeared.

And long before any of that, even in ancient Rome, there were times when protest took a different shape. Senators, faced with proceedings they could no longer support, stood and walked out. No speeches. No chanting. No performance. Just absence. A way of saying, without spectacle or noise, that they could not be part of it any longer.

These were not acts of abandonment. They were acts of memory. A way of saying: This is not what we signed up for. This is not care.

Simone Weil once wrote that to be rooted is perhaps the most important, and least recognized, need of the human soul. She was not speaking poetically. She meant belonging. Dignity. The quiet conviction that one’s work is still connected to something human, something whole.

Medicine, when bent by cost-cutting and bureaucratic drift, gradually strips away that meaning. It separates us from the reasons we entered the profession. And then it tells us we are burned out, as if the fault is ours. To strike, then, is not escape. It is recognition.

Still, the conflict is real. I have lived it.

To stop can feel like failure. To keep going can feel like complicity. We live between those two tensions and call it professionalism. We are told to endure. To press on. To do the work.

But endurance is not always integrity.

Kierkegaard once said that life can only be understood backward, but must be lived forward. I return to that line often. I think of the silences I allowed. The small accommodations I made to stay afloat. The years I spent trying to work around something I should have called out directly.

I no longer believe that silence equals care. Sometimes the ethical act, the braver one, is to stop. To step off the wheel, not because you are exhausted, but because you are finally clear.

The patient in front of you matters. Yes. But so does the patient you will never meet. The one ten years from now. The one who might suffer because we kept nodding along to a system we no longer believed in.

There are moments when pausing is not abandonment. It is a kind of remembering. To remember what medicine was supposed to be. To remember that harm is not always sudden. Sometimes it accumulates quietly.

You see it in metrics. In early retirements. In resignation letters that no one reads twice.

And if that is true, then continuing is not always the most ethical choice.

Sometimes the right thing is to stop. To sit with what matters. To say no, not loudly, not with anger, but with clarity.

And to place your hands in your lap and say:

Not this.

Not anymore.

Not in my name.

Patrick Hudson is a retired plastic and hand surgeon, former psychotherapist, and author. Trained at Westminster Hospital Medical School in London, he practiced for decades in both the U.K. and the U.S. before shifting his focus from surgical procedures to emotional repair—supporting physicians in navigating the hidden costs of their work and the quiet ways medicine reshapes identity. Patrick is board-certified in both surgery and coaching, a Fellow of the American College of Surgeons and the National Anger Management Association, and holds advanced degrees in counseling, liberal arts, and health care ethics.

Through his national coaching practice, CoachingforPhysicians.com, which he founded, Patrick provides 1:1 coaching and physician leadership training for doctors navigating complex personal and professional landscapes. He works with clinicians seeking clarity, renewal, and deeper connection in their professional lives. His focus includes leadership development and emotional intelligence for physicians who often find themselves in leadership roles they never planned for.

Patrick is the author of the Coaching for Physicians series, including:

He also writes under CFP Press, a small imprint he founded for reflective writing in medicine. To view his full catalog, visit his Amazon author page.