[This post will be familiar to those on Twitter, where I have posted much of the below in a couple of long tweets that kicked off a lot of debate. At least it is getting people thinking about the consequences of what many at first think is a virtuous policy]

My ‘shame of the week’ award goes to Wes Streeting, the UK Health Secretary. He said this past Wednesday that people who are racist to NHS staff in health settings “can and should” be turned away from care.

That prompted a remarkably fast same-day endorsement from the Royal College of Nursing. For the first time, the country’s largest nursing association changed its 'withdrawing care' guidelines to include “racism" to instances in which "there is discriminatory behavior."

The Health Secretary and the RCN said that NHS staff should never have to be subjected to abusive and violent behavior. That is undoubtedly true. But it is not what the Health Secretary and the Royal College of Nursing embraced. The new standard, as evidenced on the RCN's own site, is about controlling behavior.

Doctors in civilian settings treat convicted serial killers and terrorists among many other unsavory patients, and during war, tend to enemy combatants. Israeli surgeons, for instance, saved the life of Hamas chief Yahya Sinwar, when he had a brain tumor while in prison in 2004. There is a duty of care that is the ethical foundation for medical practitioners.

One UK health care provider posted, "I nurse all of my patients in the same way, be they sex offenders, racists, petty criminals, or Mary Poppins. My job isn't to judge or press my opinion, it's to provide health care to anyone who needs it. No matter how I privately feel about them." Another said, "When I was nursing, we treated prisoners shackled to prison officers, paedophiles, rapists etc. Everyone did, and should, get equal care by the NHS."

A lot of people seem to have forgotten the outrage in 2010 when a German surgeon refused to operate on a man who was already anesthetized when he noticed a swastika tattooed on the patient’s upper arm. Are Muslim doctors going to decide not to treat patients who served in the IDF? Can Jewish doctors turn away patients with a Hamas or ISIS symbol? Are there health care providers in the UK, who are guided by the Health Secretary’s declaration, who would refuse to treat Tommy Robinson, one of the UK’s most prominent right-wing activists?

Introducing racism as a supposedly objective factor is particularly challenging given that it is a constantly shifting, and often overused, concept. Is the standard for refusing to treat a patient now subject to the interpretation of racism by the treating medical staff?

The University of Chicago offers a course that teaches that "Speech is a medium within which violence is performed." Does that empower someone who is triggered by what a patient says to turn them away for medical treatment? Many young people contend that anything they dislike or disagree with constitutes "literal violence."

How would that work in an A&E/emergency room setting when the patient exhibiting the "discriminatory behavior, including racism" might be suffering from mental illness, dementia or Alzheimer's disease, be on the spectrum, or in great pain, or even strung out on drugs?

Many patients arriving at a busy A&E are in both a physical and mental distress that brings out their worst sides. That is not an excuse for abusive behavior. It is instead a challenge to the medical staff to quickly and accurately determine whether the patient has their full mental capacity before refusing to treat them. Abuse and violence toward medical staff can and should be criminally pursued. Patients, however, even the difficult ones, are also entitled to medical care.

It is a slippery slope to turn healthcare providers into subjective arbiters of whether patients should be refused medical care for "discriminatory behavior, including racism." What's next, turning away patients for misgendering? That might seem farfetched. However, Kellie-Jay Keen, a prominent British gender critical activist, has been banned recently from her general practitioner’s office for objecting to pronoun badges worn by the medical staff.

Once this creeps into medical treatment, you never know where it ends. But it never ends well.

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