Tuesday, 17 March 2015

Socialism is a "Belief"

The Employment Appeals Tribunal has made an "interesting" decision in General Municipal and Boilermakers Union v Henderson [2015] UKEAT 0073_14_1303 where it has agreed that a strong commitment to "left-wing democratic socialist beliefs" would constitute a "philosophical belief" for the purpose of s10 Equality Act 2010  which say
(1) Religion means any religion and a reference to religion includes a reference to a lack of religion.

(2) Belief means any religious or philosophical belief and a reference to belief includes a reference to a lack of belief.
The judgement itself is lengthy to the point of tedium and involves a dispute between Mr Henderson and his employer who happened to be the GMB Union.  It seems from the judgement that it was accepted by both sides that Mr Henderson had strongly held “left-wing democratic socialist beliefs” and that it was also accepted that these constituted protected beliefs for the purpose of s10.  The rest of the judgement involves the EAT Judge deciding that Mr Henderson was not actually discriminated against because of those beliefs.

However was the EAT Judge right to agree that left wing Socialism was a protected belief under s10 ? In my view she was emphatically and hopelessly wrong.  I covered the question in Chapter 3 of my book "Religious Discrimination and Hatred Law" where I quoted the Parliamentary debate when the Equality Bill was going through Parliament.  Chapter 3 read as follows

"One thing that was made clear in both the Lords and the Commons was that Parliament did not want to see Political Beliefs or the membership of a political party being treated by the courts as a “belief” for the purposes of section 44. Questions were raised on this point in both houses because the definition of “religion or belief” in s44 differed from the definition that was already in place in s2(1) of the Employment Equality (Religion or Belief) Regulations 2003 namely
"religion or belief" means any religion, religious belief, or similar philosophical belief

Concerns were raised that removing the word "similar" could mean that it would become illegal to discriminate against people because of their political beliefs. Home Office Minister Baroness Scotland said (Hansard 13 July 2005 Col 1109)
"The intention behind the wording in Part 2 is identical to that in the employment regulations. However, in drafting Part 2, it was felt that the word "similar" added nothing and was, therefore, redundant. This is because the term "philosophical belief" will take its meaning from the context in which it appears; that is, as part of the legislation relating to discrimination on the grounds of religion or belief. Given that context, philosophical beliefs must therefore always be of a similar nature to religious beliefs. It will be for the courts to decide what constitutes a belief for the purposes of Part 2 of the Bill, but case law suggests that any philosophical belief must attain a certain level of cogency, seriousness, cohesion and importance, must be worthy of respect in a democratic society and must not be incompatible with human dignity. Therefore an example of a belief that might meet this description is humanism, and examples of something that might not—I hope I do not give any offence to anyone present in the Chamber—would be support of a political party or a belief in the supreme nature of the Jedi Knights."

Whilst Home Office Minister Paul Goggins MP said (Hansard 6 December 2005 Col 146)
"philosophical belief is not limitless; for example, it would not be possible to claim that belief in the supremacy of a certain football team qualified as a religion or philosophical belief. Nor, indeed, could that claim be made about belief in the principles of a political party, the point raised by the hon. Gentleman. We know that because of the case in April this year of Baggs v. Fudge, in which a member of the British National party sought to challenge the refusal of an organisation to interview him for a job under the Employment Equality (Religion or Belief) Regulations 2003, which incorporate wording about “philosophical belief” similar to that in the Bill. That individual’s argument, that his support for the BNP constituted a philosophical belief, was thoroughly rejected by the tribunal, so there is no case to suggest that any such political belief would qualify as a religion or belief under the Bill. We are not making up the provisions on the spur of the moment; as I said, there is a precedent for them in the 2003 regulations.
Mr. Grieve: I can understand the rationale in Baggs v. Fudge, which concerned an adherence to a political party, as I understand it. That seems to me to be capable of being distinguished from an adherence to a particular philosophical belief. There may be no such difference, but the Minister may understand why I remain slightly troubled by this point. It is one thing to say, “We refused to interview him because he was a member of the BNP” and another to say, “We refused to interview him because we knew that he had a belief in white supremacy”. Maybe there is no distinction between those two statements, but I see a capacity for one. I wonder whether we are in danger of opening a door to people to make such arguments.
Paul Goggins: Often those two things, a particular belief and association with an organisation, are inextricably linked. In the end it will always be for the court, the employment tribunal or other judicial setting to determine whether the provisions of a particular employment law are relevant to a particular case. Our job here is to set out in legislation the overall provisions, and that we do, in a way that does not give limitless extent to the concept of philosophical belief, but ensures that it is consistent with the hallmarks of religious belief, such as cogency, which I quoted earlier"

So is a belief in Political Islamism or indeed Fascism, now protected by the Equality Act ?   


Thursday, 12 March 2015

Equality and Human Rights Commission Report

The Equality and Human Rights Commission has issued a Report on Religion or belief in the workplace and service delivery which is an analysis of a consultation regarding the operation of the Equality Act 2010 in relation to protecting (or not protecting) expressions of Religion and Belief especially in the workplace

I was asked to speak on the subject to BBC Radio Merseyside this morning and you can hear my contribution HERE (I am at 01:06:00  the contribution from the EHRC is at 00:06:00 )

My main point which I have made before is that the real problem is the fact that people increasingly look for reasons to be 'offended' rather than adopting a 'live and let live' attitude to others.  

The EHRC consultation elicited responses from 2,500 people with the largest number of responses coming from Christians from a number of denominations. The EHRC website says that

"Positive experiences included respondents describing workplaces with an inclusive environment in which employees and employers were able to discuss openly the impact of religion or belief on employees or customers. Some respondents of different religions also reported they were easily able to take time off to celebrate religious holidays.

Some employees or service users stated that they had experienced no or few negative issues in their workplace or in receiving a service which they attributed to the view of employers or service providers that religion or belief was a private matter and should not be discussed in the workplace or the service.

Some employees and students stated that they had encountered hostile and unwelcoming environments in relation to the holding, or not holding, of a religion or belief. The issues raised concerned the recruitment process, working conditions, including the wearing of religious clothing or symbols, promotion and progression, and time off work for religious holidays and holy days. Some reported that particular beliefs were mocked or dismissed in the workplace or classroom, or criticised unwelcome 'preaching' or proselytising, or the expression of hurtful or derogatory remarks aimed at particular groups.

Employees and employers reported that requests relating to religion or belief issues were not always fairly dealt with in the workplace and some called for better guidance on how to achieve this.

Many participants were concerned about the right balance between the freedom to express religious views and the right of others to be free from discrimination or harassment. Specific issues raised included conscientious objection in relation to marriage of same sex couples and how to protect employees from harassment and discrimination by staff, customers or service users with a religion. There was a marked divergence of opinion about when it was desirable and appropriate to discuss religious beliefs with service users during the delivery of a service.

A group of service providers with a religious ethos expressed concerns about reductions in funding opportunities from the public and private sectors.

Some participants viewed the current equality and human rights legal framework relating to religion or belief favourably, arguing that it provided a single robust framework to deal with discrimination and equality. Others were broadly favourable, but felt a pluralistic approach had not yet gone far enough. A third group viewed the law negatively, with some Christian employers, service users and providers considering that Christianity had lost status as a result of the legal framework. "

My own view is that I do not expect to see anything positive coming from the EHRC which so far as I am concerned is simply a waste of the taxpayers money. It is a paradox of EHRC like so many other organisations in modern Britain that is considers itself a beacon of liberal tolerance but that liberal tolerance is only extended to similarly minded tolerant liberals.   

Saturday, 24 January 2015

Allah for Muslims Only ? - 2

On 23 June last year I blogged about a case in Malaysia where the Government had prevented the Catholic Herald of Malaysia from using the word "Allah" in its Malay publication.  In its Judgment Roman Catholic Archbishop of Kuala Lumpur v Negeri & Ors Civil Application No.: 08-690-11/2013 the Federal Court of Malaysia, which is the highest Court in the Country, noted [para 30]
" the reasons given by the Minister in his Affidavit In Reply, it is clear that he was concerned with national security and public order."

the Federal Court in the same paragraph endorsed the view of the Court of Appeal
"the usage of the word ‘Allah' particularly in the Malay version of the Herald, is without doubt, do have the potential to disrupt the even tempo of the life of the Malaysian community."

In its Judgement the Federal Court basically took a very narrow and technical view of its powers of Judicial Review and regarded the decision as one that fell within the area of Executive discretion.  

The Catholic Church recently applied to the Federal Court to reconsider its Judgment on the basis that it had not properly taken account of the provisions of the Constitution of Malaysia  relating to religious freedom.  Not surprisingly perhaps the Federal Court having looked at its own decision decided it had been right all along and so the possibility of any further review of the Federal Court decision has ended see News Links HERE, HERE, HERE, There appears to be no further legal route for the Catholic Church to appeal this ban on it using the word "Allah" for God in Malay services and publications and there are already attempts to try to stop the Catholic Herald publishing anything in Malay.

As an outsider this decision by the Malaysian Government to try to control the use of the word "Allah" seems bizarre.  Arab Christians use "Allah" and I was recently in Malta, an extremely Catholic country, where in services God is routinely called "Alla".  In a strange way to try to keep Allah as a word only to be used by Muslims actually diminishes "Allah" who ceases to be "the God", the one true creator of the Universe and instead becomes merely the God of Muslims on a par with Zeus or Odin.   

I wonder however whether this idea of restricting the use of the word "Allah" will spread within the Muslim World.  A particular danger may be that the Ahmadiyya Muslims will be targeted and prevented from using the word "Allah" in their services.  They are not regarded as "true" Muslims by most Sunni and Shia groups and are already prevented from describing themselves as Muslims in many countries

Monday, 19 January 2015

Caste Discrimination in the Employment Tribunal

A recent case in the Employment Appeal Tribunal has accepted that Caste Discrimination, may (and I emphasise "may") constitute a subset of Racial Discrimination for the purposes of a Discrimination claim under the Equality Act 2010.

In  Chandhok v Tirkey  [2014] UKEAT 0190_14_1912 a claim was brought by a former domestic worker against her former employers alleging that they had treated her in a demeaning and prejudiced manner.  Both the worker and her employers were of Indian origin though she alleged that the reason for this treatment was her perceived lower caste status.  The defendants applied to strike out that element of the claim since caste is not one of the "protected characteristics" listed in the Equality Act  

The ET and the EAT refused this application in large part because it was possible that, on the facts of the case, the caste of the claimant arose from her descent in which case it could fall under the definition of race.  If caste was for some other reason, ie religious, then it would not constitute race discrimination.  The matter had to be decided on its own facts and therefore the "caste" element of the race discrimination claim could not be dismissed without a hearing where it could be determined whether on the facts it could fall within the protected characteristic of race/ethic origin.

The decision certainly does not throw open the doors to straightforward claims of caste discrimination but it does make such claims easier to bring which is something that caste activists have been seeking for some time.  Whilst caste as a formal concept is inextricably linked to the Indian sub continent it is not unique to Hinduism.  There is a great deal of evidence that both Muslims and Sikhs continue to have a strong conciousness of caste even though the concept is condemned by their own religions.

Interestingly on 31st December 2014 Parliament issued The Equality Act 2010: caste discrimination - Commons Library Standard Note which is a useful source of information on the issue including mention of the Chandhok case.  I can also heartily recommend Caste discrimination: the Government’s progress which is a posting in April 2014 on the invaluable Law and Religion UK Blog

Wednesday, 24 December 2014

Goodbye 2014

This Blog is now closing down until January 2015 and I thought I would finish with a bit of a look back on a rather depressing year.

The lowest point was undoubtedly the Supreme Court decision in  Greater Glasgow Health Board v Doogan [2014] UKSC 68  which in effect neutered the Conscientious Objection provision in the Abortion Act 1967 and in my view on very questionable legal grounds.  

The high point for me personally was the opportunity to represent Mr Thomas  Monson,  President of the Church of Jesus Christ of Latter Day Saints (the Mormon Church) who was summonsed to answer a private prosecution issued by a disafected ex Mormon Bishop, Mr Tom Philips.  The Summons was described in The Daily Telegraph as "one of the most unusual documents ever issued by a British Court"  and I would certainly agree with that.  

Before I was instructed to act I had been contacted by a reporter from the Arizona Republic Newspaper asking for my response which ended up being syndicated across the US 

Anyway I was involved with other lawyers in getting the case chucked out at the first hearing on the basis that the issues related to religious doctrine and were therefore "Non Justiciable". 

Prior to the hearing I spent some time following ex Mormon Blogs (almost as bad as ex Catholics, leave the Church but refuse to leave it alone) in order to try to understand the logic behind the case.  What became apparent was that the case was based on a fundamental failure to understand the legal and philosophical nature of religious belief. The idea behind the case was that because certain beliefs of the Mormon Church are expressed by the Church as assertions of facts then they could be examined in Court  however that ignores the reality that most religious beliefs are expressed as assertions of fact, "Christ was crucified and rose from the dead", "Mohammed was visited by the Angel Gabriel who said 'recite' (Arabic 'Quran') and the assertions of fact/belief by the Mormon Church are no different in that respect.

Interestingly the question of whether and to what extent issues relating to religious belief are Non Justiciable was considered by the Supreme Court a few months later in  Shergill v Khaira [2014] UKSC 33  which reaffirmed the principle of Non Justiability with just a little bit of tweaking.


During the year I have been paying a bit more attention to my Blog statistics in particular where visitors come from.  Most are from the UK with the US the next most common, I have visitors from France and Germany (Bienveue and Guten Tag) Vistors also come from Australia (G'day sport) and from Canada (Happy Christmas/Joyeux Noel, Hey !)

I also have visitors from Russia and Ukraine though for some reason nobody from Belarus so I wonder what I have done to upset the Belarussians.  Anyway Счастливого Рождества  and щасливого Різдва to my Slavic readers.

The mention of Ukraine and Russia of course inevitably brings up thoughts of the conflict in Eastern Ukraine and the increasing hostility between Russia and Ukraine.  I actually own a map of Europe published in 1913 and it shows what we call Ukraine named as "Little Russia" with Belarus as "White Russia" and Russia proper as "Great Russia"which is why the Tsars were called "Tsar of all the Russias".  The relationship between Ukraine and Russia is therefore an historically close one so making the conflict between them even sadder and no doubt more bitter because family disputes invariably are the bitterest.

And besides Ukraine there is the ongoing Syrian Civil War and the growth of the self styled Islamic State where frankly I doubt if any outsider truly understands what is really going on or the motivations behind all the death and destruction that is happening.

So as I said a depressing year all I can do is to wish you all well and to hope that 2015 will be a good year for you and a better year for the world.

Until then Good Night and God Bless 

Call The Midwife I want an Abortion ! - 4

In an attempt to try to derive some good from the Supreme Court decision in  Greater Glasgow Health Board v Doogan [2014] UKSC 68  the comments of Lady Hale in paras 23 and 24 are worth noting 

23: There was some discussion, at an earlier stage in these proceedings, of the relevance of the petitioners' rights under article 9 of the European Convention on Human Rights. This protects the "right to freedom of thought, conscience and religion," including the freedom "to manifest his religion or belief, in worship, teaching, practice and observance". It is our duty, under section 3(1) of the Human Rights Act 1998, to read and give effect to legislation, whenever it was passed, in a way which is compatible with the Convention rights, so far as it is possible to do so. However, the article 9 right is a qualified right, which may be subject to "such limitations as are prescribed by law and necessary in a democratic society in the interests of public safety, for the protection of public order, health or morals, or for the protection of the rights and freedoms of others". Refusing for religious reasons to perform some of the duties of a job is likely (following the decision of the European Court of Human Rights in Eweida v United Kingdom ((2013) 57 EHRR 8) to be held to be a manifestation of a religious belief. There would remain difficult questions of whether the restrictions placed by the employers upon the exercise of that right were a proportionate means of pursuing a legitimate aim. The answers would be context specific and would not necessarily point to either a wide or a narrow reading of section 4 of the 1967 Act.


24: The better course, therefore, is for this court to decide what that section means according to the ordinary principles of statutory construction. That will then set a limit to what an employer may lawfully require of his employees. But a state employer has also to respect his employees' Convention rights. And the Equality Act 2010 requires that any employer refrain from direct or unjustified indirect discrimination against his employees on the ground of their religion or belief. So, even if not protected by the conscience clause in section 4, the petitioners may still claim that, either under the Human Rights Act or under the Equality Act, their employers should have made reasonable adjustments to the requirements of the job in order to cater for their religious beliefs. This will, to some extent at least, depend upon issues of practicability which are much better suited to resolution in the employment tribunal proceedings (currently sisted pending the resolution of this case) than in judicial review proceedings such as these.

This does give Supreme Court approval to an argument that I have successfully used to defend pro-life medics being pressurised to assist with Abortion services even if they do not "participate" in the narrow sense in which that word has been interpreted by the Supreme Court.  In a Blog on 12 August 2011 "Abortion and the Equality Act" I discussed my use of the Equality Act with the pro-life position being put forward either as a religious or a philosophical belief ( as I have frequently mentioned in the past pro-life views are not restricted to religious believers, it is quite possible to be an Atheist and pro-life )

In an ET1 (Employment Tribunal Claim Form) drafted by myself on behalf of a pro-life employee in the NHS I relied on Article 9 and s10 as follows

"The claimant is a member of the Roman Catholic Religion.  She has both a religious and a personal philosophical belief that human life begins at conception and that Abortion is the killing of an innocent human life and is harmful both to the unborn child and to the mother of that unborn child. This is a belief which is compatible with human dignity and worthy of respect in a civilised society and as such it is protected under Article 9 of the European Convention on Human Human Rights and under section 10(1) and 10(2) of the Equality Act 2010."

The cases I have been involved in have however all been resolved without litigation and therefore it is still unclear how far the Equality Act will be effective in protecting pro-life medics and Lady Hales remarks do seem to be an encouragement to litigation which will be expensive and uncertain for all concerned.  

Personally I would have preferred the simpler and more realistic solution of the Supreme Court giving a broad reading  to the Conscientious Objection clause in s4 of the Abortion Act 1967.  However since that has not happened pro-life medics and lawyers such as myself will now have to look increasingly to the Equality Act and the Human Rights Act in order to protect conscience and avoid participation in Abortion

Wednesday, 17 December 2014

Call the Midwife I want an Abortion ! - 3

The Supreme Court has issued its decision in the case of  Greater Glasgow Health Board v Doogan [2014] UKSC 68 which was an Appeal from the decision of the Inner House of the Court of Session [2013] ScotCS CSIH_36 itself an Appeal from the earlier Outer House decision [2012] ScotCS CSOH_32.   

I have Blogged about the cases in 2012 and 2013.  In brief Ms Doogan and Ms Wood are experienced senior Midwives who worked in a supervisory capacity in the Labour Ward of their Hospital. Due to changes in Hospital routines etc Abortions began to be performed in the Labour ward and this change put the two midwives in a moral and legal dilemma that eventually led to the Supreme Court. 


They objected to Abortion on Religious Grounds (they are Roman Catholics and the Catholic position on Abortion is pretty unambiguous) and sought to rely on the Conscientious Objection clause in s4(1) Abortion Act 1967 which says.
"no person shall be under any duty whether by contract or by any statutory or other legal requirement to participate in any treatment authorised by this Act to which he has a conscientious objection"

It is worth pointing out that the conscientious objection clause is not restricted to believers in religion, a Secular Pro-Life person is entitled to rely on s4(1) just as much as a religious person. 

The problem that the two Midwives had was that the Hospital did not accept that s4(1) covered their supervisory functions but insisted that it only applied to direct involvement in the physical act of Abortion and the legal case at all Courts has revolved around the question of what "participate in any treatment" actually meant. 

The Supreme Court found against the Midwives and the Judgment was, ironically, delivered by Lady Hale.  I say "ironically" because on 13th June 2014 Lady Hale gave a speech to the Law Society of Ireland where she said 
"I am not sure that our law has yet found a reasonable accommodation of all these different strands [of religious freedom and conscientious objection]"

One thing is clear from the Doogan Judgment namely that the Supreme Court did not even try to find a "reasonable accomodation" and instead went out of its way to emasculate and limit the Conscience Clause in s4.  The Court in para 37 of its judgment accepted that the word "participate" can have a narrow or a wider meaning and then in para 38 plumped for the narrow meaning

37: The more difficult question is what is meant by "to participate in" the course of treatment in question. The employers accept that it could have a broad or a narrow meaning. On any view, it would not cover things done before the course of treatment began, such as making the booking before the first drug is administered. But a broad meaning might cover things done in connection with that treatment after it had begun, such as assigning staff to work with the patient, supervising and supporting such staff, and keeping a managerial eye on all the patients in the ward, including any undergoing a termination. A narrow meaning would restrict it to "actually taking part", that is actually performing the tasks involved in the course of treatment.

38: In my view, the narrow meaning is more likely to have been in the contemplation of Parliament when the Act was passed. The focus of section 4 is on the acts made lawful by section 1. It is unlikely that, in enacting the conscience clause, Parliament had in mind the host of ancillary, administrative and managerial tasks that might be associated with those acts. Parliament will not have had in mind the hospital managers who decide to offer an abortion service, the administrators who decide how best that service can be organised within the hospital (for example, by assigning some terminations to the Labour Ward, some to the Fetal Medicine Unit and some to the Gynaecology Ward), the caterers who provide the patients with food, and the cleaners who provide them with a safe and hygienic environment. Yet all may be said in some way to be facilitating the carrying out of the treatment involved. The managerial and supervisory tasks carried out by the Labour Ward Co-ordinators are closer to these roles than they are to the role of providing the treatment which brings about the termination of the pregnancy. "Participate" in my view means taking part in a "hands-on" capacity.

My first objection to this is that there is absolutely no factual or legal basis on for the Court to decide that the "narrow interpretation" is more likely to have been "in the contemplation of Parliament". There appears to have been no reference made to the Parliamentary Debates as is allowed by the case of Pepper v Hart [1993] AC 593 and which would have revealed that the Abortion Act was only passed because of the conscience clause in s4 and assurances that there would be no compulsion regarding participation in Abortion 

There seemed no recognition that the  job of a Labour Ward Co-ordinator required a medical qualification and was carried out by these Midwives in their capacity as qualified Midwives so the comparison Lady Hale makes with cleaners etc is simply fatuous 

More worryingly the Judgment deals with 2 issues relating to Abortion but which were not part of the issues before the Court

In para 36 Lady Hale says that the Conscience Clause provisions in s4 do not cover a Doctor who is asked to sign an authorisation form to legalise an Abortion 
"In Janaway [1989] AC 537, 572 Lord Keith pointed out that such an interpretation would not cover the doctors forming the opinions required by section 1 and signing the certificates to that effect" 
This is actually a complete misrepresentation of Lord Keiths remarks in Janaway where after discussing whether s4 applied to Doctors Certificates he said (very correctly) 
"I do not think it appropriate to express any opinion on the matter."
I rather wish Lady Hale had accepted the same degree of proper Judicial restraint in commenting on matters which were not specifically part of the issues in the case especially having regard to the fact that Doctors Organisations were not represented at the Supreme Court case and had not been forewarned that legal decisions might be made relating to them so that they could make representations if they wished.

In para 40 she says
"it is a feature of conscience clauses generally within the health care profession that the conscientious objector be under an obligation to refer the case to a professional who does not share that objection. This is a necessary corollary of the professional's duty of care towards the patient. Once she has assumed care of the patient, she needs a good reason for failing to provide that care. But when conscientious objection is the reason, another health care professional should be found who does not share the objection."
Once again this was not an issue in the case, Doctors and Nurses Organisations were not forewarned that judgments might be made on this point so that they could be represented and make representations if they wished.  Also it is reading something into an Act of Parliament which has not been put in by Parliament.  

Those two elements of the Judgment are frankly disgraceful, Lady Hale and her fellow Judges stepping completely and unjustifiably outside their legitimate role and function as Judges and making judgments on issues which are not before them and on which the persons affected have not been allowed to make any representations.  Frankly what annoys me as a lawyer is the sheer lack of professional competence in the way the Judgment is reasoned and the way in which the scope of the judgment goes quite improperly beyond the parties and issues involved.

Two final and closing points on what is a depressing evening

In para 8 Lady Hale goes into depressing detail concerning various methods of Abortion provision and says, in passing.
"Feticide is also carried out where there is a risk of the foetus being born alive following the termination"
To which I can only respond "a risk" ? So she happily accepts that the purpose of the legislation is amongst other things to ensure that babies who might be born alive are prevented from being born alive.

In para 14 she looks at the organisation of the Labour Ward where the Midwives worked
"Since 2010, there have been about 6000 births a year at the Southern General Hospital and just under 60 terminations a year in the Labour Ward."
Therefore since Abortions are just 1% of the work in this ward it would not have caused Glasgow NHS any real difficulties to have "reasonably accommodated" the conscientious objections of these Midwives.

In conclusion the case is an overall disaster for good honourable pro-life Doctors and Nurses who may well find themselves either pushed out of medicine altogether or forced to accept that they can never progress and accept supervisory medical posts