The Ethics of Industrial Action by Doctors

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Abstract

The traditional and majoritarian view of medicine as a vocation rather than a job remains the basic principle that motivates doctors. Nevertheless, over the last two decades, there has been an erosion of their authority and an inability to fulfil the best care they can provide with successive cuts to the NHS and a relative salary reduction. That festering discontentment likely spurred many doctors to seek a route to express their feelings by taking IA. Nevertheless, for many, the ethical turmoil of potentially causing harm to patients from withdrawing services cannot be overemphasised. The conflict between professional duty and personal gain is at its acutest at such times. It remains to be seen how this will be reflected in campaign turnouts and on the picket line. Ultimately, full-blown strike action is neither in doctors' nor the government's interest. Patients have long memories, especially as many are still reeling from the injustices of the pandemic, albeit doctors and others on the front line were celebrated as heroes. The media has little regard for the legal case of strikes or any ethical basis. They will record events for posterity, ensuring that stories on both sides are personalised and sensationalised. The real casualty in this could be the NHS, which is yet again at the forefront for the wrong reasons. On the other hand, the doctors’ strike actions and those of others in healthcare might, in part, hope that these would wake the public to defend an institution at the highest risk in its 75 years since Aneurin Bevan gave birth to it.

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Global medicine: Is it ethical or morally justifiable for doctors and other healthcare workers to go on strike?

Sylvester C Chima (2013)

Background Doctor and healthcare worker (HCW) strikes are a global phenomenon with the potential to negatively impact on the quality of healthcare services and the doctor-patient relationship. Strikes are a legitimate deadlock breaking mechanism employed when labour negotiations have reached an impasse during collective bargaining. Striking doctors usually have a moral dilemma between adherence to the Hippocratic tenets of the medical profession and fiduciary obligation to patients. In such circumstances the ethical principles of respect for autonomy, justice and beneficence all come into conflict, whereby doctors struggle with their role as ordinary employees who are rightfully entitled to a just wage for just work versus their moral obligations to patients and society. Discussion It has been argued that to deny any group of workers, including "essential workers" the right to strike is akin to enslavement which is ethically and morally indefensible. While HCW strikes occur globally, the impact appears more severe in developing countries challenged by poorer socio-economic circumstances, embedded infrastructural deficiencies, and lack of viable alternative means of obtaining healthcare. These communities appear to satisfy the criteria for vulnerability and may be deserving of special ethical consideration when doctor and HCW strikes are contemplated. Summary The right to strike is considered a fundamental right whose derogation would be inimical to the proper functioning of employer/employee collective bargaining in democratic societies. Motivations for HCW strikes include the natural pressure to fulfil human needs and the paradigm shift in modern medical practice, from self-employment and benevolent paternalism, to managed healthcare and consumer rights. Minimizing the incidence and impact of HCW strikes will require an ethical approach from all stakeholders, and recognition that all parties have an equal moral obligation to serve the best interests of society. Employers should implement legitimate collective bargaining agreements in a timely manner and high-handed actions such as mass-firing of striking HCWs, or unjustifiable disciplinary action by regulators should be avoided. Minimum service level agreements should be implemented to mitigate the impact of HCW strikes on indigent populations. Striking employees including HCWs should also desist from making unrealistic wage demands which could bankrupt governments/employers or hamper provision of other equally important social services to the general population.