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Doctors attended about picket lines across England, including holding 'Meet the Doctors' events in city centres to explain their reasons for. Nurses are considering a strike over low pay that is damaging members across the UK whether they want to take industrial Nurses vote on strike action after NHS pay cuts leave staff 'struggling to make ends meet'. The NHS's health secretary wants junior doctors to work until 10 PM without overtime and add Saturday to their normal working week. We met.
The professional virtues behind such strikes raise moral and ethical questions.DOCTORS’ STRIKE: Government asks doctors to wait for public salary review
Most early literary writings on ethics of physician strikes were analyzed in terms of justice, rights, or moral duties [ 3637 ]. Reitemeier believes that adherence to a few basic ethical principles is required for any protest action that impacts patient care [ 16 ]. Otherwise, the lay individual cannot empathize with the notion that highly educated and literate individuals such as medical doctors deign to take industrial action. Therefore physicians should serve the interests of their patients according to their professional commitments above and beyond their own personal and immediate interests [ 39 ].
Only as a last resort and that under almost inconceivable conditions, might a total strike of health care professionals be justified [ 32 ] and one of these conditions is, that their actions will not harm the lives of their patients. Such justification could vary across different countries and contexts based on their political, social and cultural background.
Health care system is also different between nations on account of its structure, funding, infrastructure etc. In the medical profession there are a set of shared values which relate to their behavior towards their patients. This behavior is regulated by guidelines, recommendations and biomedical principles. Hippocrates Oath and code of ethics: The Hippocratic Oath, the first reflective code of professional ethics, is historically taken by doctors swearing to practice medicine ethically.
It enables doctors to adopt a more humane and professional approach to the service. Pellegrino clearly emphasizes the importance of the Hippocratic Oath - Without the Oath the doctor is a skilled technician or laborer whose knowledge fits him for an occupation but not a profession…….
He or she enters the company of others with similar commitments. At this moment, one enters a moral community whose defining purpose is to respond to and to advance the welfare of patients — those who are ill, who are in need of help, healing, or relief of suffering, pain or disability. Thus his or her commitment becomes ethically challenging for any activity like strike with a focus on personal and financial gain of doctors at the expense of treating patients [ 17 ] and violates ethical codes of the conduct of his or her service.
Further, different Codes of Medical Ethics [ 43 ] have also been controlling, directing and guiding doctors in various aspects including refrain from staging collective actions. In India, there are various laws and regulations which also exist to control such collective actions by health care professionals including the national constitution.
In a historic judgment in involving the striking government employees in Tamil Nadu, the Supreme Court ruled that Government employees cannot take society at ransom by going on strike [ 44 ]. This ruling refers to the moral duties of public employees, such as doctors, concerning the fact that they have no legitimate claim to go on a strike and take the helpless patients at ransom to meet their demands with the government [ 45 ]. Further, in India, the Essential Services Maintenance Act ESMAenables the government to ban strikes and demand conciliation or arbitration in certain essential services to maintain proper functioning of the community [ 46 ].
In essence, all strikes are against someone and causing harm to somebody directly or indirectly. The principle of non-maleficence is more important in this context. Do not do unto others that which would cause you pain if done to you.
Beneficencereferring to actions that promote the wellbeing of others, is considered as one of the core values of health care ethics [ 47 ]. In the medical context, this means taking actions that serve the best interests of patients Salus aegroti suprema lex. All health care systems revolve around this core principle. Hence, how can a striking doctor serve the well-being of patients? Autonomy is one of the most discussed principles in biomedical ethics. The autonomous individual acts freely in accordance with a self-chosen plan [ 47 ] and respecting autonomy involves acknowledging value and decision making rights of person and enabling them to act autonomously.
Here, doctors are autonomous to do work or not, and have right to conduct strike [ 49 ] for their needs and resolving problems in their professional situations, especially in a democratic country. The new organizational changes are having profound effects on professional autonomy and accountability in virtually every aspect of patient care [ 16 ]. In medical profession, there is a set of shared ethical values and they over all relate to the saving of life, the healing of the sick, the wellbeing of the patients and the special responsibility of doctors for their patients [ 50 ].
Deontological versus utilitarian reasoning: Deontological reasoning refers to duty, which is usually determined without regard to circumstances or consequences. According to Kant, man is subject to the moral law; since man is a moral agent, he is responsible for his actions. In other words, the ends do not justify the means.
Here, strikes are considered as means in democratic society to achieve certain ends.
Disruption expected as junior doctors' strike called off
As opposed to this, many contemporary ethicists and philosophers are in line with utilitarian theories which seem to be an effective tool to assess a specific action in terms of its utility [ 51 ]. Utilitarian reasoning always considers circumstances and consequences. According to utilitarianism, actions are right insofar as they tend to promote the greatest happiness for the greatest number, and wrong as they tend to promote the opposite [ 52 ]. Nevertheless, there are many situations in which maximizing happiness improvement of health care system due to strike could conflict with other values and principles, namely nonmaleficence.
However, it is impossible to reach an agreement regarding the justification because of the relative importance of various features and different aspects including social, economic, legal and cultural aspects of India and Indian health care system. Goold pointed out that there are a number of rationales that could be used to justify strikes by physicians [ 1 ]. The wages for doctors working in the Indian public health sector are very low compared to that of their counterparts in most other countries.
In addition, the salary of doctors in the public health care system is always many fold less than that of private hospitals in India. Here, the first condition closely adheres to the Hippocratic Oath which gives commitment to the well-being of patient and thus considering deontological reasoning, strikes are morally not allowed; promise is always a promise.
Pellegrino emphasised that the well-being of the patients lie less in the expertise of the concerned physicians than in their dedication and commitment to something other than self-interest while providing their services [ 4054 ].
Dedication and compassion have always been promoted as important virtues in Indian medicine. It has also been reported that in ancient India, Hindu doctors even took Hindu physician Oath, which also stressed the wellbeing of the patient and the oath summarizes the love as the anchor in the medical practice [ 56 ] which prevents doctors abstaining from their duty.
The doctor must act within the law [ 57 ]. It enables the government to maintain a normal condition in the health care system which may also create stress and conflicts among striking doctors. Considering the qualification, knowledge, risk of the job and expertise needed, doctors are entitled to get decent payment and good labour conditions and in order to achieve such primary goals they have a right to strike.
But, as opposed to, for instance factory labourers, the legitimate goals of improving payments and working conditions, are achieved by harming patients.
In public hospitals, the patients are coming from poor financial and social backgrounds and most of them are vulnerable people including elderly. They would be harmed in different ways because of the strike. From a utilitarian perspective a weighing of goods versus harms might result in an ethical justification of a strike.
That could be the case, if the strike ends up with success by getting fair wage to doctors and providing better working conditions and overall improvement of the infrastructure of the health care system which would definitely benefit a large group of patients. Huge ethical problems also exist when there are too few doctors to attend to too many patients in the Indian context and if such problems are resolved, it would also improve the patient-doctor ratio.
Overall, such radical change results in the improvement of the quality of care with definite long term positive implication for the future patients also.
In such context, based on utilitarian reasoning, harming a small group of patients at present for the benefit of very large group of future population overweighed.
Strikes for the policy issues in India [ 451024 ], are always an eye opener for government and which would result to the benefit of a large population of future medical students in order to get admission in post graduate studies and appointment in government sector without consideration of any class and creed. Thus, considering utilitarian argument that, at times, it is permissible to harm a few for the benefit of many.
Usually every person who participates in strikes wants to implement more aggressive strike strategy to get more attention and quicker results. Such strikes can be acceptable, if they work and do usual jobs and people will also support the doctors for achieving their needs [ 33 ]. Frequent strike reported from health care system in a specific region or specific group like resident doctors reveals mainly the problems and inadequacy of the health care system [ 2859 ].
If the other strike dates, yet to be announced, are in winter, they will cause particular strain on the health system.
Junior doctors’ strike: March Live blog - The BMJ
There have been five previous walkouts in the dispute, all this year. The longest lasted for two consecutive days, and the first all-out strike — including junior doctors working in emergency departments — was held in April.
More thanoperations and outpatient appointments have been cancelled so far as a result of industrial action. As a result, Hunt is pushing forward with plans to impose the contract on junior doctors — those below the level of consultant — in October.
He resigned after the ballot results were announced, and was replaced by McCourt. The Department of Health accused the BMA of putting confrontation before cooperation in order to score political points. Cooperation not confrontation is the way forward to make sure patients get the best treatment and the NHS is there for people whenever they need it. Hunt told BBC News: Perhapsoperations will now have to be cancelled.