Archive for January 2011

Medical Strikes

Strike action by healthcare providers-ethically correct or not

By

Jose de Carvalho

 

When the basic needs of doctors and healthcare providers are not met, what should they do?  Whether one agrees or disagrees with the participation of individuals in industrial action, the question should be posed: what should the Christian healthcare provider do?

 Situational analysis

The doctors’ strike that rocked South African hospitals in 2010 have catapulted the issue of healthcare strike actions into the spotlight of South African medical ethics, with heated debate both for and against. Although not a recent development in world health (in fact healthcare-related strikes have occurred for more than 40 years) the South African situation must be viewed against a backdrop of an ever-increasing debate as to the true nature of medical professionalism and the its obligations. The unions declared a dispute two months before going on strike and by law would have been able to give notice and go on strike within seven days.  Instead they decided to “play the game”. Government did not “play the game” – forcing unions to go along with the strike action. Nevertheless according to labour law, police officers, doctors and nurses are declared essential services and are not allowed to strike. Union president Michael Makwayiba said the unions couldn’t be held accountable for members of essential services going on strike, as the government had not yet agreed to a minimum service agreement for these employees, but that the unions would work on a quota system to ensure that essential services continued (Daily Dispatch 2010/08/09) http://www.dispatch.co.za/article.aspx?id=424156.

 Reasoning and moral debate

If doctors go on strike have they lost their sense of duty to their primary calling namely to care and heal the patient? The supreme reason for industrial action is usually for the benefit of the striker; is this ethical egoism? Often the struggle is between the individual and the benefit of the profession as a whole.

 I must agree with Stuard (2010:4-7) that in the 21st century a shift in perspective has taken place regarding the underlying motivation for entering the profession – money and status lead to dual incentives and dual loyalties. Is strike action maybe the natural progression of such a shift? Or will a reversal to the original, founding and moral drive to enter the medical profession rectify the situation – namely a profession, by its very nature, founded on clear moral and ethical principles where strike action has traditionally been viewed as contrary to the most basic ethical guidelines governing the medical profession.

 McQuoid (2008:1-10) goes beyond bioethics to the common law and the constitution that governs the medical profession and protects the rights of the patient to ensure medical care, by simply asking: ‘is medical striking a legal option? Even if it is a democratic right and despite the reason, is it appropriate?’ Given the disadvantages of strikes is it morally acceptable?

 This is the crux of the matter. When the basic needs of the doctor are not met, what should he do? Whether one agrees or disagrees with participation in industrial action, what should a Christian doctor do?

 The following factors need to be considered before drawing a conclusion:

 Hippocratic Oath

 The principle of non-malevolence (non- injury) and beneficence (act for the benefit of the patient not self) is found in the Hippocratic Oath. How then do we consolidate striking subsequent to taking the oath? The basic reading of the oath seems to indicate that industrial action by medical doctors is harmful to patients. Though this oath has secular origins, Christians have adopted it with the central belief in God to whom the doctors are ultimately accountable to (God first, then humanity). God defines the ethics when it comes to medical practice. This form of Christian ethics is seen as a duty to obey God through a proper reading and interpretation of Scripture that becomes normative and binding.

 Scripture

 A Christian is committed to the laws of God as expressed in scripture.  Love is commanded (Luke 10:27) in every situation.  The Christian should try to discern what God’s Will is, including what He determines to be most loving. Lets see what else scripture teaches us? Although there is no mention of strikes we can delve into the spirit of scripture to acquire appropriate behavioural models. Christian physicians have a model in Jesus to heal out of compassion, even if doctors want to improve their working conditions they have a model that transcends economic reasons. If they want to foster biomedical ethics, they must first obey God regardless of the cost to their own desires.

Industrial action

 Christian doctors will be hard pressed to justify a strike that prevents care to patients. So what is the Christian doctor to do during an industrial action? The Biblical story of the Good Samaritan demonstrates what a Christian doctor should do. What the Samaritan did was against the cultural norms of his society.  He went out of his way to do what is right, obeyed God and loved his neighbour. Christian medical doctors cannot fold their arms and watch patients die.  Such action is unscriptural and amounts to disobedience to God, “what shall profit a man if he gains the whole world and lose his/her soul” (Matt 16:26, NKJ).  Therefore a medical strike and bringing harm to our neighbour is never justifiable by Christian doctrine and does not bring honour to God.

 Conclusion

The answer to what the medical Christian doctor should do when his basic needs or that of the profession are not met is therefore,  “rather than strike or leave things as they are and not get involved, he achieve his goals through persuasive arguments.  He must bring rational, intellectual arguments that will eventually capitulate wickedness.”

 In the words of Kunhiyop (2003:127):

“Truth is a powerful tool when it is argued and becomes even more powerful when it is exhibited. Remember it is said the power of the pen is stronger than the power of the gun.”