Are doctors’ strikes ethically justifiable? | Daily News

Are doctors’ strikes ethically justifiable?

Medical doctors’ strikes have now become a common Sri Lankan phenomenon. These strikes carry the potential to negatively impact on the quality of healthcare services and, particularly, the deterioration of physician-patient relationship and public’s respect for the medical profession.

There was a time, not so long ago, when people looked upon doctors as one of the most ethical and respected professionals as they were regarded as educated and responsible section of the society. People considered them doing a noble job in the country. Whether that image still persists or slowly deteriorating is something debatable today. To be fair, however, the majority of the doctors are doing the same noble work, but the high-pitched voice they collectively emit through their trade union doesn’t project the professionalism expected by the common citizen.

Strikes, in general, are a legitimate form of collective protest in a democratic country and as such they are an important weapon that workers possess and use to increase their bargaining power. As an accepted general principle, it is used when negotiations have reached an impasse.

However, health is an exceptionally important human value and hence health care is a paramount social good. In such situation, when a strike is launched by the doctors, the ethical principles of respect for autonomy, justice and fair play all come into conflict. The doctors themselves will have to decide their role – whether to be ordinary employees who are legally entitled to strike work to win their demands or to bow down to their moral obligations to patients and society.


GMOA has consistently maintained that they are compelled to action to make their demands met, and that strikes may be chosen as an ultimate choice of action. We should appreciate their line of thinking. However, this argument just does not hold water when one looks back to some of the strike actions initiated by GMOA during the past few months.

Doctors struck work mainly for two major issues. One was Indo-Lanka Economic and Technical Cooperation Agreement (ETCA) and the other was SAITM. These two are national policy issues not directly related to monetary or non-monetary demands of the doctors. Nevertheless, as a registered trade union, GMOA has a legal right to move beyond its workplaces and campaign against national policies and even lobby to help change laws in the whole country and gain new rights for workers. There is no problem in it. They are quite welcome.

But the issue is – should patients suffer due to this struggle? Should they?

As GMOA quite rightly agreed, strike should be the last resort, if and when, all other avenues of negotiations are exhausted. And, all other forums are fully utilised. The average citizen believes that requirement was not met. And, fair number of citizens and media believe there is a political agenda behind this action.

Ethical justification

Unfortunately, for GMOA, compromise is a distasteful word. Webster’s New World dictionary defines compromise as primarily “a settlement in which each side gives up some demands or makes concessions.” Unfortunately, the word compromise has become an ugly term, meaning to selling out. In reality, compromise means working things out, or as Webster’s says in a secondary meaning, “an adjustment of opposing principles.” As such compromise is essential to getting things done. It can mean the difference between failure and success. Any seasoned trade unionist will tell us that compromise is essential to the negotiation process.

At the same time, doctors’ strikes, regardless of the reason for them, had received a lot of media attention and met a great deal of criticism and resistance from the general public as well. In fact, it has aroused intense debate on the ethical justification of medical professionals failing to prioritise human life and their needs, and to find less harmful ways of negotiating their own needs without harming patients.

* In September last year, Chief Executive and Registrar, has set out the latest General Medical Council (UK) advice for doctors. It covers those contemplating industrial actions.

‘The duties of a doctor are set out in Good medical practice, which says that doctors must make the care of their patient their first concern. Parliament has not fettered the right of doctors to take industrial action, unlike some other professions and occupations. Doctors therefore have a right to strike and take industrial action. The question each doctor must ask, however, before taking action is whether what they are proposing to do is likely to cause significant harm to patients under his or her care or who otherwise would have come under his or her care. This is a matter of professional duty and we expect each doctor to comply with it.”

“The 1983 Medical Act and the accompanying guidance require doctors to exercise their professional responsibilities in the interests of their patients, to put their patients first and protect them from harm. The GMC has powers under the Act to investigate and apply sanctions to any doctor whose behaviour has fallen consistently or seriously below the standards required. Where we are presented with evidence that a doctor’s actions may have directly led to a patient or patients coming to significant harm, we would be obliged to investigate and if necessary take appropriate action.”

* Editor of the New Zealand Medical Journal, said that the short-term inconvenience of a strike must be balanced against an improvement in care. “If doctors (and others) truly believe it is important for patient care, then they must sometimes have the courage to do things that are unpopular and difficult,” he wrote. “If the conditions that doctors work under put patients at risk, then (on balance) they are morally obliged to strike.”

* Editor of Nigeria Africa Health, said that a strike by health workers was the worst option in the business of negotiating for higher wages. “The pawn is the public, with human lives and limbs as the bargaining chips,” he wrote. He warned that doctors who abandoned their patients were likely to be found guilty of misconduct if tried by the Medical and Dental Practitioners’ Disciplinary Tribunal.

* Doctors’ strikes are rare in the United States. David Kemp, a lawyer and columnist, said that healthcare providers might ethically leave their patients’ bedsides to go on strike only when the benefit of the patient was the ultimate goal and only after all other avenues of negotiation had been exhausted.

* In a judgement in 2003 involving the striking government doctors in Tamil Nadu, the Supreme Court ruled that Government employees cannot take society at ransom by going on strike. 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.

In the ‘Code of Ethics and Regulations’ framed under the Medical Council of India (MCI) Act, it is unconditionally stated that medical doctors cannot refuse treatment to any patient who is in need of emergency medical care and once a physician has undertaken a case, he or she should not neglect the patient, nor he / she should withdraw from the case without giving adequate notice to the patient and the family.

* In December 2010, the Delhi Medical Council issued a statement in response to doctors’ strike at the Safdarjung Hospital mentioned that it violates the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations and so under no circumstances doctors should resort to strike. Further, in India, the Essential Services Maintenance Act (ESMA), 1981 enables the government to ban strikes and demand conciliation or arbitration in certain essential services to maintain proper functioning of the community. In this Act, ‘essential services’ incorporates any service connected with the maintenance of public health and sanitation including hospitals and dispensaries. Laws like ESMA are not implemented effectively to minimize the negative impact to the public and/or end the strikes.


Finally, in the context of doctors’ strike, the significance and meaning of the Hippocratic Oath deserves to be mentioned. 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.

If the Oath is taken seriously as a binding commitment to place one’s special knowledge and skill at the service of the sick, the graduate has then made his ‘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.

In essence, all doctors’ strikes are against someone and causing harm to somebody directly or indirectly. The first moral reason constituting the ‘deliberative presumption’ (the principles that govern our moral life) against physicians’ strike is that physicians cause harm to patients through their strikes and harm to patients ranges from physical injury to psychological stress or anxiety to prolonged pain and suffering to added expense in accessing care.


By strike action, doctors and the GMOA are crossing the line, both professionally and morally. As a reasonable common citizen, I strongly support the right of our doctors to vigorously campaign for their inadequate current income, and non-monetary aspects such as better working conditions, adverse administration policy issues and hospitals’ physical and administrative infrastructure etc.

Yet, to threaten to deliberately affect patient care by forcibly imposing GMOA’s own amendments to two National policies, in my opinion, is wrong. Eventually, it could well give an advantage to those who seek to erode the doctors’ power base, which is built on the respect the patients and prospective patients have for doctors in Sri Lanka. 

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