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Monday, November 23, 2015

Doctors’ ethics and “industrial action”

By Nihal D. Amerasekera

Hippocrates is often called the father of modern medicine. He wanted the medical practitioners to maintain ethical standards. He wrote down the ethical guidelines between the 5th and 3rd Century BC.  Although the world has changed much since the days of Hippocrates his oath has remained a beacon for doctors until the present day.

The earliest reference to certification of doctors in England goes back to 1411 but the body called the General Medical Council was born in 1858. The General Medical Council (GMC) regulates British doctors through the Medical Act. The Council comprises doctors and lay people. It registers doctors for UK practice, sets professional standards, regulates basic medical education, and manages doctors' fitness to practice.

We have the medical trade unions like the British Medical Association and the GMOA who represent the doctors when there is a conflict between the profession and the government.

Mostly, conflicts between doctors and the government arise due to pay or conditions of service or both.

The provision of healthcare in a country like the UK is a joint venture between the Government, hospital, doctor and the patient. So the responsibility for healthcare has multiple limbs. If the relations between any of the partners in this contract breaks down, the patient suffers. If the government fails to meet its contract with the doctor then it makes strike action more ethically justifiable. Society must be willing to support the doctors by paying them a proper wage. Here we assume the doctors are reasonable in their demands. As the Journal of Medical Ethics points out  “Little harm can accrue from shattering a somewhat antiquated myth of sainthood and injecting a good dose of realism”

On the other hand doctors have a duty of care to their patients. If a patient dies as a direct consequence of strike action is it morally justified? Does that amount to medical negligence when the GMC can take appropriate action? Should the striking doctors make contingency plans for medical emergencies or is that the responsibility of the hospital and the government?

If the doctors strike purely to improve patient care in their refusal to put patients lives at risk. Does it make strike action justifiable?

The doctors too have lives to lead with professional and family commitments. They have bills to pay and have a right to a decent wage and a reasonable quality of life. Their long years of study and onerous routines must be adequately remunerated.

Provision of free healthcare is an enormous burden to any government. In their attempts to economise the government will inevitably try to slash healthcare costs and doctors pay will not be exempt from the cuts. This will result in conflict and recurrent disputes.

As you see there are more questions than answers. I would ask for your opinion on this ethical dilemma that would be a recurrent problem to the medical profession worldwide.

Should doctors go on strike?


  1. Good question. But I will not try to find an answer. Instead, I am offering only a clarification.

    I am not at all conversant with the situation in UK. So, my comment applies only to Sri Lanka.

    I think I am more than qualified to offer a clarification having served in the Committee of the GMOA for many years. My parting with the GMOA in the 1980s was also during a strike when I was compelled by circumstances to defy the GMOA's call for strike action.

    In Sri Lanka, we have the Government Medical Officers Association (GMOA) and I am told that the Association of Medical Specialists (AMS) has also been revived after many years. These two fall into the category of trade unions. The Sri Lanka Medical Association (SLMA) is a professional body which serves as the umbrella organisation to many other professional colleges like the College of Surgeons, College of Physicians, College of Community Physicians etc. There are a few others which are not "colleges" but are simply called associations (eg. Association of Neurology, Sri Lanka Heart Association, Diabetic Association etc.). Thirdly, there is the Sri Lanka Medical Council (SLMC) under which all medical practitioners are registered. It is the SLMC that has the responsibility of looking into ethical matters and maintaining standards and discipline in the profession.

    As a matter of interest, may I state that the raging issue right now is that the SLMC is refusing to recognise the MBBS degree offered by the new private medical school in Malabe called SAITM. This is the second attempt at establishing a private medical school in Sri Lanka. The first attempt came a cropper in the 1980s when the North Colombo Medical College (NCMC) was taken over by the government following a political upheaval. It now functions as the Faculty of Medicine under the University of Kelaniya. SAITM was started a few years ago by Dr. Neville Fernando who is a former Member of Parliament. New buildings have been put up in Malabe to house the new Medical Faculty. A new Teaching Hospital has also been constructed at enormous cost. Already, many batches of students have been enrolled. The refusal on the part of the SLMC to recognise the MBBS degree has however turned out to be a stumbling block.

  2. Lucky
    What are the reasons for the SLMC refusal to recognise the degree? There must be some valid grounds for refusal. Once those issues are sorted SAITM will be recognised. Are the reasons for refusal so serious that they cannot be put right?

  3. ND, you have started a good thread for discussion. I shall respond in more detail but a few general points come to mind. The weapon of Industrial action is an accepted mode of protest by workers (employees). The direct result of such action always produces harm. If potential harm wasn't a problem, Industrial action would cease to be an useful weapon. It is therefore incumbent on both sides involved in a dispute to avoid Industrial action by continuous dialogue and negotiation. The problem lies in interpreting the stand taken by both sides. Is the stand taken by the employer unreasonable in that what is being proposed? Who makes that judgement? Is the employer taking undue advantage of the employee as he knows that in some instances, especially in the field of Health care, Industrial action is something that the employee genuinely wants to avoid but is aggrieved by the fact that the employer is taking advantage of this fact. Is the employee being unreasonable in their demands? Have negotiations being done in a spirit of mutual cooperation and understanding, long enough, with the right people or is the whole atmosphere one of confrontation and anatagonistic? Are the employees taking action to just protect themselves or are they acting on behalf of people they care for, e.g. doctors protecting patients by opposing financial cut backs or privatisation? How carefully are doctors (where they are the employees), doing everything possible to cause least harm to their patients in the event of Action? As you can see, this is a very complex issue and my own view is that doctors should not take Strike action (there are other forms of effective Industrial action to take) as it is impossible to prevent harm to patients and caring responsibly for our patients is our prime responsibility after all. But I am a realist and recognise that circumstances surrounding the Action must be taken into consideration and I am not sure how I would behave in the circumstances I would be placed in. If Industrial action is being contemplated, have all the members been balotted in a fair and comprehensive manner? What proportion of members took part in the ballot? What proportion of members voted for Industrial action? All these factors have to be considered in passing judgement. At present in the UK, we have a Tory Govt hell bent on destroying the greatest National Assett, the NHS and it is very difficult to sympathise with them as their methods are underhand and far from explicit. They are driven by political dogma and financial and corporate gain. The current Junior Doctors proposed Industrial action had 80% turnout for the ballot and a 98% vote for Industrial action and these figures suggest to me quite a widespread dissatisfaction with what is being suggested. One can only hope that the Govt will recognise the strength of feeling against the changes being proposed and renegotiate a deal which is more acceptable. This would be the civilised way to behave and let us hope that common sense prevails.

  4. I can speak for myself as a Radiologist. If the current situation arose where my pay was reduced and working arrangements were changed I would join a strike. As a result of my striking the waiting lists will get longer and operations will get cancelled and there will be a lot of gnashing of teeth. If there is a major incident like an RTA I will indeed go back to work to help. The bottom line is that there is no justification to reduce the pay in this day and age. It leads to a disastrous calamity with reduction in the quality of life. The politicians got a 10% pay rise when there was a pay freeze for everyone else. Society too has a responsibility to play its part if they want good healthcare