Three Reasons Why a Doctor's Strike Is Ethically Justifiable

On 17th October 2015, I marched alongside over 15,000 fellow junior doctors to protest against the government's imposition of a new working contract. With the reverberating plea of "Save our NHS" we finally gathered around the humbling statue of Gandhi at Parliament Square.

On 17th October 2015, I marched alongside over 15,000 fellow junior doctors to protest against the government's imposition of a new working contract. With the reverberating plea of "Save our NHS" we finally gathered around the humbling statue of Gandhi at Parliament Square.

In recent weeks, thousands of doctors have been outraged by the government's imposition of an unworkable and dangerous contract, posing as a strategic step towards dismantling the NHS. (A more detailed analysis of the recommendations can be found here). With the collapse of negotiations, this drama has led to impending industrial action. The BMA issues ballot papers today and every junior doctor will cast his/her vote on whether to strike.

It is with this light that I share a common moral and ethical dilemma with my colleagues - "how far am I willing to take it?" Rather than rely on 'groupthink' and or be a 'slacktavist', this question is so important that I feel it the calling of every individual doctor, nay every citizen, to find their moral compass and act according to their conviction. This article focuses on a key question:

When is a strike ethically justifiable?

As I mull over my uncertain future, I am reminded of Mahatma Gandhi's famous Salt March. On 12th March 1930, Gandhi led a 24-day, 241-mile march from his hometown to the coastal village of Dandi, to make salt. In doing so, he shook the very foundations of the British Empire.

17th October at Parliament Square. Photo Credit: Kiranjit Dharni

I believe Gandhi's narrative for action enables us to find our moral and ethical grounding in light of this current situation. He offers three primers for taking direct action:

1) Understand the policy. If you are convinced it is unjust, proceed to action.

During the British colonial rule of India, the 1882 Salt Act forbade the sale, production or collection of salt by anyone but the British government. The majority labourers and farmers in India, who would normally have produced salt freely, were charged extortionate amounts of tax. As a result, the common man grew weaker and poorer. Gandhi, like many others, saw this as a serious infringement of equal liberty and a blatant violation of human rights. After weighing up the situation, he was convinced that the policy and the policy-makers were unjust.

The new contract will mean doctors working dangerously long hours without the vital safeguards in place to protect both patients and staff. Despite longer hours, there will be a significant pay cut, and an end to experience-based pay progression. 14 Royal Colleges have offered stern warnings that the new contract "represents a real and immediate threat to the current priorities of the NHS". The overall result - an overworked, understaffed and demoralised workforce. Doctors are already considering a mass exodus abroad, where working conditions are fairer and safer. The long term sequelae will leave the NHS in a fragile state.

A strike is therefore justified.

2) If the government have remained indifferent to other forms of negotiation, proceed to action.

Rather than perpetuate fruitless negotiations, or delve into high-end windy rhetoric, Gandhi chose salt as the substance to bring the common man together. He stated, "Salt, next to air and water is perhaps the greatest necessity in life".

The BMA have been bullied out of negotiations. The government seems adamant to push their own agenda, whilst skewing statistics to malign the medical profession. Most notably is Jeremy Hunt often expressed "11,000 excess deaths over the weekend" which he irresponsibly attributes on the workforce. In a last-ditch effort to diffuse the situation prior to balloting, Mr Hunt has once again showcased spin to the highest degree.

Honest dialogue can only take place when all pre-conditions are lifted. Unless the government is willing to do this, entering a negotiation would be ethical suicide.

A strike is therefore justified.

3) If you are motivated by the humanitarian values of justice and equal liberty, and willing to undergo personal inconveniences, proceed to action

Gandhi's Salt March gathered thousands of villagers en route who were prepared to go to jail for breaking the salt tax law. On April 6th 1930 at 6:30am, after reaching the shore at Dandi, Gandhi collected a handful of salt to mark a new chapter for justice. He knew the repercussions of his actions and cheerfully accepted the consequences - "If they arrest me and my companions tomorrow, I shall not be surprised; I shall certainly not be pained".

Every effective treatment has inevitable side effects; there is no doubt the strike will have its own. The delay to all routine activities will cause inconveniences. Consultants have already shown their overwhelming support to cover shifts. When balancing the core ethical values of beneficence and non-maleficence, we can take guidance from the GMC's 'Good Medical Practice 2013', which states "If patients are at risk because of inadequate premises, equipment or other resources, policies or systems, you should put the matter right if that is possible."

A strike is therefore justified.

So you see, the contemporary salience of Gandhi's Salt March empowers us to stop remaining aloof and take a stand for the issue.

When the ballot papers arrive, don't be apathetic. Find your ethical grounding and say "YES".

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