The Morality of Medical Workers' Strikes

For patients whose lives are hanging on a thread, it makes sense to see a medical worker’s strike as the most evil thing man can ever do; and to the medical worker who is not satisfied with his working conditions and remunerations, it seems there is justification, on his part, that an industrial action is the ultimate undertaking that can compel his employees to consider his plight. Yet, oftentimes, the question of whose plight matters most – that of the patient or that of the medical worker – has never been fully answered

Job satisfaction is one thing that every individual must make every effort to attain in order to work competently and with ultimate allegiance. It basically means taking pleasure in one’s particular profession. Nevertheless, sometimes individuals can find themselves taking certain jobs because they are the ones which have been tendered to them. And in other situations, some professions, like those in the medical field, are pursued for the sake of others.

Notwithstanding the fact that some medical workers may opt for the career because of being concerned with lives of people who become sick and need medical attention, it should be acknowledged that they, too, are human resources and need, therefore to be treated as such.

They too, have their individual needs as any other employee and need not be exempted as long as the welfare of workers in general is concerned. But these professionals have more often than not found themselves on the receiving end of a great deal of criticism once they stage a strike.

Now, a story is going around town that workers at Kamuzu Central Hospital (KIA) in Lilongwe are planning to go on strike in an attempt to force their employers to consider adjusting the allowances they get when they work out of the normal hours. As expected, there is a debate in social media and other online sites on whether or not the medical workers are justified in their threats.

Writing in the Wits Medical Journal of South Africa, Amanda Stuart points out that “strikes by medical workers are supposed to be carried out once all achievable measures of reconciliation have been exhausted and have failed to reach a compromise.” In the case of the KCH scenario, sources indicate the authorities are not doing enough that can promise light at the end of the tunnel. But still, the question remains: should medical workers go on strike?

Indeed it may sound ridiculous to expect a saviour of life to be comfortable in harsh living conditions and or with little pay. In fact, it is true that only a happy healthcare worker will execute their duty with the ultimate dedication. And, of course, it has already been reported that the welfare of medical personnel is very pathetic now as compared to how it was in the 80’s. But is strike the best option?

“For example, one nurse or midwife has to look after 70 plus babies the whole night and at the end he/she becomes very exhausted,” argued one member of the Nurses and Midwifery Association sometime back.

In this case, there is temptation to believe that the only logical conclusion should be that such people are rewarded handsomely, and if they stage industrial actions to protest against their meagre rewards, it is just indispensable. After all, freedom of association is guaranteed by the constitution and the labour code allows medical workers to form unions which address their problems. Therefore, since they are not barred from forming unions, then they may have the right to stage industrial actions where they feel their needs are not being satisfied.

It is quite true that in Malawi, medical personnel do not receive their pays deservedly. That is why most of them leave the country for greener pastures after graduating. And those who stay argue that they do so just for the sake of their country and therefore, need to have their welfare duly taken care of.

In essence, no one can deny that medical workers are human beings as well and need to be heard in whatever effective way. Those who support ‘medical strikes’ usually argue that those who argue that it is not ethical for medical personnel to go on strikes ignore that by the mere fact that medical personnel are concerned with the welfare of patients, it means their welfare, too, should be put under consideration.

Yet, there are others who still argue that strikes by medical personnel undermine the rights of patients to healthcare and the duties of medical personnel to protect life. Nevertheless, the proponents still bring forward the argument that these two aspects will always work side by side, since it is only a satisfied worker who will work to the greatest of his ability. The medical workers usually maintain that until other practical options through which their grievances against their employers can be addressed are discovered, they cannot stop striking.

Maybe it is true that for a physician or a nurse to reach the decision of staging a strike is not easy. It could indeed be months, or even years of poor remunerations and working environment which drive them to this last option. They might indeed not necessarily be abandoning their patients, but rather advocating for an environment that will ultimately benefit the patients themselves and improve the whole healthcare system.

Traditionally, medical workers slave away for many years in medical or nursing schools and they, therefore would be justified not to be satisfied with little pay or appreciation. Perhaps, indeed these professionals should not just watch if their professional services and benevolence are being abused in the name of vocational ethics. But, is strike the best option?

While previously, the health profession was being considered a vocation very sensitive to human life, it appears that view has now been challenged. Many experiences vindicate this. Yet, it still stands that the duty and responsibility to protect human life is among the first in the hierarchy of values.

In his paper titled “Medicos’ Strike: Relevant Issues” which appeared in the Radical Journal of Health some years back, Jesani Amar observes: “Every time health workers go on strike, a battle is waged not only between strikers and their managements, but also between the right to strike and the ethics of not doing so. The latter battle appears to be important, for it raises some controversial issues.”

He further points out that “one must strive to exercise one’s rights while being sensitive to the ethical issues involved in the methods of struggle. Such sensitivity will help health workers be resolute in providing alternative care to patients during a strike. It will also help them further radicalize their struggle by moving from a strike (no patient care) to hospital occupancy (continued patient care under self-management).”

Amar doesn’t seem to completely reject the option of strikes; rather he advocates for a situation where the medical workers will still respond to their patients’ needs without the formal process recognised by management.

Before we begin the vilify medical workers for staging strikes, we should understand that they play the role of delivery of primary health care and improve our health and well-beings, and therefore need to be properly taken care of. We also have to consider the fact that they have the right to express discontentment and protect themselves from unfair treatment and exploitation.

But still more, this right is limited by their responsibility to save life and promote the health of citizens as stipulated by the medical profession’s code of conduct which every medical worker is supposed to adhere to.

Of course, the constitution of Malawi recognizes that workers should be fairly rewarded and provides for industrial actions, but the legal provisions do not necessarily imply that it is ethical in every circumstance. And in the case of medical workers, a patient’s right to life must be given priority since the main responsibility of medical workers is to save life at whatever cost. The right to life currently supersedes all other rights. So – or so it seems – any struggle undertaken by medical personnel that violates the rights of the patient is unethical even though it may not be illegal.

On rather a very formal note, most medical and nursing schools administer some form of moral oath; it may not be the Hippocratic Oath, but the application and the implication are the same: to try one’s utmost to save life.

Some of the main aims of the oaths taken by medical workers are: to teach them that their job requires that they practise and prescribe to the best of their ability for the good of their patients, and to try to avoid harming them. This beneficial intention is the purpose of the medical workers even though it may not apply across the board.

They are also required to avoid violating the morals of their community. Many licensing agencies will revoke a physician’s license for offending the morals of the community which is called moral turpitude. However, in Malawi, this phenomenon appears to be only theoretical.

Medical workers also have to keep the good of the patient as the highest priority. “There may be other conflicting ‘good purposes,’ such as community welfare, conserving economic resources, supporting the criminal justice system, or simply making money for the medical worker or his employer that provide recurring challenges to physicians, but whatever the case, life has to be prioritized,” says the oath.

It adds that “they are also required to fulfil, to the best of their ability and judgment, this covenant: that they will respect the hard-won scientific gains of those physicians in whose steps they walk, and gladly share such knowledge as is theirs with those who are to follow; and that they will apply, for the benefit of the sick, all measures that are required, avoiding those twin traps of over-treatment and therapeutic nihilism.” This declaration points towards the sovereignty of human life.

Perhaps the most compelling part of the oath is that which stipulates that “medical workers are also required to remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug. Most especially, they are supposed to tread with care in matters of life and death. If it is given to them to save a life, all thanks.”

Maybe, this is where any strike by medical workers is always met with a great deal of criticism from the public, because the strike defeats the provision that medical workers need not to do anything that may become detrimental to the welfare of their patients.

The oath goes on to say that if they (the medical workers) do not breach these requirements by avoiding unconstructive actions, likes strikes, “they may take pleasure in life and art, respected while they live and be remembered with affection afterwards.” But if they go on strike, therefore, it is against the statements of a moral of conduct which is supposed to be used by them all, assuming the respect for all human life, even unborn.

Additionally, according to anthropologist Margaret Mead who lived between 1901 and 1979 and whose views are still held to date, there is supposed to be a complete separation between killing and curing. She points out that throughout the primitive world, he who had the power to kill also had the power to cure. He who had the power to cure would necessarily also be able to kill.

Healthcare workers were to be dedicated completely to life under all circumstances, regardless of rank, age or intellect – the life of a slave, the life of the Emperor, the life of a foreign man, the life of a defective child and the life of everyone. This excluded circumstances; if one was employed to cure, nothing would divert their responsibility. Thus, a strike would always seem impossible.

Such is the sovereignty accorded to human life, such that it may not be wrong to conclude that an industrial action, whichever form it may take and wherever it may stem from, is unethical and should not be staged by medical workers, whatever the case.

In fact, in its revised edition of the Code of Ethics and Professional Conduct, “which shall be observed, mutatis mutandis, by all medical practitioners, dentists, paramedicals and allied health professionals practicing in Malawi”, the Medical Council of Malawi points out that every practitioner shall respect all aspects of human life, and shall do all that can reasonably be done to safeguard and improve the quality of human life, and shall not do anything which may cause suffering or terminate life. Thus, strikes by medical workers seem unethical even though they may not be illegal.

If at all they have to protest, then they must undertake a non-detrimental action that at no time separates them from their patients. In fact, such an action has the power to further radicalize their struggle where the medical workers continue to take care of their patients under self-management. It can be a soul-searching experience for the employers who will not hesitate to respond to the demands of the medical workers.