The Moral Justification Behind The Doctors' Strike

In the wake of the on-going strike by doctors in Pakistan, the morality of the issue has been raised and questioned. There are mixed reactions from the public, and both Doctors and Government are being held as responsible for the harm to the public. This article intends to explore the circumstances in which a strike by doctors can be justified and in what way it ought to be carried out.

The Responsibility of Health Care

Whose responsibility is it to provide health-care to the people? The traditional and usual answer to this is that it is the responsibility of the doctors, that doctors are responsible for treating those who are in need of treatment. However, this answer is utterly simplistic and ignorant of the ways in which the medical profession works in the modern world. In our current society, it is the Government, as a representative body of the people, that takes up the fundamental responsibility of ensuring availability of medical care to the public. The Government fulfils this responsibility by shifting it into the hands of people who have the necessary expertise to provide this treatment, and the Government does so by means of a Government-Doctor moral contract: Government will provide adequate facilities and working conditions for the doctors and doctors will in return provide health-care to the people on the Government’s behalf. It is only via this third party – the Government – that doctors enter into any sort of moral contract with the society in our modern world.

It is further thought that the doctors are bound by the principle of primacy of patient welfare, i.e. a doctor should always give priority to the welfare of the patient above his own personal gain. It is said that doctors take up this special obligation by their own willingness and are therefore bound to follow it. This notion too is overly-simplistic. A person who chooses to become a doctor does not avow to forge his self-interest for the rest of his life, nor does he declare that he will offer all his life to medical service without getting anything in return. What a doctor is bound to, yes, is to provide the best possible treatment for a patient he has already accepted to provide treatment for. A doctor cannot be expected to work all his life as a doctor; he doesn’t have an obligation to patients who would have become his patients in future had he continued to work.

A Justified Strike

With this sorted out, let us see when a strike by doctors can be justified. A doctor enters into a contract with the society only by virtue of his contract with the Government, therefore, if the Government refuses to honor its obligation of providing adequate facilities and working conditions for the doctors, then the doctors’ obligation to work for the Government is nullified. This includes the issue of pay, because doctors are humans, and have to support themselves and their families. If the amount of work they are expected to perform deviates significantly from the pay they are receiving, Government is violating its obligations. This can be augmented by a utilitarian justification. If the short-term harm brought about by the strike is balanced by a long-term benefit to the society in the form of an improvement in health-care, virtue of the fact that doctors can work more efficiently in better working conditions, then a strike is justified. In fact, a utilitarian might even say that the strike in such circumstances is not just justified, but it is the moral thing to do! By going on a strike, the doctors are not holding the patients as ransom, but are reminding the Government that if the Government does not fulfil its obligation to the doctors, the doctors have no obligation to the people.

Now that we have shown the moral justification of a strike by doctors, let us see what can be the moral way to go about this strike. A strike on the part of doctors can be said to be carried out in a morally justified manner, if

* the demands of the doctors are reasonable
* the doctors made their demands clear to the Government and the public, and gave them adequate time to reflect upon it
* they are flexible and are willing to negotiate in a rational manner
* they are not actively harming patients

The Current Strike

It should be clear to any observer who is aware of the conditions under which junior doctors work in Pakistan that what they are demanding is reasonable, especially when you compare it to the conditions in other countries. The current pay of House Officer is Rs 18,000 (Pakistani rupees, monthly) and that of Postgraduate Trainee is Rs 22,000. The demands are Rs 35,000 for H.O. and Rs 75,000 for P.G. Despite this, doctors were happy when the Government announced that HO pay will be raised by Rs 12,000, and PG/MO/SR pay between 20,000-30,000, to be applicable from 1st July. The Doctors, however, wanted a guarantee and written certainty from the Government that this raise will happen. The Government refused to offer any guarantee and kept offering its hollow promises, promises it has been known to break in the past, and it was in response to this that the doctors announced to carry on with the strike, also with-drawing themselves from work in the emergency.

I believe that all the conditions mentioned above for moral justification of a strike are being fulfilled by the current on-going strike of doctors in Pakistan, and therefore I judge that the strike is not only morally justified but is also being carried out in a morally justified manner. Instead of blaming the doctors, the public should understand the complexity of the issue. Any harm that has come to the public as a result of this, it is a consequence of the strike by the doctors, but it should be realized that the real blame and responsibility for this strike lies on the Government.

[For a more detailed analysis of the issue, see this article from a New Zealand medical journal.]

Comments

Anonymous said…
i believe it would've been morally justified, if proper talks would've been done with the government. As far as the data suggests, when the first time doctors united against the media and sent a complaint to the government, they actually ended up breaking up into various groups with respect to their stance. Seeing the current scenario,the doctors didnt attempt unified tactical talks with the government, if at all. they didnt use media as a tool to substantiate their need. their action would've been justified if they would've had an agenda. which should've been propogated amongst the to-be doctors too. right now, i believe the doctors have gone biserk and i still believe proper tactical and diplomatic talks are the solution.
Umair said…
Very well written piece. Just what one can expect from Awais :)

Though I completely agree with the main argument presented here, however, I would like to add few observations. In my opinion, human life is so precious that even if medical practitioners go on strike its better to provide medical facilities, at least, to the patients whose life hang in a death balance.

And secondly, every service publicly provided in the society is provided through government. The government acts as an agent of the society to arrange the public utilities and services required by the society. Overall, the government should pay better to the personnel engaged in providing these social services. But, in Pakistan, only those are rewarded who struggle for it. For example, military and police employees got special increments in their pay when the War on Terror intensified in the country. Education sector got boosted when HEC was created and hefty amounts were allocated for general students as well as faculty development programs. FBR people got special allowance in their pay on the plea that they collect all the revenue for the government so they should be better paid.

Now, its good to see young doctors demanding their rights. But, there is also a fact that everyone who joins government sector, agrees to the ongoing pay scale and the benefits offered by the government. So, it is a struggle to improve upon that agreement which is outdated now.
Fahham Asghar said…
More than glad to hear that some people actually do understand the reasons and circumstances forcing the doctors to go on strike.
puzzled said…
''But there is something that I must say to my people, who stand on the warm threshold which leads into the palace of justice: In the process of gaining our rightful place, we must not be guilty of wrongful deeds.''(martin luther king)
The protest of doctors for their rights it is highly justified but the strike although justified according to a mathematical morality is highly a disregard for human life.
I felt shame when I heard the news that people dying because of unavailability of doctors.We are justified but we don't deserve the respect we get ,because we work for money not for humanity.
F. said…
@Awais
*points to Anonymous, Umair, and Puzzled*
Yeah, what they said. And what I said that they didn't say.
dr.ash said…
i would like to add one most important point which hasnt come up in any discussion yet...YDA, ie. young doctors association has gone on strike, and rightly so. It does not mean that hospitals have beocme void of doctors. Senior doctors are serving the patients, round the clock. It has become extremely exhausting for the seniors, who are used to being just the 'supervisors' and 'being on call'..while 90% of the work is being done by the juniors. This is how it works, coz we are in the 'learning phase'. So, the issue of morality, human lives and virtue (and sentiments related to the issue) are exaggerated. Its all media and govt created hype. Doctors are there, they are serving the patient, day in day out. Only the young, junior doctors are on strike.
Anonymous said…
I want to add my 2 cents to this discussion brought up by the cream of the nation.
Firstly, when we call ourselves the cream of nation, that leaves a big burden of responsibility on us, we have to act better than other people under harsh circumstances. What would a normal person do when denied of his rights? Rise up in a violent protest. That is what we are doing! Any difference? No.
True that doctors take an oath to the government, but what about our conscience taking an oath to the whole humanity. And here we are talking about the people who are much much much more deprived than the doctors who are protesting.
The people who afford to go to medical school in Pakistan; 90% of them are from the top 5% of Pakistani population. The people who go to public hospitals for treatment; more or less 90% of them belong to the $1 a day/ household type of families. The question that rises here is; who is being hurt in all of this? the government, no. it is the common man of Pakistan, the trademark poor class. So the argument about doctors' rights being usurped just dies here, because in turn doctors are usurping the rights of those who are far more needy.
One more question, if doctors are so underprivileged, how come they are among the top financial class of the country? Because they have many doors open for them, apart from public hospitals they can run clinics etc. to get money.
The government needs to pay the doctors. OK. but tell me one thing, where is the govt. going to get the funds from? All the rich, so called upper class patients tend to go to clinics and private hospitals, which lands all the funds in private sector. When govt. is getting just those 2 cents a day admission fee from a laborer, how do you expect them to come up with a good sum for you?
I heard someone saying senior docs. still working at hospitals, really you need to look at news and the turn outs and death rate increase etc. before saying that.
I am not a govt. lota, nor do I like them, but I have learned done thing in my 21 years of growing up here; they are deaf and they are blind. They simply do not care.
Now the question is what can be effective in the long run; 2 suggestions;
1. You can argue about raising the fee in public medical schools. The current fee is ridiculously low. Most of the students attending medical school are well off enough to pay a few more Ks, well, they are used to paying those Ks to the "ACADEMIES", so why can't they pay the same money to govt.?
1. Doctors can carry on their strike but start working part time (at least). It will help the patient, may be who knows, they will support doctors and help them in their protest!!
2. The real concern should be about certain 'Biggies' in the profession hoarding up the money. The private sector needs to be controlled a little bit??
Anonymous said…
CONTINUED:


About 3-4 years ago around the time when blasphemous Danish cartoons were published), there was a strike on mall road. I saw the tires burning, a man came and hit a car in front of me with a Danda, another man was standing on the roof of a rikshaw, dancing! It all seemed wrong, something Holy Prophet (SAW) would never be happy about.
Today, I watched a you tube video, in which people in white coats were clapping and jumping in the middle of the road, swearing and being beaten up... IT DID NOT SEEM RIGHT AT ALL! that is not your place, or your level. It seemed as if a part of them was enjoying all the commotion, it did not seem like the illuminated educated youth!
I was so proud to once be a part of KE, part of that enlightened group of people, but today I felt ashamed, because if I had been there I would have been doing the same thing and justifying it...
The concept and philosophy of greater good, you ask? It has been taught to us by our leader and Imam Holy Prophet Muhammad(SAW), who would bear all the pains and griefs on his chest, just for the sake of preserving Haqooq-ul-Ibad, which have a higher values in eyes of the lord, than the supplication and prayer.
Quran, talks about justice from an unjust ruler, and that it is wrong to bear injustice and not do anything, so you should raise a voice... no stopping from it, but it also says not to hurt an innocent soul in the process...

It is up to you to consider,which contract is more important to you? The one with the government, or the one with Allah?
There are ways in which you can achieve your objective without compromising the rights of common public.
Your demand is CORRECT, but the way of damanding is NOT!
dr bilal said…
@ anonymous .... dear u have no idea wt u r talking about u r just acting as an emotional young man who is living far from reality //
whr th govt is going to bring fund from??? r u serious dont u know where the fund go ?? and whr thy can b generated ..??? have any idea about the swiss banks statement of pakistani politicians accounts .. have any idea abt the property they have!! have any idea that none of ur ministers likes to sit in a car thats not bullet proof .. !! have any idea how much ur DEAR POOR GOVRNMENT spends on protocols ??? have any idea how many vehicles are usually present in a squard ??? have any idea how many patients wait when a rout is set in ?? i have coz m th so called cream of th nation !! and i think at least more deeper than u !! i know coz i receive patients at th hospital emergencies..have any idea who owns ittefaq industry and many industries abroad?? have any idea who owns sarray palace and the 2 of th most expensive towes in dubai and who has 7 railway stations at his property in sindh ?? have any idea who owns most of the cng ang petrol stations arround all of us ?? have any idea who ows most of th food chains around u ??? have nay idea who owns sugar and floor mills ???have any idea that pakistani parliament is the worlds richest parliament .. its the only parliament in the world who has every member having his own car and guard squard ... its the only parliament has the largest parliamentarians car parking in the world ... and it is on th worlds expensive property worth 60 billion when was acquired years back.. its th only parliament where a bicycle ,motorcycle or rakshaw is not allowed to enter ... pakistan has 1076 members of national and and provincial parliament many of them with fake degrees .. many fudal lords .. many of them are not the people u wold like to have a quarrel with ..every one of them being paid millions as salary and allowences (even no one has clear figures) and u dont have funds ??? shame!!! just the swiss accounts money can give pakistan 60 years of tax free budget, one way traffic from any village to any where in pakistan , 2000 rupees to every pakistani for many years a pocket mony !! and u dont have funds ???. pakistani doctors working abroad are considered the best professionals .. they are also trained at the same institutions as others working here. people like u are only aware of on side of th story the darker side .. ever thought if every one is being trained at th same institutions then why this difference??? i can tell becoz its me who has worked days and nights ..its me who has been awake 54 hours without a single minute nap at the hospitals . its me who has been working 36 hours at go 3 times a week .. its me who has missed many meals working at the emergencies. its me who has spent eid days at th hospital looking for ill. its me who was late for his engagement ceremony even … how can u expect some one to work this hard and not get paid??? how can u expect a system b working good after all this .. but i can still hope and u dont … becoz its me a doctor!!! not u miss marya!! i advise u to speak only if u have enough background info … thanks !! u r rocking doctors!!! wake up !!!! wake up pakistan join hands with doctors .. its th begining of a revolution .. its about us ... its about pakistan ...i rest my case .. if u r intelligent enough !! cream of nation is supposed to b considerate if they r doing so it must have been necessary ... think again !!