Doctors in Israel: Is it ethical to strike?
The latest series of strikes are the first in over 10 years, with doctors demanding a rise in pay, a pension fund and financial incentives for doctors working in more remote areas.
In addition, doctors are demanding an increase in the allotted time for each patient seen in health clinics, from the current 10 minutes per patient to 12-15.
Negotiations between the Israeli Ministry of Finance and the Israeli Medical Association (IMA), an organization which represents physicians in Israel have reached an impasse, which as of yet has not resolved the many issues in discussion, including the unpopular proposition that would necessitate doctors clocking in and out of work.
Dr Leonid Eidelman, chairman of the IMA said that the strike is a response to the government’s wish to “hang the healthcare system to dry”. He ended his 12 day hunger strike on August 3 an attempt to prompt the government to accept the IMA’s demands and halt the progression of a collapsing health system, commenting “We cannot continue to lend a hand to the destruction of the public health care system”.
Communicating with an Israeli colleague, a physician based in Jerusalem explained that the strike in Israel is part of a general dissatisfaction in the way the budget of the country is shared; not only for salary “but for social justice in improving the health care to the poor and periphery”. It seems that it is not a general strike as emergency, oncology and obstetric services continue whilst elective surgery and outpatient clinics remain closed.
Although we are familiar with other professionals striking, one is far less cognizant of doctors partaking in strikes; the strong moral code preventing them from doing so. Thus I wonder, is it ever ethical for doctors to strike?
I put forth this question to Dr Miran Epstein, Lecturer in Medical Ethics, an outspoken Israeli doctor now residing in the UK who felt it was a question of semantics “It is not ethical for doctors to strike…but it is immoral for a government to force its doctors to resort to striking”.
Customarily, a plethora of reasons are articulated which preclude doctors from striking. Predominantly, the claim that the results of such action would result in avoidable harm or death of patients and that most often the most vulnerable segments of society suffer as a result.
Counterarguments suggest striking can often be justifiable from a utilitarian perspective, if such short term actions will ultimately result in better health outcomes in the long term.
Despite this, eventually all roads lead to Rome or in this case, the oath of Hippocrates; which is often revived for just such an occasion and utilised for moral justification against striking.
Evermore confused, I propose my question to internationally renowned Professor Abdallah Daar at the weekend over tea. As a surgeon, public health physician and ethicist at the University of Toronto, he is supremely qualified to answer.
Daar explained that it is not so much the Hippocratic Oath itself which is inviolable but rather, the major values that are enshrined therein and whether “they are still valued or have they been suppressed by other values”.
In retrospect, the crucial question is whether patients are going to suffer; in the case of Israel this seems like a pertinent question for the government to answer.Tagged in: doctors strikes, israel
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