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17.10.2011 Feature Article

Should Doctors go on strike? Ethics versus Egotism

Should Doctors go on strike? Ethics versus Egotism
17.10.2011 LISTEN

The answer is simply yes since strike is a legitimate action to frown on unfavorable conditions. Strike action is legal and any institution that has legal rights can embark on strike when it deems fit by the abiding conditions. If doctors qualify under this democratic legitimacy, then under which conditions should doctors be on strike?

Why doctors go on strike
From our history as Ghanaians, we have seen doctors going on strike for salary increment. These urgencies may be as result of the following:

From global perspective, the medical profession is indeed one of the various professions that carry dignity and every doctor has this rooted deep in his or her mind. The cost that involves to become a medical doctor is less talked about. It really cost. For that matter many doctors don't see it reasonable to leave on a meager salary.

Another point might be the gravity of their services to patients. Many doctors do heart transplanting, fix bones, treat cancer, kidney, liver etc. These works are very delicate and any careless attempt will end up paralyzing or resulting in the death of the patient. They are called deep in the night to respond to emergencies and many other emergency engagements.

Doctors have also argued that the risky nature of their profession demands a higher salary. Sometimes they are prone to contagious diseases like flu, HIV/AID's, TB, and over 200 more contagious deadly diseases. For that matter a high salary must be given to encourage or motivate them.

All these points are reasonable though debatable. But often when we talk of risky professions, medical sector is the least talked about. We talk about areas like the military, veterinary, police, fire service, prisons etc. are all coupled with high risk and are sectors that need great attention.

Possible reasons against doctors strike action
Even though some international researches have proven that, doctors' strike increases mortality rate, nevertheless, we can not overlook to project consequences that comes as a result of doctors' strike.

1. Untimely death of patients
2. Prolongation of suffering of patients in severe cases
3. Breach of international code of ethics that doctors themselves have sworn into
4. Put pressure on government
5. Sensitizes other equally rated professions to follow suite
6. The public might see them as greedy other than selfless civil servants
7. Not ethical in its nature since it involves humans' life
8. Their profession is no greater than others, etc.

The question of ethics
In most cases, doctors' strike has attracted many protests because the public think they are risking the lives of millions and however not ethical. Can ethics be applied to doctors' strike?

First, every doctor is already bonded by code of ethics. Each doctor before taking up the post swears to abide by a code of ethics. One of the lines in the international code of ethics for doctors reads like this, “I will maintain the utmost respect for human life from its beginning even under threat and I will not use my medical knowledge contrary to the laws of humanity;” The international code of ethics further states, “A physician shall not permit motives of profit to influence the free and independent exercise of professional judgment on behalf of patients.” To the doctor, the life of the patient comes first to all other things.

Doctors are also legally required to attend to patients and offer to them an undivided medical attention. This legality exists between the doctor and the government. Though the patient has intent of receiving an excellent care and treatment after paying his NHIS, in cases of strike, the patient has no legal right to sue the doctor in question, unless a private or personal doctor. He can only sue the NHIS or Ministry of Health.

The issues of ethics comes into play when we talk of issues of good and evil, live and death, justice and crime, etc. Since the doctors primary job is to save lives and that a lost life cannot be revived, it therefore becomes delicate for the doctor when taking any action that will obliterate these ethics. Should a patient loss his or her life as a result of doctors' strike, who would be blamed? The doctor or the government?

The issue of egotism
When we are talking of labor strike, we must consider the consequential results also. This is what we call utilitarianism. From Wikipedia, “Utilitarianism is an ethical theory holding that the proper course of action is the one that maximizes the overall "good" of the greatest number of individuals. It is thus a form of consequentialism, meaning that the moral worth of an action is determined by its resulting outcome.” When doctors think an action is right, then it must have a national impact as well.

I am yet to offer a round of applause for doctors embarking on a strike action to improve quality health care products, laboratory equipment, enough patient wards, digital and IT infusion into the health practice, to stop nurses' and medical personnel's migration and others that bring a unanimous good for the majority of the people in the country. Strike actions under such circumstances are justifiable and must be given an immediate support and attention.

When these important things which I think are the pressing needs of Ghana are overlooked by doctors and rather, they are seeking to fulfill their own selfish gain, then their strike action would be considered as greed and however, unethical.

Nevertheless, in most cases, we might see the salaries of doctors not fitting them to take care of their own family and expenses. This will result in what Dr. Andrew Rowland considers as “Working without enthusiasm.” In such cases a petition must be sent to the government and the government must charge the appropriate authorities to look into the matter. If it deems fit for salary increment, the government must do it without hesitant. And in this increment the government must be carefully of what he is giving out in order not to trigger other strike actions from other equally rated public sectors. On the contrary if the government refuses to adhere to their request upon countless request, then doctors can use strike as the last resort to communicate their worries.

In conclusion, doctors by constitution have every right to embark on a strike action but this must be as a result of an extreme maltreatment or lack of health facilities which makes rendering services difficult and which in effect will enrich the lives of all; both doctors and nationals as well. Doctors must esteem the lives of their patients and refrain from greed. Government must make every effort to enrich, not only the lives of doctors alone, but to make a reasonable salary rate for all public servants. The last but not the least, the constitution must also make it clear under which and what conditions delicate professions like medicine, military, police etc. can embark on strike.

World Medical Association International Code of Medical Ethics
Adopted by the 3rd General Assembly of the World Medical Association, London, England, October 1949 and amended by the 22nd World Medical Assembly Sydney, Australia, August 1968 and the 35th World Medical Assembly Venice, Italy, October 1983

DUTIES OF PHYSICIANS IN GENERAL
A PHYSICIAN SHALL always maintain the highest standards of professional conduct.

A PHYSICIAN SHALL not permit motives of profit to influence the free and independent exercise of professional judgement on behalf of patients.

A PHYSICIAN SHALL in all types of medical practice, be dedicated to providing competent medical service in full technical and moral independence, with compassion and respect for human dignity.

A PHYSICIAN SHALL deal honestly with patients and colleagues, and strive to expose those physicians deficient in character or competence, or who engage in

fraud or deception. The following practices are deemed to be unethical conduct:

a) Self advertising by physicians, unless permitted by the laws of the country and the Code of Ethics of the National Medical Association.

b) Paying or receiving any fee or any other consideration solely to procure the referral of a patient or for prescribing or referring a patient to any source.

A PHYSICIAN SHALL respect the rights of patients, of colleagues, and of other health professionals and shall safeguard patient confidences.

A PHYSICIAN SHALL act only in the patient's interest when providing medical care which might have the effect of weakening the physical and mental condition of the patient.

A PHYSICIAN SHALL use great caution in divulging discoveries or new techniques or treatment through non-professional channels.

A PHYSICIAN SHALL certify only that which he has personally verified.

DUTIES OF PHYSICIANS TO THE SICK
A PHYSICIAN SHALL always bear in mind the obligation of preserving human life.

A PHYSICIAN SHALL owe his patients complete loyalty and all the resources of his science. Whenever an examination or treatment is beyond the physician's capacity he should summon another physician who has the necessary ability.

A PHYSICIAN SHALL preserve absolute confidentiality on all he knows about his patient even after the patient has died.

A PHYSICIAN SHALL give emergency care as a humanitarian duty unless he is assured that others are willing and able to give such care.

DUTIES OF PHYSICIANS TO EACH OTHER
A PHYSICIAN SHALL behave towards his colleagues as he would have them behave towards him.

A PHYSICIAN SHALL NOT entice patients from his colleagues.

A PHYSICIAN SHALL observe the principles of the "Declaration of Geneva" approved by the World Medical Association.

DECLARATION OF GENEVA
Adopted by the 2nd General Assembly of the World Medical Association, Geneva, Switzerland, September 1948 and amended by the 22nd World Medical Assembly Sydney, Australia, August 1968 and the 35th World Medical Assembly

Venice, Italy, October 1983 and the 46th WMA General Assembly
Stockholm, Sweden, September 1994.

AT THE TIME OF BEING ADMITTED AS A MEMBER OF THE MEDICAL PROFESSION:
I SOLEMNLY PLEDGE myself to consecrate my life to the service of humanity;
I WILL GIVE to my teachers the respect and gratitude which is their due;

I WILL PRACTICE my profession with conscience and dignity;

THE HEALTH OF MY PATIENT will be my first consideration;

I WILL RESPECT the secrets which are confided in me, even after the patient has died;
I WILL MAINTAIN by all the means in my power, the honor and the noble

traditions of the medical profession;
MY COLLEAGUES will be my sisters and brothers;
I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, or social standing to intervene between my duty and my patient;

I WILL MAINTAIN the utmost respect for human life from its beginning even under threat and I will not use my medical knowledge contrary to the laws of humanity;

I MAKE THESE PROMISES solemnly, freely and upon my honor.

Clifford Owusu-Gyamfi, University of Lausanne, Switzerland

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