Several important ethical dilemmas emerge when nurses join a public-sector strike. Such industrial action is commonplace in South Africa and was most notably illustrated by a national wage negotiation in 2010. Media coverage of the proceedings suggested unethical behaviour on the part of nurses, and further exploration is merited. Laws, policies and provisional codes are meant to guide nurses’ behaviour during industrial action, while ethical theories can be used to further illuminate the role of nurses in industrial action. There are, (...) however, important aspects to consider before judging whether nurses act unethically when striking. Following Loewy’s suggestion that the nature of the work, the proceeding commitment of the nurse to the patient, the prevailing situation when the strike is planned and the person(s) who stand(s) to benefit from the strike be considered, coupled with a consideration of the South African historical socio-political context, important aspects of the ethics of nurses’ behaviour in industrial action transpire. (shrink)

Bioethics and its offspring Health-care Ethics have a variety ofuses and obligations among which and perhaps most importantly istheir social obligation. This paper raises questions as toBioethics fulfilling the necessary criteria for a profession,suggests that it can serve as a link between individual andcommunal problems, discusses the task of health-care ethics as well as ways of teaching it, lists some of the obligationsof health-care ethics professionals and discusses the dangers to and failings of these health-care professionals today. Itconcludes that we (...) are at a crossroads in which we must choosebetween our own personal security and comfort and fulfilling our social role. (shrink)

Since its inception, bioethics’ principled stance has been to argue against paternalism and elitism, and for an inclusive ethical perspective. But at least in North America, the growth of bioethics as a special area of applied ethics has created conflicts within the field itself. Those who, a generation earlier, argued against paternalism and for both professional and public accountability in medical decision making are now part of the decision making process. Too often, it is argued in this paper, their allegiance (...) is to the employer, or to a view of medicine that is institutionally based. As a result, it is suggested by this review, medical ethicists have adopted the perspective that, in the early 1970s, they most criticised. The answer, it is argued here, is to revisit a lexicographical ordering of responsibility in bioethics, one that recognises professionals as individuals with responsibilities, as citizens with a public posture, and finally, as professionals involved in the process of medical decision making. (shrink)

There has been much discussion of the justifiability of strikes by healthcare workers, but comparatively little discussion of the political processes through which strikes occur. This article focuses on the Trade Union Act 2016, which currently governs strike ballots in the UK. This legislation has important implications for healthcare workers being balloted on strikes (or other forms of industrial action). The article first explains the legal requirements for a strike mandate and illustrates how votes in strike ballots can be counterproductive, (...) bringing about outcomes opposite of what the voter wanted. Second, it argues that the turnout threshold responsible for these surprising results is undemocratic, since it means that outcomes need not reflect the wishes of those balloted. Third, it suggests that this has consequences for how balloted workers ought to vote, if they want the process to be more democratic. In particular, I propose that those who are neutral or indifferent have reason to cast spoiled ballots, in order to negate the turnout threshold. Further, those who oppose a strike also have reasons—if they value democratic decision-making—to vote, even though this may be less effective than abstaining. As I write, in August 2023, junior doctors in the UK are once again being balloted over strike action.1 While the global picture is more varied, strikes by medical professionals have historically been rare in the UK. When British doctors went on strike in 2012, over changes to pensions, it was the first time since 1975.2 Since then, however, industrial action has become more common. Some attribute this to an erosion of patient-centred professional values, which has made workers more prepared to strike in response to deteriorating pay and conditions.3 4 Whether or not this is the explanation, the increased prevalence of strikes has caused some concern. It is often …. (shrink)

Workers who go on strike are sometimes accused of holding their employer “to ransom”, the implication being that strike action is a kind of extortion. The paper provides an analytical reconstruction of this objection, before presenting and interrogating different strategies for countering it. The first says that work-stoppages can only be extortionate if they infringe an employer’s rightful claim to productive labour, but that no employer has any such claim under capitalism. The second says that work-stoppages cannot be extortionate because, (...) by themselves, they cannot put an employer under duress. The third and most promising strategy says that an employer’s claim to the productive labour of workers is conditional upon his/her not exploiting them. This approach does not produce a blanket exoneration; it tells us that the aptness of describing a strike as extortionate depends on a prior appraisal of the conditions that the strikers work under, and the fairness with which they are treated. (shrink)

While Bioethics is now taught at all medical colleges in the United States as well as in other nations, and while discussions about Bioethics have become frequent in most medical journals there are increasing barriers to teaching and incorporating what has been taught into daily practice. I shall discuss some of these barriers and suggest that integrating the teaching of Bioethics throughout the curriculum after presenting some of the basic theory and methodology is the most effective way of teaching this (...) vital subject. Furthermore, courses in health care ethics are often taught as something distinct and distinguishable from one's medical practice. I shall emphasize what I consider to be the failure of Bioethics to participate effectively in creating a context whereby what has been taught can be put into praxis. In this brief article I will discuss such barriers and suggest several approaches and remedies. (shrink)

Strike action in healthcare has been a common global phenomenon. As such action is designed to be disruptive, it creates substantial ethical tension, the most cited of which relates to patient harm, that is, a strike may not only disrupt an employer, but it could also have serious implications for the delivery of care. This article systematically reviewed the literature on strike action in healthcare with the aim of providing an overview of the major justifications for strike action, identifying relative (...) strengths and shortcomings of this literature and providing direction for future discussions, and theoretical and empirical research. Three major themes emerged related to (1) the relationship between healthcare workers, patients and society; (2) the consequences of strike action; and (3) the conduct of strike action. Those who argue against strike action generally cite the harms of such action, particularly as it relates to patients. Many also argue that healthcare workers, because of their skills and position in society, have a special obligation to their patients and society more generally. Those who see this action as not only permissible but also, in some cases, necessary have advanced several points in response, arguing that healthcare workers do not necessarily have any special obligation to their patients or society, and even if so, this obligation is not absolute. Overwhelmingly, when talking about the potential risks of strike action, authors have focused on patient welfare and the impact that a strike could have. Several directions for future work are identified, including greater explorations into how structural and systemic issues impact strike action, the need for greater consideration about the contextual factors that influence the risks and characteristics of strike action and finally the need to tie this literature to existing empirical evidence. (shrink)

Several important ethical dilemmas emerge when nurses join a public-sector strike. Such industrial action is commonplace in South Africa and was most notably illustrated by a national wage negotiation in 2010. Media coverage of the proceedings suggested unethical behaviour on the part of nurses, and further exploration is merited. Laws, policies and provisional codes are meant to guide nurses’ behaviour during industrial action, while ethical theories can be used to further illuminate the role of nurses in industrial action. There are, (...) however, important aspects to consider before judging whether nurses act unethically when striking. Following Loewy’s suggestion that the nature of the work, the proceeding commitment of the nurse to the patient, the prevailing situation when the strike is planned and the person(s) who stand(s) to benefit from the strike be considered, coupled with a consideration of the South African historical socio-political context, important aspects of the ethics of nurses’ behaviour in industrial action transpire. (shrink)

For several years, the Democratic Republic of Congo has been the scene of strikes by the country’s doctors. The strikers’ demands are essentially financial and statutory and are intended to put pressure on the government. In this country, as is the case almost everywhere in the world, medical strikes are allowed. Every worker has the right to denounce by strike working conditions that are considered unacceptable. But are doctors just like any other workers? Do they not have particular moral obligations (...) linked to the specificities of their profession? To shed light on these questions, the authors of this article propose three essential moral benchmarks that can be generalized to medical strike situations elsewhere in the world. The first concerns the recognition of the right to strike for doctors, including for strictly financial reasons. Health professionals cannot be asked to work in inhuman working conditions or without a salary to support their families. The second benchmark argues that it is unacceptable for this right to strike to be exercised if it sacrifices the most vulnerable patients and thus denies the very essence of the medical profession. A third benchmark complicates the reflection by reminding us that the extreme dilapidation of the Congolese health system makes it impossible to organise a minimum quality service in the event of a strike. To overcome these difficulties, we propose a national therapeutic alliance between doctors and citizens to put patients back at the centre of the health system’s concerns. (shrink)