Abbasi Imran Naeem
Research fellow, Department of Community Health Sciences, Aga Khan University, Stadium Road, P,O, Box-3500, Karachi, Pakistan.
BMC Med Ethics. 2014 Mar 10;15:24. doi: 10.1186/1472-6939-15-24.
Peaceful protests and strikes are a basic human right as stated in the United Nations' universal declaration on human rights. But for doctors, their proximity to life and death and the social contract between a doctor and a patient are stated as the reasons why doctors are valued more than the ordinary beings. In Pakistan, strikes by doctors were carried out to protest against lack of service structure, security and low pay. This paper discusses the moral and ethical concerns pertaining to the strikes by medical doctors in the context of Pakistan. The author has carefully tried to balance the discussion about moral repercussions of strikes on patients versus the circumstances of doctors working in public sector hospitals of a developing country that may lead to strikes.
Doctors are envisaged as highly respectable due to their direct link with human lives. Under Hippocrates oath, care of the patient is a contractual obligation for the doctors and is superior to all other responsibilities. From utilitarian perspective, doctors' strikes are justifiable only if there is evidence of long term benefits to the doctors, patients and an improvement in service delivery. Despite that, it is hard to justify such benefits against the risks to the patients. Harms that may incur to the patients include: prolongation of sufferings, irreversible damage to health, delay in treatment, death, loss of work and waste of financial resources.In a system of socialized medicine, government owing to greater control over resources and important managerial decisions should assume greater responsibility and do justice to all stakeholders including doctors as well as patients. If a doctor is underpaid, has limited options for career growth and is forced to work excessively, then not only quality of medical care and ability to act in the best interests of patients is adversely affected, it may also lead to brain drain.
There is no single best answer against or in favor of doctors' industrial action. The author calls for the debate and discussion to revitalize the understanding of the ethical predicaments of doctors' strikes with patient care as the priority.
正如《联合国世界人权宣言》所述，和平抗议和罢工是一项基本人权。但对于医生而言，他们与生死的紧密关联以及医生与患者之间的社会契约，被视为医生比普通人更受重视的原因。在巴基斯坦，医生举行罢工以抗议服务结构缺失、安全保障不足和薪资过低。本文在巴基斯坦的背景下讨论了与医生罢工相关的道德和伦理问题。作者谨慎地试图在讨论罢工对患者的道德影响与发展中国家公立医院医生可能导致罢工的工作环境之间取得平衡。
由于医生与人类生命的直接联系，他们被视为备受尊敬的职业。根据希波克拉底誓言，照顾患者是医生的契约义务，且高于所有其他责任。从功利主义角度来看，只有当有证据表明医生罢工对医生、患者有长期益处且能改善服务提供时，罢工才是合理的。尽管如此，很难证明这些益处能抵消对患者的风险。可能给患者带来的伤害包括：痛苦延长、健康的不可逆转损害、治疗延误、死亡、工作损失和财务资源浪费。在社会化医疗体系中，政府由于对资源和重要管理决策有更大控制权，应承担更大责任，公正对待所有利益相关者，包括医生和患者。如果医生薪资过低、职业发展选择有限且被迫过度工作，那么不仅医疗质量和为患者谋求最大利益的能力会受到不利影响，还可能导致人才外流。
对于医生的罢工行动，没有一个绝对支持或反对的最佳答案。作者呼吁进行辩论和讨论，以重新唤起对医生罢工伦理困境的理解，并将患者护理作为首要任务。
