Toynbee Mark, Al-Diwani Adam Aj, Clacey Joe, Broome Matthew R
Warneford Hospital, Oxford Health NHS FT, Oxford, UK Department of Psychiatry, University of Oxford, Oxford, UK.
Warneford Hospital, Oxford Health NHS FT, Oxford, UK.
J Med Ethics. 2016 Mar;42(3):167-70. doi: 10.1136/medethics-2015-103310. Epub 2016 Jan 12.
An impasse in negotiations between the Department of Health (DoH) and the British Medical Association in November this year led to an overwhelming vote for industrial action (IA) by junior doctors. At the time of writing, a last minute concession by DoH led to a deferment of IA to allow further negotiations mediated by the Advisory, Conciliation and Arbitration Service. However, IA by junior doctors remains a possibility if these negotiations stall again. Would the proposed action be ethically justifiable? Furthermore, is IA by doctors ever ethically defendable? Building on previous work, we explore important ethical considerations for doctors considering IA. The primary moral objection to doctors striking is often claimed to be risk of harm to patients. Other common arguments against IA by doctors include breaching their vocational responsibilities and possible damage to their relationship with patients and the public in general. These positions are in turn countered by claims of a greater long-term good and the legal and moral rights of employees to strike. Absolute restrictions appear to be hard to justify in the modern context, as does an unrestricted right to IA. We review these arguments, find that some common moral objections to doctors striking may be less relevant to the current situation, that a stronger contemporary objection to IA might be from a position of social justice and suggest criteria for ethically permissible doctor IA.
今年11月，英国卫生部（DoH）与英国医学协会之间的谈判陷入僵局，导致初级医生以压倒性多数投票支持采取工业行动（IA）。在撰写本文时，卫生部在最后一刻做出让步，导致工业行动推迟，以便由咨询、调解和仲裁服务局进行进一步谈判。然而，如果这些谈判再次陷入僵局，初级医生采取工业行动仍有可能。拟议的行动在伦理上是否合理？此外，医生采取工业行动在伦理上是否能站得住脚？在以往工作的基础上，我们探讨了医生考虑采取工业行动时的重要伦理考量。人们通常认为，对医生罢工的主要道德反对意见是对患者造成伤害的风险。反对医生采取工业行动的其他常见论点包括违反其职业责任，以及可能损害他们与患者及公众的关系。这些观点反过来又遭到了关于更大的长期利益以及雇员罢工的法律和道德权利的说法的反驳。在现代背景下，绝对限制似乎难以自圆其说，无限制的工业行动权利也是如此。我们审视这些论点，发现一些对医生罢工常见的道德反对意见可能与当前情况不太相关，当代对工业行动更强烈的反对意见可能来自社会正义的立场，并提出医生在伦理上可允许采取工业行动的标准。
