Institute for Lifecourse Development, The University of Greenwich, London, UK.
Nurs Ethics. 2024 Mar-May;31(2-3):148-160. doi: 10.1177/09697330231183076. Epub 2023 Aug 4.
Healthcare strikes have been a remarkably common and varied phenomenon. Strikes have taken a number of forms, lasting from days to months, involving a range of different staff and impacting a range of healthcare systems, structured and resourced vastly differently. While there has been much debate about strike action, this appears to have done little to resolve the often polarising debate that surrounds such action. Building on the existing normative literature and a recent synthesis of the empirical literature, this paper will present a deliberative framework to assess the justifiability of strike action. I will first review the empirical literature that explores the impact of strike action, on patient outcomes and healthcare delivery. I will then discuss the debates that have occurred in this area, including an existing deliberative framework proposed by Selemogo (2014). I will argue that this framework is overly restrictive in that it could lead us to find otherwise justified strike action, unjust. I will then propose a framework that remedies these shortcomings. The framework outlines two broad conditions that should be met if strike action is to be justified. It then goes on to outline two deliberative, interrelated questions that should be used to assess whether strike action meets these conditions. For the purposes of this framework, healthcare strike action is justified when 1) it makes demands or raises grievances about some form of injustice, unfairness or threat to health and when 2) the risks in striking are proportionate to its demands or grievances. These two conditions should be considered in light of two further questions, namely, the 3) social and political context of the strike and 4) the characteristics of the strike. I will offer some further reflections on the application of this framework and its shortcomings.
医疗保健罢工是一种非常普遍和多样的现象。罢工采取了多种形式，持续时间从几天到几个月不等，涉及范围广泛的不同员工，并对各种医疗保健系统产生影响，这些系统在结构和资源方面存在巨大差异。尽管围绕罢工行动存在很多争论，但这似乎并没有解决围绕此类行动的常常两极分化的争论。本文将在现有规范文献和最近对经验文献的综合基础上，提出一个审议框架，以评估罢工行动的合理性。我将首先回顾探讨罢工行动对患者结果和医疗保健提供的影响的经验文献。然后，我将讨论该领域发生的争论，包括 Selemogo（2014 年）提出的现有审议框架。我将争辩说，该框架过于严格，因为它可能导致我们发现原本合理的罢工行动是不合理的。然后，我将提出一个可以弥补这些缺陷的框架。该框架概述了如果要使罢工行动合理化，应该满足的两个广泛条件。然后，它进一步概述了两个审议性、相互关联的问题，这些问题应该用于评估罢工行动是否符合这些条件。就本框架而言，当 1）罢工对某种形式的不公正、不公平或对健康的威胁提出要求或提出不满，以及 2）罢工的风险与其要求或不满相称时，医疗保健罢工是合理的。这两个条件应根据以下两个进一步的问题来考虑，即罢工的 3）社会和政治背景以及 4）罢工的特征。我将对该框架的应用及其局限性提出一些进一步的思考。
