Guest Post by Mark Toynbee, Adam Al-Diwani, Joe Clacey and Matthew Broome
[Editor’s note: Events in the real world have moved more quickly than David or I have; the facts of the junior doctors’ strike have moved on since the paper was published and this post submitted. Still, the matters of principle remain. – IB]
A strike by junior doctors is planned for January 2016 following failure of the last-ditch ACAS (Advisory, Conciliation and Arbitration Service) mediated talks between the BMA and the Department of Health (via NHS Employers) – see media reports here, here, and here. Industrial Action had previously been planned for December last year but was suspended at the last minute when both sides agreed to the now failed mediation. The current regrettable position has resulted from over two years of formal negotiations between the BMA and NHS Employers regarding a new junior doctor contract. The BMA went to its junior doctor members for a mandate for industrial action last autumn as the talks stalled and received an almost unprecedented mandate with 98% indicating they would be prepared to strike.
Subsequently, many well-known figures voiced their concerns about the ethical and practical implications of industrial action (here and here). Strikes by doctors are not common, with only one example in the UK in the last generation, but far from unprecedented. The overwhelming recent ballot result raises many interesting issues, foremost among them the ethical legitimacy of industrial action by doctors, specifically junior doctors.
The term ‘junior doctor’ is often misunderstood. It applies to all doctors from graduation until completion of specialist training – over 50,000 individuals. Their roles and responsibilities have evolved significantly over many years; their pay and hours have reduced whilst their debts, costs and responsibilities have increased. The patient-doctor relationship has also changed with increased emphasis on patient involvement and the promotion of autonomy.
We have looked at arguments proposed during previous instances of doctor industrial action, often from this journal (see this, this, and this) and considered them in the current context. Absolute ethical objections to doctor industrial action appear old-fashioned, especially when applied to junior doctors. Concerns about harms caused by doctors withdrawing their labour also seem less sustainable in the light of recent evidence than perhaps would be expected. Indeed, the ethical responsibilities of doctors may require them to take action if they believe patient care, or the well-being of their colleagues’, is being compromised.
So far there has been strong support for the junior doctors from the Consultant bodies of many Trusts, and the Royal Colleges. The modern NHS asks more of its junior doctors than ever before, placing ever increasing responsibilities on their shoulders, with ever more challenging working conditions. With industrial action by junior doctors now likely to go ahead, claims that it would be unethical appear to us to be increasingly hard to justify.
Read the paper here.