Discounts for doctors. Gratitude and desert in a pandemic

By Catriona Boyd and Joshua Parker.

Displays of gratitude towards healthcare workers have risen throughout the pandemic. Many businesses have offered free or discounted products and services. Morrisons, for example, announced a 10% discount for all NHS workers to “support them” during the COVID-19 pandemic; and they are by no means exceptional. This isn’t limited to businesses; a weekly nationwide clap and rainbows in the windows of homes across the UK signify a ‘thank you’ to the NHS and its staff. As healthcare workers, we have benefitted from this. Yet we have also experienced a degree of disquiet. Here, we consider three ethical worries that leave us in two minds about these undeniably welcome gestures.

Many people believe that NHS workers deserve shows of thanks, and the material rewards that come with them. We usually understand desert in terms of what somebody is owed by virtue of something else, like their efforts or action. It’s often thought that if somebody deserves something, denying it is unfair. So it might be believed that the actions of NHS workers, the sacrifices they’ve made and their valuable work during the pandemic means it is only right and fair that they’re shown thanks.

The first worry is that some displays of gratitude may distract from what healthcare professionals really deserve. In some ways, COVID-19 has changed what healthcare professionals do, but in many ways it hasn’t. Whilst clinicians have coped with differing demand in unfamiliar and challenging circumstances, fundamentally they still provide care, treat the sick and tend to the dying. If they deserve thanks now, then they certainty deserved it before the pandemic if their jobs haven’t suddenly become substantially different, harder or more valuable. But a cash-strapped NHS has historically left healthcare workers massively undervalued and denied basic rewards and protections as employees. The pandemic may have made people realise what the NHS means and how important its staff are, but demonstrating this thorough the aforementioned displays risks continuing the same poor treatment as employees and inadequate funding of the NHS. If we come to see clapping and discounts as the proper way of marking the value of the NHS and its staff during a pandemic, how can we even start to have a discussion about what is owed to health workers in ‘normal’ times?

Government action to protect health workers, especially through PPE, has been woeful; leaving them to work under threats to their health and life. At least 180 NHS staff have died as a result of COVID-19; we can think of no greater sacrifice than this. Risking your own health is in no way simply ‘part of the job’. These individuals, at the very least, deserve recognition. Sadly, discounts at the supermarket may display recognition and gratitude but they hardly compensate for such extraordinary sacrifice. There is a certain directness to these gestures, and we do not discount the impact on morale, but it is the government who has the means to truly offset these risks and the public are better using political means to support health workers. Indeed, government are able to co-opt the narrative using virtues of ‘heroism’ to distract from what is truly owed to the victims of their poor decision-making. Yes, we could be accused of creating a false dichotomy here for neither are mutually exclusive; we can both clap for carers and ensure appropriate compensation via their employer. The risk is that, in reality, the two become conflated and that well-intentioned displays of gratitude are wrongly seen as adequate compensation for extraordinary sacrifice.

The second challenge regards the scope of such gestures. NHS staff perform valuable work in the pandemic and much is being asked of them, but they aren’t the only ones. Bus drivers, cleaners, care workers, supermarket staff and many other hard-working keyworkers all help to keep a locked down society running, ensuring our safety and well-being. There are differences, both in kind and degree as to what is asked of each keyworker, but there doesn’t appear to be anything so significant and unique that only NHS staff merit thanks. If we healthcare workers deserve gestures of gratitude, there is no good reason to fail to extend this to other important workers. To do otherwise appears unfair.

The final worry is that a narrow focus on a specific kind of desert can distract from need. A pandemic has consequences far beyond health. It has created deep economic concern and thousands of people have been furloughed, lost their jobs, been unable to work, and suffered pay cuts. There are many reasons to believe that NHS workers might deserve thanks, but do they need them? Many of these expressions are essentially a form of resource. Freebies and discounts keep money in our pockets and out of the businesses’. As NHS staff continue to work in the knowledge that their income is secure, there is a question as to whether others might benefit more were some of these displays directed elsewhere. In this way need becomes a form of desert all of its own. Were we to focus more on desert as need rather than desert based on effort or action, these businesses might be able to really benefit those hit hardest by the economic effects of a pandemic and in turn do much good for a country in crisis.

There are plenty of examples of people doing good things for others in response to the pandemic that lie outside of our thoughts there. We’re not suggesting that any show of gratitude towards NHS workers is in some way wrong or that we aren’t heartened by the thanks shown to us as we do our jobs. For those wanting to help, we offer three questions to ask oneself before acting: 1) Does my action demonstrate how much I value the NHS and ensure staff are properly appreciated? 2) Is there somebody else at least as deserving as healthcare workers who I might have forgotten? 3) Is there anyone else who needs this more? We hope, that by asking these questions we can ensure all sacrifices are recognised with proportionate thanks and that resources are distributed fairly and to those who stand to benefit most. After all, we’re all in this together.


Acknowledgement: The authors would like to thank Ben Davies, Paul Young and Alexandra Hayes for helpful comments on an earlier draft of this post.

Authors: Catriona Boyd and Joshua Parker

CB: Foundation Year 2 Doctor, Manchester Royal Infirmary, Manchester.
JP: Education Fellow in Ethics and Law, Wythenshawe Hospital, Manchester.
Conflict of interests: none
Social media accounts of post author: @joshp_j

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