Doctor’s strike : An ethical dilemma

Doctors in Kenya have been on strike since Monday this week (5th Dec, 2016). The doctors want a 300% pay rise as agreed in 2013. Negotiations with the government have failed though discussions continue.

In many countries across the world when doctors and nurses strike, emergency cases are treated. At the moment, in all public hospitals in Kenya, NO ONE is getting any treatment, emergency or not and deaths are increasing.

Death toll rises in Kenyan doctor’s strike

Who is to blame for doctor’s strike in Kenya?

I cannot help but see a serious moral dilemma at play.

I came across a paper published in the BMC Medical Ethics journal by Imran Abbasi from the Aga Khan University in Pakistan. The paper titles ‘Protests of doctors: a basic human right or ethical dilemma’ was published in 2014. I will plagiarize per verbatim bits of this article but the full article is available free online.

Protests by doctors: a basic human right or ethical dilemma?

Dr Abbasi starts by arguing that doctors enter a social contract with patients when they swear the Hippocratic oath.
According to this oath, he/she swears to act in the highest interest of his patient and keep the health and life of his patient a priority above everything.

When doctors strike, it’s not just another government worker on strike, they are too close to life and death.

BUT

The Dr Abbasi questions whether doctors should continue to suffer low pay due to this social contract. The author argues that if a doctor is underpaid, has no options of career growth and is forced to work excessively, then not only do the quality of medical care and the ability to act in the best interests of patients get adversely affected, it can also lead to brain drain.

Dr Abbasi suggests that the media play an important role and should use this to verbalize the point of view of all stake holders not just patients. When only the patients suffering is emphasised, then the media fails in helping people to understand the situation.

Dr Abbasi concludes that there is no easy answer to this problem and that there needs to be more open debate as to whether doctors should be tied by the oath and deny their human needs, common to all of us, just because of their social contract with patients. He questions whether doctors should be held entirely responsible when patients suffer as a result of strikes, when governments have failed to listen and doctors feel the need to pressurize them.

However, in his paper, Dr Abbasi makes the assumption that strikes do not disrupt emergency care. He assumes that a mother needing an emergency CS will get one, a child with a bone sticking out of his leg will have something done and a child with terminal cancer with get painkillers. He assumes that deaths will be kept to a minimum.

Mawere Munyaradzi writes from the perspective of one who observes this type of strikes in Africa, where people die because doctors and nurses will not take care of those in urgent need during a strike. Mawere is from Universidade Pedagogica in Mozambique, writing in a paper published in The Pan African Medical Journal in 2010, argues that is morally unjustifiable for physicians to strike….

Are physician strikes ever morally justifiable?

I do not deny that doctors need to earn more – they need to feel that they can focus on the patient without worrying about rent and things like that. Health workers in Kenya and across Africa have a point – things need to change. Health care decision making needs to include them more – salaries need to come on time, equipment needs to be available so that they can serve their patients.

I totally understand the frustration a doctor faces in Kenya. Watching MCA’s earning hundreds of thousands of shillings – some of whom can barely read or write. People who care nothing about the people they are supposed to serve, planning joy rides to Isreal and Singapore to ‘learn about recycling’ using tax payers money. Have ‘sitting allowances’ for doing their work as well as a fat salary, for meeting in big hotels on the Coast to discuss ‘development’. Governors spending money on lavish houses, parties and little on the people they are meant to serve. They have to placate the MCA’s to avoid impeachment so the joy ride never ends. Our MP’s, all 400 of them will get several million shillings each when the leave parliament as well as all the other benefits, not withstanding the huge salaries.

Our MP’s earn more than the British Prime Minister.

Hundreds of thousands of shillings are wasted and then the end of the month approaches and there is no money to pay health workers.

Kenyan doctor’s have reason to be livid.

Doctors did not spend years in college, filling their heads with all that knowledge and have nothing to show for it. Having the respect of being called ‘doctor’ but hiking a lift from an MCA home. The agreement of a payrise with the government was made in 2013 and so far nothing has come of it. If the country can pay MCA’s so much, so should the doctor’s pay be.

In fact, many middle class Kenyans support the doctor’s strike. The government is wasteful and all that waste could easily pay the few doctors we have, a decent salary.

However……

Is it possible to strike and avoid the suffering of the severely ill? To preserve life? Could the courts have been used? Could more pressure have been applied in other ways? Could there be an open debate about how to go about these strikes?

In Kenya, few middle class people attend public hospitals. When health workers in public hospitals strike, it is the poor that suffer. The doctors can strike as long as they like and the people they are negotiating with, will not feel the pinch of the strike in the least.

I know many doctors will be cross for my saying this – but I really believe that strikes that paralyse emergency care an unethical. There is no justification for a baby to die as a woman, who cannot afford private care, gives birth on her own outside a hospital, children born to poor parents, suffering from cancer, getting no pain relief – because there is a health worker strike. There is a suffering that is just immoral to watch and do nothing about, regardless.