'Do everything without grumbling or arguing,' wrote Paul from his prison cell to the hard-pressed Christians in Philippi, 'so that you may become blameless and pure, children of God without fault in a warped and crooked generation. Then you will shine among them like stars in the sky as you hold out the word of life.' (Philippians 2:14-16)
This article tackles the difficult issue of whether Christian doctors should strike. I'm no expert. I doubt there is a single answer that is right across the board - we are all in different positions and feel God's call on our lives in different ways. Forgive me if you think I overstep the mark at any point. Do pray through what your own response should be.
As Christians, we have freedom to hold a vast range of political views. Our love for Christ should most definitely influence our politics, but not necessarily all in the same direction for each of us. Love for God and neighbour can be expressed in many different ways. The Bible doesn't include a blueprint for the modern state, and complex questions of national policy and priority must be worked out in dialogue with those living around us.
Christians can, in all good faith, think medical salaries are too low, too high, or about right. They can believe that the NHS is the best model for providing care, or that we would do much better with a different system. They can support medical strikes, or think they are a step too far. The Bible doesn't speak directly to these issues, and we can easily be wrong.
Where Christians don't have room to choose is over the attitudes in our hearts. There is no option for Christians to be proud, greedy, rude or cynical. We are called to follow the example of Jesus: who made himself nothing, becoming a servant and offering his very life in obedience to his father (Philippians 2:5-8). The Holy Spirit brings power to help us get rid of old sinful ways and be transformed by the renewing of our minds.
The issue of doctors' pay is complex. How should the economic forces which define labour costs operate when there is a monopoly, state-run healthcare employer? How should doctors' and nurses' pay compare? Should pay rise with inflation? How should the decisions of independent pay-review bodies be acted on by government?
Christians will come to different views on all of these things. It is certainly true that medical pay has been eroded significantly - perhaps more than that of other professions - by below-inflation pay rises. Junior doctors leave medical school with far more debt than before, and face large living and accommodation costs, as well as the cost of professional registration and exams. I know of colleagues who are working less than full time and facing significant childcare costs, and who are really struggling. These are issues of justice, and there is a strong case to be made that doctors deserve a pay rise.
Against this, it is clear that the finances of the nation are not in a good position. Growth has not kept pace with inflation: as a society we have all become poorer. Who should feel the effects of this squeeze? Should doctors be seeking a pay rise that exempts them from this pain? The British Medical Association calculates that a 35 per cent pay rise is required to bring junior doctors' real-terms income back to its 2008 levels, which they term 'pay restoration'. But is this a just ambition, or are we asking for doctors to be treated differently from other groups in society? Those in other professions - including nurses - have settled for much less.
Aside from the pay demands, what about the question of whether doctors should ever strike, when it causes such disruption to patient care? Historically, enormous improvements have been made to workers' standards of living through coordinated industrial action. Christians have been at the forefronts of the trade union movement and strikes work through solidarity. Industrial action by doctors is legal and can be done safely - at least in the short term. But how should we feel about the claims of the BMA Chair, Prof Philip Banfield, to 'strike for as long as it takes' - when those most personally affected by strikes are not government ministers, but patients? How should we, as doctors, wield the considerable power we possess?
In 1999, with the threat of medical industrial action looming, Triple Helix included an article suggesting that Christian doctors shouldn't strike but might consider alternative forms of limited industrial action. Indeed, at that time, Christian Ethics in Medical Practice, an ethical statement produced by CMF, suggested Christians should 'decline to take part in collective action' and 'subordinate personal gain to the interest of the patient.' Subsequent negotiations with the Labour government of the day, perhaps informed by the threat of industrial action, resulted in the 'New Deal' pay award that saw significant improvements in pay and conditions for junior doctors.
In 2016, with the threat of strikes looming again, Triple Helix ran two articles. One encouraged juniors to join in industrial action 'for a contract that is safe for patients, fair and safe for doctors, and sustainable for the NHS'. Another urged Christian juniors not to strike, because 'your colleagues, your patients, and those looking in from the outside need to see and hear a group of juniors with a different message. One of self-sacrifice and responsibility versus entitlement. Yes, one even of submission. Supremely, one of a crucified saviour…'
What should Christian juniors and consultants do today? I think we have freedom to choose. Pray about your decision, seek God's will. Immerse yourself in the Bible and ask him to guide you through his word. We are told to look not only to our own interests, but to the interests of others; to beware of the love of money, which is a root of all kinds of evil; to fear God, and not other people's opinions. We should be especially concerned for the poor - whether they are within our own profession, working elsewhere in the NHS, or coming to us as our patients. We can ask God to grant us contentment in all circumstances; we should be content with our pay. We are told that God blesses peacemakers. There is a hard call to love our neighbours as ourselves.
Paul's reminder to the Christians in Philippi to shine as stars seems especially relevant. Where there is opportunity, take opportunities to speak to others about being a Christian. Explain how knowing God affects your decision making.
For many of us, these strikes have been acutely uncomfortable, and have forced choices on us that we would much rather avoid. This is an opportunity to rise to the challenge and acknowledge that God has put us where we are for a purpose, with a word of life to proclaim to a cynical world where many have lost all hope. To paraphrase Paul's words to Christians in Corinth, 'whether you strike or don't strike, or whatever you do, do it all for the glory of God.' (from 1 Corinthians 10:31)
David Randall is a renal consultant in London