A recent British Medical Association survey of junior doctors found that 95% would back industrial action, short of going on strike. This industrial action might include work to rule, refusal to carry out administrative duties, refusal to participate in waiting list initiatives and refusal to act as porters.
The core problem is the hours worked by junior doctors. According to the BMA:
- One in four junior doctors works more than 72 hours a week
- It is not uncommon for some to work 100 hours or more
- Some work shifts as long as 36 hours, with very little rest time
- Whereas in most occupations a premium is paid for out-of-hours work, junior doctors receive half the normal rate for overtime.
- Other health professionals could equally perform a proportion of the tasks done by junior doctors
- The European Commission wants to impose a limit of 48 hours on the working week of junior doctors, but Britain persuaded it to postpone implementation for 13 years
The situation has been in stalemate for some time. 'The government hasn't been listening to us' a BMA spokesperson told Triple Helix. She added 'What is important is patient care. Under the present arrangements junior doctors are often tired, not alert, and they miss things.' What that adds up to is that patients do not receive the standard of care junior doctors would like to be able to give.
There are signs that the government is starting to listen. Frank Dobson, Secretary of State for Health, is on record saying that he believes the whole system by which junior doctors are paid is 'very archaic' and he has offered a 'New Deal'. The BMA, for its part, says that some progress has been made. It remains sanguine, however, on whether a full agreement will be reached.
Junior doctors last took industrial action in 1974-75. It didn't paralyse the healthcare system. Accident and emergency patients received treatment. Because consultants saw patients, absence of juniors if anything meant a higher quality of care and death rates did not change noticeably. All this indicates that if precedent is anything to go by, Britain's junior doctors possess very few bargaining chips. But junior doctors are adamant that they have a just cause, so some form of limited industrial action remains a possibility.
So should the health professional consider going on strike? For their part the BMA and the Royal College of Nursing both rule out the proposition of going on strike. 'The RCN has an agreement that nurses can take limited industrial action' a spokesperson said. But she added that the procedures to be followed in getting to that position were 'very complicated'. RCN members have never engaged in authorised industrial action. The RCN, however, does not speak for all nurses or for other health professions. Unison, a major union for other health-care workers, has in the past embarked on various forms of industrial action.
Where, then, should Christians stand?
My submission is that the Christian conscience needs to take into account three biblical 'megathemes' - compassion, justice and grace.
The biblical passage that typically sums up the Christian attitude to the sick is Jesus' parable of The Good Samaritan. It is a story of how compassion and mercy towards one's neighbour stand in parallel to the requirement to love God. This parable helped impart a vision that played a huge part in the expansion of Christianity in the first four centuries. When plague swept through Carthage in the second century, pagan households would consign infected people to the streets to die. Christians, led by the local bishop, were seen on the streets caring for them. At great risk to themselves they gave plague sufferers shelter in their own homes. Christians became renowned all over the Roman Empire for their care of widows and orphans in a culture where too often they were left in desperate poverty.
Acts of Christian compassion left an indelible imprint on the Roman Empire. Some time after Christianity was made the official religion of the Roman Empire there arose an emperor who is known today as Julian the Apostate. Julian tried to reinstate paganism. He wrote that for his mission to succeed, pagan apologists would need to show that they and their adherents cared for people even more than the way Christians cared. Gradually Julian's mission melted away.
But what makes the parable of The Good Samaritan even more potent is how the Samaritan's compassion went beyond the expected. He treated the man's injuries. He put him on his own donkey. He took him to an inn. And when it was time for the Samaritan to move on he made financial arrangements to ensure that the victim's needs would continue to be met.
So, it can be argued, the teaching of Jesus offers the Christian health professional a model of caring that goes beyond the usual norms and limits of care.
The imperative of justice stands alongside compassion as a golden thread throughout the Bible. But we need to unpack it to appreciate fully its relevance to this issue. In the biblical tradition, justice has different nuances from our contemporary understanding of it. Informed by the principles of Roman Law we tend to see justice as weighing the evidence and agreeing a verdict based it. In the Bible, justice is a much more active process. When the Old Testament, in particular, speaks of God's justice, it speaks of God actively taking the side of the person who has been wronged. Justice was an act which God undertook and it was an imperative of faith to 'do what is just'. I would submit, therefore, that it is a Christian imperative to seek justice, including justice for colleagues who may be being subjected to injustice.
Beside compassion and justice, the biblical megatheme 'grace' speaks volumes. Grace, in the biblical sense, is 'unmerited favour'. The Bible is a record of God's acts of generosity, lavished on people who have no claim to deserve it. And because God has acted in this way, says the Bible, God's people should act in the same spirit of generosity. 'Freely you have received, freely give'.
These megathemes, then, form some of the key values that a Christian would bring to the practice of healthcare. They also inform and underpin the Christian Medical Fellowship's Affirmation Christian Ethics in Medical Practice. While this statement could do with some revision (for example, it could use an inclusive language makeover), it remains one of the most concise and helpful formulations of how the Christian ethic applies in relation to human life, in relation to patients, and in relation to colleagues.
Clause 3 of the Human Life subsection speaks of the idea of 'vocation' expressed in service for one another. The same clause also recognises the need for proper rest, which grows out of 'the Creator's rule of one day's rest in seven'. How would this principle apply in the matter of the hours that junior doctors are sometimes required to work?
Clause 2 of this subsection speaks of serving patients according to their need, 'subordinating personal gain to the interest of the patient' and 'declining to take part in collective action' where this would be harmful to patients. This statement, while not ruling out industrial action in some forms, seems to suggest there would be a limit on its extent.
Clause 1 of the Colleagues subsection speaks of the need for honest relationships with colleagues and of the requirement to fulfil the 'just requirements of the State'. There is a further rider. These requirements must not violate 'basic ethical standards'. Again, while cautioning care, this statement does not appear to rule out industrial action completely. But, I wonder, would doctors be prepared to take action on behalf of other health professionals, and vice-versa?
So, should the Christian health professional go on strike? I would submit that the answer is 'no'. The weight of the combined biblical megathemes of compassion, justice (in its Hebraic understanding) and grace all suggest that a Christian will not turn away from a patient needing care.
Should the Christian health professional take or support more limited industrial action? The weight of the justice megatheme suggests to me that there may indeed be occasions when this is justified.