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Junior doctors’ strikes: it’s time to stop the walkouts and start negotiations

BMJ 2023 ; 381 doi: (Published 11 April 2023) Cite this as: BMJ 2023;381:p813

Rapid Response:

Re: Junior doctors’ strikes: it’s time to stop the walkouts and start negotiations

Dear Editor

The moral obligation to strike and the temptation of extremism

Fraz Mir argues that the recent industrial action by junior doctors put patients in harm’s way, endangered them by compromising their safety, created hardship for thousands (if only in the short term) and was likely to have eroded public trust in the medical profession (1). Presented in this way, industrial action by doctors looks like a definitive moral wrong.

However, much of the argument about the ethics of industrial action by doctors runs in the opposite direction. In a socialised health care system concrete circumstances promoting conflict between doctors and the State must be considered, alongside general ethical principles. Toynbee and colleagues (2) point out that the change to a shift-based system has decreased the number of junior doctors on site at any given time, whilst intensifying their workload and eroding the quality of care. Junior doctors have largely lost control of their training which they experience as inflexible, impersonal and overly specialised (just when the NHS needs generalists). All of this was rewarded by a 15% real term reduction in salaries between 2009 and 2014. It is hardly surprising that junior doctors have opted for industrial action.

Limited short-term industrial action seems unlikely to be harmful to patients (2) and emergency care may even improve (3). The erosion of the quality of care poses a longer-term risk to the public. Davies argues that “If the conditions that doctors work under put patients at risk, then (on balance) they are morally obliged to strike” (4) .

Roberts (5) offers some ethical conditions for legitimate industrial action: strikes should be proportionate, not obviously futile, a last resort, organised through a body with a legitimate claim to represent medical interests and announced in advance. Health services should nonetheless ensure that emergency care is made available during walkouts, and that junior doctors “avoid the temptation of extremism by protecting the weak and the vulnerable during their quarrels with their employer” (4).

1) Mir FA Junior Doctors’ strikes: it’s time to stop the walkouts and start negotiations BMJ 2023:381:p813
2) Toynbee M, Al-Diwani AAJ,Clacey J, Broome MR J.Med Ethics 2016;42: 167-170
3) Metcalfe D, Chowdhury, Salim A What are the consequences when doctors strike? BMJ 2015;351: h6231
4) Davies M Is it ethical for doctors to strike? BMJ 2015; 351:h5597
5) Roberts AJ A framework for assessing the ethics of doctor’s strikes J Med Ethics 2016;42(11) 698-700

Competing interests: No competing interests

16 April 2023
Steve Iliffe
Emeritus Professor of Primary Care for Older People
University College London
London NW2 3BP