Watch Tower: Should doctors resort to strikes?

Resident physicians in several hospitals in Jodhpur, Rajasthan started an indefinite “doctors’ strike” to protest alleged lathi-charge by the police. The regular services in government hospitals were paralyzed bringing endless miseries for the innocent patients, mostly from the impoverished section of the society who cannot afford the expensive treatment in private hospitals. And after almost three days of extreme medical muddle created by the agitating healers, the striking medicos withdrew the strike after the government bowed down to their demands of disciplining the police but not before dozens of the defenseless patients including many children succumbed to their illnesses as a result of absence of treatment in the hospitals.
“Doctors’ strike” has become a routine affair in India these days. Indian medicos frequently choose to cease work or “strike” in order to settle their scores against the government or hospital authorities. Strikes are launched by the members of the medical community to mount pressure on the authority by crippling the healthcare services for a variety of reasons. Doctors have started “strikes” for demand of extra security, seeking punishment for the grieving patient-party for alleged assaults on their medical colleagues and even to claim a higher pay scale from the authority. But do our healers have any moral, ethical or legal rights to join a “strike” that denies essential medical services from the ailing people? Who should be held responsible if innocent patients die without treatment because of a “doctors’ strike”? Both the government and the members of the medical fraternity must ponder about these burning questions that are highly relevant in Indian healthcare today.
The concept of a “doctors’ strike” is incomprehensible in most countries in the world. The Hippocratic Oath, a common pledge for doctors around the globe, demands that members of the noble profession of medicine must try to help the sick in all conditions without any reservation or extraneous influence. The financial reward for treating patients should only be a secondary consideration. In fact, the “Code of Ethics” of the Medical Council of India (MCI), the highest regulatory body for medical education and practice in India, clearly reflects the primary virtues of the Hippocratic Oath as the Section 1.1.2 of the MCI “Code of Ethics” reads, “The prime object of the medical profession is to render service to humanity; reward or financial gain is a subordinate consideration”. But yet it is a common knowledge that financial profit is the principal motivating force for a large fraction of the medical community in India today. Mushrooming private hospitals and nursing homes on almost every street corner bear irrefutable testimony that practice of medicine has turned into a highly lucrative business in modern India. The principles of the great Greek philosopher Hippocrates, father of modern medicine, of serving the humanity first without caring for money has become an obsolete and meaningless ideology for the Indian healers today. Although many government hospitals suffer from lack of adequate infrastructure, doctors these hospitals are also not impervious to the evils of greed for extra money. The obvious outcome of this ominous combination is a far greater incidence of medical calamities in government hospitals in India which in turn raise the chance of mob attacks on doctors. But the picture of a “doctors’ strike” is overtly repulsive from every angle. Even when only the junior doctors go on a “strike” in a government hospital, patients in need of urgent medical care are deprived of life-saving treatment because the junior medicos form the backbone of healthcare in government hospitals. But the ultimate price of any “doctors’ strike” is always paid by the defenseless patients- often with their lives as so many patients have already died as a result of the only 3-day “doctors’ strike” in Jodhpur. Obviously, doctors do not have a moral right to go on a “strike” at the expense of the vulnerable patients.
There is no argument that a peaceful “strike” by workers in most professions is an important tool in a democratic society to fight injustice. But workers who are involved with providing essential public services like healthcare or fire-fighters cannot have a right go on a “strike” to undermine the safety for the rest of the society. The Article 21 of the Indian Constitution guarantees protection of rights to life and personal liberty for all people. The Supreme Court of India has corroborated this notion many times in the past that the rights to go on a “strike” by some in one profession can never supersede the combined rights for life and liberty for countless others in the society. In a historic judgment in 2003 involving the striking government employees in Tamil Nadu (T.K. Rangarajan vs. State of Tamil Nadu; Civil Appeal No. 5556 of 2003), the Apex Court has ruled against the striking workers and categorically said, “Government employees cannot claim that they can take the society at ransom by going on strike.” Similarly, doctors cannot have a right to go on a “strike” and take the helpless patients at ransom to settle their personal disputes with the authority. In fact, doctors in Delhi went on a massive strike to protest against the “quota” resulting in acute disruption in essential hospital services and several patients died waiting for treatment in the Emergency ward in 2006. A public interest litigation (PIL) was filed against the striking doctors and the Medical Council of India (MCI) through a writ petition (People for Better Treatment vs. MCI & Ors; W.P. Civil No. 316/2006) seeking a complete ban on “doctors’ strike”. The Apex Court has already issued notices to the respondent medicos in this case which might have significant implications on the future of “doctors’ strikes” in India.
But even without any legal repercussions from the court, the “Code of Ethics and Regulations” framed under the MCI Act which is binding on all practicing physicians in India also has a strong prohibition against any “doctors’ strike”. The Section 2.1.1 of the MCI “Codes” has clearly stated that doctors cannot refuse treatment to a patient who is in need of urgent medical care. While a doctor may be able to wriggle out of a situation for his refusal to treat someone suffering from an insubstantial medical condition, the doctor cannot refuse therapy under any ground to a patient who is critically ill. The death of so many patients following the “doctors’ strike” in Rajasthan is in clear breach of the medical laws in the MCI. These striking doctors should face disciplinary action from the medical council for violation of the “Code of Ethics”. In fact, these errant medicos are also liable for cancellation of their medical registration for violation of the MCI regulations. It would be extremely difficult for a striking medico to defend that a patient was not in need of urgent medical care if the patient succumbs without receiving any treatment. Ironically, most members of the medical fraternity are not aware about the intricate rules and regulations that indirectly bar doctors from joining a “strike” and refuse treatment to an ailing individual. Doctors in the government (and private) hospitals would be well advised to stay away from “doctors’ strike” that can put them into serious trouble with the medical councils. Unfortunately, it is a common knowledge today that medical councils in India primarily function to shield their errant medical colleagues without caring for the lives of the ordinary citizens. Will the MCI or Rajasthan Medical Council take appropriate disciplinary actions against the striking doctors who were responsible for the death of so many innocent patients in Jodhpur hospitals? If previous history provides any indication for the future, it can be safely predicted that the striking doctors in Rajasthan has little fear to face any punitive action from the medical councils in India. Public trust in our healers has been plummeting in the recent years for more reasons than one. Further erosion of the doctor-patient relationship is likely to occur from frequent “doctors’ strikes”. The trade-union mindset of our medical leaders must change as “doctors’ strike” has no place in modern day medicine as it can only further undermine the fragile trust between doctors and patients.