Physicians’ strikes are not unique to Israel. The Association of American
Medical Colleges, the American College of Physicians and the American Medical
Association have all opposed such strikes, but they nevertheless seem to be
almost a universal feature in most Western countries.
In the past,
disputes between individuals were settled by physical struggles, such as duels.
Today such methods are considered primitive and barbaric. Most democratic
societies have established courts, based on the premise that impartial, trained
individuals should decide on the merits of the evidence. The use of force is
considered unethical, and civilized societies reject the “might is right”
behavioral pattern in interpersonal disagreements.
However, when dealing
with labor disputes the public accepts strikes as the normal method of
The strike is recognized as an almost inalienable human
right. But is a strike a fair way of settling disputes? Who wins? Is justice
decisive? “Strong” unions that can cause the most chaos and suffering by
striking gain the best conditions. Electric company and dock workers have
disproportionately favorable labor contracts, not because they are the most
deserving, but because their strikes become unbearable for society. A labor
strike represents the use of force to settle a disagreement.
in modern society raise a new ethical dilemma: If Reuven has a dispute with
Shimon, by what right may Reuven inflict damage on a third party, an innocent
bystander, to force the bystander to pressure Shimon to grant relief to Reuven?
There is a recent relevant Israeli Supreme Court decision. Israel had refused to
release imprisoned Lebanese citizens who had completed their prison terms. This
refusal was imposed to apply pressure for release of Israeli soldiers and to
obtain information about missing soldiers. These prisoners were being held as
“bargaining chips.” The court ruled it is illegal and immoral to hold innocent
people hostage in order to put pressure on the kidnappers. Most strikes in the
public sector present an analogous situation. By depriving citizens of services,
they are being kept hostage in order to apply pressure on the
Historically, strikes developed in societies where power was
vested largely in the hands of an upper class which controlled the media, the
means of production, the courts and the government. Exploited workers had no
reasonable way of getting fair compensation for their work and no realistic
alternative other than to go on strike.
The employer, when faced with
considerable personal financial damage, often found it expedient to submit to
the workers’ demands. The gains made by organized labor contributed immeasurably
to raising standards of living and relieving injustices and
Compare those struggles to local or national government
When employees go on strike, the public officials who are
“responsible” for their alleged unfair treatment do not suffer personally. They
continue to receive their salaries. But the public suffers, although they are
innocent bystanders. The strike is based on the hope that these innocent
bystanders will apply enough pressure on the offending management – a bizarre
I HAVE no realistic expectations that any democratic
society is currently likely to rescind or seriously limit strikes. The concept
of the right of workers to strike is so engrained in modern societies that it is
unlikely to change in the near future. There are also various vested interests
in preserving the present ground rules.
Are strikes by physicians
different than strikes by other groups? I believe that physicians are indeed
different. They deal with human lives. Even when emergency services are
allegedly provided during strikes it is impossible to prevent serious human
suffering and unnecessary death. There are inevitably delays and cancellations
of critical treatments, and the already underprivileged are those who bear the
brunt of the strike.
The wealthy find avenues of treatment via the
Almost all of the physician strikes of which I am aware
have taken place largely for the personal benefit of the physicians and not for
improvement of patient care conditions.
In none of the strikes were the
physicians in such dire economic straits as to justify the degree of
endangerment of patient lives and suffering.
professionals. The key component in medical professionalism is the primacy of
the interests of the patient and the community over those of the physician. For
centuries physicians have taken oaths promising to forgo personal benefit for
the sake of their patients.
A most damaging effect of physician strikes
is the impairment of the public’s trust. Denial of treatment to patients for
physicians’ benefit is perceived by many as a betrayal of an implied
Another negative impact of strikes is the confrontational
atmosphere engendered between the physicians and their employers, as well as
conflicts with patients and their families.
Charges and countercharges,
often exaggerated, are inevitable, leaving a significant residue. Emotionally
charged disagreements between striking and non-striking doctors often occur.
Quality health care requires teamwork and active cooperation between all levels
of personnel, which are often damaged during strikes.
(Jewish law) attitude toward physicians’ responsibilities differs fundamentally
from the legal and ethical norms in the West, especially in the US. In America
no physician is required to treat a patient, even in emergencies.
Samaritan laws only provide legal protection against malpractice suits if
physicians volunteer to provide emergency care, but do not mandate
In Judaism, provision of treatment to a patient is not a matter of
private contract, or discretion, but is a religious obligation, a biblical
The Shulhan Arukh states, “If a physician withholds his services
it is considered as shedding blood.” Even if other physicians are available, the
physician approached by the patient must not refuse to treat, because “not by
every person is an individual privileged to be cured” – this admonition probably
results from the recognition of the importance of patient confidence in the
The specific issue of physicians’ strikes has been
discussed by a number of rabbinic authorities. None have permitted such strikes.
Former Chief Rabbi Shlomo Goren said, “Even if the physicians will suffer great
financial losses by breaking the strike in order to treat patients, and as a
result their demands will be rejected, they cannot be freed from their
obligation to come to the aid of the patients, because of the Biblical
admonition ‘do not stand idly by the blood of your fellow.’” Other senior
rabbinic authorities have confirmed that stance.
Strikes are not
acceptable in the military or the judiciary. Physicians logically belong to a
group for whom binding arbitration by objective experts should be the accepted
method for settling labor disputes.
Even if collective actions are felt
to be indicated they must not be directed at patients. It is incumbent on
physicians as leaders in society to find creative and dynamic ethical ways for
the settling of labor disputes.
The writer is an internist and
endocrinologist, a former president of Israel Endocrine Society and professor
emeritus on the Faculty of Health Sciences at Ben-Gurion University of the