doctors protest 311.
(photo credit: Marc Israel Sellem)
For many weeks Israel’s physicians have been taking various labor actions in an
effort to improve their pay and working conditions. Lately the nurses
have also initiated sanctions. What is the ethical standing of these sanctions?
First let’s examine the general topic of labor sanctions, and then the unique
factors relating to the medical sector.
The ethical basis for a strike is
the basic insight that a person has the right to withhold his work effort if he
feels that compensation is inadequate.
Otherwise he is no more than a
slave or a conscript. However, this ethical principal may or may not generalize
to a group of workers; the ability to apply it to a strike depends on a number
The most anticompetitive kind of strike is when a particular
group is given, or arrogates to itself, a monopoly on a certain area of the
Striking in this case is just a way of exploiting an unfair
monopoly power. A picket line is usually a good sign of this kind of strike. Of
course, the workers have the right to withhold their labor, but in this case
they are doing something else: trying to get other people to withhold their own
labor. That is in no way a corollary of the basic ethical principle that a
person can’t be forced to work.
When there is a group of workers who
actually do have a unique kind of ability or skill and they go on strike, then
there are two conflicting ethical issues. One is the right to free association;
workers may have a desire or inclination to form an association or group and
bargain collectively, and in a free society we are reluctant to interfere with
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On the other hand, when such an association encompasses an
entire profession, it is a kind of cartel or monopoly, and there is a basis for
regulating the right to strike, just as we regulate the right of companies to
merge due to antitrust considerations.
The most unambiguous affirmation
of the right to organize exists when the workers themselves are victims of
anticompetitive conduct. This is what the economist John Kenneth Galbraith
termed “countervailing power.” Sometimes it takes a monopoly to beat a
While there are pluses and minuses to collective bargaining in
the public sector, one point in its favor is that many public-sector workers are
in lines of work that virtually tie them to that sector, leaving them at the
mercy of the government for future wages. This was a factor in the strike of
foreign-service workers; their pay scale did not keep up with the rest of the
economy, but many highly skilled people had nowhere else to go.
judge the specific merits of the physicians’ claims, but the structure of the
market is such that their bargaining as a group qualifies as “countervailing
power.” The public health system in Israel makes it virtually impossible for a
physician to demand as an individual whatever the market will bear; virtually
every area of treatment provision is subject to regulation and price
The individual physician does not enjoy the right shared by
virtually every other citizen to decide that he or she will only work for a wage
that suits them; their wages are set to a large extent by legislation and
bureaucracy, and their only way of bargaining for a better wage is by battling
the legislature and the bureaucracy collectively.
It is necessary to
relate to the special status of health provision. Access to life-saving
treatment is considered a basic right, and physicians and nurses, as the
authorized providers of such treatment, have to take that fact into
consideration in their work actions. This is one reason why the doctors have
stopped short of a full strike and instead have limited access, generally, to
non-vital services, in various ways.
However, the responsibility to
provide vital services does not fall only on the physicians; it applies equally
to the health system. It is partially a reason for health providers to be
judicious in the use of work sanctions, but it is equally a reason for payers –
in this case, primarily the government – to be judicious in enduring the strike
in an effort to bargain them down.
Asher Meir is
research director at the Business Ethics Center of Jerusalem, an independent
institute in the Jerusalem College of Technology (Machon Lev).
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