Ethics @ Work: Is the physicians’ strike anticompetitive?

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.

doctors protest 311 (photo credit: Marc Israel Sellem)
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 of factors.
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 economy.
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 that right.
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 monopoly.
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.
I cannot 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 restrictions.
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).