Journal of medical ethics, I976, 29 1-2
Editorial
Industrial action by doctors The popular image of the doctor is of a kindly soul prepared to struggle through wind and weather to do his best to help the suffering sick. Indeed, this is the image most doctors like to have of themselves - good and determined men and women prepared to rise at any time of the day or night to use their expert abilities to serve their fellow man. (This ethos may be traced back to the mediaeval Christian Brothers and Sisters of Charity who gave their all to save the sick.) But the image of dedicated altruism has suffered a cruel shock in the past year in Britain. Consultants and junior hospital doctors have, in turn, shown themselves willing to neglect their professional commitment to care for the sick in order to protect their own interests, professional on the one hand or financial on the other. These doctors have been supported in their action by the British Medical Association, once looked upon by some, at least, of its members as a stronghold of traditional ethics. The torch of unswerving care for the sick has been cautiously kept alight by the presidents and deans of the Royal Colleges and Faculties in their statement of 26 November I975 in which they refused to associate themselves with the profession's proposals to limit their services to the treatment of emergencies. But in the present era when the constraints of moralists are so widely scorned can we blame those doctors who have put their rights before the welfare of their patients ? Surely they must have a worthy defence. The action group of consultants claim that the ultimate welfare of sick people in this country depends upon doctors maintaining their freedom to practice, unshackled by the constraints of the National Health Service, so that they can uphold the highest standards for those patients who are able to pay for them. Submission to the political whim of a monopoly employer is to surrender this freedom. They regretted that a few patients might suffer from their action in the short term but saw no other way, in the long term, of attaining the benefit to many patients of preserving professional freedom. The end, they claimed, justified the means however evil. This has always been the cry of terrorists and dictators the world over. Is there, in truth, any difference between the death and suffering the IRA are using to attain their political ideals and
the death and suffering the doctors were asking their patients to risk for their professional ideals ? A facile and unjust comparison, the man of the world may cry (was it Tubby Clayton who said, 'The more I see of the world, the less I want to be a man of it ?'). After all, doctors did regret their action and they had no alternative. That indeed is where the nub of the argument lies. Doctors are no longer individual good samaritans. They are virtually employees of the state. When the- state tells doctors to do what they consider wrong or denies them the ability to do what they consider right, and if sensible negotiation fails, must they obey ? What force can they exert if their ethos prevents withdrawal of their services ? This is the question to which the profession must devote more profound study than it has hitherto given. In relation to salaries, the profession and government have accepted an independent review body to settle disagreements. Perhaps some other independent body is needed to adjudicate in other conflicts between the profession and the government. But governments may always place political dogma and electoral convenience before impartial justice and when this happens doctors may once more have to challenge them with force which is effective but is also ethical. There are certainly other means of civil disobedience which, while perhaps inconveniencing the public seriously, will not leave the sick to die or to suffer unaided. Such means which may involve united civil disobedience must now be vigorously explored by the Royal Colleges and Faculties aided by colleagues in the law and politics. With such means at their disposal, doctors may in future confront the unyielding state with a political weapon which it will respect but which will not dishonour the profession as some of its members have done in recent months.
Philosophy and medical ethics Preoccupation with one's own identity is said to be a feature of adolescence. Perhaps then this first issue of our second volume is an appropriate stage in our development to begin reflexion upon the nature of the discipline to which this journal is committed. Professor Basil Mitchell's paper on moral consensus (originally delivered in a series
Editorial
Industrial action by doctors The popular image of the doctor is of a kindly soul prepared to struggle through wind and weather to do his best to help the suffering sick. Indeed, this is the image most doctors like to have of themselves - good and determined men and women prepared to rise at any time of the day or night to use their expert abilities to serve their fellow man. (This ethos may be traced back to the mediaeval Christian Brothers and Sisters of Charity who gave their all to save the sick.) But the image of dedicated altruism has suffered a cruel shock in the past year in Britain. Consultants and junior hospital doctors have, in turn, shown themselves willing to neglect their professional commitment to care for the sick in order to protect their own interests, professional on the one hand or financial on the other. These doctors have been supported in their action by the British Medical Association, once looked upon by some, at least, of its members as a stronghold of traditional ethics. The torch of unswerving care for the sick has been cautiously kept alight by the presidents and deans of the Royal Colleges and Faculties in their statement of 26 November I975 in which they refused to associate themselves with the profession's proposals to limit their services to the treatment of emergencies. But in the present era when the constraints of moralists are so widely scorned can we blame those doctors who have put their rights before the welfare of their patients ? Surely they must have a worthy defence. The action group of consultants claim that the ultimate welfare of sick people in this country depends upon doctors maintaining their freedom to practice, unshackled by the constraints of the National Health Service, so that they can uphold the highest standards for those patients who are able to pay for them. Submission to the political whim of a monopoly employer is to surrender this freedom. They regretted that a few patients might suffer from their action in the short term but saw no other way, in the long term, of attaining the benefit to many patients of preserving professional freedom. The end, they claimed, justified the means however evil. This has always been the cry of terrorists and dictators the world over. Is there, in truth, any difference between the death and suffering the IRA are using to attain their political ideals and
the death and suffering the doctors were asking their patients to risk for their professional ideals ? A facile and unjust comparison, the man of the world may cry (was it Tubby Clayton who said, 'The more I see of the world, the less I want to be a man of it ?'). After all, doctors did regret their action and they had no alternative. That indeed is where the nub of the argument lies. Doctors are no longer individual good samaritans. They are virtually employees of the state. When the- state tells doctors to do what they consider wrong or denies them the ability to do what they consider right, and if sensible negotiation fails, must they obey ? What force can they exert if their ethos prevents withdrawal of their services ? This is the question to which the profession must devote more profound study than it has hitherto given. In relation to salaries, the profession and government have accepted an independent review body to settle disagreements. Perhaps some other independent body is needed to adjudicate in other conflicts between the profession and the government. But governments may always place political dogma and electoral convenience before impartial justice and when this happens doctors may once more have to challenge them with force which is effective but is also ethical. There are certainly other means of civil disobedience which, while perhaps inconveniencing the public seriously, will not leave the sick to die or to suffer unaided. Such means which may involve united civil disobedience must now be vigorously explored by the Royal Colleges and Faculties aided by colleagues in the law and politics. With such means at their disposal, doctors may in future confront the unyielding state with a political weapon which it will respect but which will not dishonour the profession as some of its members have done in recent months.
Philosophy and medical ethics Preoccupation with one's own identity is said to be a feature of adolescence. Perhaps then this first issue of our second volume is an appropriate stage in our development to begin reflexion upon the nature of the discipline to which this journal is committed. Professor Basil Mitchell's paper on moral consensus (originally delivered in a series
