-E Letters to the Editor Letters are welcomed and will be published, iffound suitable, as space permits. The editors reserve the right to edit and abridge letters, to publish replies, and to solicit responses from authors and others. Letters should be submitted in duplicate, double-spaced (including references), and generally should not exceed 400 words.
Strikes by Health Workers: Another View My faculty colleague, Samuel Wolfe, writes:' "Badgley has taken the position, with which I tend to agree that if the rights and health of patients and the public are preserved, (emphasis Professor Wolfe's) strikes can serve as an important catalyst in converting a rigid and conservative health system into a more flexible democratic organization for all its workers. I also agree with Badgley's contention that health worker strikes, if his important caveat is protected, have in general not been shown to harm innocent people."
Let us analyze this excerpt. If we link the dependent clause, i.e., Badgley's caveat of the first sentence, to the independent clause in the second sentence, we have in paraphrase: "Health worker strikes have in general not been shown to harm innocent people if the rights and health of patients and the public are preserved," which is to say that innocent people are not harmed if they are not harmed. This is tautology. The nagging question persists: Is it in fact possible, in the objective circumstances of a strike of health workers, NOT to jeopardize the rights and health of patients and the public? Dr. Wolfe then assesses the objectives of health worker strikes. He implies that certain health worker strikes, while regrettable, have desirable social purpose and are therefore justifiable. Other strikes motivated by ignoble purposes are not. 1066
Wolfe thus presents a good-guy bad-guy dichotomy in his Streikanschauung. He distinguishes between the motivational origin of low income health workers and that of physicians. Low income health workers, says Wolfe, often have "'a concern for the change in the status quo." (One must assume that such concern is a social good because the status quo is a bad thing.) In ethical contrast, physicians "seek to maintain things as they are and, in particular, to retain monopoly control of fees and their levels, and to prevent encroaching public sector financing of health services." (Presumably such physician endeavor is bad because MD control of fees is by its nature bad; public sector financing of health services is intrinsically good, so attempts to contain the growth of public sector financing is prima facie bad.) As a laudable exception among physicians, Wolfe cites with evident approval the recent strike in New York City's municipal hospitals of unionized MD house staff who struck selflessly "not for economic concessions for themselves, but to express their grave concerns about decisions being made that affect patient care...." In this moralistic calibration of health worker strikes, whether the strike is good or evil relates to the ideological proclivities of the judge. Ethics are situational. Ends determine and justify means. But, whether or not one agrees with Wolfe's categorization of the specific examples he presents, one cannot help but wonder. To the patient hooked up to the respirator or to the artificial kidney, what does the motivation for health worker abandonment signify? To the ambulatory patient undergoing diagnostic studies to track down the origin of disquieting signs and symptoms, what is the ultimate relevance of health worker motivation for withdrawal of more mundane services?
I believe that the burden of proof rests today upon those who claim that strikes of health workers in health care settings rarely or never cause deaths, and upon those who rely on traditional precautionary measures applied in health worker strikes in an effort to prevent such deaths. Motivation of the strike-whether deemed selfless or self-serving-is irrelevant to the issue of strike induced mortality of innocent patients. The strike may be appropriate as a last ditch weapon in the automobile plant or the steel mill. It has no civilized place in institutions that care for ailing human beings. Lowell E. Bellin, MD, MPH Professor ofPublic Health Columbia University School of Public Health New York, NY 10032
REFERENCE 1. Wolfe S: Strikes by health workers: a look at the concept, ethics, and impacts, (editorial) Am J Public Health, 69:431433, 1979.
Author's Response I invite Dr. Bellin to read carefully the editorial on "Strikes by Health Workers" that I wrote, as well as some of its associated references. The following points were made: * there is a growing tempo of organization among all kinds of health workers; * there has been a simultaneous increase in strike actions, slow downs, and work to rule in all kinds of health institutions and by all kinds of health workers; * public sector financing and bureaucratization represent realities and may lead to conflict with the goals of various health workers; * while the goals of low and high AJPH October 1979, Vol. 69, No. 10
Strikes by Health Workers: Another View My faculty colleague, Samuel Wolfe, writes:' "Badgley has taken the position, with which I tend to agree that if the rights and health of patients and the public are preserved, (emphasis Professor Wolfe's) strikes can serve as an important catalyst in converting a rigid and conservative health system into a more flexible democratic organization for all its workers. I also agree with Badgley's contention that health worker strikes, if his important caveat is protected, have in general not been shown to harm innocent people."
Let us analyze this excerpt. If we link the dependent clause, i.e., Badgley's caveat of the first sentence, to the independent clause in the second sentence, we have in paraphrase: "Health worker strikes have in general not been shown to harm innocent people if the rights and health of patients and the public are preserved," which is to say that innocent people are not harmed if they are not harmed. This is tautology. The nagging question persists: Is it in fact possible, in the objective circumstances of a strike of health workers, NOT to jeopardize the rights and health of patients and the public? Dr. Wolfe then assesses the objectives of health worker strikes. He implies that certain health worker strikes, while regrettable, have desirable social purpose and are therefore justifiable. Other strikes motivated by ignoble purposes are not. 1066
Wolfe thus presents a good-guy bad-guy dichotomy in his Streikanschauung. He distinguishes between the motivational origin of low income health workers and that of physicians. Low income health workers, says Wolfe, often have "'a concern for the change in the status quo." (One must assume that such concern is a social good because the status quo is a bad thing.) In ethical contrast, physicians "seek to maintain things as they are and, in particular, to retain monopoly control of fees and their levels, and to prevent encroaching public sector financing of health services." (Presumably such physician endeavor is bad because MD control of fees is by its nature bad; public sector financing of health services is intrinsically good, so attempts to contain the growth of public sector financing is prima facie bad.) As a laudable exception among physicians, Wolfe cites with evident approval the recent strike in New York City's municipal hospitals of unionized MD house staff who struck selflessly "not for economic concessions for themselves, but to express their grave concerns about decisions being made that affect patient care...." In this moralistic calibration of health worker strikes, whether the strike is good or evil relates to the ideological proclivities of the judge. Ethics are situational. Ends determine and justify means. But, whether or not one agrees with Wolfe's categorization of the specific examples he presents, one cannot help but wonder. To the patient hooked up to the respirator or to the artificial kidney, what does the motivation for health worker abandonment signify? To the ambulatory patient undergoing diagnostic studies to track down the origin of disquieting signs and symptoms, what is the ultimate relevance of health worker motivation for withdrawal of more mundane services?
I believe that the burden of proof rests today upon those who claim that strikes of health workers in health care settings rarely or never cause deaths, and upon those who rely on traditional precautionary measures applied in health worker strikes in an effort to prevent such deaths. Motivation of the strike-whether deemed selfless or self-serving-is irrelevant to the issue of strike induced mortality of innocent patients. The strike may be appropriate as a last ditch weapon in the automobile plant or the steel mill. It has no civilized place in institutions that care for ailing human beings. Lowell E. Bellin, MD, MPH Professor ofPublic Health Columbia University School of Public Health New York, NY 10032
REFERENCE 1. Wolfe S: Strikes by health workers: a look at the concept, ethics, and impacts, (editorial) Am J Public Health, 69:431433, 1979.
Author's Response I invite Dr. Bellin to read carefully the editorial on "Strikes by Health Workers" that I wrote, as well as some of its associated references. The following points were made: * there is a growing tempo of organization among all kinds of health workers; * there has been a simultaneous increase in strike actions, slow downs, and work to rule in all kinds of health institutions and by all kinds of health workers; * public sector financing and bureaucratization represent realities and may lead to conflict with the goals of various health workers; * while the goals of low and high AJPH October 1979, Vol. 69, No. 10
