Doctors, Nurses Striking -- Is It Ethical?

Arthur L. Caplan, PhD


June 01, 2023

This transcript has been edited for clarity.

This video was recorded days prior to a strike of more than 150 resident physicians at Elmhurst Hospital Center in Queens, New York, who were protesting their low pay. On the third day of the strike, a tentative deal was reached.

Hi. I'm Art Caplan. I'm at the Division of Medical Ethics at the NYU Grossman School of Medicine.

Recently, some nurses in New York City went on strike for a few days and two big hospitals here had walkouts.

Other things are taking place in the healthcare labor marketplace. Residents at the University of Pennsylvania Health System have decided to unionize. They had a vote and they're going in that direction. There have been labor walkouts in England throughout the National Health Service. Other unions are threatening nurses to go out in California and Arizona later this year.

It's not the first time that people have gone on strike in healthcare, but I think it's a growing phenomenon. Many healthcare workers, doctors, and nurses are starting to feel overworked, understaffed, and unhappy when, say, private equity takes over a rural hospital and begins to put in schedules or cut back on staffing, which the healthcare workforce thinks is dangerous to patients.

There are some places that are insisting upon very restrictive ability to work. If you leave an institution and try to go somewhere else, these noncompete clauses are causing more anger as more hospitals being fueled by business ethics over medical ethics start to be very restrictive about a doctor, a nurse, a PT, or whoever being able to work within a 25-mile radius of a place that they decided to leave.

I happen to agree that these kinds of restrictive arrangements may be appropriate if you're making beer or widgets or if you are some sort of corporate person who has insight into, let's say, car-manufacturing secrets. It seems to me that to try to restrict an overworked and understaffed healthcare workforce with restrictive covenants could be triggering more labor disputes and strikes as well.

We even see people saying they were offered training or continuing education and their institution picked up the cost, but if they say they want to leave, they're expected to pay it back if they leave before their contract or arrangement runs out. This, again, fuels tremendous anger on the part of many doctors, nurses, and healthcare workers — and I would say appropriately so.

Sadly, this movement toward unionization is more and more being triggered by the replacement of professional ethics and medical ethics with business ethics. It's just that simple. The bottom line is starting to drive more how administrators and management at many places behave.

The appearance of private equity, which is just that they're looking for profit — particularly in, say, rural hospitals or small clinics that they buy up — they're not people who come from backgrounds of medicine or nursing. They're people who come from backgrounds with MBAs and a business orientation that says to make money and make it fast. With small, rural hospitals, maybe you can make some money quickly and then close them.

I'm not saying that unionization is wrong. I think you can start to see the case for it more and more. Unions have one powerful weapon, which is withholding services and strikes. For many in healthcare, that's just a no-no. You cannot put patients at risk. You cannot put their lives at risk. You shouldn't be delaying unnecessary surgeries by withholding services, by going on strike, or going on slowdowns. Many doctors and nurses will just say, "That is the height of immorality. I cannot do that."

I think we're going to start to see more nuanced versions of withholding services. I could easily see people starting to say that elective services are going to be delayed. Diagnostic exams that don't require rapid administration are going to be pushed back for a couple of days, or maybe a week, while labor activity involving strikes and withholding services goes on.

It's not going to be a world in healthcare of all-or-nothing strikes. That does put too many people at risk. You can't close the emergency room in the name of trying to achieve what may often be an appropriate goal in terms of better pay, better staffing, getting rid of noncompete clauses, or whatever the labor dispute is.

You don't have to use a broad-based approach. You can be surgical and specific, and slow services in ways that are not going to put patients at risk — or not at very much risk — but can cause inconvenience, catch the attention of management, and force their hand as perhaps some of the more lucrative things that they offer and do (think plastic surgery for one) start to slow down because of anger and labor disputes.

I think the future is going to see more unionization and more calls for collective action. We may see strikes that some people view as completely wrong — entire walkouts of the workforce — but they may be coming. It may be important to be thinking about whether you would cross the picket line if you worked in a vital area of healthcare to make sure that no harm befalls patients.

I think we're going to see more nuanced versions of trying to slow or withhold some services in order to achieve goals that stand for professional ethics, not business ethics.

I'm Art Caplan at the Division of Medical Ethics at NYU Grossman School of Medicine. Thank you for watching.

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