The junior doctors in government hospitals in Bihar have started a “ doctors’ strike” demanding higher pay. “Doctors’ strike” is not new in India. Doctors in other parts of the country have frequently resorted to “strike” in order to satisfy their claims. The picture of a “doctors’ strike” is ugly anyway you look at it. Even when only the “junior doctors” go on a strike, patients in urgent need of medical care are denied life-saving therapy because the junior medicos form the backbone of treatment in the hospitals. This is especially true in case of government hospitals in India. It is safe to say that most of the victims of the “doctors’ strike” in government hospitals would be the patients who hail from the lower socioeconomic strata of the society since they have little option to avail the medical services offered by the expensive private hospitals. There can be little dispute that the defenseless patients always pay the ultimate price for any “doctors’ strike” – some literally through their lives as several patients have already died because of the present doctors’ strike in Bihar. The question that the Indian Medical Association (IMA) leaders and all members of the medical community must consider is whether boycott of work or “strike” by our healers is right - morally, ethically or legally?
There is no doubt that peaceful “strike” by any group of workers is an important weapon to fight unjust treatment in any democratic society. But do the workers involved in providing essential public services like healthcare have a right go on a “strike” to undermine safety for the rest of the society? The answer of this important question must be a categorical “no”. The Article 21 of the Constitution guarantees protection of rights to life and personal liberty for all citizens of India. The rights to go on a “strike” by a few can never supersede the combined rights of thousands for their rights for life and liberty. The Supreme Court of India has upheld this notion many times in the past. In a historic judgment in 2003 involving striking government employees in Tamil Nadu (T.K. Rangarajan vs. State of Tamil Nadu; Civil Appeal No. 5556 of 2003), the Apex Court has ruled against the rights to go on a “strike” by the government workers and has categorically stated, “Government employees cannot claim that they can take the society at ransom by going on strike.” Can our healers hold the defenseless patients at ransom by going on a strike to settle their score against the government? Who should be held responsible if a patient dies in a hospital because of a “doctors’ strike”? In fact, doctors went on a general strike to protest against the “quota” resulting in massive disruption in essential medical services in several hospitals in Delhi and several patients died without treatment in the Emergency ward in 2006. A public interest litigation (PIL) was filed against the striking doctors and the Medical Council of India (MCI) through a writ petition (People for Better Treatment vs. MCI & Ors; W.P. Civil No. 316/2006) seeking a complete ban on “doctors’ strike”. The Apex Court has already issued notices in this case. This PIL may have significant implications on doctors’ strikes in India.
Apart from the judicial ramifications, the Rules framed by the MCI, the central regulatory body for practice of medicine in India, also prohibit the doctors from going on a strike. The Section 2.1.1 of the MCI “Code of Ethics and Regulations” has unequivocally stated, “in case of emergency, a physician must treat a patient”. While a doctor may be able to wriggle out of a situation for his refusal to treat a patient suffering from an insubstantial medical condition, a physician must attend all seriously ill patients to the best of his/her ability under this mandatory rule from the MCI. Refusal to provide necessary treatment to an acutely ailing person on the ground of a “doctors’ strike” might not be able to protect the striking medico if a patient dies or suffers serious injury as a result of lack of therapy. Such an act by the striking doctor would clearly violate the MCI “Code of Ethics and Regulations” and the doctor may even lose his/her practicing license for professional misconduct under this scenario. It would be extremely difficult for a doctor to prove that a person was not in need of urgent medical care when the patient actually dies without receiving any treatment. However, not many members of the medical fraternity are aware about the intricate MCI rules and regulations that the Indian medicos must follow. Our healers would be well advised to stay away from “doctors’ strike” in order to avoid regulatory actions by the MCI. Instead of having a higher salary through the threat of a “doctors’ strike”, these medicos might eventually end up with no income after losing their registrations. Unfortunately, if past history is any indication for the future, there is little hope for the hapless patients in India that MCI would suddenly start taking disciplinary actions against the striking doctors for violation of the medical laws.
It must be said that the gripes made by the junior doctors in Bihar demanding a higher salary may not be without any merit. It is reported that the junior doctors in Bihar are paid much less than their counterparts in other Indian states. If this is true, they have every right to be unhappy and to blame the inept health department in Bihar. But doctors should never resort to a “strike” and refuse medical treatment to their patients in order to satisfy their legitimate demands from the government. Apart from the legal implications, the idea of a “doctors’ strike” is grossly wrong from an ethical or humanitarian perspective. While a “doctors’ strike” is not likely to bother the devious political leaders sitting in the health department, it is likely to devastate innocent families who cannot afford to go to the pricy private medical clinics seeking treatment while their loved ones succumb from a lack of simple medical treatment. The Hippocratic Oath that all doctors must take before starting practice preaches that the primary object of the medical profession is to render service to humanity and any financial reward should only be a subordinate consideration. Do the doctors in India have become totally oblivious of the oath from the father of modern medicine? Do they ever ponder about the pain of the ailing patients left untreated at the hospital doorstep before abandoning hospital duty to join the “doctors’ strike”? Public trust towards the doctors in India has been on a rapid decline in the recent years for more reason than one. The idea of doctors disrupting essential hospital services and bringing added sufferings for the hapless patients by joining a “doctors’ strike” only to secure a higher salary would undoubtedly further erode doctors-patients relationship in India. Will our medical leaders wake up and think about this?
Strike which is considered to be right of employees is common in India. I think it is the worst way to put demand to the concerned for acceptance. It is inhuman in general and some times it is worst than that. The Indian government should make laws about where such strike is visible, where it is repressible, where it is unacceptable and where it is forbidden. A public and customer service sector should not be given any right to have strike. In some sector like medical services strike should be completely banned because it kills lives of the people. It is similar to mass-killing which is worst than a murder.
Without laws and its proper implementation a society or state is a jungle-like system.
Strikes by junior doctors in India in general and Bihar in particular is a common occurence. In any civilised society no one from essential services - medical, fire brigade, police - ever take resort to such drastic action. It is morally, ethically, professionally repungent way to make demand, however genuine and legitimate they may be. To me, it is a criminal act, because it leads to harm to the poorest section of society. Every doctor must remember this fact, that no one comes to them in times of happiness; people come to them in distress with tears in their eyes and pain in their body. To ignore and neglect them is tantamount to rape of humanity as enshrined in the profession of Medicine. As Buddha said all those years ago, blessed are the people who has means and skill to benefit those in need. And a doctor is such a person. We have to be available 24 hours a day, seven days a week. This is what medical profession is all about, patient first,
anything else later, at all times, at all hours. And there is such a thing called Hippocratic oath which is our guiding principle.
The rot in medical profession has not only set in amongst the junior doctors but has percolated down to medical students too. While I was in Patna earlier this year, students from Patna Medical College took out a procession and blocked Dack Bunglow Chowk, thus disrupting traffic and creating chaos. They sat on the road for hours !!
I remember my very first lecture which has nothing to do with medicine, back in 1962 at Darbhanga Medical College by late Dr. B. N. Sinha, then lecturer in Medicine. He told us that as from that moment we have become different than other students. We are doctors now. We have to have high moral character, become compassionate, treat females as our own mother, sisters, dress smart and clean, be available at all times and at all hours and set highest standerd of personal conduct. For we are now a pillar of society and society look to us for inspiration in selfless service, morality and behavior. I wonder if such lectures are given now to first year students.
Dr. A Kumar