There has been much discussion of the justifiability of strikes by healthcare workers, but comparatively little discussion of the political processes through which strikes occur. This article focuses on the Trade Union Act 2016, which currently governs strike ballots in the UK. This legislation has important implications for healthcare workers being balloted on strikes (or other forms of industrial action). The article first explains the legal requirements for a strike mandate and illustrates how votes in strike ballots can be counterproductive, (...) bringing about outcomes opposite of what the voter wanted. Second, it argues that the turnout threshold responsible for these surprising results is undemocratic, since it means that outcomes need not reflect the wishes of those balloted. Third, it suggests that this has consequences for how balloted workers ought to vote, if they want the process to be more democratic. In particular, I propose that those who are neutral or indifferent have reason to cast spoiled ballots, in order to negate the turnout threshold. Further, those who oppose a strike also have reasons—if they value democratic decision-making—to vote, even though this may be less effective than abstaining. As I write, in August 2023, junior doctors in the UK are once again being balloted over strike action.1 While the global picture is more varied, strikes by medical professionals have historically been rare in the UK. When British doctors went on strike in 2012, over changes to pensions, it was the first time since 1975.2 Since then, however, industrial action has become more common. Some attribute this to an erosion of patient-centred professional values, which has made workers more prepared to strike in response to deteriorating pay and conditions.3 4 Whether or not this is the explanation, the increased prevalence of strikes has caused some concern. It is often …. (shrink)

The 2023 doctors’ strikes in the UK have elicited a familiar moral outcry that such strikes are morally wrong. We consider five arguments that might be thought to show doctors’ strikes are morally impermissible but show that they all fail. The most we can conclude from such arguments is that doctors’ strikes are morally permissible in a narrower range of circumstances than strikes in other sectors. We then outline two independent but compatible justifications for doctors’ strikes, one that appeals to (...) doctors’ interests in fair pay and working conditions and one that appeals to doctors’ duty to protect public health. We also suggest that doctors’ strikes can be supererogatory when they aim to correct a government failing in its own duty to protect public health. Finally, we assess the 2023 UK doctors’ strikes. We conclude that they are justified and there is a case for considering them supererogatory. (shrink)

While American physicians have traditionally practised as non-unionised professionals, there has been increasing debate in recent years over whether physicians in training (known also as interns, residents or house staff) are justified in unionising and using collective action. This paper examines specific ethical criteria that would permit union action, including a desire to ameliorate patient care as well as the goal of improving the conditions of working physicians. We posit that traditional rebuttals to physician unionisation often lean on an infinite (...) conception of a doctor’s energies and obligations, one that promotes burnout and serves to advance the financial motives of hospital management and administration. Furthermore, this paper explores the empirical justifications for collective action, which include substantial reductions in medical error. Finally, we address the free-rider problem posed by non-union physicians who might benefit from working improvements garnered through union action. We conclude that in order to maintain a notion of justice as fairness, resident physicians who benefit from union deliberations are impelled to acquire union membership or make a commensurate donation and that the healthcare organisations for which they work ought to share in the responsibility to improve patient care. (shrink)

In the UK, healthcare workers are again considering whether to strike, and the moral status of strike action is being publicly debated. Mpho Selemogo argued that we can think productively about the ethical status of healthcare strikes by using the ethical framework often applied to armed conflict (2014). On this view, strikes need to be just, proportionate, likely to succeed, a last resort, pursued by a legitimate organisation and publicly communicated. In this article, I argue for a different approach to (...) the just war comparison. Selemogo adopts a traditional, collectivist conception of just war reasoning but this is not the only view. So-called ‘individualist’ approaches to the morality of war can also be applied to strike action. Taking an individualist perspective complicates the traditional picture of a dispute arising between three well-defined groups of healthcare workers, employers and the innocent subjects of collateral damage: patients and the public. We arrive instead at a more complicated moral picture: some people might be more morally liable to be harmed than others during a strike, or can justly bear increased risks, and some are more obliged to strike than others. I describe this shift of framework before critically examining some of the traditionaljus ad bellumconditions as applied to strikes. (shrink)