title: Physicians and strikes: can a walkout over the malpractice crisis be ethically justified?
abstract: Malpractice insurance rates have created a crisis in American medicine. Rates are rising and reimbursements are not keeping pace. In response, physicians in the states hardest hit by this crisis are feeling compelled to take political action, and the current action of choice seems to be physician strikes. While the malpractice insurance crisis is acknowledged to be severe, does it justify the extreme action of a physician walkout? Should physicians engage in this type of collective action, and what are the costs to patients and the profession when such action is taken? I will offer three related arguments against physician strikes that constitute a prima facie prohibition against such action: first, strikes are intended to cause harm to patients; second, strikes are an affront to the physician-patient relationship; and, third, strikes risk decreasing the public's respect for the medical profession. As with any prima facie obligation, there are justifying conditions that may override the moral prohibition, but I will argue that the current malpractice crisis does not rise to the level of such a justifying condition. While the malpractice crisis demands and justifies a political response on the part of the nation's physicians, strikes and slow-downs are not an ethically justified means to the legitimate end of controlling insurance costs.
authors.affiliation: Department of Medical Ethics, University of Pennsylvania, USA.
authors.forename: Autumn
authors.initials: A
authors.lastname: Fiester
mesh_terms: D000574:American Medical Association; D032781:Codes of Ethics; D026690:Ethics, Clinical; D004992:Ethics, Medical; D006801:Humans; D007351:Insurance, Liability / Q000639:trends; D008318:Malpractice / Q000191:economics*; D028681:Moral Obligations; D010817:Physician-Patient Relations / Q000941:ethics; D010820:Physicians / Q000941:ethics* / Q000592:standards; D016079:Refusal to Treat / Q000941:ethics; D012955:Societies, Medical; D013317:Strikes, Employee / Q000941:ethics*; D014481:United States