“I wait every year hoping that the government would grant us a permanent position within the healthcare system that offers benefits to pursue our specializations, pay benefits and allowances as well as leave days just like permanent medical officers because mind you, we are all doing the same job,” — Doctor from Ampang Hospital, who prefers anonymity [1].
26th July 2021 was a very significant date in the history of Malaysian healthcare, a country ranked no.1 in the world’s best healthcare category in the 2019 International Living Annual Global Retirement Index [2]. An active nationwide workers’ strike was initiated by the healthcare workers particularly medical officers to demand the cessation of policy and to probe an end to the problem of medical officers in the country’s healthcare system. Aside from that, a number of other concerns were mentioned including decreased pay, difficulty with employee leave, and a lack of opportunities for furthering their education to become medical specialists [3]. As this situation came in conjunction with the COVID-19 pandemic, mixed reactions were received from those in the profession as well as the public.
According to the UN and EU, the right to strike is a fundamental human right [4] and across the globe, strikes and protests are commonly held to condemn the violation of basic human rights, to strongly put forward one’s point of view to the authorities or for the fulfillment of specific needs. However, the strike by Malaysian doctors was viewed as ethical misconduct by society because of their proximity to life and death circumstances. This directly relates to what is known as doctors’ social contract with their patients; A contract that comes into place after swearing the Hippocrates oath that entails a doctor’s promise to act in the best interests of their patient and to place his or her health and life above everything else [5].
Therefore, strikes by doctors are perceived as ethical misconduct not only in Malaysia but other countries like Pakistan and India as well.
Within this perspective, there is little room to explore the causes that have prompted the protest of Malaysian doctors. Inevitably, it is common knowledge that the journey of becoming a doctor is a long and grueling one. The career path cut out for those pursuing medicine has never been easy. It takes approximately 10 years of education and clinical practice before one becomes a reputable clinician. Even though a doctor’s role within our society is undeniably significant, collectively, the struggles of doctors are usually invisible to the public eye. Even more so, with the COVID-19 pandemic affecting the entire globe, the huge role played by doctors treating and curbing the widespread of the virus took utmost priority. Over the past year, there have been repeated mentions of their remarkable contributions in almost all media. Praises were upon the doctors, for endlessly contributing to the nation’s recovery.
However, this selfless community is the victim of low pay, a lack of safety, no job security and overworked hours. This protest served as a way to enlighten the responsible authorities of the inexplicable realities physicians face in their day-to-day job. Healthcare workers in public sectors from multiple countries such as Zimbabwe, Belarus and Turkey also have expressed their dissatisfaction for similar reasons in the past in public sectors [6]. When viewed through the lens of socialized care, doctors’ protests may appear to be the result of governmental negligence, yet utilitarian theory and the Hippocrates oath do not negate doctors’ moral obligation to prioritize patients’ health [7].
It has become a global concern that these strikes would cause a reduction in the quality of care by healthcare personnel. Historically, multiple systematic reviews showed that strikes involving physicians resulted in patient mortality rate remaining constant or even decreased [8]. The 2012 British Medical Association strike showed that there were fewer inpatient deaths on the day for both elective and emergency populations [9]. According to Park et al. (2013), doctors have the right to object if any emergency care is required. Doctors’ definitions of emergency, on the other hand, may diverge from widespread opinion. The risk here involves when non-emergency cases may become preventable emergency cases if treatment is delayed. As a result, doctors face moral consequences as a result of this kind of strike. Patients may experience an increase in the severity of their medical condition, a prolonging of their sufferings, irreversible damage to their health or death, a delay in treatment or undesirable drug interruptions, a loss of work, or a waste of money on transportation as a result of strikes.
Experts in the fields of law, ethics, and medicine have long disputed whether and when healthcare workers strikes are appropriate. Although the focus of these discussions have been on the hazards that strikes bring to patients, these actions also constitute a risk to healthcare workers, since they can harm morale and reputation. Strikes pose fundamental questions about what healthcare workers owe to society and what society owes to them.
Reflecting on the odds and benefits, the protest of doctors needs to be taken into serious consideration as a human right’s issue and approached in a fair manner. The reasons behind such protests need to be paid attention to with immediate effect. It is important to acknowledge doctors as human beings with similar feelings and emotions as a common man. It adds another load of social responsibility which is well tied to their profession. An inadequate working environment and unfulfilled working needs may lead to frustration that then would progress to demotivation and demoralization. In an eagle’s eye view, this may compromise the quality of patient care.
In conclusion, the current treatment of healthcare professionals, as one of the most important pillars of the society, has to be looked into and overhauled completely. This is to ensure they are able best to carry out their role in maintaining and improving the physical well being of the people. The government and lawmakers have to work together to revamp the entire healthcare system to make it more conducive for healthcare professionals by providing better pay, benefits, job security and opportunities for further education. At the end of the day, it is almost impossible to argue with the fact that a significant investment in the healthcare system would only end up benefiting the citizens of the nation as a whole.
References
- Malaysian contract doctors protest for better work conditions. (2022). Retrieved 9 February 2022, from https://arab.news/wb65b
- Malaysia ranks 1st in world’s best healthcare category. (2022). Retrieved 9 February 2022, from https://www.thestar.com.my/news/nation/2019/02/07/malaysia-ranks-1st-in-worlds-best-healthcare-category/
- “Hartal Doktor Kontrak, Polemik Tanpa Kesudahan Sektor Kesihatan”. Getaran (in Malay). 2021–06–27. Retrieved 2021–08–26.
- Maina Kiai, “Report by the Special Rapporteur on the Right to Freedom of Peaceful Assembly and Association,” 2016. [Online]. Available: [http://freeassembly.net/wp-content/uploads/2016/10/A.71.385_E.pdf.]
- Brecher, R. (2022). Striking responsibilities. Retrieved 9 February 2022, from https://jme.bmj.com/content/11/2/66.short
- Abbasi, I. (2014). Protest of doctors: a basic human right or an ethical dilemma. BMC Medical Ethics, 15(1). doi: 10.1186/1472–6939–15–24
- Human rights. (2022). Retrieved 10 February 2022, from https://www.bma.org.uk/what-we-do/working-internationally/our-international-work/human-rights
- S. A. Cunningham, K. Mitchell, K. M. Venkat Narayan, and S. Yusuf, “Doctors’ strikes and mortality: A review,” Soc. Sci. Med., vol. 67, no. 11, pp. 1784–1788, Dec. 2008, doi: 10.1016/j.socscimed.2008.09.044.
- M. Ruiz, A. Bottle, and P. Aylin, “A retrospective study of the impact of the doctors’ strike in England on 21 June 2012,” J. R. Soc. Med., vol. 106, no. 9, pp. 362–369, 2013, doi: 10.1177/0141076813490685.
