Dr Fiaz Maqbool Fazili
The image of a healer felled in the act of tending to the sick evokes deep disquiet — a profound violation that strikes at the very heart of our shared values. It pits the sanctity of human dignity, inviolable and uncompromising, against the solemn Hippocratic oath to preserve life and relieve suffering.
As cases of doctors facing physical assault on duty proliferate across the globe, from Asia to the Middle East to Europe and beyond, the question resounds with new intensity: Do doctors possess the right to strike in defense of their own safety and dignity, even when such action may jeopardize patient care? In this crucible of ethical tension, we are forced to ask: Where should the balance lie, and what path leads to true safety in healthcare?
The case for the right to strike: Unyielding dignity and worker safety
Proponents of the right to strike argue from the solid foundation of universal human rights and a fiercely protected sense of self-respect. They contend that the expectation for doctors—or indeed, any worker—to simply accept violence as an occupational hazard is not only unjust, but morally indefensible. Physical assault is not a mere workplace risk like a slippery floor or a malfunctioning light. It is a violent crime, a fundamental violation of the bodily integrity and inherent dignity owed to every person, regardless of their profession.
Doctors, often idealised as tireless healers, are not immune to trauma or fear. To tolerate repeated assaults is to erode the very self-respect that makes compassionate care possible. Accepting violence as “part of the job” signals a dangerous message: that the caregiver’s humanity is secondary to their function. This is an affront to dignity, a principle described by Dr Fiaz Maqbool Fazili as “uncompromisable.” Their dignity is not an expendable commodity to be sacrificed for institutional convenience or societal expectations.
While channels such as ombudsmen, legal recourse, and complaints procedures exist, the continued prevalence of violence—despite strict laws and widespread awareness campaigns—reveals a gap between rhetoric and reality. Posters and proclamations, like those seen in Saudi Arabia and elsewhere, are toothless without effective enforcement and cultural change. Strikes, then, become a collective cry for help, a last-ditch response to institutional neglect after all other avenues have failed. The demand is not for privilege, but for the basics: real security, de-escalation training, safer infrastructure, and swift legal recourse.
Significantly, staff safety is not separate from patient safety; the two are inextricably linked. A workplace where doctors and nurses fear for their lives is, by definition, unsafe for patients. Stressed, traumatised, and demoralised staff are more prone to errors, burnout, and ultimately, to leaving the profession in droves.
Protecting doctors, in this view, is a means of protecting patients in the long run. A strike, while disruptive in the short term, is cast as a painful but necessary act to create a sustainably safer environment for future care.
Moreover, the collective strength of a strike sends an unequivocal message: violence against healthcare workers will not be tolerated and will have severe, system-wide repercussions. It compels institutions, governments, and societies to move beyond platitudes and cosmetic reforms, forcing them to grapple with the crisis head-on. Inaction and silence, in this light, become forms of complicity.
The sacred duty and its inviolable boundaries: The argument against striking
Yet, the counterargument carries its own undeniable moral force. Critics of doctors’ strikes do not minimise the horror of workplace violence, but they maintain that withdrawing care—even partially, even for non-emergency services—is an ethically untenable breach of the Hippocratic covenant. The doctor-patient relationship is founded on the principle to “first, do no harm.” To strike is to temporarily sever that trust, and in so doing, to inflict collateral harm upon the innocent.
The reality is that the patients who suffer most from strikes are the most vulnerable—the elderly, the critically ill, the impoverished, and those who have traveled great distances in desperate need. Appointments are missed, surgeries postponed, chronic conditions neglected. These individuals are not parties to the conflict between staff and system; they become the collateral damage of a battle they never chose.
To leverage their suffering as a bargaining tool is viewed as a profound injustice
Furthermore, doctors hold a unique position of societal trust. Strikes, especially those over safety rather than pay, can erode that trust, potentially recasting the profession as self-interested rather than self-sacrificing. This undermines the social contract at the heart of healthcare, risking alienation of public support. Critics argue that strikes are a blunt instrument, rarely yielding lasting safety solutions and often hardening opposition rather than fostering reform.
Instead, they advocate for relentless, multifaceted pressure through other means: sustained media campaigns, direct lobbying of politicians and law enforcement, public demonstrations that do not withdraw care, alliances with patient advocacy groups, and strategic litigation. The focus, in this view, must remain on continuous enforcement of existing laws and systemic reform—without ever relinquishing the duty to serve.
An additional concern is the “slippery slope” argument: granting the right to strike over safety could open the door to strikes over other grievances, with the potential to disrupt essential services. In many jurisdictions, healthcare is legally designated as an “essential service,” where strikes are prohibited or tightly restricted due to the life-or-death consequences of work stoppages. The innate asymmetry in the doctor-patient relationship—where patients are utterly dependent—imposes heightened ethical and legal responsibilities.
Beyond the binary: Seeking solutions where dignity and duty converge
The stark dichotomy of “strike or suffer” is, in itself, an indictment of system failure. The real solution lies not in choosing between two absolutes, but in forging a path where such a tragic choice is never necessary. This demands proactive, comprehensive action:
• Zero Tolerance Enforcement: Laws protecting healthcare staff must be more than ink on paper. Swift prosecution, mandatory reporting, and decisive penalties for perpetrators are essential.
• Infrastructure and Training: Investments in security systems, panic buttons, controlled entry, and emergency department design must be matched by staff training in de-escalation and crisis management.
• Support and Accountability: Victims of assault require immediate medical, psychological, and legal aid. Independent investigations and regular public audits can build accountability and trust.
• Systemic Reform: Addressing chronic understaffing, overcrowding, and resource scarcity can help alleviate the frustrations that often escalate to violence.
• Cultural Change: National campaigns must foster respect for healthcare workers and raise awareness of patient responsibilities. Dignity and mutual respect must become cultural norms, not empty slogans.
Real-world examples abound. In India, for instance, the Delhi Medical Council condemned a doctors’ strike at Safdarjung Hospital in 2010 as unethical and harmful, yet similar strikes have recurred, underscoring the persistence of unsafe conditions and unaddressed grievances. The tension between medical ethics and occupational safety remains unresolved, creating an agonising ethical dilemma: is it more unethical to strike, or to remain silent amid danger?
Scholarly analysis, such as the 2014 Journal of Medical Ethics criteria, suggests that any justified strike must be a last resort, minimize patient harm, maintain transparent public reasoning, aim for systemic reform, and arise from collective consensus. In under-resourced settings, doctor strikes often signal desperation rather than disregard, highlighting the need for robust grievance redressal and independent oversight.
Conclusion: Deserving the right, requiring a better path
In the final analysis, doctors deserve to work in an environment where their dignity is respected and their safety assured. Striking in the face of violence is a moral response grounded in human rights, but it should remain a last resort—an option only when all other avenues have been exhausted and urgent danger persists. Even then, the cost is grave: innocent patients, vulnerable and blameless, bear the brunt of systemic failures.
The optimal solution, therefore, is not to exercise the right to strike as a primary weapon, but to render it unnecessary through the creation of functional, resourced, and culturally embedded safety systems. Only when doctors feel genuinely protected, respected, and heard will the specter of strikes recede. The ultimate goal must be a healthcare environment where the sacred duty to heal can be fulfilled without sacrificing the unyielding dignity of the healer, and where no patient is made a pawn in the quest for basic safety.
(Note:The author Dr Fiaz Maqbool Fazili is a practising surgeon deeply engaged in healthcare policy analysis, and a passionate advocate for patient and family rights.)
