Vulnerable had no voice in nurses' strike

In all industrial action, some disruption, even harm, may result. Traditionally, a strike inflicted harm on an employer's business, and this was justified on the basis that the worker's right to seek improvements in pay and conditions was greater than the right of the employer not to have his (it usually was his) business interrupted.

But what was different in the recent strike was that the effect of the nurses' action was direct and immediate on the patients in hospital, on those who had to leave and on those who could not gain admittance.

To raise ethical questions in the current climate of political, church, business and financial scandals may appear to many about as relevant as Don Quixote's tilting at windmills.

Support for the nurses' grievances was rooted in personal experience of nursing care and a basic recognition of their contribution to the health service.

It seemed easier to identify with the plight of undervalued nurses than with suffering patients. Too stark a comment? Who spoke for the vulnerable, the sick and the less well off? Above all else, sickness means apartness, isolation. W.H. Auden's poem Surgical Ward encapsulates insightfully the world of separation that lies between the healthy and the unhealthy:

They are and suffer; that is all they do;/ A bandage hides the place where each is living,/ His knowledge of the world restricted to/ The treatment that the instruments are giving . . .

The world of the well can only fleetingly appreciate the singular focus that accompanies pain, where the only reality is endurance. To be sick and in need of medical care is to be the most vulnerable of human beings. Is it ever ethical to exacerbate the distress of such people and their immediate families?

Patients were used as a bargaining chip: cause enough distress to sick people and the Government will cave in. Is such cruelty ever justified? To deny, postpone or delay care to one in need, and thereby increase their physical and psychological stress, is cruel. To cause unnecessary suffering and pain to another human being indicates a breakdown in human solidarity; that universal concept that we are all connected, linked to each other in our common humanity.

Can we be in solidarity with the nurses at the cost of solidarity with patients? Can we be in solidarity with a Government that allows a dispute to escalate to this point?

Does the end justify the means? Proportionality is a necessary element in moral deliberation: a judgment is made between the action under consideration and its effects on the doer of the action and on other parties involved. Are the distress, anxiety and pain of another human being appropriate weapons in industrial disputes?

Heart-rending stories of experiences in hospitals during the dispute highlighted the dilemma faced by nurses. Some doctors have spoken about the inadequacy of patient care during the conflict. Junior doctors, who enjoy no legal protection against long working hours, filled the gap, working even longer hours.

Subtle arguments about what was or was not an emergency were stunningly abstract in the face of sick children or adults, particularly those with a diminished capacity to understand.

An adult may have some comprehension of the postponement of treatment. But any parent who has ever had to nurse and comfort a sick child knows such fine distinctions as between emergency treatment, essential treatment and normal treatment are as relevant as local elections in Patagonia.

THE other party to the dispute, the health services employers, i.e. the Government, also had a moral dilemma. They had to weigh up what they see as a need for restraint in public pay against the increased suffering that will result from engaging in confrontation with those who can relieve that suffering.

Is public pay restraint so much for the common good that the rights of sick adults and children to healthcare and relief from stress can be set aside?

Were there other means for settling the dispute that would avoid withdrawal or curtailment of health services? Are the disadvantages of alternative methods so great that they could not be considered?

It appears that prolonged negotiations during the strike made significant progress. Why was it left until after the last moment to engage in these negotiations?

Nurses care for their patients: anyone who has been in a hospital, or who works in a hospital, can testify to that. They deserve to be recognised, not merely in words, but in their pay-packet and conditions. The Government has to watch the public purse for the good of the entire community.

But is it medically or morally defensible to use as the cornerstone of industrial action the inconvenience, anxiety, suffering and risk of death of one of the most vulnerable sections of our community?

Publicly funded hospitals bore the brunt of the dispute. Private hospitals largely avoided it. Whatever ethics allow a two-tier healthcare service, there are none that allow healthcare for the better off and virtually none for the less well off.

It is almost as if the public have forgotten that the main weapon in the dispute was the poor, the sick and the elderly. Did we see the dispute as a confrontation between an amorphous mass of workers on the one hand and a faceless employer on the other. Where is the humanity in all of this? Have we become so desensitised that we think the sick and their loved ones as of lesser importance?

Healthy people inhabit what Auden describes as "the common world of the uninjured". Illness, especially serious illness, pushes a person to the margins of life: above all else, an ill person needs the compassion, comfort and assurance of their medical team. Following the nurses' strike it has to be asked whether the uninjured in our community have forgotten the injured?