Can unions lead to better patient care?

Ethics Forum. Aug. 6, 2007.

Is it ethical for physicians to form a union?

Facing a budget crisis, the Cook County (Ill.) government closed clinics and laid off hundreds of doctors and nurses. In response, a majority of physicians involved once again signed cards to join a union. Is it the right response?

Reply:

The question of whether it is ethical for physicians to join a trade union is frequently confused with a variety of secondary questions. Often individuals who discuss these issues in medical journals introduce their attitudes about trade unions in general, the history of specific unions, the social role of unions within the U.S. or opinions about specific trade union tactics, for example, strikes. These issues, while engrossing, are not the nub of the debate. Removed from its more inflammatory aspects, the question is whether it is ethical for physicians to bargain collectively the conditions of their practice.

The first part of this question asks whether the individual physician has a responsibility to his or her patients outside of the clinical interaction. The AMA's Principles of Medical Ethics notes that "A physician shall, while caring for a patient, regard responsibility to the patient as paramount." I would emphasize that the responsibility does not stop there, by quoting the preamble to those principles: "As a member of this profession, a physician must recognize responsibility to patients first and foremost, as well as to society, to other health professionals, and to self."