Did Slovakian doctors abuse of their power?

On December 28th, the Slovak government has declared the state of alarm, forcing doctors, including strikers to return to duty. Has the government exceeded its powers by undermining the fundamental rights of doctors? Was it a legitimate act to end at all costs the unprecedented crisis of medical care?

Doctors, kidnappers of Slovakia

01/14/2013 - 23:11
Slovak society has experienced an unprecedented trauma of (the lack of) medical care, because of the claims of incongruous unions and the inability of the Provisional Government to act. The categorical refusal of doctors to work led to the declaration of a state of alarm. Against a similar endangering of health in general, preventive means are being developed.

Early in 2011, doctors' unions threatened the government to organize a general strike. The rise of tension led to a national crisis when nearly a quarter of all medical doctors announced their resignation. The failed negotiations are interpreted as the failure of the entire government, consumed by successive internal crises. Clearly, the government had seriously underestimated the determination of trade unions. The situation was all the more difficult to solve; since October the country has a provisional government with only limited powers. Despite a willingness to negotiate, excessive demands and aggressive means of the trade unions have been condemned by the whole society, in the context of budget cuts due to the economic crisis. Even though the government has finally given in, the doctors won a Pyrrhic victory.

Excessive requirements endangering the lives of patients

Slovak doctors were largely inspired and encouraged by the success of their Czech counterparts – who, instead of an “ordinary” strike preferred deposits of massive resignations. In Slovakia, the announced departure of about 2,400 of the 12,000 doctors in the country led to the questioning of the medical system as a whole. The union demands in terms of higher wages were obviously impossible. With a deficit of 4.9% of the GDP and the prospect of only 1.1 growth for the next year an austerity policy was announced. In addition, average incomes earned by doctors (€ 1,600) are double the average wage in Slovakia (€ 760), also the standard in countries of Western Europe. This is why the legitimacy of the strike was questionable, especially after the major concession made by the government: to halt the transformation process of hospitals into private institutions. Given the fact that two thirds of Slovaks are paid below the average wage (!), requests for the increase to three times the average wage seemed outrageous. Especially since Mr. Kollár proposed that this increase was funded at the expense of the acquisition of new medical equipment.

"The blackmailing by the doctors frowned upon by the Slovak population"

The intransigence of physicians, deaf to the government’s compromise, and to the general condition of the country, further degraded by the fall of the government, led to the declaration of a state of alarm. The president declared it the day before the expiry of the ultimatum, the period during which the government tried to prevent the departure of doctors and force them to get back to work. This shows in itself the urgency of the situation, just like the convening of Czech military doctors in order to minimize the fatal impact on the population. However, most doctors did not hesitate to ignore the state of alarm and the obligations it carried. Under the pretext of taking sick leave, they refused to provide any medical care. Thus, while the Slovaks have shown initial support to the efforts of unions, public opinion turned against their actions, detrimental to the public interest. The kidnapping of health, what is more of the life of citizens is incomprehensible, especially since doctors justify their claims by the specificity of their profession. Does this truly special position, the fact they are indispensable, excuse them? Is it not all the more scandalous to use the Slovak society’s needs to health and professional access only to see their demands accepted?

Protection of public safety superior to individual and individualistic claims

The outcome of the case can be seen as a real Pyrrhic victory for physicians. Public opinion has changed dramatically since the beginning of the case; today it would be in favour of a tough management of such crises by the government. Indeed, people seemed to start wondering where the violence of the unions would lead the country. No need to go far to find an answer: Great Britain before Thatcher, constantly paralyzed by strikes and the omnipotence of trade unions is a good example. Wouldn’t society be paralyzed in the future by strikes if each group of professionals behaved the same way? Because doctors have no more legitimacy to protest than other officers, for health is far from being the only under-funded state sector: education (3.69% of GDP versus 4.98% the European average) and research (0.46% of GDP versus 1.83% of EU average) are also desperately missing public funds.

Thus, a new offense to the law will be defined - the breach of duty in state of alarm. This new measure is part of Constitutional law that limits the existing right to strike of certain groups in order to preserve public safety in this context, particularly the health of the Slovaks. For general interest is superior to the claims of any pressure group. If the result of a strike is endangering the health or life of citizens, the government, in its new reform, shall give permission to end the movement in order to guarantee the population the access to medical care. Finally, despite the government's concession on wages, another adverse effect of the persistence of trade unions is the desire of hospitals to increase the number of contracts with Ukrainian physicians at the expense of Slovak doctors. For while we observed for years the brain drain of Slovaks to the Czech Republic, the same phenomenon has just appeared with an influx of Ukrainian doctors in Slovakia. Willing to work for Slovak dream wages, they will now deprive Slovak doctors of jobs, or at least of their ability to lobby.

This article deliberately presents only one of the many existing points of views of this contorversial subject. Its content is not necessarily representative of its author's personal opinion. Please have a look at Duel Amical's philosophy.

Doctors, victims of Slovakia

01/14/2013 - 23:11
The last echoes of the case of doctors' strikes show a great weakness of the democracy in Slovakia. Political elites, lacking the culture of negotiation, provoked the trade unions to take extreme measures. Not only has the Slovak government been disrespectful to physicians and has failed to meet their commitments, the government also violated the fundamental rights of the doctors.

On the 16th of December, immediately after the signing of a law which met the requirements of the majority, doctors ended their strike. They had already wanted, in the beginning of 2011, to draw minister Uhliarik’s attention to the poor condition of the health system. However, his impassive attitude towards the doctors’ demands led to the radicalization of protests. Actions culminated in masses of doctors sending their notice of termination. The Slovak authorities showed their inability to conduct peaceful negotiations, which led to the collapse of the health system. In addition, the measures foreseen by the government following the end of the protests will influence greatly the professional associations of doctors, and constitute a real threat to fundamental rights, such as their right to freedom of expression or freedom of association and to democracy itself, which is still young in Slovakia.

The use of extreme measures due to extreme conditions

The state of the public health sector in Slovakia is alarming and trade unionists have expressed their disagreement with such a state as early as January. Indeed, the health sector in Slovakia (6% of GDP) is significantly underfunded compared to the European average (10% of GDP). While in Germany the starting salary of a doctor is around 3,700 Euros in Slovakia it is only 500 Euros. In addition, doctors in Germany can benefit from a greater number of days off. Their Slovak counterparts have technical equipment of inferior quality and, of course, their working conditions and promotion prospects are not any more promising. Despite this, Ivan Uhliarik showed no willingness to negotiate with doctors, already desperate because of their situation. This led them to express their dissatisfaction in more and more radical terms: in September, more than 2,400 doctors have presented their resignation.

An ignorant government unwilling to negotiate

Only this action has managed to force political authorities to cooperate. However, the measures proposed by the government were too limited or illusory, and therefore could not be accepted by the union. The government then, instead of continuing the negotiations, decided to declare a state of alarm, which obliged all doctors to return to work. Under such pressure, the medical associations have given in, showing their good will, and thus demonstrating their desire to find solutions. They came to an agreement with the government to the detriment of their original objectives. Indeed, doctors have been very magnanimous, especially regarding wages. They agreed to an increase in the average salary multiplied by 1.5 - 2.3, whereas initially they claimed that their wages rise to the level of average salary multiplied by 3 on the horizon of 2013.

The fundamental right of doctors threatened

The government has put a lot of pressure on physicians during their strike, and recent statements by the authorities give reason to fear for a real oppression of the professional group of doctors in the future. First came the statements of the Prime Minister I. Radicova, on December 15, declaring the need for the revocation of the direction of LOZ2, which is a significant intervention in the rights of trade unions. In addition, on December 16th the government claimed its desire to limit the right of doctors to strike, involving penalties of up to five years in prison! The current crisis in the health sector reveals how incompetent the government is, how it refuses to help the population and how it is subject to certain financial groups. Doctors have tried to oppose them, but ended up being even more oppressed. Here is a step back on democratic development and a step towards authoritarianism, once the government is dominated by the right.

This article deliberately presents only one of the many existing points of views of this contorversial subject. Its content is not necessarily representative of its author's personal opinion. Please have a look at Duel Amical's philosophy.

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