On October 17, I received a brief email from a former Association of Salaried Medical Specialists (ASMS) vice-president: “Can’t wait for your blog covering the reception of Simeon Brown at conference yesterday!!”

The context was the aggressive address of Minister of Health Simeon Brown to the ASMS annual conference.

As reported by Radio New Zealand’s Ruth Hill (October 16), Brown accused senior doctors of crossing an “ethical line” by taking strike action involving non-acute care.

• READ MORE: Simeon Brown accuses doctors of crossing ‘ethical line’ with mega strike
  
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His accusation was made in the lead up to the “mega strike” of around 100,000 senior doctors, nurses, teachers and public servants on October 23.

It included misleadingly Brown claiming that patients were paying the price for the strike action and that ASMS had walked “away from negotiations”.

Further, he added, “Patients should never be collateral damage in disputes between management and unions.” He urged ASMS to call off the strike action and return to negotiations (conveniently ignoring that it never left them).

Clicking my heels – but how?
As the ASMS executive director until 31 December 2019, what could I do but click my heels and obey the former vice-president. But this left me with a problem of what to focus on in a short blog.

The Health Minister had raised several options.

One was the fact that his address, reinforced by Public Services Minister Judith Collins’ stridently inaccurate “attack dog open letter” attack on the health and education unions (October 19) is the most aggressive and hardline government approach towards health unions, at least, since I first became involved with the newly formed ASMS in 1989.

Another was the deliberate use of misleading claims such as Brown accusing ASMS of not being prepared to negotiate while, at the same time, Health New Zealand was refusing to meet ASMS to discuss negotiations. Also deliberately misleading was his false claim about senior doctors’ average salaries.

Eventually I landed on the accusation that triggered much of the media interest and most of the criticisms from ASMS conference delegates — Brown’s claim that senior doctors were crossing an ethical line.

Understanding medical ethics
As Ruth Hill reported there were “audible cries of disbelief” from the delegates. Also see Stuff journalist Bridie Witton’s coverage (October 16).

Let’s get back to basics. Ethics is the branch of knowledge that deals with moral principles that govern a person’s behaviour or the conducting of an activity.

Following on, medical ethics is the disciplined study of morality in medicine and concerns the obligations of doctors and healthcare organisations to patients as well as the obligations of patients.

Medical ethics starts with the Hippocratic Oath beginning with its first principle of ‘first do no harm’.

As part of an earlier post on the ancient Oath and this principle (5 February 2022) I argued that not only were they still relevant today, but that they should be applied to the whole of our health system, including its leadership.

Who really crossed the ethical line?
Dr Elizabeth Fenton is a lecturer in bioethics at Otago University. On October 22 she had an article published in The Conversation that shone a penetrating analytical light on Simeon Brown’s ethical line crossing claim.

Her observations included:

“Striking is an option of last resort. In healthcare, it causes disruption and inconvenience for patients, whānau and the health system – but it is ethically justified.

“Arguably, it is ethically required when poor working conditions associated with staff shortages, inadequate infrastructure and underfunding threaten the wellbeing of patients and the long-term sustainability of public health services.

” . . . The real ethical issue is successive governments’ failure to address these conditions and their impact on patient care.”

In response to the health minister’s implication that striking doctors are failing to meet their ethical obligations to provide healthcare, she noted that:

“These are the same doctors who, alongside nurses, carers and allied health professionals, kept New Zealand’s health system functioning during the COVID pandemic in the face of heightened personal risk, often inadequate protections and substantial additional burdens.

“While the duty of care is of primary ethical importance, codes of ethics also recognise doctors’ duties to all patients, and responsibilities to advocate for adequate resourcing in the health system. These duties may justify compromising care to individual patients under the circumstances in which industrial action is considered.”

Further, doctors:

“. . . are striking because their ability to meet these obligations [to provide high quality care] is routinely compromised by working conditions that contribute to burnout and moral injury – the impact of having to work under circumstances that violate core moral values.

“A key goal of the industrial action is to demand better conditions for clinical care, such as safe staffing levels, that will benefit patients and staff and improve the health system for everyone.”

The penultimate final word
In the context of Dr Fenton’s incisive analysis, as reported by Ruth Hill in her above-mentioned RNZ item it is appropriate to leave the penultimate final word to the response of senior doctors at the ASMS annual conference to Simeon Brown’s ethical line crossing accusation. These comments were made in among their boos and groans.

ASMS president and Nelson Hospital anaesthetist Dr Katie Ben said:

“We have now taken to putting the number of times the patient has been cancelled on the operating list to ensure the patient doesn’t get cancelled for the fourth, fifth or sixth time. Non-clinical managers were cancelling planned care because they could not fill rosters.”

Waikato Hospital rheumatologist Dr Alan Doube said many people (with crippling chronic conditions) did not even get a first specialist appointment (FSA).

“In Waikato, we decline regularly 50 percent of our FSA so we can provide some kind of sensible ongoing care.”

Emergency medicine specialist Dr Tom Morton at Nelson Hospital added:

“Our ED waiting time have blown out with more than doubling of patients leaving without being seen, which I think is a significant marker of unmet need that’s not being recorded or reported on officially.”

The ultimate final word: nailing who crossed an ethical line
In a subsequent RNZ item (October 17), the Health Minister threatened a law change to remove senior doctors’ right to strike: Right to strike threatened.

The reported response of leading patient advocate Malcolm Mulholland nailed who was crossing the ethical line. Describing Simeon Brown’s threat as “pathetic”, he added:

“I think the reason why our doctors and our nurses are striking is because there’s just simply not enough staff. I don’t know how many times they have to tell him until they are blue in the face.

“You know, all this talk about crossing an ethical line, I would say, ‘take a look in the mirror, minister’.”

Indeed Health Minister — look in the mirror! It is the striking doctors who are acting in accordance with the Hippocratic Oath and adhering to the principle of “first do no harm”. It is the Health Minister who is not.

Ian Powell is a progressive health, labour market and political “no-frills” forensic commentator in New Zealand. A former senior doctors union leader for more than 30 years, he blogs at Second Opinion and Political Bytes, where this article was first published. Republished with the author’s permission.

Thousands have marched through major city streets and rallied in small towns across Aotearoa New Zealand as part of today’s “mega strike” of public workers.

More than 100,000 workers from several sectors walked off the job in increasingly bitter disputes over pay and conditions.

It was billed as possibly the country’s biggest labour action in four decades.

• READ MORE: Thousands of nurses, teachers and doctors take part in NZ’s ‘mega strike’
• Gerard Otto’s G News video commentary on the ‘mega strike’
• More photos and speech videos
• Other NZ public service reports

Strike action in Auckland’s Aotea Square.    Video: RNZ

Among those on strike were doctors, dentists, nurses, social workers and primary and secondary school teachers.

Several rallies were cancelled by severe weather in the South Island and lower North Island.

Many carried signs and chanted, cheered and danced as they made their way down.

Green Party co-leader Chlöe Swarbrick said it was embarrassing that the government was labelling the action politically motivated.

“Of course this is political. Politics is about power and it’s about resources and it’s about who gets to make decisions that saturate and shape our daily lives,” she said.

There was a smaller, earlier rally in the morning in Henderson.

Tupe Tai from Western Springs College, who has been teaching for several decades, said the situation had become untenable.

“We’ve got really underpaid and overworked teachers, they need that support.”

She also said teachers needed an environment where they could work on the curriculum, have time to do it, but also have a life.

Hamilton
The crowd swelled to an estimated 10,000 in Hamilton’s rally.

Kimberly Jackson and her daughter were at the rally on behalf of her husband, a senior doctor who had to be at the hospital working as part of lifesaving measures.

“For us it is personal, but it’s also about this country that I love, that I’ve grown up in, and I can see terrible things happening in this country and I feel really passionate about public health care,” she said.

Jackson said she had seen the system deteriorate over her lifetime.

Chloe Wilshaw-Sparkes, regional chair of the Waikato PPTA said teachers were on strike because the offers from the government were not good enough.

“They’ve been saying ‘get round the table, have a conversation,’ but a conversation goes two ways and I think they need to be reminded of that,” she said.

Principal of Hamilton East School, Pippa Wright, was at the rally with some of the school’s teachers.

She said she believed in the NZEI’s principles, and she wanted changes which would ensure schools had really good teachers in front of students.

Wright also said pay rates needed to rise.

“So they’re not treated like graduates, and we need better conditions for teachers, and nurses, and all the public sector,” she said.

Northland
In Whangārei, the weather was sweltering and a stark contrast from conditions further south.

About 1200 people marched through several city blocks, after leaving Laurie Hall Park.

As well as teachers, nurses and other union members there were students and patients showing support.

Sydney Heremaia of Whangārei had heart surgery a few weeks ago but said he was marching to show his concern about staffing levels and creeping privatisation.

Deserei Davis, a teacher at Whangārei Primary School, feared there would be no new teachers soon if pay and conditions were not improved.

“We’ve voted to strike because we feel that the government hasn’t been addressing our issues, and especially at bargaining,” she told RNZ.

“The government scrapped pay equity claims. And that was a shocking blow to women in general, but an absolute shock and a blow for us women in education. And it’s completely scrapped it.

“More importantly, we are standing up for our tamariki, who are really poorly resourced in schools, in terms of support and the requirements coming down on teachers on a daily basis, on a monthly basis.

“It’s burning out our teachers. We’re fighting for our support staff, our teacher aides, the most vulnerable of all our staff who don’t have job security.”

She said the ministry’s offer was “absolutely atrocious”.

“$1 extra an hour over a period of three years. Like let that sink in. 60 cents one year, maybe 25 cents the following and 15 cents the following year. How does that keep up with the rate of inflation?”

Northland emergency doctor Gary Payinda told RNZ it was “pretty important to support our essential public services”.

“We don’t like what’s been going on. Then the understaffing, the refusal to acknowledge the severity of the understaffing and then, of course, pay offers that are below the cost of living, which means . . .  pay cut. None of those things seem fair to the group of public workers that are working harder than ever under huge demand.”

Striking staff called in after power outage
A union organiser said striking staff returned to Nelson Hospital to care for patients after its backup generator failed in a power outage.

The top of the South Island lost power on Thursday as wild weather hit the country. It began to be restored from 9.30am.

PSA organiser Toby Beesley said the generators at the hospital started, but it’s understood they blew out an electrical board, which led to a 45-minute total power outage.

“The senior leadership at Nelson Hospital reached out to us under our pre-agreed crisis management protocol that we’ve been working on with them for the last three weeks for an event of this nature, and they asked for additional PSA member support, which we immediately agreed to to protect the community.”

This article is republished under a community partnership agreement with RNZ.

It is being billed as quite possibly New Zealand’s biggest labour action in more than 40 years.

It is the latest in a growing series of strikes and walkoffs this year, but the sheer size of it today means much of New Zealand will come to a halt.

Several public sector unions say the strike is going ahead in spite of wild weather across the country — though plans for some rallies may change due to conditions.

• READ MORE: RNZ’s live news blog