Medical Care

Skip Navigation LinksHome > May 2014 - Volume 52 - Issue 5 > Labor Unions in Medicine: The Intersection of Patient Advoca...
Text sizing:
Medical Care:
doi: 10.1097/MLR.0000000000000123

Labor Unions in Medicine: The Intersection of Patient Advocacy and Self-advocacy

Manthous, Constantine A. MD

Collapse Box


Background: Labor unions have been a weak force in the medical marketplace.

Objectives: To briefly review the history of physicians’ and nurses’ labor unions, explore the ethics of unions in medicine, and offer a solution that simultaneously serves patients and professionals.

Research Design: A selective review of the literature.

Results: Labor unions of medical professionals pose an ethical quandary, that is a tension between selfless patient advocacy versus self-advocacy. The primary role of labor unions has been to extract from management benefits for employees. The threat of work actions is the primary tool that labor unions can apply to encourage management to negotiate mutually acceptable conditions of employment. Work actions—namely slow-downs and strikes—may harm patients and may therefore run afoul of professionals’ primary duty to the primacy of patients’ welfare. An alternative model is offered wherein medical unions align self-centered and patient-centered interests and leverage the Public Good, in the form of public opinion, to encourage good-faith bargaining with management.

Conclusions: As medicine becomes increasingly corporatized, physicians will join nurses in “at-will employment” arrangements whereby self-advocacy and patient advocacy may be impacted. Although labor unions have been a means of counterbalancing unchecked discretion of corporate management, conventional labor unions may run afoul of medical ethical principles. Reconsideration and innovation, to address this ethical dilemma, could provide a solution that aligns both clinicians’ and patients’ welfare.

© 2014 by Lippincott Williams & Wilkins.


Article Tools


Article Level Metrics

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.