Making a living or working yourself to death? Exploring the brave new world of work

This case study describes the current workplace situation for young professionals and other workers in Europe. It explores their working conditions notably in the area of excessive working hours, and illustrates some of the regulatory efforts that have been undertaken to tackle the situation. The case provides the opportunity to reflect on the potential reasons why certain jobs and professions might be particularly vulnerable to unhealthy working conditions, and offers a chance to consider the benefits and limitations of alternative approaches to the problems, such as flexible work patterns.

The Japanese call it ‘karoshi' and the Chinese ‘guolaosi' - but even though the English language does not have a word for it as yet, working yourself to death is increasingly becoming a risk for many professionals. The case of Sid Watkins who died in 2003 from medication that was supposed to help him cope with his 100 hour a week work schedule is an extreme case, but Watkins' experience highlights a growing phenomenon of excessive hours among professionals. The law firm Peninsula published a report in 2005 indicating that 80 per cent of their staff worked for more than 60 hours a week and 70 per cent got only four hours of sleep a night. The problem of overwork is growing in Europe with the UK leading the list of working hours at 43.6 per week (the European average is 40.3). A particular case in point is the medical profession though it can be considered as fairly representative for many other lines of work.

In many European countries such as the UK, Ireland, Germany, or France, doctors are facing working conditions that are increasingly intolerable for both staff and indeed their patients. For example, in 2002 the average working hours for hospital doctors in Germany was 80 hours a week. In the UK, working hours are limited to 56 hours a week, but surveys have shown that one doctor in six works longer than this. Of course, with doctors on an annual salary, these long hours are effectively usually unpaid. Moreover, with the ambiguity about the question of whether time ‘on call' counts as ‘work time' or ‘leisure time' (the latter of which has tended to be the norm in most European countries until recently), shifts of 72 hours and more are a normal occurrence in the profession.

Research though has shown that 24 hours without sleep has the same effect as a blood level of 1.3 pro mille of alcohol. Given that 0.5 pro mille is the limit for driving a car in most European countries, it appears that some doctors are expected to carry out potentially life-threatening operations in the same or worse state as someone who would not be allowed to drive. The situation in other professions is similar with 26 per cent of the workforce in the UK now working more than 48 hours a week. Experts warn that working consistently longer than 45 hours a week has serious risk for physical and psychological health of workers.

Problems of excessive hours are not of course restricted to junior doctors, as many young professionals, labourers, and various other employees will be all too aware. As a result, there have been several attempts to tackle problems of excessive working hours through legislative means. In Europe, the most important development has been the 1993 EU Working Time Directive (Council Directive 93/104/EC). The directive sought to make a 48-hour week the legal maximum for all workers across Europe, as well as ensuring suitable rest periods during the working day/night. To make the transition smoother, a number of sectors were exempt, including transport, working at sea, and junior doctors. The latter were only included from August 2004 - more than ten years after the directive was issued!

What are the reasons for this situation? Well, if we look first to the medical profession, one group of reasons certainly lies in the nature of the profession itself. With the ‘vocation' to help people and a duty of care embedded in medical training, there is naturally a level of implicit pressure on the profession to put patients first. This commitment becomes problematic though when combined with the fact that most hospitals are run by the government. Consequently, with tightening welfare budgets in many European countries, public health institutions have been under constant pressure to reduce costs whilst seeing no reduction in patient numbers.

Yet another problem lies in the nature of doctors' typical career paths. Most junior doctors see their time in hospitals as the first step in their career, aspiring to stages where they might work as consultants, or in their own practice, or in a private healthcare facility. Since access to these subsequent career steps is administered in most European countries by professional bodies, or chambers of the medical profession, there are major risks for the individual junior doctor to risk conflicts with their superiors. These reasons equally apply to other professions, such as law, investment banking, accounting, or business consulting. The lucrative careers in these jobs all ask for considerable investment in early stages in the profession.

Most members of these professions are still being seen as relatively affluent, so there seems to be little public pressure to change this situation. Only recently with growing incidents of, for instance, surgical mishaps and longer waiting times in hospitals, has the general public seem to have been alerted to the worsening situation among young professionals.

A significant turning point though in the approach to work demands for young professionals has come about through the debate on rapidly declining birth rates in most European countries. For instance in the UK, birth rates have fallen from 2.95 children per person in the 1960s to 1.77 in 2004. In a 2006 survey, 63 per cent of young professionals said that career pressures make it hard to have children. As a result, we have witnessed a growing trend towards working patterns that allow for both a demanding professional career and time to raise a family. The dominant manifestation of this debate is a rapid increase in flexible work.

In 2003, the UK introduced legislation that allows parents ‘the right to request' flexible work at their employer. Flexible work in this context includes a number of aspects, including choice of:

• When to work. Instead of working 40 hours over 5 days, workers would have the choice of working these hours on just 3 or 4 days. Similar models exist on an annual basis, compressing the work into, say, 8 months and taking 4 months off.

• How much to work: This would include choice about the total number of hours to work.

• Where to work: This would include choice about the work location with working from home being the most common alternative.

According to 2005 figures, 11.5 per cent of all UK employees are working ‘flexibly' now, with a growing tendency towards flexibilisation evident. In 2010, 27m of European workers are expected to have shifted to flexible working patterns. And some evidence certainly suggests that flexibility can be a win-win solution for employers and employees: in the UK, 49 per cent of employers claim to find flexible workers more productive especially as substantial numbers of them (3.8m) still work more than 48 hours a week. In another recent survey, a third of the workers said they would rather work flexibly than have an extra £1,000 a year.

So, is all good now in this brave new world of flexible work? Laura Williams, a researcher at the Work Foundation, observes: ‘In companies where flexible working is only offered to parents and carers that will create a culture of resentment because other workers will think: "Why can't I have every second Friday off to do some further education, or to do a hobby?" There are other reasons to want to work flexibly.' Only 38 per cent of companies allow flexible work to groups not mentioned in the law (which basically means parents). On another note, 80 per cent of flexible workers indicate that they miss the social interaction in the office and a substantial number of employers argue that there are too many difficulties in coordinating and too many distractions at home for flexible workers.

The trend towards more family friendly work places though appears to be continuing, and even expanding beyond the professionalised workplace. Some high street companies, such as McDonald's, now offer their workers a ‘family contract': if mum cannot go to work she can send her husband, her sister or her son to do the job instead. Other initiatives are particularly focusing on the compatibility of family and careers for women. For instance, the UK recently introduced measures to extend paid maternity leave from six to nine months, and offering fathers the option to stay at home if the mother decides to go back to work after three months. In Germany, paid maternity leave has recently been extended to 14 months on condition that the father stays at home for at least two months of these.

Whichever way we look at it then, the idea of a responsible approach to working time in Europe seems set to become a major question for employees and employers alike over the next few years. Legislation will clearly have significant impacts, but the ethical choices of employers may well end up having a significant impact on whether companies can attract and retrain the best young professionals in the workplace of the future.

Questions

1. What are the main ethical conflicts and issues in this case?

2. Set out the main ethical arguments that might be used to (a) criticise and (b) defend the excessive hours typically imposed on doctors and other young professionals. How convincing is each set of arguments?

3. Reflect on the reasons given to suggest why the problem of excessive working hours might arise in the medical profession. To what extent are these reasons valid for other jobs and professions?

4. Flexible working patterns are considered a solution to some of the issues raised. Discuss the pros and cons using a stakeholder perspective. What would be your overall judgement?

5. Assess the role of legislation in protecting employee rights in the context of working hours and flexible work patterns. Is it an effective ‘solution' to this problem? How does the role of legislation in this situation compare with its role in the context of other employee rights, such as the right to participation and the right to be free from discrimination?