Working to Death: The Regulation of Working Hours in Health Care


  • This research was supported by Health Canada, the Canadian Institutes for Health Research, the Alberta Heritage Foundation for Medical Research, and the Nova Scotia Health Research Foundation. Thanks to Christina Holmes, Dr. Jocelyn Downie, William Lahey, Dr. Mavis Jones, Bridget Lewis, the editors and the anonymous reviewers for their helpful comments.

Address correspondence to Fiona McDonald, School of Law, Queensland University of Technology, GPO Box 2434, Brisbane QLD 4001 Australia. Telephone: + 61 7 3138 2010. E-mail:


Recent research highlights significant risks associated with health professionals working long hours—risks to their health and safety, to the safety and quality of care provided to patients, and to public safety. This article undertakes a review of the various instruments used to regulate working hours in health systems, using six countries (Australia, Canada, Denmark, New Zealand, the United Kingdom, and the United States) and the European Union as primary comparators. The review demonstrates differences in the instruments used to regulate the issue in these countries and in the economic, social, and cultural factors that limit instrument choice and moderate instrument effectiveness.