Professional_Autonomy_Self-Governance

Annual Assembly of the Turkish Medical Association
Saturday, 29 June 2013
Ankara, Turkey
Professional Autonomy and Self-Governance
A Public Service to Patients and the Population
Remarks by the WMA Secretary General
Dr. Otmar Kloiber
Madam Chair,
President,
Distinguished Guests,
Thank you for inviting the World Medical Association to be with you on this
special occasion. We stand with you for the service to our patients, the
impartiality of medicine, and the professional autonomy essential for us to
provide this service and to be there for all people.
We congratulate the Turkish Medical Association for its continued efforts to
provide solid self-governance for the profession and to resist political
attempts to remove/erode autonomy and self-governance.
I would like to say a few words about why professional autonomy, clinical
independence and self-governance are so important. But before I do so,
please let me pass on the best wishes of the World Medical Association, its
President, Dr. Cecil Wilson, and the Chairman of Council, Dr. Mukesh
Haikerwal, the latter who joined you last year for two public events staged
by the Turkish Medical Association here in Ankara and in Istanbul.
When we physicians talk about and demand professional autonomy we are
often misunderstood. People sometimes think we are asking for a privilege,
the privilege to do what we want. But actually professional autonomy is less
about us and more about our patients and their rights. Autonomy is the
assurance that individual physicians have the freedom to exercise their
professional judgment in the care and treatment of their patients without
undue influence from others.
In the complex world of medicine our patients expect us to be free to make
clinically appropriate recommendations in their best interest.
We are aware of and take into account the structure of the health system
and available resources. We assume our responsibilities. However
unreasonable restraints on clinical independence imposed by governments
and administrators are not in the best interests of patients: They can
damage the trust which is an essential component of the patient-physician
relationship.
Due to political decisions in many of our countries, our health care systems
have become more and more commercial. Hospital administrators and
third-party payers may consider physician professional autonomy to be
incompatible with prudent management of health care costs. However, the
restraints that administrators and third- party payers attempt to place on
clinical independence may not be in the best interests of patients.
However, we sometimes also have to withstand inappropriate demands by
our patients themselves. Whether in the best interests of all patients or of
society as a whole, physicians must be able and allowed to refuse such
inappropriate demands.
Professional autonomy and clinical independence are not only essential
components of high quality medical care, and therefore a benefit to the
patient that must be preserved, they are likewise essential principles of
medical professionalism.
It is therefore important that we as a Medical Association are dedicated to
protecting professional autonomy.
In order to foster and protect the individual physician’s right to treat patients
without undue interference, we must assume responsibility for
implementing a system of professionally-led regulation. Self-governance is
an important element of political and social participation in a democratic
society. Democracy means more than just the holding of elections.
We urge our member societies to take responsibility and pride in self-
regulation in order to ensure a high degree of professional autonomy and
clinical independence. We are well aware that the physicians of Turkey and
the Turkish Medical Association have been fighting hard over the past year
to maintain this role.
We share your view that ultimate control and decision-making authority in
regulating the profession must rest with physicians, based on their specific
medical training, knowledge, experience and expertise.
This dedication is not in conflict with the self-determination and autonomy
of our patients, but ultimately assures full clinical independence in patient
care decisions.
Yes, self-governance with its regulatory functions may clash with the
representational function a medical association has. I am sure that this is a
conflict you have experienced here at the Turkish Medical Association
many times. But it is therefore even more important to help to promote and
support the concept of professionally-led regulation amongst our
membership and the public.
Any system of professionally-led regulation must ensure
 the quality of the care provided to patients,
 the competence of the physician providing that care and
 the professional conduct of physicians.
To ensure the continuing quality of patient care, we commit ourselves to
participate actively in the process of Continuing Professional Development
in order to update and maintain clinical knowledge, skills and competence.
We insist that the professional conduct of physicians must always be within
the bounds of the Code of Ethics governing physicians in our countries.
As National Medical Associations we promote professional and ethical
conduct among physicians for the benefit of their patients. And we must
ensure that Ethical violations will be promptly recognized and reported. The
physicians who have erred must be appropriately disciplined and where
possible be rehabilitated.
This is all very difficult and we often encounter criticism from both sides:
From our colleagues because we supervise them and sometimes have to
sanction certain individuals, and from society because we are sometimes
seen as being protective or self-serving.
However we are also under threat, for instance from political attempts to
deprive us of our self-governance. The ongoing exchange of information
and experiences between National Medical Associations is essential for the
benefit of patients. And we welcome the cooperation and experience
brought by the Turkish Medical Association to the global family of Medicine
at the World Medical Association.
Let me conclude:
Professional autonomy and clinical independence are derivatives of patient
rights: to be served by a physician who is independent from undue
influence and who can serve his or her patients to the best of his or her
knowledge and skills and to the best of his or her ability.
We stand for a responsible system of professionally-led regulation by the
medical profession: Fair, reasonable and transparent, and not self-serving.
We guarantee the safety, support and confidence of the general public, as
well as the honour of the profession itself.
And we do this better than governments will ever be able to do it.
In a democratic society, self-governance is an element of horizontal power-
sharing and therefore an important pillar of civil society and democracy
itself. Removing self-governance is to remove a viable element of
democracy. Removing self-governance is destructive to the social fabric of
our societies.
Dear Colleagues, we are proud to stand with you. The impartial services
that have been rendered by your physicians to the wounded during recent
weeks deserve our respect. We ask all parties, and especially the Turkish
government, to guarantee medical neutrality – even in times of conflict.
This is the only way to respect humanity in a manner befitting the great
culture of this nation.
I thank you for your time.
References:
 WMA Declaration of Seoul on Professional Autonomy and Clinical Independence
 WMA Declaration of Madrid on Professional Autonomy and Self-Regulation
* Related press release and video of Turkish Medical Association