PHYSICIAN AUTONOMY VS. SELF-REGULATION: YOU CAN'T HAVE ONE WITHOUT THE OTHER by ProQuest

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									Vol. 26:2 summer 2010                                                                              	




physiCian autonomy Vs. self-
regulation: you Can’t haVe one
Without the other
AMIR A. KHALIQ, PHD, ARI K. MWACHOFI, PHD, ROBERT W. BROYLES, PHD


Abstract:
Physician	autonomy	is	intricately	linked	with	the	quality	of	care	and	patient	protection.	
Professional	autonomy	which	gives	physicians	the	freedom	to	exercise	their	judgment	
in	the	best	interest	of	the	patient	without	societal	interference	is	based	on	the	premise	
that	physicians	will	act	competently	and	will	put	the	wellbeing	of	the	patient	ahead	of	
their	 own	 personal	 interest.	 	 Since	 individual	 physicians	 cannot	 always	 be	 relied	 on	
to	be	competent	 and	scrupulous,	the	social	contract	that	gives	the	medical	profession	
the	 privilege	 of	 autonomy	 goes	 hand	 in	 hand	 with	 the	 responsibility	 for	 effective	 self-	
regulation.	 Governments	 delegate	 their	 regulatory	 and	 policing	 power	 to	 the	 medical	
profession	 with	 the	 expectation	 that	 the	 profession	 will	 fulfill	 its	 self-regulatory	
obligation.	 For	 a	 variety	 of	 reasons,	 the	 medical	 profession	 has	 done	 a	 poor	 job	 in	
this	regard	and	has	been	accused	of	complicity	and	complacency.	Largely	in	response	
to	 negative	 media	 coverage	 and	 public	 pressure	 in	 various	 countries,	 the	 medical	
profession	 has	 undertaken	 initiatives	 in	 recent	 years	 to	 ensure	 continued	 physician	
competence,	information	sharing	among	different	jurisdictions,	increased	transparency,	
greater	 public	 participation	 in	 the	 regulatory	 process,	 and	 more	 vigorous	 exercise	 of	
its	policing	power.	Recertification	and	revalidation	requirements	have	helped	address	
the	issue	of	competence,	but	physician	conduct	still	remains	a	source	of	concern.	The	
progress	toward	effective	self-regulation	has	been	slow,	and	greater	effort	is	necessary	
to	allay	public	concerns	in	this	regard.

Conceptual Background
The Declaration on Professional Autonomy and Self-Regulation adopted by the World
Medical Association in October 1987 and revised in 2005 recognizes the “importance
of professional autonomy and self-regulation” around the world.1 The first principle
in the declaration enunciates that “the central element of professional autonomy is the
assurance that individual physicians have the freedom to exercise their professional
judgment in the care and treatment of their patients.” Whereas the central element of
autonomy is the freedom to exercise professional judgment in the best interest of the
patient, the central element of the medical profession’s self-regulatory obligations is
policing and punitive action.2
     Physicians have long understood that professional autonomy can only be preserved
by demonstrating effective self-regulation.2-5 While physicians place a great deal
of emphasis on professional autonomy, they also recognize society’s interest in
accountability and protection of patients against negligent, incompetent, and unethical
practitioners. The authority of licensing boards, peer review organizations, and
credentialing committees to license and regulate physicians stems from an implicit                      111
      ethiCs & me
								
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