Medical associations and society

Gonzalo Herranz, department Bioethics, University of Navarra
discussion paper the First conference of Official Medical Associations
First discussion paper: Professional Associations
high school Medicalhigh school of Guipúzcoa
San Sebastián, November 21, 1997

Greetings and thanks

An introductory overview

It doesn’t take much effort to identify the reference letter points reference letter will guide my talk on the relationship between the reference letter Associations and society. They are set forth in article and 3 of our General Statutes (EG), our governing body of laws.

Start at the beginning

It seems to me article is a bit of a hodgepodge of unrelated items. To begin with, point 1 outlines the channels for our relations with the central government: we are told that the agency we should contact is the Ministry of Health and Social Security, now the Ministry of Health and Consumer Affairs. By analogy, relations with regional governments will be channeled through the corresponding regional ministry.

Point 2 imposes upon us the duty—and confers upon us the right—to provide our financial aid to the legislative and regulatory process regarding the professional role. Things have not always gone smoothly in this area, but that does not prevent us from affirming that our manager contribution manager this field is of great value to society.

Points 3 and 5 of this article might seem merely ceremonial, as they grant institutions and individuals honorary titles and the status of authority. But, at their core, they convey a profound message: that their power—their status as authorities—does not stem from themselves, but is bestowed by society, to which they are accountable. It is not, therefore, a matter of autocratic authority, but of moral responsibility. I imagine that executives, upon assuming their duties—when they swear or promise to submit their conduct to established rules and to fulfill corporate objectives with intelligence and loyalty—realize that they are not going to promote personal interests, but rather the corporate purpose in service to society. That commitment is the basis of their authority.

Point 4 is particularly significant: The Medical Association (OMC), which is dedicated to contributing to the common good, shall enjoy the protection of the law and recognition by the State. It appears that the powers and privileges granted to the OMC are contingent upon this fundamental provision: that it is dedicated to contributing to the common good. If there is no focus on the common good, authority, rights, functions, and credit lose their raison d’être and become corrupted. The OMC cannot be confined to personal or corporate interests: the oxygen it breathes is that of the common good. I believe this should give us pause for thought.

The WTO's social mission: article

There is no doubt that what I have just said is quite strong, but also very general. To avoid confusion, article of the General Provisions specifies the fundamental purposes of the OMC. It contains four points. The first and third points highlight the centripetal dimension—the purpose we might call corporatist—for we must not forget that there is a positive form of corporatism, a legitimate esprit de corps, which must be understood as follows: to better serve society, the Medical Association has, within the scope of its skill as an expression of its skill , the obligation to inform society of the best way to regulate the practice of medicine, and to identify the legitimate interests that must be defended so that the human and professional standing of its members is not degraded or falls below the required standard of dignity. It is not merely a matter of preserving one’s image, but an existential necessity to define the boundaries of freedom without which service is impossible, for service would otherwise have become servility. Point 3 obliges us to promote, by all means at our disposal—which are presumed to be legitimate, since the nobility of the end does not justify the use of underhanded means here either—the constant improvement of the physician’s standards of humanity: their science, their culture, their economic security, and their social dignity. This obliges the WMA to be a promoter of Education and cultural inspiration. And also to create and maintain systems of financial aid and social security.

Paragraph 4 of article highlights the WTO’s social mission: it sets a social goal—to ensure, in partnership public authorities, that all Spaniards enjoy the right to health protection; and that attendance and the practice of medicine are regulated in the most efficient, fair, and equitable manner. The OMC is not indifferent to subject social justice. It cannot refrain from intervening in matters related to the economic aspects of healthcare, such as ways to eliminate waste and promote savings, the rationalization of control systems, the role of physicians in management , etc.

Finally, in point 2, the association entrusts the Medical Association with safeguarding and upholding the professional and ethical-social principles of the medical profession, as well as its dignity and prestige, and assigns it the role of codifying discipline ethics and exercising discipline .

The ethical role, social commitment, and legal mandate

Naturally, it is impossible to cover this vast subject in detail. I believe I have been invited here to address precisely this point, but before commenting on it, I want to highlight a fact so obvious that we tend to forget it: the EG are part of the legal system of the Kingdom of Spain. They were approved and enacted by Royal Decree 1018/1980, which the King signed on May 19, 1980, and the Official State Gazette (BOE) published nine days later. Failure to comply with their rules constitutes unlawful conduct. They are not a set of regulations that a group of friends devised to resolve conflicts and establish rules for their games. Now, as the OMC works on draft rule , it is worth recalling that the EG are an expression of a fundamental fact: that the Medical Associations and their code of ethics were born and developed, following a long historical process, from a social pact: society submission medical corporation the exclusive authority to grant, to those who meet the necessary qualifications, the licence practice medicine, on the condition that it would be the corporation itself that established the ethical rules for the competent and proper practice of the profession and monitored the professional conduct of physicians.

The social dimension of the WTO’s deontological function

As we have heard, there is no consensus on the basis for the legal status of professional organizations, an issue that—in the absence of modern legislation—is easily entangled with considerations of Constitutional Law administrative Constitutional Law , social policy, and community ethics.

Accepting, provisional tentatively, the argument that deontological jurisdiction is the result a dialogue between the profession and society—and that the selection process codifying norms and criteria for internship self-regulation will continue—it seems appropriate, in my view, to highlight the following ideas:

1. The Code, a public document

A code of medical ethics sets forth the ethical commitments that physicians publicly make to society as a whole, in order to ensure that everyone receives professional services of an adequate standard. In a sense, it is an agreement between society and the medical profession.

The code must be known. In a few countries, the Code has the status of rule . In others, as is the case here, its authority stems from the fact I just mentioned: it is a public commitment that tells society: physicians will act within these ethical guidelines. In Germany, France, and Italy, this takes the form of an oath. Upon enrolling in high school , the physician high school that they are familiar with the Code and commit to upholding it.

Let us ask ourselves: How many doctors in Spain are in a position to take that oath in good conscience? It would be interesting in this discussion procedures for complying with the rule of Article 3.2 (“It is the fundamental purpose of the OMC to safeguard and uphold the deontological and socio-ethical principles of the medical profession, as well as its dignity and prestige; to this end, it is responsible for drafting the corresponding codes and ensuring their implementation”). And article of the Code of Medical Ethics and Deontology (CEDM), which echoes this: “The WMA assumes as one of its primary objectives the promotion and development professional deontology, devoting its primary attention to disseminating knowledge the precepts of this Code and committing itself to ensuring compliance with it”).

The task of disseminating the Code is part of the social contract: medical ethics is an essential element of the consideration that the medical profession offers in exchange for the authority it receives to organize the practice of medicine. Keeping it hidden is like wrapping a talent in a handkerchief and burying it underground. The Code is an extraordinarily interesting book for patients and their families. If the Code were available in the waiting rooms of clinics, doctors’ offices, and hospitals, patients would feel safer. They would undoubtedly admire the ethical generosity of the profession. And they would help us become better doctors by reminding us of the commitments we have made to them.

2. Powers and responsibilities: of society and for society

To fulfill this primary purpose, the OMC is vested with powers and assumes the corresponding responsibilities. It possesses considerable powers: the committee and the Colleges enjoy, within their own distinct spheres of activity, separately and individually, full legal capacity and the power to act. In a sense, through the constitutional mandate of democratic internal organization, the committee and the Colleges receive, via the electoral process for their executives, a kind of power of attorney to exclusively represent the professional association and make the executives valid interlocutors with society. Executives cannot betray this commitment through bad corporatism or ethical negligence. The price of manager conduct manager the decline in the prestige of the ethical system and the massive diversion of patient complaints from their natural destination—the high school —to the ordinary courts of justice.

3. rule : The WMA Madrid Declaration

Last month marked the 10th anniversary of the WMA’s adoption of the Madrid Declaration on Professional Autonomy and Self-Regulation. It is worth taking a moment to consider some of the key points of this important Declaration.

It states, in the opening paragraphs of the document, that the core rationale for professional autonomy lies in the need to assure society that physicians, when caring for and treating their patients, are free to exercise their professional judgment. Professional autonomy, in addition to being an essential component of medical care, is also a benefit owed to the patient and to society. Therefore, the World association and national medical associations must strive to maintain and guarantee such autonomy.

With autonomy thus established, the need for professional self-regulation emerges as an inevitable consequence. “The medical profession assumes the ongoing responsibility to regulate itself. The purpose of any self-regulatory system is to evaluate and improve the quality of care provided and the skill the physicians who provide it. Only physicians have the necessary expertise to conduct such evaluations.” A comment: to claim that unique skill then fail to exercise it would be cynical and shameless conduct: a fraud against society.

The Declaration refers to the need to improve internship through Education , research complies with ethical standards, the equitable and efficient provision of medical services, and concern for expense . All of these functions have a strong social dimension. But the Declaration goes on to state: “The professional conduct of physicians must always remain within the limits set forth by current codes of professional ethics. Violations of ethics must be corrected promptly. This is a responsibility that national medical associations must fulfill effectively and efficiently through appropriate actions.”

He offers us an excellent, bold yet effective solution: he urges medical organizations to raise public awareness of the nature and effectiveness of ethical oversight: “National medical associations must inform the general public of the existence of an effective and manager system manager self-regulation. The public must know that it can rely on such a system for an assessment and objective assessment of issues related to the practice of medicine and the care and treatment patients have received.”

4. Social and Ethical Ethics

The Code places certain public duties on physicians and establishes a social ethic for the medical profession. Articles 5.1 and 5.2 are clear: “Art. 5.1. Physicians must be aware of their professional duties toward the community. They are obligated to strive for the greatest effectiveness in their work the optimal use of the resources that society makes available to them. Art. 5.2. Since the healthcare system is society’s primary instrument for health care and health promotion, physicians must ensure that it meets the requirements quality and adequacy of care, and upholds ethical principles. They are obligated to report its deficiencies, insofar as they may affect the proper care of patients.”

Physicians have a duty to persevere in their efforts to ensure that the healthcare system meets the necessary requirements quality, adequacy, and ethics. To do so, they must more actively fulfill their role as a healthcare advocate, which is one of the most effective ways to invest a physician’s time and expertise. They also have an ethical obligation to identify deficiencies in the healthcare system and serve as a social conscience. This requires them to report technical and ethical shortcomings in the healthcare system, a report that must be made truthfully and without exaggeration. It is in the interest of the general public and of individual patients to know whether they are experiencing significant cuts in the services they receive, or whether there is a significant gap between the care they should be receiving and the care they actually receive. Medical reporting must always be positive in nature. It should seek to remedy deficiencies, never to overturn the healthcare system. The criticism must be made by individual physicians as well as by various medical organizations, through coordinated actions by physicians at a healthcare center, a professional association chapter, a high school the OMC itself. Strikes may even be resorted to, but that is a highly undesirable option. If carried out with ethical and social responsibility, it is a symbolic gesture, not an act of force.

5. Legislative influence

The OMC has an opportunity to participate in the drafting of legislation not only by virtue of report referred to in Article 2.2 of the EG. Article 40.1 of the CEDM assigns it a very ambitious, almost utopian task. It states that “the Medical Association must strive to ensure that the ethical standards of this Code are respected and protected by law.” It is the duty of executives and members to demonstrate to authorities and legislators the profound social and professional values of the rules and regulations , so that they may be respected and recognized by laws and lower-ranking provisions, and to prevent these from eroding the necessary freedom and corresponding responsibility of physicians. This is a contribution of great civic dignity.

6. Other obligations to the company

A review of the Code and the Bylaws would give us new points for reflection. The vast majority of those managing public health are doctors. I believe it is a loss that, in the laws governing professional associations—whether those currently being drafted or those already in force in some autonomous communities—the push for civil servant doctors to become independent from the associations has reached obsessive proportions. I am not concerned about the minor financial implications; what worries me is the erosion of professional ethics that this phenomenon brings with it. We have clearly done something wrong when society believes it will be better served by non-licensed physicians in matters that, while not strictly clinical, involve ethical decisions of considerable significance.

We must take this seriously and take the lead in the movement toward economic accountability. It is our ethical duty to use and expand our knowledge to contribute to a more equitable allocation of resources. We must learn the basics of Economics so that we can responsibly advocate for patients and fulfill our civic duty to avoid wasting both public and private funds.

The function of certify has very serious consequences for society. Society grants us credit and relies on our integrity and professionalism. There are scandalous abuses of certification that terribly damage the profession’s prestige. In the Ribera de Navarra region, people say with contempt to a super-hero: “You’re more fake than a certificate .” It is necessary to prosecute this fraud. Something similar is beginning to happen with the expert role of medical examiners. Instead of serving justice, they confuse it with their fabricated testimonies.

Anyway, there’s no shortage subject cover. But I’ll stop here.

Thank you very much