Professional Autonomy and Self-Governance
A Public Service to Patients and the Population

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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,


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.


* Related press release and video of Turkish Medical Association