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Turkish Medical Association calls for help to defend its role

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e529 (Published 20 January 2012) Cite this as: BMJ 2012;344:e529
  1. Ned Stafford
  1. 1Hamburg

The Turkish Medical Association has issued an appeal for support from the World Medical Association, saying that a decree adopted by the Turkish government to give more authority to the Ministry of Health is threatening its autonomy.

In a letter to the world association the Turkish association says that the decree, adopted in November, has stripped it of several key functions, making it impossible to fulfil some of its chief missions, including “ensuring that [medicine] is practised and promoted in line with public and individual wellbeing and benefit” and protecting the rights of doctors.

Feride Aksu Tanik, secretary general of the Turkish Medical Association, told the BMJ that the government decree has amended laws that affect not just the association but other medicine related organisations and medical schools.

“We deeply believe in the necessity of the self governance, self regulation, and independence of medical associations, as well as the professional autonomy and independence of physicians,” said Professor Tanik, a member of the public health faculty of Ankara University. “We wanted to inform our colleagues about what is happening in Turkey to create international awareness and solidarity. We know that self regulation is the basis of qualified healthcare given to our people.”

She said that the legal changes are aimed at “intimidating and eliminating the pressure group functions of professional organisations and academics who are not in line with existing government policies.”

Specifically the Turkish Medical Association says that the government created a new Board for Health Professions that will take over many of its functions. Some 14 members of the board will be appointed by the health ministry and one by the association. “Hence, the board is composed of members whose professional and scientific freedom and autonomy is highly questionable,” the association wrote in its letter to the World Medical Association.

This board has been given many of the powers that used to be exercised by the association, including giving opinions on medical education curriculums and on training and employment. The board is also involved in “laying down ethical codes and principles in health professions” and can investigate alleged violations and apply disciplinary sanctions. Professor Tanik added that the decree gave the health ministry powers to “exercise authority in scientific research and studies conducted by universities.”

The association said in its letter, “The latest arrangement by the government virtually erodes the established duties and authorities of the medical association and other professional associations and undermines the autonomy of the profession and its guarantees by delegating full authority to a board whose members are to be appointed by the Ministry of Health. In short we face a situation not compatible with any democratic society.”

The association described the government’s health decree, just one of 35 decrees modifying the system of public administration without parliamentary approval, as unconstitutional, noting that “the main opposition party in the parliament has brought the case to the Constitutional Court.”

The World Medical Association has issued a letter to its national member associations in support of the Turkish association. Otmar Kloiber, secretary general of the world association, told the BMJ: “The self governing and regulating powers were given to the communities of physicians by law, and now they are taken away by a government order. We don’t see how this can be justified.”

He noted that his association is also concerned about attempts by governments in other nations to “interfere” in self governing medical associations, including moves by the Slovakian government to disempower the national trade union for doctors and a new Polish law holding doctors financially liable for administrative deficits of the Polish healthcare administration.

The world’s medical community needs to make it clear that “professional autonomy and self governance—and, with that, confidentiality—are not elite privileges of doctors but derivatives of patients’ rights,” said Dr Kloiber. “They are there to protect the patient-physician relationship [and] to ensure that the physician can do his or her best to treat the patient without undue influence of governments or insurers, which often only want to ration care.”

Notes

Cite this as: BMJ 2012;344:e529

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