8 May 1999

Professional Autonomy must be respected and safeguarded for public good

 (Keywords:- standard, professional-led mode of practice, pharmacy, reproductive technology)

          During the days of drafting of the Basic Law, the nine main professions in Hong Kong, in an unprecedented demonstration of solidarity, sojourned in full force to Beijing to lobby for “professional autonomy”.

          Professional autonomy entails that standards of any professional practice be depicted by that profession itself, not by the state; not by the government; nor to be unduly influenced by power and politics. It would be doomsday for the medical profession if the state or lay persons have the power to dictate whether appendicitis should or should not be treated by surgical removal. It is equivalent to the government or the state influencing the judges in courts in their interpretation of the law.

          The joint effort bore fruit. Professional autonomy is enshrined in the Basic Law. Regrettably, recent incidents have shown a threat to this time honoured and hard earned autonomy. In a recent debate in the Legislative Council on health care reform, an amendment was moved to instigate to “discard the present professional-led mode of practice”.

          Health care service is a service that require persons with knowhow to perform the proper functions. In this aspect, there can be no question that it must be profession-led. Anything else would result in non-professionals directing the nurses, doctors and other health care professionals in their treatment to patients. Health care and medical science will come to a halt. Worse, patients’ well being and safety becomes at stake!

          If the motive behind such an amendment is to curb the “controlling” power of health care professionals in health care service, then it has gone too far! In the final event, legislators’ wisdom prevails and the amendment was defeated yet not without significant support.

          The implication are wide ranging. Professions from whatever disciplines must take heed lest the ill effects of non-professionals leading professionals even in their exercise of professional duties are not too far away!

          The presence of professionals being controlled by non-professionals are not unknown in the health care field, and they have demonstrated their obvious deleterious side effects.

          Take the pharmacist profession as an example. The common arrangement in a dispensary is that a businessman is a licensee and he hires a pharmacist as a responsible person. Many drugs can only be sold across the counter under registered medical practitioners’ prescription. The pharmacist will no doubt adhere to this to the letter, for any non-compliance lands him in a disciplinary hearing of his own professional council with the danger not only of a heavy fine, but also his registration suspended.

          Yet, there are incidents, and not too few, that the businessman will sell these prescribed drugs illegally when the pharmacist turns his back. Worse, many face threats to dispense illegally or lose their jobs. Such practice accounts for the easy access and thereby the rampant use of “soft drugs” amongst our public, especially the young, that this society can do without.

          Regrettably, Government and politicians have still not learnt a lesson. In the Human Reproductive Technology Bill, which is currently scrutinised by the legislators, the concept is to register all institutes that perform reproductive technologies, monitoring and regulating their procedures. Ironically, this bill insists that the licence holder and the responsible person be two separated persons, with the later obviously a professional and the former possibly a commercial orientated personnel. The saga of the pharmacist and his dispensary boss will repeat itself.

          Yet, professional autonomy should never be interpreted as ignoring the public nor the society. Instead, in these days of open society, every degree of transparency should be introduced into professional operations to ensure that fairness is not only done, but seen to be done! Public scrutiny  and monitoring is essential. But in a professional service, public control may well be deleterious. It is erroneous to conceive that the professionals and the public are oppositions. They are not, and in the health care field, they all aim to produce a healthy society!

(Hongkong Standard)