Madam, - Your Editorial of July 19th addressed the published heads of the Medical Practitioners Bill 2006. Your concentration on the disciplinary aspects of this proposed legislation was understandable, given public concerns expressed during the recent scandal at Our Lady of Lourdes Hospital in Drogheda. In addition to that important function however, the council will also be responsible for: specifying and approving courses of medical education and specialist training; standards of competence; criteria for registration, which would include assessing overseas educational qualifications; skills and attributes required of medical practitioners; setting ethical standards.
However, close reading of the proposals gives rise to deeper concerns that the Tánaiste and Minister for Health and Children is pursuing another agenda.
Autonomy and self-regulation define a profession. The World Medical Association Declaration of Madrid 1987, revised in 2005, states: "The central element of professional autonomy is the assurance that individual physicians have the freedom to exercise their professional judgment in the treatment of their patients.
As a corollary to professional autonomy the medical profession has a continuing responsibility to be self-regulating. In addition to any other source of regulation that may be applied to individual physicians, the medical profession itself must be responsible for regulating the professional conduct and activities of individual physicians."
The recent World Health Organisation review of the "Regulation and Licensing of Physicians in the WHO European region (2005)" found: "Currently there does not seem to be general concern about this arrangement, and it is difficult to see why the medical profession should be singled out as the only profession in which this principle should be challenged in relation to standards of performance, which are largely established by the medical profession itself to safeguard the public interest."
The degree of ministerial and political control of the Medical Council envisaged by Ms Harney can be surmised by reviewing a series of quotations from the Heads of the Bill:
"The Minister may give general policy directions to the Council. . .and the Council shall comply with any such directions."
"'The Council. . .shall prepare a statement of strategy. . .within six months of commencement or appointment of a new Minister. . in a form and manner in accordance with directions issued by the Minister. . .having regard to the policies of the Government."
"The Council shall consist of 25 members appointed by the Minister. . .if the Council fails or refuses to perform any function assigned to it under the act the Minister may instruct the Council to discharge that function. . . The Minister may remove all members of the Council from office if the Council does not comply with a direction of the Minister. . ."
The anaemia referred to in your Editorial, Madam, is evident only in the lack of explicit and clear implementation of Judge Harding Clarke's recommendations for a statutory competence assurance structure and revalidation procedures, which the previous council has been calling for since 1991, as has this association. A council of ministerial appoint- ees will not have the confidence of the 17,000 medical professionals and, I suspect, the public which it is supposed to serve.
The Medical Council has served the public well since its inception. Its calls for greater statutory power and a proactive role in competence assurance have been diluted in this Minister's bid to devalue the profession of medicine by making it responsible to a largely politically appointed body.
The doctor-patient relationship in particular cannot be dictated by the "policy of a Government". That was not an allowable defence in Nuremberg, nor is it today! - Yours, etc,
Dr DAVID O'KEEFFE, Vice President, Irish Hospital Consultants Association, Dundrum, Dublin 14.