Move to change Medical Council will undermine autonomy of Hong Kong doctors
Professional autonomy in Hong Kong is founded on the provisions in Article 142 of the Basic Law. It states that the government “shall, on the basis of maintaining the previous systems concerning the professions, formulate provisions on its own for assessing the qualifications for practice in the various professions”. It also states that the government “shall continue to recognise the professions and the professional organisations recognised prior to the establishment of the [special administrative] region, and these organisations may, on their own, assess and confer professional qualifications”.
Three elements are important, namely the maintenance of the system prior to the establishment of the Hong Kong Special Administrative Region on July 1, 1997; the pledge to continue to recognise the professions and professional organisations recognised before that date; and to let these professional organisations assess and confer professional qualifications.
The Medical Council of Hong Kong is one such professional organisation.
There are 28 members in the council, of which four are lay members, with doctors composing the rest. Of all its members, half are appointed by the chief executive of Hong Kong, and the rest elected from among doctors.
Elected members are responsible to their electorate, who, as doctors, are in turn responsible to their patients: a deep-rooted ethical doctrine enshrined in the Hippocratic Oath and other historic declarations. Such responsibility to the electorate is not automatic from members appointed by the government, except out of personal goodwill. The collective voice of the profession therefore hinges on a 1:1 ratio of appointed to elected membership in the Medical Council.
There have been calls to increase lay representation in the council. Last November, a private bill by a lawmaker called for an increase in lay members from four to eight, pushing the ratio of lay/doctor membership from 1:6 to 1:3. The bill was subsequently withdrawn when the government pledged to absorb the proposal into its own blueprint, which it announced this month (“Doctors’ leader cautious over more lay members on Medical Council”, January 13).
The government’s move to increase four lay members will effectively tip the balance and give the government a decisive majority in the Medical Council. That will be an unfortunate fallback into autocracy from professional autonomy. Any hope that the ruling class might eventually nurture the slightest trust in the people might disappear into thin air. Autonomy is going down the drain.
Dr David T. Y. Lam, honorary secretary, Hong Kong Medical Association