University of Minnesota

World Medical Association, Declaration of Madrid on Professional Autonomy and Self-Regulation (1987).

Adopted by the 39th World Medical Assembly
Madrid, Spain, October 1987


The World Medical Association, Inc., having explored the importance of professional autonomy and self-regulation of the medical profession around the world, and recognizing the problems and the current challenges to professional autonomy and self-regulation, hereby adopts the following Declaration:
1. The central element of professional autonomy is the assurance that individual physicians have the freedom to exercise their professional judgement in the care and treatment of their patients, as set out more fully in the World Medical Association Declaration on Physician Independence and Professional Freedom, adopted in October 1986 (See document 17.O).
2. The World Medical Association and its National Medical Associations re-affirm the importance of professional autonomy as an essential component of high quality medical care and therefore a benefit due to the patient that must be preserved. The World Medical Association and its National Medical Associations therefore re-dedicate themselves to maintaining and assuring the continuation of professional autonomy in the care of patients which is an essential principle of ethics.
3. As a corollary to the right of 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.
4. The World Medical Association urges its National Medical Associations to establish, maintain and actively participate in a system of self-regulation for the physicians in their respective countries. It is this dedication to effective self-regulation that will ultimately assure professional autonomy in patient care decisions.
5. The quality of the care provided to patients and the competency of the physician providing that care must always be a primary concern in any system of self-regulation. Physicians have the expertise to make the necessary evaluations. These evaluations must be used for the benefit of patients to assure them continued quality care by competent physicians. Included in this area of responsibility is the need to monitor advances in scientific medicine and the use of therapeutic regimens that are safe and effective. Experimental procedures must comply with the protections required by the World Medical Association Declaration of Helsinki and other protections as may be required in each country. Discredited scientific theories must not be used on patients.
6. Cost consciousness is an essential element of self-regulation. The highest quality of care can be justified only by assurances that the cost of such care will allow access to that care for all citizens. Again, physicians are particularly qualified to make the evaluations that are necessary for cost containment decisions. National Medical Associations must, therefore, include cost containment activities in their respective system of self-regulation. Common issues in cost containment activities relate to methods of delivery of medical care, access to hospital and surgery, and the appropriate use of technology. Cost containment activities must not be used to deny patients needing access to necessary medical care. Nor should over-utilization of medical facilities be permitted to drive the cost of medical care upwards so that it will not be available to all who may need the particular care.
7. Finally, the professional activities and the conduct of physicians must always be within the bounds of the professional code of ethics or the principles of medical ethics governing physicians in each country. National Medical Associations must promote ethical conduct among physicians for the benefit of their patients. Ethical violations must be promptly corrected, and the physicians guilty of ethical violations must be disciplined and rehabilitated. This is a responsibility that only National Medical Associations can undertake and perform effectively and efficiently.
8. There are, of course, many other areas of self-regulation for which National Medical Associations must take responsibility. National Medical Associations are urged to assist each other in coping with new and developing problems. The exchange of information and experiences between National Medical Associations is encouraged and the World Medical Association will assist in facilitating this exchange of information to improve self-regulation.
9. The World Medical Association and its National Medical Associations must also educate the public generally as to the existence of an effective and responsible system of self-regulation by the medical profession in each country. The public must come to recognise that it can rely on this system of self-regulation for an honest and objective evaluation of the issues relating to the practice of medicine and the care and treatment of patients.
10. The collective action by the National Medical Association in assuming responsibility for implementing a system of professional self-regulation will enhance and assure the individual physician's right to treat patients without interference with his or her professional judgement and discretion. Responsible professional conduct by individual physicians and an effective and efficient system of self-regulation by the National Medical Association are necessary to assure the public that when they are patients they will receive quality medical care provided by competent physicians.

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