Untitled

Abstract

This paper reviews the concept of professional autonomy from an historical perspective. It became formalised in the United Kingdom only after a long struggle throughout most of the nineteenth century. In its pure form professional autonomy implies unlimited powers to undertake medical investigations and to prescribe treatment, irrespective of cost. Doctors alone should determine the quality of care and the levels of remuneration to which they should be entitled. In the second half of the twentieth century a steady erosion of professional autonomy occurred in the United Kingdom. The level of remuneration has been restricted for most doctors for nearly fifty years, whilst the costs of health care have steadily reduced the doctor's ability to provide unrestricted care within the health care system. Reorganisation of the National Health Service in 1983 and 1991 has substantially eroded professional autonomy, to the point where research developments, clinical judgement and ethical standards are all now being placed at risk.

Performance of the local health system and contingent influences in Northeast-Brazil: breaking vicious and virtuous circles

“…Thirdly, much of medical sociology has provided a critique of the autonomy and culture of medical professionals both on systems management grounds such as cost containment [43-45] and on moral or ethical grounds with respect to vested interests [46,47]. The results here indicate an alternative viewpoint.…”

Professional Archetype Change: The Effects of Restricted Professional Autonomy

“…Another way of understanding professional autonomy in the literature is to tease out some separate elements of the concept. For instance, Horner (2000) describes professional autonomy as consisting of three aspects: (1) the ability to make and exercise decisions, (2) the ability to determine and judge the quality of professional work, and (3) the ability to value one's own work and determine an appropriate level of remuneration. A similar example can be found in Schulz and Harrison's (1986) division of the content, terms and conditions of work into clinical, economic and political autonomy.…”

“…Finally, political autonomy involves the ability to make policy decisions and control the conditions of professional practice, such as location and hours. Although these three dimensions can be described as interrelated, variations can emerge over time and among professions in different countries in terms of the extent to which autonomy is experienced along these three dimensions and the extent to which they are affected by different reforms (Horner, 2000;Randall and Williams, 2009;Schulz and Harrison, 1986).…”

The Politics of Medical Curriculum Accreditation

“…In focusing on the medical profession, he identified that the professionalization effort that started in the early 18 th century could best be characterised by precisely these parameters: autonomy, authority, and state-sanctioned altruism. Horner (2000) describes the importance attributed in the profession to the successful attainment of such autonomy (the "freedom to control the process of recruitment, training and practices, and control over the conduct of individual members, who each enjoy the right of clinical autonomy"). This is explicitly still endorsed for some European countries (Jochemsen & Ten Have, 2000) but refuted on moral, economic and ethical grounds by Dupuis (2000).…”