Physicians and professional autonomy.

154 JMAJ, May / June 2014—Vol.57, No.3 1. What constitutes the exact definition and concepts of the term profession is not clear. In Europe, where the word profession was born, clergy, physicians, and attorneys have been traditionally referred to as the 3 major professions. Here, I would like to state the fundamental features of profession bearing in mind the latter two in particular: physicians and attorneys. (Please note that many of the following statements are based on The Profession of the Modern Times [Ishimura 1969].1) The fundamental features of a profession are as follows: (1) Advanced knowledge and skills The first characteristic is that people in a profession have a certain systematic knowledge and professional skills (i.e., professionality) that are substantiated by scientific, historical, and other academic principles, and often require long-term education and training to master. (2) Recognition of qualification and privileges by state Secondly, the usefulness of physicians and attorneys has been approved both historically and socially. The government approves their licenses through public qualification exams and other means, provides privileges, and legally prohibits those who are not qualified from performing the acts of professionals. (3) Non-profitability Thirdly, the aim of physicians or attorneys is to contribute to the benefit of the general society by providing necessary services that clients demand. This feature distinguishes physicians and attorneys from the commercial activities and business transactions with its primary objective to seek profits. (Please refer to Article 1 of the Medical Practitioners’ Act and Article 1 of the Attorney Act.) (4) Activities as professional organizations The fourth feature is that physicians and attorneys have professional organizations in order to function expeditiously. To be acknowledged by society as a professional and to gain, maintain, and further develop their social status, it is considered a necessity for physicians or attorneys to form professional organizations and perform useful activities. These organizations share certain characteristics, such as: 1) carrying out political and social activities to gain approval from the society as professionals; 2) bearing the essential responsibility to educate, train, maintain, and improve the members’ skills as professionals; and 3) setting up regulations for members’ behaviors and serving as an entity of ethical autonomy by providing disciplinary punishments for members’ misconducts as needed. These are the fundamental features of a profession. All 4 features relate to the theme of this paper, professional autonomy. However, the last feature, activities as professional organizations, is particularly pertinent, and I will later describe them in more details. 2. The term of professional autonomy. The first question is what autonomy means. Autonomy in English is translated as “self-discipline” or “jiritsu” in Japanese. In its common use, autonomy means to proactively regulate one’s behavior or to behave according to one’s established standards, and not based on external governance or control. In the field of philosophy, it is the term that conPhysicians and Professional Autonomy