The hospital doctor in legislation and medical deontology: tension between profession and institution.
1. Every health policy should make clear the organization of its offer of care; also, more particularly, the role of the individual professionals and their groups, as well as the role of the services and institutions, all within the chosen private, public or mixed framework. 2. Both in public law and in private law as well as in deontology, clear rules will have to be formulated concerning the relationship of doctor-patient and institution-patient; therefore also concerning the relationship of hospital-doctor. 3. It is evident that the lack of clarity frequently encountered in the Belgian and many other national legal systems with respect to these matters is unfortunately also reflected in international health law. 4. The issue of the legal relationships in the patient-doctor-hospital triangle should no longer be delayed until the catastrophic moment when medical liability should be considered. 5. Can we indeed speak of integral quality of a hospital, when it is anything but clear whether it concerns a single integrated enterprise or a roof under which two or more enterprises or entrepreneurs organize their own separate services to the clients? 6. Although the decision is a societal matter, the organisations of institutions and professionals should (continue to) play an important role in the preparation of this debate, which must bring the necessary clarity to the present relations and preferably also about the future options with respect to these relations. 7. A fundamental question, which remains to be solved for the future health policy, appears to be whether hospitals can be integrated institutions and, in the affirmative, whether they should be so. 8. The law, with priority to deontology, should formulate basic rules to clarify all possibilities in the patient-hospital-doctor triangle relationship--which is evolving into a polygon through fusion and group practices--and especially to trace out the consequences of health policy options with regard to the integrated hospital formula, also for patients, and to enhance its chances of success. 9. Will the professionals succeed in convincing the hospital responsibles that the integrated hospital itself is already a far too traditional construction to offer a valuable answer to the future needs of the patients?
K.U.Leuven, Belgium.
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Schutyser
D001530:Belgium; D004992:Ethics, Medical; D005060:Europe; D006291:Health Policy; D018578:Hospital-Physician Relations; D006801:Humans; D016365:Liability, Legal; D010344:Patient Advocacy / Q000331:legislation & jurisprudence*; D010817:Physician-Patient Relations