In 2000, Burma’s military government passed the Medical Council Law, replacing the previous Burma Medical Act of 1957 and setting up the Myanmar Medical Council, which represents medical practitioners.
However, related by-laws are yet to be enacted more than 10 years later, drawing the criticism that medical council members are not free to act. Calls for an independent medical council have become louder as the country has entered “democratic transition.” Now, the military-backed government has put a draft of the medical council by-law on the table. I’ll discuss whether or not this by-law grants the medical council complete autonomy.
On comparison, the old and new medical council laws are not very different. Section 4(a) of the medical council draft says, “Myanmar Medical Council is an independent organization.” The phrase sounds great, but then Section 4(b) was inserted to limit the council’s freedom. Section 4(b) says the medical council is responsible to the government through the Ministry of Health. How can an organization responsible to the government be independent? It has to dance to the government’s tune.
An association leading the medical world has to be accountable only to those engaged in medicine and patients. It does not need to be accountable to the government. In the past, the lack of the by-law was used as an excuse by the government to restrict the old council. Now, the council has been authorized to draft the by-law. But this is just on the surface. Section 61 reads: “The council may enact necessary by-laws and procedures with the government’s approval.”
To report to the government means restriction, in other words it is saying: “You can’t do it by yourself.” If the government does not agree, the by-law may not come out. To form an independent medical council, Section 4(b) must be annulled and Section 61 must be amended. As long as the medical council is not free, universities of medicine will not have autonomy.
What is worse in the new law is that the health minister takes one of the three patron positions in the Myanmar Medical Council, which even the old law did not provide. The three patrons will appoint medical council members, according to Section 6. It is clearly against democratic practice since council members will not be elected by medical practitioners. This section will allow directors-general of the Health Ministry and heads of region/state health departments will automatically become medical council members. So, it is clear that the medical council will be under the thumb of the government. Rectors of medical universities and all the other medical professors are government staff. (This is not strange because the old law provided the same. It is estimated that there will be at least 77 council members, according to the new law.) However, public health professors, pathologists and psychiatrists are not included in the council. Seasoned medical practitioners devoting themselves to public health care service delivery should be included in the council.
The provision (in the new law) that “one representative each from respective region/state must be elected,” was also in the old law. However, representatives were never elected. Since the new law includes the same provision, it is expected that the same thing will happen again. Though seven retired seasoned medical practitioners are included in the medical council, young medics are neglected. A young medic aged between 30 and 35 can’t become a member in the medical council. I wish young, active medics were also included in the medical council, as well as the seasoned ones.
Looking at the council’s structure, it seems that only those that are willing to dance to the tune of the government and top-ranking officials will be appointed to the council. Since the retired medical practitioners who are used to doing what they are told by the military government are now in Parliament as representatives of the Union Solidarity and Development Party, I do not think the enactment of medical council law will bring significant changes to the medical world. The aim of the new health security law—to ensure each and every citizen residing in the country has access to quality, effective and safe health care services—sounds great. The new law enshrines the word “health security.” But, there is no provision regarding patients’ rights and protection of patients.
With regards to the right to sue medical practitioners, Section 56 says: “If the patient suffers even though the medic treats him/her for the sake of him/her with honest intention, the medic cannot be sued either under civil or criminal laws.” Here, “honest intention” and “for the sake of” must be defined clearly. There can be cases of medical research on patients and medical paternalism by abusing this section. Patients can be victimized by medics as medical guinea pigs. The potential to abuse this section needs to be taken into consideration. In fact, the law should enshrine provisions for patients to be able to report malpractice that results in suffering.
One good thing, however, is that in the past, if a government staff medic refused to discharge their duty in remote places, the government terminated his or her medical practitioner license, but now, this provision is revoked. I welcome that.
The major responsibility of the medical council is to issue medical practitioner licenses to those who graduate from government-recognized medical universities, as well as to revoke licenses. In fact, the number of those currently giving medical treatment without a medical practitioner license is greater than that of medical practitioners. Quacks, quack acupuncturists, quack traditional medicine practitioners, quack healers, those giving medical treatment after attending a three-month pharmacological course, and pharmacy owners selling over-the-counter medicine have no medical practitioner license. So there is a question—should legal actions be taken against them under this law?
In fact, these cases must be punished severely. Only then can there be safe health care delivery. How can these cases be prevented? Shall the medical council take actions against them? I find no particular provision protecting patients in the entire law. Far from it; it seems to restrict licensed medical practitioners.
Again, there is another case—the problem of fake medical degrees. The medical council is said to be responsible for scrutinizing and affirming international medical degrees. Between 2000 and 2014, I have not seen the medical council announcing which degrees it recognizes and which it does not. So, some physicians who have not gained Fellowship of the Royal College of Surgeons (FRCS) pay membership fees of US$200 and apply for FRCS membership. Then, they put FRCS after their names to mislead people into believing that they hold FRCS degrees. Whether action shall be taken against them under the new law is also a question.
According to the new law, the Myanmar Medical Council is responsible to the government. Again, old council-member medical practitioners are likely to remain in the council under the new law and I therefore do not expect that the new law will totally change the medical world. Mainly, provisions regarding protection of patients and the entire medical world need to be enshrined in the new law. As “medicine” is defined as the “subject related to all health care services,” there should not be a separate traditional medicine council, but it should be under the umbrella of Myanmar Medical Council. Other specialist boards should also be formed.
We have to wait and see what announcements the new medical council will make. The current draft law is not much different from the old law. The autonomy granted to the council is a sham. If the medical council is to have autonomy, the Medical Council Law must be drafted under the leadership of medics, like journalists have taken the lead role in designing the new Media Law. The drafting process must also involve patients’ representatives, lawyers, traditional medicine practitioners and specialists.
The medical council, in order to set an example in practising medical professionalism, has to be responsible to all medics and patients. The council needs to take actions against or report practising medicine without medical practitioner license. The medical council is responsible for protecting the medical world and patients. Patients themselves need to know where they can report to if they suffer.
There are consumer protection associations and the medical council needs to set up patient protection associations. As the draft law doesn’t grant the Myanmar Medical Council complete autonomy, whether the council can really protect medical practitioners and patients and promote the medical world is in question.
Dr Myint Oo (GP) is the author of “medical ethics,” which won the Tun Foundation literary award. He has contributed more than 400 articles on health education. He currently works as an adjunct assistant professor at Public Health and Community Medicine Department, Tufts University School of Medicine in Boston, United States, giving lectures on medical ethnics, health and human rights.