의료 전문직의 자율성과 자율성 확보를 위한 실천 방안*

Physician autonomy and medical professionalism have been changing ever since the patient-physician medical relationship was changed to patient-physician-third-party payer medical relationships. Until now, physician autonomy has meant that physicians should have complete freedom to provide the best treatments for their patients, without external constraints, but ever since medical insurance was introduced, medical decisions have been controlled by the third-party payers, and many conflicts have emerged in the patient-physician-third-party payer medical relationships. The concept of physician autonomy thus has to be changed. That is, the society should respect the rational and deliberated decisions of the physicians to resolve the conflicts between their patients and the third-party payers beyond the obligation of beneficence towards the patients. To mediate between their patients and the third-party payers, the physicians should carry out two roles - as healer and as manager - and should adjust the different applicable principles, such as patient autonomy, beneficence, and justice. The physicians have to be well acquainted with such principles and should make the appropriate decisions so as to gain social trust. To help resolve the conflicts between the patients and the third-party payers, the physicians should effectively carry out their roles as healer and manager by considering evidence-based practice, the treatment goal, and cost-effectiveness in their clinical practice. These criteria can help the physicians make reasonable and well-deliberated decisions in relation to their just provision of medical care for their individual patients.