Etat des lieux de l'homéopathie en Belgique - KCE

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76 Homeopathy KCE Reports 154 These are acts that entail a substantial risk for the health of the patient if they are not carried out by a competent therapist (particularly surgery, obstetrics and anaesthesia). However a diagnosis can be performed by anyone. The freedom to practice medicine is offset by a penal counterweight: any person that harm’s the health of another is punishable under the BIG law. 5.2.2.2 The BIG law The BIG law is partially a framework law. The main points governed by this law are registration of constitution and protection of certificates, the reserved acts (including the associated mission), disciplinary law and criminal law, specialities and the accreditation of foreign diplomas. Many of the modalities have to be finalised by ‘general administration measures’ (executory decisions), such as the training requirements, the fields of specialisation and the periodic registration system, as well as quality criteria. The legislation also entrusts a large number of issues to self-regulation by professional associations, within the framework defined by the law, such as the introduction of specialities 100 . Because Dutch law has also opted (partially) for a framework law, its implementation is subject to executory decisions. In the Netherlands this approach has also been onerous and has also been staggered over several years. The principle of the BIG law is based on the registration of professional certificates and training certificates, with a fundamental distinction between two categories. The first category is that of ‘heavy regulation’ (literal translation) and covers doctors, dentists, psychologists, psychotherapists, physiotherapists, obstetricians and nurses (article 3). For each of these professions, the BIG law governs the level of competence and the requirements in terms of training. The BIG law also contains provisions governing the introduction of specialities, in close consultation with the representative professional organisations. The second category is that of ‘light regulation’, which applies to the paramedical professions, based on the principle that training must satisfy quality criteria (article 34). Only people that have followed successfully the training imposed or recommended by the minister can use the certificate issued after such training 101 . The legal authorisation to hold a certificate protected by the law is granted via a substantive registration, which also acts as protection of the certificate under the ‘heavy regulation’ of the professions mentioned in article 3, and via protection of the training certificate under the ‘light regulation’ mentioned in article 34. The fact of having successfully completed the required training gives the right to inscription in the BIG register (comparable to the INAMI in Belgium) under the terms of article 3 or, for the protection of the training certificate, under article 34. Inscription in the article 3 register authorises the person that followed the training to hold the related certificate. The training certificate for the professions in article 34 is protected and can be used without prior registration. Non-registered persons are not authorised to hold the certificate. The illegitimate use of a protected certificate or a similar title is punishable by law 100 . A corollary of inscription in the BIG register is the authorisation to evolve independently in the field of reserved acts, provided that such acts are considered by the law to form part of the profession in question. Inscription is also equivalent to formal recognition of the competence of the person in the domain specific to the profession (or specialisation). The fields of competence are described for each group of professions, which gives particular importance to the issue of public information. The field of competence also intervenes in disciplinary law (which only applies to therapists registered in the context of article which does not allow the practitioners of an ‘article 34’ profession to evade the legal obligation to provide suitable care) and the penal provisions. The respective fields of competence of doctors, dentists, pharmacists and nurses are described briefly in the BIG law. For the other ‘article 3’ professions and for the ‘article 34’ professions, the field of competence is governed by the executory decisions, taking into account the fact that these fields are less fixed and more likely to evolve. The authorisation to perform reserved acts is the legal restriction in relation to the professional practice of competent persons.
KCE Reports 154 Homeopathy 77 The competence to perform reserved acts can be used independently in practice, provided that the competence was acquired by experience. If a person is authorised, but not competent, to perform reserved acts, that person can give a prescription for the treatment. Assessment of competence is entrusted to the practitioner of the profession in question, or to the professional association 100 . 5.2.2.3 Evaluation of the BIG law As for alternative medicine, Dutch legislation has adopted the principle of self-regulation for improving healthcare quality and public information by alternative practitioners. The practitioners of alternative medicine are not covered by the BIG law and have no official recognition. There is no registration mechanism for alternative medicines 91 . Because of the BIG law, the position in society of the associations representing alternative medicines has considerably changed in several ways, especially with the disappearance of the concept of the unauthorised practice of medicine. Moreover, the BIG law governs exclusively what the law terms ‘qualified persons’, tipping the scale too far in the direction of freedom of choice for citizens, to the detriment of safety. In addition, control by public bodies of non-conventional (alternative) practitioners is considered inadequate and the public ministry would not sufficiently pursue litigation. Other criticisms: the penal sanctions are considered to be too heavy, the plaintiff is not sufficiently protected and the quality of care is too dependent on the approach chosen by the professional association 100 . Many criticisms have also been levelled against the attitude of the public authorities, which are more or less neutral concerning alternative medicine. Some believe that the public authorities should draw up without delay a specific policy concerning the alternative professions mentioned in article 34. This would provide sufficient clarity in the meantime concerning the criteria to be used 100 . Key points: the situation in the Netherlands • In principle the BIG allows anyone to provide medical care, with the exception of certain ‘reserved’ acts that can only be performed by the professional practitioners authorised by the BIG law. • The BIG law is partially a framework law which governs various important matters. Many other modalities are nevertheless left to self-regulation by the professional organisations. • The BIG law is based on the principle of registration of professional certificates and training certificates, and makes a distinction between two categories, each subject to specific rules. 5.2.3 France 5.2.3.1 General As in Belgium, French law considers only qualified doctors that can practice medicine. As a result, the exercise of alternative treatments is reserved for doctors, which has led to a paradox in France, where certain doctors that only have a fragmentary knowledge of alternative treatments are authorised to use them, while these practices are prohibited for non-doctors that have followed proper training in alternative therapies. If this prohibition is flouted, non-doctors are open to litigation. 100 Notwithstanding these principles, France shows a degree of tolerance, as we shall see below.
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