Health Professions: A Brief History of the Health Professions

Just as the history of mankind is accompanied by illness, birth and death, the healing profession is also one of the oldest of all. Also malpractice and legal disputes do not seem to belong only to the everyday life of the modern age – the first systematically sorted legal sets of rules known to us included also regulations to the welfare, above all physician occupation: The nearly 4000 year old collection of Babylonian right, the well-known Codex Hammurapi, contains e.g. remarks to fee regulations and liability questions.

Between authorizations and prohibitions

In the Middle Ages, in addition to the physician, the pharmacist and the midwife also found their way into the legal professional regulations: Statements on duties of assistance and on the fee, regulations in the case of complications and on the duty of confidentiality, instructions on examination regulations. Many of these regulations are still valid today. In the middle of the 16th century, the foundation was laid for the profession of non-medical practitioner: The practice of medicine by laypersons was regulated by law for the first time. Over the next centuries, there was a constant alternation between so-called courier freedom and courier prohibition, not infrequently motivated by individual occupational groups to secure their own status or to limit regimentation.

Courier freedom means that anyone may practice the healing art without a license or proof of training, as long as no one is harmed.

Active courier freedom means a ban on practicing the healing arts without proper training, while passive courier freedom prohibits those seeking healing from being treated by a layperson. In 1869, freedom of couriers was introduced, so that only those who wanted to use a specific title such as doctor or pharmacist needed a special license (Approbation); anyone was allowed to treat. As a result, the number of lay practitioners increased sharply and did not stagnate until the introduction of health insurance, which only covered the costs of treatment provided by a doctor or ordered by a doctor.

Heilpraktikergesetz

Then in 1939, the Heilpraktikergesetz (which in principle still applies today) again abolished the freedom to cure. The plan was to completely dismantle the Heilpraktiker profession with this over a period of time. Both already practicing non-medical practitioners and new aspirants could only obtain a license to practice after verifying their knowledge; new aspirants were not to be licensed at all. In the 1950s, it was determined that the bar on admission to the profession was not compatible with the right to free practice of the profession, and it was abolished. Since then, anyone who meets the requirements can obtain a Heilpraktiker license in Germany.

In Germany, the professional titles are protected and only a few healing professions (such as physicians, non-medical practitioners, psychotherapists, physiotherapists, midwives) are allowed by law to make diagnoses and carry out healing treatments; all others are only allowed to act in an advisory capacity. However, the title “therapist” is not protected, so it can also be used by people with insufficient or unprofessional training who are not authorized to provide treatment. However, the days of passive courier prohibition are over – each patient may decide for himself by whom and how he wants to be treated.