An Osaka tattoo artist was found guilty Wednesday of violating the Medical Practitioners’ Law in a case that drew international attention to Japan’s tattoo culture.

Osaka District Court Judge Takaaki Nagase ruled that tattoo artist Taiki Masuda, based in Suita, Osaka Prefecture, had violated the law when he drew tattoos on three individuals in 2014 and 2015, because the use of a tattoo needle was a form of medical work and not, as Masuda had insisted, a form of art and self-expression.

“With tattoo treatment, medical knowledge and skills are indispensable in order to sufficiently understand the dangers and carry out sufficient judgments and measures,” the ruling said. “Therefore, unless carried out by a doctor, there is a danger to health and no guarantee of sanitation, making this a medical activity.”

The ruling leaves questions over the fate of other similar establishments.

Masuda told reporters after the ruling that he planned to appeal the decision.

“I do not accept this ruling. I’m practicing art and tattooing is a part of traditional Japanese culture,” he said.

The case came about after Masuda decided to appeal an earlier order by the Osaka Summary Court to pay a fine of ¥300,000 for violating the Medical Practitioners’ Law, which forbids anyone other than licensed doctors from engaging in “medical practices.”

A 2001 notice issued by the Health, Labor, and Welfare Ministry said that, as there was a danger due in terms of public health and sanitation, tattooing, laser hair removal and chemical peel treatments can only be carried out by licensed doctors.

Masuda, however, argued that they were a form of self-expression and that denying him the right to operate a tattoo parlor violated Articles 13, 21, and 22 of the Constitution.

Article 13 guarantees that people shall be respected as individuals and that their right to life, liberty, and the pursuit of happiness shall, to the extent that it does not interfere with the public welfare, receive supreme consideration in legislation. Article 21 guarantees freedom of speech and all forms of expression and Article 22 gives all the right to choose their occupation to the extent that it does not interfere with the public welfare.

The court rejected his claims that the Medical Practitioners’ Law violated Article 22 while saying that placing a tattoo on someone else was a dangerous activity not within the bounds of Article 21, though putting a tattoo on your body was.

The court also said that it was logical to have a license for tattooing, when considering the health and sanitation aspects, and therefore not in violation of Article 13.

The ruling ordered Masuda to pay only a ¥150,000 fine, half the original ¥300,000 levy. His legal team was unsure of the exact reason for the decision, although the ruling did note that Masuda made efforts to preserve the health and sanitation of his shop so perhaps the judge had decided to take a lenient approach.

However, Michiko Kameishi, one of Masuda’s chief lawyers, added that any fine was of concern.

“The point is not whether he had to pay even ¥10,000 but that the ruling was unfair. He shouldn’t have had to pay anything,” Kameishi said.