• In France the case of Vincent Humbert, a young man severely injured in a road accident, elicited widespread public and professional discussion about whether euthanasia is morally acceptable and should be legal in such situations.
  
• In Korea, two cases of euthanasia were reported in the media during October.
  
• In May Columbia's Constitutional Court ruled that no person can be held criminally responsible for taking the life of a terminally ill patient who has given clear authorization to do so. Since the ruling directly contradicts current law, the court directed the country's Congress to develop procedures to 'regulate' the practice of euthanasia, leaving it up to the legislators to determine how the terminally ill who want to die may express their consent and how they should be killed.
  
• In September the Social, Health and Family Affairs Committee of the Council of Europe Parliamentary Assembly released a report on euthanasia that asks the Governments of the member states "to collect and analyse empirical evidence about end-of-life decisions, to promote public discussion of such evidence, to promote comparative analysis of such evidence in the framework of the council of Europe, and, in the light of such evidence and public discussion, to consider whether enabling legislation should be envisaged." The Committee on Legal Affairs and Human Rights subsequently issued a critical opinion on this report .
  

The WMA's position on euthanasia and assisted suicide in unequivocal. Its 1987 statement reads as follows; "Euthanasia, that is the act of deliberately ending the life of a patient, even at the patient's own request or at the request of close relatives, is unethical. This does not prevent the physician from respecting the desire of a patient to allow the natural process of death to follow its course in the terminal phase of sickness." This policy, and the 1992 statement opposing physician-assisted suicide, were reaffirmed in a resolution adopted at the Washington, DC Assembly in 2002.

In response to a report that the Code of Ethics for Belgian physicians might be changed to require participation in euthanasia, if only by referring a patient to another physician willing to perform euthanasia, the WMA Council at its May 2003 meeting passed a resolution on the relation of law and ethics that states:

1. Ethical values and legal principles are usually closely related, but ethical obligations typically exceed legal duties. In some cases, the law mandates unethical conduct. The fact that a physician has complied with the law does not necessarily mean that the physician acted ethically.
   
2. When law is in conflict with medical ethics, physicians should work to change the law. In circumstances of such conflict, ethical responsibilities supersede legal obligations.
   

November 2003 - International Recruitment of Physicians and Other Health Professionals

Meeting in Helsinki, Finland from 10-14 September 2003, the WMA General Assembly adopted a new policy statement on Ethical Guidelines for the International Recruitment of Physicians. With this statement the WMA joins with other international organizations that have expressed concern about the detrimental effects on health care in exporting countries caused by the loss of their health professionals to other countries. For example:

WONCA (World Organization of Family Doctors): THE MELBOURNE MANIFESTO: A Code of Practice for the International Recruitment of Health Care Professional, May 2002
http://www.globalfamilydoctor.com/aboutWonca/working_groups/rural_training/melbourne_manifesto.htm

Commonwealth Health Ministers: Commonwealth Code of Practice for the International Recruitment of Health Workers, May 2003
http://www.thecommonwealth.org/docs/health/CommonwealthCodeofPractice.pdf

As its title indicates, the WMA statement focuses on the ethical principles that should govern the recruitment of physicians from one country to another: justice, co-operation and autonomy. Although the application of these principles depends on particular circumstances, which can differ from one location to another, there are some rules that apply in all situations, for example:

• Justice requires that each country do its utmost to produce and retain an adequate number of physicians to meet the needs of its citizens and that physicians be treated fairly by their own national health authorities, by international recruiters and by host countries;
  
• Co-operation requires that countries that recruit physicians from other countries first reach an agreement regarding the terms and conditions of such recruitment; the WMA statement recommends that this agreement be formalized in a Memorandum of Understanding;
  
• Autonomy requires that physicians not be prevented from leaving their home or adopted country to pursue career opportunities in another country and that they receive full and accurate information on all aspects of their potential employment in the other country.
  

The WMA encourages all parties involved in the international recruitment of physicians and other health professionals to recognize and implement these principles. We invite readers to inform us of actions on the part of governments and recruiters that reflect adherence to these principles so that we can publicize best practices in this area. We would also appreciate receiving reports of flagrant violations of the principles so that we can suggest appropriate remedial action.

Contact: williams@wma.net