Medical ethics has a long history of dealing with the conduct of physicians during outbreaks of infectious diseases. When plague struck in the Middle Ages, physicians were expected to, and generally did, care for those affected. More recently, medical associations have reminded physicians of their ethical obligation to care for patients with HIV/AIDS. The WMA Statement on the Professional Responsibility of Physicians in Treating AIDS Patients is unequivocal with regard to this obligation: "Patients with AIDS and those who test positively for the antibody to the AIDS virus must be provided with appropriate medical care and should not be treated unfairly or suffer from arbitrary or irrational discrimination in their daily lives. Physicians have a long and honoured tradition of tending to patients afflicted with infectious diseases with compassion and courage. That tradition must be continued throughout the AIDS epidemic."

Some infectious diseases do not pose much danger to physicians, either because infection can be avoided without great difficulty (as with HIV/AIDS, although this is not necessarily the case for certain surgical procedures) or because vaccines are available (as with certain strains of influenza). However, in 2003 a new infectious disease, which came to be named Severe Acute Respiratory Syndrome (SARS), quickly spread from China to other parts of Southeast Asia and elsewhere, notably Canada. Its ease of transmission and serious outcomes, including death, prompted public health authorities everywhere, led by WHO, to take urgent measures to prevent its spread. Thanks to this rapid action, SARS was eventually contained, but not before over 8000 individuals had been infected and over 900 deaths had occurred.

In addition to the laboratory, clinical and epidemiological issues raised by this outbreak, five major ethical issues have been identified: the justification for quarantine, the limits on the confidentiality of personal health information, the duty of care, priority setting and global issues of infectious disease governance (cf. Singer et al.: Ethics and SARS: Lessons from Toronto. Of these, only the duty of care and, in part, the confidentiality of personal health information directly affect physicians in their relationships with patients. However, all the issues require attention by public health authorities as they develop plans for dealing with future outbreaks. Medical associations should ensure that the authorities do not neglect these ethical issues.

The WMA has recognized SARS as a major public health issue. The 2003 General Assembly in Helsinki adopted a resolution to "strongly encourage the World Health Organization to enhance its emergency response protocol to provide for the early, ongoing and meaningful engagement and involvement of the medical community globally, including initiating immediate discussion on the establishment of an effective and real-time means of communicating reliable, evidence-based information to front-line workers and the establishment of reliable sources of products and materials needed to safeguard the health of front-line health professionals and their patients." Early in 2004 the WMA published on its website a discussion paper on SARS that had been prepared by the Canadian Medical Association. Finally, the 2004 Assembly adopted as WMA policy a Statement on Health Emergencies Communication and Coordination.

Among National Medical Associations that have been active in addressing SARS and related issues, besides the Canadian Medical Association, the Hong Kong Medical Association deserves special mention (cf. its SARS Homepage).

October 2004 - Physicians and Commercial Enterprises

The relationship of physicians and commercial enterprises, particularly pharmaceutical and medical device companies, has been a subject of intense scrutiny by medical associations, medical journals and the popular press for well over a decade. As for-profit companies have become ever more prominent in the funding of medical research and continuing medical education (continuing professional development), the potential for conflict of interest in the relationships of physicians with these companies has increased. To prevent these conflicts from arising, and to help physicians deal with them when they do occur, the WMA recently adopted a set of guidelines that are available on this website at www.wma.net/e/policy/r2.htm. The background paper that helped inform the WMA policy can be viewed at www.wma.net/e/publications/pdf/wmj2.pdf.

Many National Medical Associations and other medical organizations have policies on this topic, including the following:

American Medical Association: Gifts to Physicians from Industry

Australian Medical Association: Doctors' Relationships with the Pharmaceutical Industry

Canadian Medical Association: Physicians and the Pharmaceutical Industry

Finnish Medical Association: Doctors and the Medical Industry - A Guidance for Doctors

The following websites provide resources for further reflection and action on this topic:

www.ama-assn.org/ama/pub/category/5689.html

www.nofreelunch.org