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Adopted by the 39th World Medical Assembly
Madrid, Spain, October 1987
and rescinded at the WMA General Assembly,
Santiago 2005
The World Medical Association has adopted the following statement
to assist physicians with the ethical and professional issues
that arise from scientific advances in the field of genetics.
GENETIC COUNSELING
There are two primary areas of genetic diagnosis:
- screening or evaluating prospective parents before conception
for genetic disease to predict the likelihood of conceiving
an affected child; and
- in utero testing after conception, such as ultrasonography,
amniocentesis, and fetoscopy, to determine the condition of
the fetus.
Physicians engaged in genetic counseling are ethically obligated
to provide prospective parents with the basis for an informed
decision for childbearing. In providing information to couples
who choose to reproduce, physicians should adhere to the ethical
requirements and the professional standards for medical practice
in the community, as established by WMA National Medical Association
and other appropriate medical organizations.
Technological developments have improved the accuracy of predicting
and detecting genetic disorders. Where a genetic defect is found
in the fetus, the prospective parents may, or may not, request
an abortion. Physicians, for personal moral reasons may, or may
not, oppose the provision of contraception, sterilization or abortion
as part of the genetic counseling services. Whether they advocate
or oppose providing such services, physicians should avoid the
imposition of their personal moral values and the substitution
of their own moral judgment for that of the prospective parents.
Physicians who consider contraception, sterilization and abortion
to be in conflict with their moral values and conscience may choose
not to provide genetic services. However, in appropriate circumstances,
the physician is nevertheless obligated to alert prospective parents
that a potential genetic problem does exist, and that the patient
should seek medical genetic counseling from a qualified specialist.
GENETIC ENGINEERING
As genetic engineering research develops, appropriate guidance
must be provided by the scientific community, medicine, industry,
government and the public to regulate such research.
If and when gene replacement with Normal DNA becomes a practical
reality for the treatment of human disorders, the World Medical
Association urges that the following factors be considered:
- If procedures are performed in research setting, reference
should be made to the World Medical Association Declaration
of Helsinki on biomedical research involving human subjects.
- If procedures are performed in research setting, reference
should be made to the World Medical Association Declaration
of Helsinki on biomedical research involving human subjects.
- Full discussion of the proposed procedure with the patient
must be required. The consent of the patient or his legal representative
must be informed, voluntary, and written.
- There must be no hazardous or other unwanted virus on the
viral DNA containing the replacement or corrective gene.
- The inserted DNA must function under normal control within
the recipient cell to prevent metabolic damage that could damage
healthy tissue and the patient.
- The effectiveness of the gene therapy should be evaluated
as best as possible. This will include determination of the
natural history of the disease and follow-up examination of
subsequent generations.
- Such procedures should be undertaken in the future only after
careful evaluation of the availability and effectiveness of
other possible therapy. If simpler and safer treatment is available,
it should be pursued.
- These considerations should be reviewed, as appropriate,
as procedures and scientific information are developed in the
future.
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