WMA JDN Bulletin Med Ed April 2025

2025
www.wma.net/junior-doctors/
THE VIEWS AND OPINIONS EXPRESSED IN THIS BULLETIN ARE SOLELY THOSE OF THE
AUTHORS AND DO NOT NECESSARILY REFLECT THE OFFICIAL POSITIONS OR POLICIES OF
THE JUNIOR DOCTORS NETWORK (JDN) OR THE WORLD MEDICAL ASSOCIATION (WMA).
World Medical Association
Junior Doctors’ Network
SPECIAL EDITION BULLETIN
(FORMERLY NEWSLETTER) ON
MEDICAL EDUCATION &
MEDICAL ETHICS
Special Edition Bulletin on
Medical Eduction &
Medical Ethics
S.NO. CONTENTS PAGE NO.
1 About WMA JDN 3
2 Meet the WMA JDN Leadership 2023 – 24 4
3 Meet the WMA JDN Leadership 2024 – 25 5
4 Meet the Publications Team 6
5 Foreword by Chair (2023 – 24) 7
6 Foreword by Deputy Chair 8
7 Foreword by Medical Education and Medical Ethics Leads 9
8 Foreword by Publications Director (2023 – 24) 10
9
The Evolution of the Declaration of Helsinki : A Critical Analysis of
its Implications for Junior Doctors
11
10
Training Doctors for an Ethical and Sustainable Future: Special
Interview
15
11 Professionalism and Ethics in Healthcare Delivery 18
12
Navigating the Landscape of Medical Specialty Training: Insights from the
JDN participation to the first German Young Physicians Dialogue
20
Table of Contents
www.wma.net/junior-doctors/
ISSN (PRINT) 2415-1122
ISSN (ONLINE) 2312-220X
S.NO. CONTENTS PAGE NO.
13
Integrating Cultural Competence into Medical Training: A Necessity
for Modern Healthcare
22
14 Ethical Dynamics of AI in Intensive Care: A Compassionate Advance 24
15 Integrating Ethics into Medical Curriculum and Training 26
16 Surgical Ethics: An In-Depth Exploration 28
17
Integrating Ethics in Medical Education: India’s AETCOM Approach
and the Global Implications
30
18
Navigating Ethical Waters: The Junior Doctors’ Strike in South Korea
and Its Implications for Healthcare Professionalism
32
19
Patient-Centered Care and Shared Decision-Making: Navigating
Ethical Complexities in the Treatment of Suicidal Patients
34
20 Ethical Considerations of Healthcare Technology Advancements 37
21 How to become a WMA JDN Member? 39
www.wma.net/junior-doctors/
Special Edition Bulletin on
Medical Education &
Medical Ethics
ISSN (PRINT) 2415-1122
ISSN (ONLINE) 2312-220X
About Us
What is the JDN?
The Junior Doctors Network (JDN) serves as an international platform for junior doctors to facilitate an open dialogue of
global events and activities that are relevant to their postgraduate training and the World Medical Association (WMA).
It was created at the 61st WMA General Assembly (October 2010) in Vancouver, Canada and the inaugural JDN meeting
was held at the 62nd WMA General Assembly (October 2011) in Montevideo, Uruguay. The network, which started from
a few motivated junior doctors, now has a total of over 900 members from more than 90 countries from all regions of
the world.
Junior doctors are defined as physicians, within 10 years after their medical graduation or who are still in an ongoing
postgraduate medical education program.
What is the mission?
The purpose of the JDN is to empower young physicians to work together towards a healthier world through advocacy,
education, and international collaboration.
What do we do?
Networking:
During the regular JDN meetings, members get to know each other, discuss global health issues, share challenges, and
start collaborations on global health issues. The JDN meets on several occasions during the year, both in-person and via
online teleconferences:
Biannual meetings in conjunction with the Council Meeting and the General Assembly of the WMA (April & October).
Monthly general membership and management team teleconferences
Ad-hoc online and webinars organized by the JDN
3
DR. MARIE-CLAIRE WANGARI
CHAIR PERSON
DR. BALKISS ABDELMOULA
DEPUTY CHAIR PERSON
DR. DEENA MARIYAM
SECRETARY
DR. FRANCISCO FRANCO PÊGO
SOCIO-MEDICAL AFFAIRS OFFICER
DR. MERLINDA SHAZELLENNE
MEDICAL EDUCATION
DIRECTOR
DR.SHIV JOSHI
MEDICAL ETHICS OFFICER
DR. PABLO ESTRELLA
MEMBERSHIP DIRECTOR
DR. JEAZUL PONCE H.
PUBLICATIONS DIRECTOR
DR. SAZI NZAMA
COMMUNICATIONS DIRECTOR
DR. UCHECHUKWU ARUM
IMMIEDIATE PAST CHAIR
DR. LWANDO MAKI
IMMIDIATE PAST DEPUTY
CHAIR
Special Edition Bulletin on
Medical Education &
Medical Ethics
MEET THE WMA JDN LEADERSHIP 2024 – 2025
Meet the WMA JDN Leadership 2023 – 24
4
Meet the WMA JDN Leadership 2024 – 25
DR PABLO ESTRELLA PORTER
CHAIRPERSON
DR BALKISS ABDELMULA
DEPUTY CHAIRPERSON
DR SAZI NZAMA
SECRETARY
DR ADEEL RIAZ
SOCIO-MEDICAL AFFAIRS
OFFICER
DR MERLINDA SHAZELLENNE
MEDICAL EDUCATION DIRECTOR
DR.SHIV JOSHI
MEDICAL ETHICS OFFICER
DR YUJIN SONG
MEMBERSHIP DIRECTOR
DR VENKATESH KARTHIKEYAN
PUBLICATIONS DIRECTOR
DR JEAZUL PONCE
COMMUNICATIONS DIRECTOR
DR MARIE-CLAIRE WANGARI
IMMEDIATE PAST CHAIR
Special Edition Bulletin on
Medical Education &
Medical Ethics
5
Editorial Team
DR.BONNKE ARUNGA DR. SREEJA A
DR.ARUNAGIRI G
DR VENKATESH KARTHIKEYAN
EDITOR IN CHIEF
DR MERLINDA SHAZELLENNE
MEDICAL EDUCATION DIRECTOR
DR.SHIV JOSHI
MEDICAL ETHICS OFFICER
Special Edition Bulletin on
Medical Education &
Medical Ethics
DR.DOUAA ROUFIA ATTABI DR. ARSALAN NADEEM DR. CAROL KANGETHE DR. SHRAVAN R. DAVE
DR. AMANUEL Y. NEGASH DR. JAMIE COLLOTY DR. MAYMONA CHOUDRY DR. MICHAEL JOHNSON
DR. LUIS MIGUEL
ALFONSO FERNÁNDEZ
GUTIÉRREZ
MAHA AWAN
DR. JEANETTE GODINEZ YAHAYA DR. AQSA SHAFIQUE
Address for Correspondence : Dr Venkatesh Karthikeyan, National Convenor – AMR, IMA House,
Indraprastha Marg, New Delhi, India – 110 002. Email : 4852012@gmail.com 6
DR. JEAZUL PONCE H.
PUBLICATIONS DIRECTOR
2023-24
Foreword by Chair (2023 – 24)
Dear JDN alumni and members,
It is my great pleasure to welcome you to the third edition of the Junior Doctors Network (JDN) newsletter, which
focuses on two pillars of our profession—medical education and medical ethics. As Chair of the JDN for the
2023/24 mandate, I have witnessed firsthand how these critical areas shape not only our training but also the
integrity and future of healthcare systems worldwide.
Medical education forms the foundation upon which we build our careers. It is a dynamic process that goes far
beyond the confines of textbooks and classrooms. In recent years, we have seen a shift towards more inclusive,
technology-driven, and competency-based learning models. As junior doctors, we must actively engage in these
transformative changes to ensure that we are equipped with the necessary skills to meet evolving healthcare
demands. The JDN has always emphasized the importance of continued professional development, and I am proud
that this edition showcases innovative approaches to medical education from diverse regions.
Equally significant is the role of medical ethics. Our work as healthcare professionals is governed by the principles
of patient autonomy, beneficence, non-maleficence, and justice. These guiding values remind us of our
responsibilities not only to our patients but also to society. In the face of complex ethical dilemmas—whether
related to patient consent, resource allocation, or the use of emerging medical technologies—it is our duty to
uphold these values while ensuring that our decisions are rooted in compassion and evidence. The articles in this
edition delve into the intricacies of medical ethics in different cultural and clinical contexts, offering insights from
junior doctors around the globe. I am confident that these discussions will inspire thoughtful reflection and
dialogue on how we can continue to uphold the highest ethical standards in our practice.
As we navigate the ever-changing landscape of medicine, it is crucial that we remember the importance of
mentorship, collaboration, and continuous learning. Our commitment to medical education and ethics is what sets
the foundation for the compassionate, competent, and ethical care that we provide to our patients. I encourage
you all to embrace these principles as you progress in your careers, and to contribute actively to the ongoing
development of these critical fields.
I would like to extend my heartfelt gratitude to all the contributors who have enriched this edition with their
valuable insights and experiences. Your dedication to advancing both medical education and ethics reflects the
spirit of excellence that defines the Junior Doctors Network. Together, let us continue to strive for a future where
medical education is accessible to all and medical ethics remains a cornerstone of our practice.
Warm regards,
Dr. Marie-Claire Wangari
2023/24 Chair,
Junior Doctors Network ,
World Medical Association.
Special Edition Bulletin on
Medical Education &
Medical Ethics
7
Foreword by JDN Deputy Chair
Dear JDN members and readers,
It is with great pleasure that I address you in this second special edition of our JDN newsletter, dedicated to two
pillars of our profession: medical ethics and medical education. These topics are not only crucial to the practice
of medicine but are also the foundation upon which our global community of junior doctors builds its expertise,
compassion, and integrity.
In a rapidly evolving world, where healthcare systems are continuously being challenged, the ethical
considerations we face as doctors are becoming increasingly complex. The ability to navigate these dilemmas
with professionalism and empathy is essential. At the same time, medical education is undergoing a profound
transformation, integrating new technologies and innovative teaching methods to ensure that we, as physicians,
remain equipped to provide the highest standard of care.
I would like to highlight the pivotal role that JDN members play in the success of this special edition. Your
contributions, insights, and continued dedication to advancing both medical ethics and education are what make
this newsletter a rich and diverse source of knowledge. You, as members, are the pillars upon which the strength
and future of our network rest. Your engagement in these discussions ensures that the ethical values we uphold
and the quality of education we pursue are continually reinforced and carried forward.
I encourage you all to remain involved, to share your experiences, and to continue pushing the boundaries of
knowledge and ethical reflections. It is through your commitment and active participation that the JDN will
continue to thrive as a global voice for junior doctors.
Thank you for your ongoing support and contributions to this important work. Together, we are shaping the
future of healthcare.
Warm regards,
Dr. Balkiss Abdelmoula, MD, MPH
Deputy Chair,
Junior Doctors’ Network,
World Medical Association.
Special Edition Bulletin on
Medical Education &
Medical Ethics
8
Dear Junior Doctors,
As the Directors of Medical Education and Medical Ethics, as well as the Chairs of their respective Working Groups, we
are honored to welcome you to this special edition of our combined Medical Education and Medical Ethics Bulletin.
This issue represents a significant milestone in our ongoing efforts to integrate educational excellence with ethical
practice in medicine.
First and foremost, we extend our deepest gratitude to our exceptional authors. Your dedication to producing high-
quality, insightful articles is truly inspiring. The time, effort, and passion you’ve invested are reflected on every page,
enhancing our understanding of complex medical and ethical issues and serving as a valuable resource for our entire
community.
Our sincere thanks also go to our meticulous reviewers. Your thoughtful evaluations have played a crucial role in
maintaining the high standards of this publication. Your expertise and constructive feedback ensure that every piece
is both rigorous and relevant, and your often behind-the-scenes work is deeply appreciated. We would also like to
express special thanks to our editorial team, whose hard work and commitment have been the backbone of this
newsletter. From coordinating submissions and managing deadlines to editing and formatting, your efforts have
culminated in a publication we can all take pride in. A particular note of gratitude goes to our Publications Director
(2023-24), Jeazul, for her steadfast efforts in ensuring this edition was completed on time.
To our readers, your continued support and engagement make this work meaningful. It is your curiosity, passion for
learning, and commitment to professional development that drive us to produce content that is both informative and
transformative. We encourage you to share your feedback and join in discussions around this bulletin to foster a
dynamic and vibrant community of practice.
Additionally, we want to express our appreciation to our Co-chairs, Balkiss and Jihoo, as well as the members of the
Medical Education and Medical Ethics Working Groups. Your vision and unwavering support have been key in bringing
this special edition to life, enabling us to explore new frontiers and bridge the gap between education and ethics in
innovative ways.
We must also extend our heartfelt thanks to the Chair and Past Chair of the Junior Doctors Network (JDN), Marie-
Claire and Uche. Your leadership and support have been instrumental in integrating the perspectives of junior doctors.
The JDN plays a vital role in shaping the future of medical practice, and your commitment to nurturing the next
generation of professionals is truly commendable.
In closing, this special edition is a testament to what we can achieve when we come together with a shared purpose.
It is a celebration of the collaborative spirit and relentless pursuit of excellence that define our community. We are
deeply thankful for each of your contributions, support, and dedication to advancing medical education and ethics.
Thank you for being part of this journey. Together, we are making a difference, one step at a time.
Foreword by Medical Education & Medical Ethics Leads
Special Edition Bulletin on
Medical Education &
Medical Ethics
Shiv Joshi, MD
Medical Ethics Officer,
Junior Doctors’ Network,
World Medical Association.
Dr. Merlinda Shazellenne
Medical Education Director,
Junior Doctors’ Network,
World Medical Association.
Dea WMA and JDN readers,
It is an honor to present this special edition of the JDN Newsletter, dedicated to a topic central to the future of
medicine: medical education and medical ethics. The Junior Doctors Network (JDN) of the World Medical
Association (WMA) has worked diligently to emphasize the importance of these areas, recognizing their
fundamental impact on the training of doctors worldwide and, consequently, on the quality of patient care.
Medical ethics is a cornerstone for the WMA, as it represents the values and principles that should guide
medical practice globally. In this regard, JDN is committed to promoting medical education deeply rooted in
respect for human dignity, equity, and justice. This special edition offers us the opportunity to reflect on how
current challenges, such as the digitalization of medicine and the evolution of clinical practice, demand a
renewed focus on ethics and the training of future doctors.
Our collaboration with the World Federation of Medical Education (WFME) has been crucial in enriching this
approach, broadening our perspectives on the challenges and opportunities facing global medical education.
The interview with the president of the WFME, a highlight of this edition and JDN Newsletters, provides a unique
insight into the role that international organizations play in promoting quality standards and adapting to
emerging challenges, ensuring that ethical values remain at the heart of medical education.
This achievement would not have been possible without the dedication and enthusiasm of our junior doctors,
who have brought fresh and critical perspectives through their articles and reflections, enriching the discussion.
I extend my special thanks to the publications team, who have worked tirelessly to bring this edition to life. I
am also deeply grateful to the Deputy Chair, Dr. Balkiss, for her active involvement in the editing process,
working alongside the team as if she were a member of the publications team. Additionally, I am appreciative
and grateful to Dr. Shiv and Dr. Merlinda, the directors of medical ethics and medical education, for their
unwavering support throughout this process, fostering an environment of collaboration and excellence.
I hope you enjoy this edition and that the content presented here serves as an inspiration to continue building a
more equitable and ethical future in the field of medicine, aligned with the principles that the WMA and JDN
uphold.
Sincerely,
Dr. Jeazul Ponce Hernandez, MD. MPH. MSc.
Publications Director (2023-24),
Junior Doctors’ Network,
World Medical Association.
Foreword by Publications Director (2023 – 24)
Special Edition Bulletin on
Medical Education &
Medical Ethics
10
The Evolution of the Declaration of Helsinki : A Critical
Analysis of its Implications for Junior Doctors
1
Shiv Joshi, Pablo Estrella Porter
The Declaration of Helsinki (DoH), first
adopted by the World Medical Association
(WMA) in 1964, is widely recognized as the
foundation of modern medical ethics in
research involving human subjects. Over the
years, it has undergone multiple revisions to
address the evolving landscape of medical
research and ethical challenges. This article
critically examines the DoH’s evolution,
incorporating insights from its latest 2024
revision, and explores its implications for
junior doctors. It concludes by outlining a
path to actively engage them as key
stakeholders in ethical medical research.
While ethical principles remain
fundamental, they must adapt to
contemporary societal and technological
advancements, necessitating periodic
updates to the DoH. The 2024 revision, led
by Dr. Jack Resneck Jr. over a 30-month
period, involved contributions from
representatives of 19 countries, 110
multidisciplinary collaborators, and an open
public consultation process [1].
Open access Editorial
Historical Evolution of the Declaration
of Helsinki
The DoH was introduced in response to
unethical research practices, most notably
the atrocities committed during World War
II and the Nuremberg Trials that followed.
Its initial version laid down basic principles
such as the need for voluntary consent and
the prioritization of patient welfare. Since
then, it has been revised multiple times to
remain relevant to contemporary ethical
challenges in medical research [2]:
2
3) 1983 (Venice Revision): Enhanced
protections for participants by refining
informed consent procedures and
establishing stricter guidelines for the use
of placebos.
4) 1989 (Hong Kong Revision): Advocated
for equitable post-study benefits, ensuring
that participants, particularly in resource-
limited settings, gain access to the
outcomes of research.
5) 1996 (South Africa Revision): Focused
on addressing ethical concerns in studies
involving disadvantaged populations,
highlighting the importance of fairness and
equity in research design.
6) 2000 (Edinburgh Revision): Further
refined the ethical framework for placebo-
controlled trials and mandated post-trial
access to beneficial interventions for
participants.
7) 2008 (Seoul Revision): Expanded the
scope to include biobank and genetic
research and enhanced protections for
vulnerable populations, including children
and marginalized communities.
8) 2013 (Fortaleza Revision): Stressed
transparency in clinical trial registration and
results dissemination.
9) 2024 (8 thematic regional and thematic
sessions): Strengthened ethical standards
in clinical research by replacing ‘subjects’
with ‘participants’ to emphasize autonomy,
expanding the scope beyond physicians,
and ensuring fair inclusion of vulnerable
populations. It promoted transparency,
addressed big data and anonymity,
reinforced justice and equity, and ensured
ethical inclusion during public health
emergencies.
WMA JDN Special Edition Bulletin on Medical Education and Medical Ethics
1) 1964 (Original Version): Established the
primacy of patient welfare and voluntary
consent in research.
2) 1975 (Tokyo Revision): Emphasized
informed consent, required special
protections for vulnerable populations, and
introduced the requirement for independent
ethical review of research protocols.
Shiv Joshi, MD
Medical Ethics
Officer,
WMA JDN
Management Team
drshivjoshi93@gmail
.com
Pablo Estrella
Porter, MD, MPH
General physician,
Quito, Ecuador
PhD student,
Universidad de
Valencia
Public Health
resident, Hospital
Clínico Universitario
de Valencia
Valencia, Spain
2
1
11
Open access Editorial
Each revision reflects an evolving understanding of
ethical considerations, adapting to advancements in
medical science and societal expectations. The
Implications for Junior Doctors:
1) Cultural Context and Equity – While earlier
versions of the DoH may have reflected a
predominantly Western ethical framework,
significant progress has been made since the 2000
Edinburgh revision in integrating perspectives from
the Global South. Key amendments – such as those
related to the use of placebos, post-trial access, and
vulnerability – were shaped by extensive dialogue
and contributions from low- and middle-income
countries (LMICs). The 2024 revision continues this
inclusive approach, emphasizing fairness, justice,
and the recognition of diverse cultural and systemic
realities. Junior doctors must be equipped to apply
ethical principles, respecting individual rights while
being responsive to the social and cultural realities
of the communities they serve.
2) Universal Applicability and Post-Trial Access –
The principle of post-trial access, introduced in the
2000 Edinburgh revision, guarantees participants
access to beneficial interventions after a study ends.
However, this presents logistical and financial
challenges, particularly in resource-limited settings.
Junior doctors, who often serve as the frontline
implementers of research protocols, may find it
difficult to advocate for post-trial benefits when such
provisions are not feasible within their local
healthcare infrastructure.
3) Digital Health and AI Ethics – The 2024 revision
of the DoH introduces ethical considerations for
digital health tools and artificial intelligence (AI),
which have become increasingly relevant in modern
medical research. While this revision acknowledges
the potential risks and ethical challenges posed by
these technologies, it leaves room for interpretation
regarding their transparency and fairness. Junior
doctors must be equipped to critically evaluate these
technologies, ensuring that AI tools and digital
health solutions used in research are ethical,
transparent, and free from bias.
These critiques underscore the need for adaptable
and inclusive ethical guidelines that address global
and local realities. Further, the challenges
highlighted by the DoH are particularly pertinent to
junior doctors, who often find themselves at the
intersection of clinical care and research. Junior
doctors often play pivotal roles in implementing
research protocols and upholding ethical standards in
clinical settings. Moreover, some key sections of the
DoH have direct relevance to their responsibilities, as
outlined in Table 1.
Junior doctors may face significant challenges in
adhering to these principles due to:
Time Constraints: Balancing clinical duties and
research responsibilities can leave little time for
ethical deliberation.
Lack of Awareness: Insufficient understanding
of how ethical standards directly impact their
clinical practice and research roles may hinder
their ability to apply these principles effectively.
Limited Ethics-centred Coursework: Many junior
doctors lack formal education in research ethics,
making it difficult to navigate complex dilemmas.
Hierarchical Dynamics: Institutional hierarchies
may deter junior doctors from questioning
unethical practices.
The Way Forward: Engaging Junior Doctors as
Ethical Stakeholders
To ensure that junior doctors can effectively
contribute to ethical research, the following steps are
recommended:
Ethics Education: Integrate structured
coursework in research ethics into medical
curricula and residency programs.
1.
Mentorship Programs: Pair junior doctors with
experienced mentors to guide them in ethical
decision-making.
2.
Institutional Support: Foster a culture of open
dialogue and transparency within medical
institutions to encourage ethical advocacy.
3.
Digital Competency: Equip junior doctors with
skills to evaluate the ethical implications of AI and
digital health technologies.
4.
Global Collaboration: Promote international
exchanges and workshops to enhance
understanding of diverse ethical perspectives.
5.
Engagement with the WMA: the WMA is a key
actor in shaping global medical ethics and
therefore Junior Doctors can engage with the
WMA through their National Medical Associations
or as individual Associate Members. By
contributing to documents, declarations,
resolutions, statements, and policies that
influence the ethical standards of medical
practice and research.
6.
WMA JDN Special Edition Bulletin on AMR
WMA JDN Special Edition Bulletin on Medical Education and Medical Ethics
12
Open access Editorial
DoH Section Year
Implications for Junior
Doctors
Practical Examples
Principle of Patient Welfare 1964
Ensures patient well-
being takes precedence
over research
objectives.
Prioritizing patient care even when
participating in clinical trials.
Ethical Review 1975
Requires all research
protocols to undergo
independent ethical
review.
Submitting proposals for audits or
clinical research to institutional
review boards.
Post-Trial Access 2000
Guarantees participants
access to beneficial
interventions post-
study.
Advocating for inclusion of trial
patients in extended treatment
programs.
Vulnerable Populations 2008
Stipulates additional
protections for
populations with limited
autonomy.
Safeguarding the interests of
pediatric, elderly, or economically
disadvantaged patients.
Transparency in Research 2013
Emphasizes the
importance of
registering clinical trials
and publishing results.
Ensuring compliance with trial
registration platforms like
ClinicalTrials.gov.
Diversity in Research 2024
Encourages recruitment
of diverse populations
in clinical trials for
generalizable results
and expands the scope
of ethical
responsibilities beyond
physicians.
Promoting inclusion of participants
from underrepresented
demographics and fostering
collaboration among
multidisciplinary research teams to
ensure diverse perspectives are
incorporated into ethical practices
Digital Health Ethics 2024
Addresses the ethical
use of AI and digital
tools in research.
Verifying the accuracy and fairness
of AI-based diagnostic tools before
clinical application.
13
WMA JDN Special Edition Bulletin on AMR
Table 1: Relevant Sections from the Declaration of Helsinki and Their Implications for Junior Doctors
WMA JDN Special Edition Bulletin on Medical Education and Medical Ethics
14
Open access Editorial
The Declaration of Helsinki remains a dynamic and
evolving document that continues to shape the
ethical landscape of medical research. For junior
doctors, its principles are not just guidelines but a
call to action—one that demands their active
participation in creating a more equitable and ethical
healthcare system. By equipping junior doctors with
the knowledge, tools, and support to uphold these
principles, we can ensure that the DoH remains
relevant and impactful in addressing the ethical
challenges of tomorrow.
WMA JDN Special Edition Bulletin on AMR
References
Resneck JS Jr. Revisions to the Declaration of Helsinki on Its 60th
Anniversary: A Modernized Set of Ethical Principles to Promote and
Ensure Respect for Participants in a Rapidly Innovating Medical
Research Ecosystem. JAMA. 2025 Jan 7;333(1):15–7.
1.
World Medical Association-. Background information on the
Declaration of Helsinki [Internet]. 2024 [cited 2025 Jan 22].
Available from: https://www.wma.net/news-post/background-
information-on-the-declaration-of-helsinki/
2.
WMA JDN Special Edition Bulletin on Medical Education and Medical Ethics
Conclusion
Training Doctors for an Ethical and Sustainable Future:
Special Interview
1
Dr. Ricardo León-Bórquez, Dr. Jeazul Ponce Hernandez
As a member of the world’s largest network
of young doctors, it is my pleasure to
present this interview, where we address
fundamental topics that affect young
doctors today. In the current context,
medical education faces significant
challenges in training future physicians who
are not only technically competent but also
have a strong ethical commitment and a
comprehensive vision of health. In a world
where global health, universal health
coverage, climate change, and social
determinants of health are inextricably
linked, it is crucial that future physicians are
prepared to face these challenges while
always upholding the highest standards of
medical ethics.
Today, I have the privilege of interviewing
Dr. Ricardo León-Bórquez, a distinguished
figure in medical education and current
President of the World Federation for
Medical Education (WFME). Dr. León-
Bórquez has had an extensive and impactful
career. He is a professor at the Universidad
Autónoma de Guadalajara (UAG), where he
also studied medicine. He completed a
Master of Science in Physiology at the UAG
and the University of Oklahoma (1987), and
later earned a Master of Science in
Administration from Central Michigan
University (1994). He is also an alumnus of
the Harvard Macy Program (Leaders in
International Education – 2000).
Throughout his career at UAG, Dr. León-
Bórquez held numerous leadership
positions: professor in the Department of
Physiology (1979–1988), Academic
Secretary of the Faculty of Medicine (1985–
1988), founder of the International Program
of the Faculty of Medicine (1988–1989),
Director of the International Program
(1989–2000), Director of the Faculty of
Medicine (2000–2007), Dean of Health
Sciences (2007–2011), and Director of
Institutional Relations at UAG (2011–
2015).
Open access Editorial
He is now retired from UAG but continues to
make significant contributions to the field of
medical education worldwide.
Dr. León-Bórquez is a founding member of
the International Association of Medical
Science Educators (IAMSE) and has held
various positions in the Mexican Association
of Medical Schools and Faculties (AMFEM),
serving as President from 2015 to 2017. He
played an active role in the Pan American
Federation of Associations of Medical
Schools (FEPAFEM), where he served as
President from 2016 to 2022. As of January
2023, he serves as President of the WFME,
following is tenure as a member of its
Executive Council from 2016 to 2022.
In this interview, Dr. León-Bórquez shares
his insights and suggestions on how to
tackle the challenges facing medical
education today, addressing the
intersection between digital health, equity,
climate change, and medical ethics. We
explore how medical education must adapt
and evolve to train physicians capable of
leading and effectively contributing to
building a more equitable, ethical and
sustainable health system.
Question 1: Digital Health and Medical
Ethics
Interviewer: Dr. Ricardo, how can medical
education effectively incorporate ethical
principles in the use of digital technology in
healthcare, considering the challenges of
privacy and equitable access?
Dr. Ricardo: Digital technology and artificial
intelligence (AI) are transforming the way
healthcare is delivered, but they also
present significant ethical challenges.
Medical education must include the
teaching of ethical principles that allow
students to understand how to responsibly
use these technologies. This means not only
WMA JDN Special Edition Bulletin on AMR
Dr. Ricardo León-
Bórquez
President of the
World Federation of
Medical Education
1
2
Dr. Jeazul Ponce
Hernandez,
Prologue and
interviewer,
Publications Director
(2023-24),
Junior Doctors’
Network,
World Medical
Association.
2
WMA JDN Special Edition Bulletin on Medical Education and Medical Ethics
15
16
Open access Editorial
ensuring the privacy and confidentiality of patients
but also ensuring that technology does not become a
barrier to equitable access to care. It is essential
that future physicians develop a deep understanding
of how technology can benefit patients while also
recognizing its limitations and potential ethical risks.
Question 2: Social Determinants and Medical
Training
Interviewer: What role should medical education
play in preparing future physicians to address the
social determinants of health in a context of growing
inequalities?
Dr. Ricardo: The social determinants of health, such
as poverty, lack of access to education, and the
environment in which a person lives, have a
profound impact on health. Medical students need to
be exposed to these realities from the beginning of
their training. Sending students to rural areas or
underserved communities provides them with a real
understanding of the challenges that many patients
face. This not only fosters empathy but also enables
them to develop the skills needed to address health
issues from a broader equity-driven perspective.
Question 3: Universal Health Coverage (UHC) and
Medical Education
Interviewer: How can medical education contribute
to promoting UHC, especially in areas with limited
resources?
Dr. Ricardo: Medical education must prepare
students to work in resource-limited settings and
teach them how to provide quality care even under
these conditions. It is crucial that future doctors
understand that health is a human right and that
their role is to ensure that all people have access to
effective and affordable healthcare. Training should
include education in health systems, public health
policies, and patient-centered care models, which
are essential for achieving UHC.
Question 4: Climate Change and Health
Interviewer: What strategies should be
implemented in medical education to prepare future
physicians to respond to the health impacts of
climate change?
Dr. Ricardo: Climate change is one of the greatest
challenges of our time and has a direct impact on
human health. Medical education must incorporate
the study of climate change effects on health, as well
as training in sustainable practices. Medical students
must learn to identify the risks associated with
climate change and how they can affect their future
patients. Additionally, they should be prepared to act
as leaders in implementing mitigation and adaptation
strategies in their communities.
Question 5: Ethics in Emerging Global Health
Challenges
Interviewer: What are the main ethical challenges
faced by physicians in the context of emerging health
crises, such as pandemics, and how should medical
education address them?
Dr. Ricardo: Health crises like pandemics present
complex ethical dilemmas, from prioritizing limited
resources to making decisions in uncertain situations.
Medical education must equip medical students and
future physicians with tools to face these challenges,
such as critical thinking, ethical decision-making, and
the ability to work in teams. Furthermore, it is crucial
to teach the importance of transparency, clear
communication, and respect for patient autonomy,
even in times of crisis.
Question 6: The Role of the World Federation for
Medical Education (WFME)
Interviewer: How does the WFME support the
adaptation of medical education to meet the current
and future challenges of global health?
Dr. Ricardo: The WFME is committed to improving the
quality of medical education worldwide. We work in
collaboration with institutions and organizations to
develop standards and guidelines that ensure that
medical training is of high quality, relevant, and
capable of responding to current and future health
system challenges and public health needs.
Additionally, we promote the integration of topics
such as global health, ethics, and sustainability into
medical curricula to prepare doctors for an
increasingly complex environment.
Question 7: Vision for the Future
Interviewer: What is your vision of how medical
education should evolve to meet the emerging
challenges of global health in the next 10 to 20 years?
WMA JDN Special Edition Bulletin on AMR
WMA JDN Special Edition Bulletin on Medical Education and Medical Ethics
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Open access Editorial
Dr. Ricardo: In the coming years, medical education
needs to be more interdisciplinary, integrating
knowledge from public health, social sciences,
technology, and ethics. Future physicians must be
health leaders who can work in diverse teams, tackle
global challenges such as climate change and
pandemics, and advocate for more equitable and
sustainable health systems. This requires a more
holistic approach to training, where values of
compassion, ethics, and social commitment are as
important as clinical skills.
Conclusion
Dr. Ricardo emphasizes the need for medical
education that equips future physicians to tackle the
complex challenges of global health, integrating
technology, ethics, equity, and sustainability into
their training. Only by doing so can we train
physicians capable of leading a fairer, healthier, and
more sustainable future for all.
WMA JDN Special Edition Bulletin on AMR
WMA JDN Special Edition Bulletin on Medical Education and Medical Ethics
Professionalism and Ethics in Healthcare Delivery
1
Dr.Fatima Khurshid
Professionalism and ethics are foundational
pillars of healthcare delivery, serving as the
backbone for ensuring patient care quality
and safety. These concepts are more than
mere guidelines; they represent the moral
fabric that shapes interactions, decisions,
and the overall culture within healthcare
settings. Healthcare professionals are not
only expected to possess clinical expertise
but also to demonstrate unwavering
commitment to ethical principles, which is
crucial for building trust, fostering effective
communication, and ensuring equitable
treatment.
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The importance of professionalism in
healthcare
The importance of professionalism in
healthcare extends beyond individual
patient encounters, as it encompasses a
collective responsibility to uphold the
integrity of the healthcare system. It
requires healthcare professionals to adhere
to core values such as respect, integrity,
accountability, empathy, and a sense of
duty toward patients, colleagues, and the
community at large. These values serve as
guiding principles in delivering high-quality,
patient-centered care and contribute to the
development of therapeutic relationships
built on trust and mutual understanding.
Ethical decision-making in healthcare is a
complex process that requires balancing
competing interests, values, and principles.
Professionals are often faced with
dilemmas that challenge their moral
judgment, such as end-of-life decisions,
informed consent, allocation of limited
resources, and maintaining patient
autonomy. Adhering to ethical guidelines—
such as beneficence, non-maleficence,
justice, and autonomy—ensures that
healthcare providers make decisions that
respect patients’ rights, promote well-
being, prevent harm, and guarantee
fairness.
Unethical actions in healthcare, such as
breaches of confidentiality, negligence, or
conflicts of interest, can have profound
consequences. These behaviors can lead to
a breakdown of trust, compromised patient
safety, legal repercussions, and damage to
the reputation of both individual
professionals and healthcare institutions.
Therefore, fostering a culture of
professionalism and ethics is not merely a
regulatory requirement but an essential
aspect of delivering compassionate, high-
quality care that respects the dignity and
rights of every patient.
WMA JDN Special Edition Bulletin on AMR
Dr. Fatima Khurshid
MBBS/ Registered
Medical Practitioner
(PMDC)
Medical Doctor,
Department of
Radiation Oncology
Shifa International
Hospital Ltd.,
Islamabad,
Pakistan.
1
Ethical Standards in Healthcare:
Healthcare practitioners often encounter
complex ethical dilemmas that require a
strong decision-making framework. The
four cardinal concepts that guide these
judgments are:
Autonomy: Respecting the right of
patients to make informed decisions
about their own care.
1.
Beneficence: Acting in the best
interests of patients and promoting
their well-being.
2.
Nonmaleficence: Avoiding harm to
patients and minimizing risks.
3.
Justice: Ensuring fairness and equity in
the distribution of healthcare resources.
4.
These principles serve as a guide for
overcoming the problems and ethical
quandaries that emerge in therapeutic
practice (1).
Implications of Unethical Behavior
Unethical behavior in healthcare can have
far-reaching and severe implications for
both patient outcomes and the credibility of
the healthcare system. Such misconduct—
whether due to incompetence, fraud,
breaches of confidentiality, or other forms
WMA JDN Special Edition Bulletin on Medical Education and Medical Ethics
Open access Editorial
19
WMA JDN Special Edition Bulletin on AMR
of ethical violations—can significantly erode trust
and inflict substantial harm on patients. The
consequences of unethical actions may include
physical injury, psychological distress, or even a loss
of life, making the need for ethical integrity
paramount in healthcare practice (2).
Moreover, healthcare professionals who engage in
unethical behavior face serious legal consequences,
such as lawsuits, loss of licensure, and disciplinary
actions by regulatory bodies. These repercussions
not only affect the individual practitioners but also
damage the reputation of the institutions they
represent, potentially leading to a loss of public
trust, financial penalties, and a decline in the quality
of care provided. In essence, unethical conduct
threatens the foundational principles of healthcare,
compromising patient safety, diminishing the
therapeutic relationship, and undermining the
overall efficacy of the healthcare system (3).
Overview of Existing Research
Research on professionalism and ethics in
healthcare has shown a significant impact on various
aspects of healthcare delivery. The National
Institutes of Health (NIH) outlines seven main
principles to guide ethical research, emphasizing
social and clinical value, scientific validity, and
respect for subjects. Key concepts include patient
outcomes, staff satisfaction, organizational culture,
and the Medical Professionalism Project. The Virtue
Ethics Theory focuses on the character traits of
healthcare providers as a cornerstone of ethical
decision-making. Research by the ABIM Foundation
supports the positive correlation between
professionalism and clinical outcomes (4,5).
However, gaps remain in teaching and integrating
professionalism and ethics into healthcare practice,
and there is a need to explore how cultural
differences affect the application of these principles
globally. Future research could investigate effective
methods for instilling professionalism and ethics in
healthcare education and examine the role of
technology in professional and ethical decision-
making in healthcare settings. Real-world case
studies on professionalism and ethics in healthcare
include Bioethics Cases from the Markkula Center for
Applied Ethics, the American College of Physicians,
the Cambridge Medical Ethics Workbook, and an
article on challenges and strategies for ethical
professional medical practice in 21st century(6-8).
WMA JDN Special Edition Bulletin on Medical Education and Medical Ethics
Conclusion:
Professionalism and ethics are cornerstone of high-
quality healthcare delivery. Ensuring that healthcare
workers follow these principles is critical for
preserving patient confidence and attaining excellent
health results. As the healthcare environment evolves,
maintaining a focus on ethics and professionalism will
be critical in navigating future obstacles and
promoting healthcare practices worldwide.
National Institutes of Health. Guiding Principles for Ethical
Research [Internet]. National Institutes of Health (NIH).
2016. https://www.nih.gov/health-information/nih-clinical-
research-trials-you/guiding-principles-ethical-research
1.
Schofield, G., Dittborn, M., Selman, L.E. et al. Defining
ethical challenge(s) in healthcare research: a rapid review.
BMC Med Ethics 22, 135 (2021).
https://doi.org/10.1186/s12910-021-00700-9
2.
Unger, JP., Morales, I., De Paepe, P. et al. The physician
and professionalism today: challenges to and strategies for
ethical professional medical practice. BMC Health Serv Res
20 (Suppl 2), 1069 (2020). https://doi.org/10.1186/s12913-
020-05884-1
3.
Edgar A. Professionalism in Health Care. Springer eBooks.
2017 Jan 1;677–97.
4.
Santa Clara University. Bioethics Cases – Markkula Center
for Applied Ethics [Internet]. Scu.edu. 2018. Available
from: https://www.scu.edu/ethics/focus-
areas/bioethics/resources/cases/
5.
Ethics Case Studies & Education Resources | ACP
[Internet]. www.acponline.org. 2024. Available from:
https://www.acponline.org/clinical-information/medical-
ethics-and-professionalism/ethics-case-studies-education-
resources
6.
Robeson, R.; King, N.M.P. Performable Case Studies in
Ethics Education. Healthcare 2017, 5, 57.
https://doi.org/10.3390/healthcare5030057
7.
Brennan MD, Monson V. Professionalism: Good for
Patients and Health Care Organizations. Mayo Clinic
Proceedings [Internet]. 2014 May 1;89(5):644–52.
Available from:
https://www.mayoclinicproceedings.org/article/s0025-
6196(14)00064-0/abstract
8.
References
Navigating the Landscape of Medical Specialty Training:
Insights from the JDN participation to the first German
Young Physicians Dialogue
1
Dr. Balkiss Abdelmoula, Dr. Eleleta Surafel
The World Medical Association’s Junior
Doctors Network (JDN) was among the
international delegations invited to the
Young Physicians Dialogue, organized by
the German Medical Association (GMA)
ahead of their 128th National General
Assembly. The dialogue served as a
platform for junior physicians to discuss
challenges and potential solutions related
to medical specialty training in Germany.
Key topics included practical challenges in
daily medical practice, national regulations
governing specialty training, and the
evolving dynamics of the health system, all
of which significantly impact junior
physicians in Germany.
One of the highlighted challenges was the
complexity arising from generational
differences in specialty training, coupled
with the rapid integration of digital
technology into undergraduate and
postgraduate medical education. As new
generations of physicians bring with them
distinct work style preferences and
technological fluency, traditional training
approaches are increasingly strained. The
dialogue revealed that bridging these
generational divides remains a persistent
challenge in Germany’s specialty training
system, despite the country’s advanced
healthcare infrastructure.
The dialogue also underscored the
importance of adaptable national guidelines
in shaping current and future trends in
medical specialty training. These guidelines
provide clarity and consistency in the
increasingly diverse and evolving field of
medical education. Continuous refinement
of these guidelines is necessary to address
emerging challenges and adapt to the
evolving healthcare workforce and patient
needs.
These guidelines serve to provide clarity
and consistency amidst the diverse and
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evolving environment of medical education.
It was noted that the continuous refinement
and adaptation of these guidelines are
necessary to address emerging challenges
and accommodate evolving healthcare
workforce and patient needs.
Moreover, the dialogue highlighted that the
existing German healthcare workforce is
aging and rapidly exiting the labor force,
with current training structures
inadequately keeping up with the growing
demand due to restrictive training
regulations and quotas. Bureaucracy, staff
shortages, and the consequent loss of
valuable working time were cited as key
factors underscoring the urgent need for
health system reforms.
Additional challenges that were highlighted
during the Young Physicians Dialogue
closely mirror those faced in low- and
middle-income countries (LMICs). Similar to
these regions, Germany experiences, there
is a shortage of medical workforce in
remote areas, limited digitization in
administrative systems, and an absence of
multisectoral collaboration—starting with
the lack of understanding of everyday
clinical practice among policymakers.
Addressing these insights requires a
multifaceted approach that proactively
tackles to address gender disparities,
embrace technological advancements,
bridge generational gaps, and uphold
principles of inclusivity and equity.
Continuing these dialogues is essential, as
they draw on collective, intergenerational,
and multisectoral expertise to inform
meaningful reforms.
As we navigate the evolving landscape of
medical training, it is imperative for junior
doctors to remain committed to shaping a
future where every one of us has the
opportunity to thrive and make a
meaningful impact. By designing reforms
WMA JDN Special Edition Bulletin on AMR
Dr. Balkiss
Abdelmoula, MD.
MPH. (Tunisia)
Deputy Chair
Junior Doctors’
Network
World Medical
Association
1
2
Dr. Eleleta Surafel,
MD. (Ethiopia)
MPH Student at the
university of the
Edinburgh
2
WMA JDN Special Edition Bulletin on Medical Education and Medical Ethics
21
Open access Editorial
that incorporate youth perspectives, we can make
significant strides toward enhancing medical
education, ultimately improving healthcare delivery.
WMA JDN Special Edition Bulletin on AMR
REFERENCES
InformedHealth.org [Internet]. (2018).Health care in
Germany: Learn More – The German health care
system. Cologne, Germany: Institute for Quality and
Efficiency in Health Care (IQWiG).Retrieved from
https://www.ncbi.nlm.nih.gov/books/NBK298834/
1.
Bettina Döbereiner.(2014). Generation Y in hospitals
today. Healthcare in Europe [Internet]. Retrieved from
Generation Y in hospitals today • healthcare-in-
europe.com
2.
German Medical Association.(2002). Work and training
in Germany [Internet]. Retrieved from: Work and
training in Germany – BAEK EN
(bundesaerztekammer.de)
3.
Federal Ministry of Health, Germany.(2024).
Digitalisation in Healthcare. Retrieved from:
Digitalisation in healthcare | BMG
(bundesgesundheitsministerium.de)
4.
Supper P, Urban D, Acker I, Linke FS, Kienast P,
Praschinger A, Anvari-Pirsch A.(2023). A concept for
adapting medical education to the next generations via
three-staged digital peer teaching key feature cases.
Wien Med Wochenschr, 173(5-6),108-114.
https://doi.org/10.1007/s10354-022-00990-7
5.
WMA JDN Special Edition Bulletin on Medical Education and Medical Ethics
Integrating Cultural Competence into Medical
Training: A Necessity for Modern Healthcare
1
Dr. Shiv Joshi, Dr. Merlinda Shazellenne
As globalization reshapes healthcare
environments, the ability to provide
culturally sensitive care has become a core
competency for physicians. For medical
students, acquiring cultural competence is
not only a professional requirement but a
moral imperative to deliver patient-
centered care. While the importance of this
skill is acknowledged, the integration of
cultural competence into medical education
remains inconsistent and, in many cases,
insufficient. This article examines the need
for cultural competence in junior doctor
training and offers actionable
recommendations for improving its
incorporation into medical curricula.
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Open access Editorial
Despite the acknowledged need for cultural
competence, current medical training
frameworks often fail to equip students with
the necessary skills. Several barriers exist,
including insufficient exposure to diverse
patient populations, lack of integration of
cultural topics into clinical training, and an
emphasis on technical over interpersonal
skills. It is possible that that while medical
students value cultural competence, they
may feel underprepared to handle
interactions with patients from different
cultural backgrounds​
.
Moreover, medical students may face
anxiety when dealing with patients whose
cultural practices or language they did not
understand, which may affect their
confidence and ability to provide care. A
more structured and comprehensive
approach to cultural education is necessary
to close this gap.
WMA JDN Special Edition Bulletin on AMR
Dr. Shiv Joshi
Medical Ethics
Officer,
WMA JDN.
Chair, Medical
Ethics Working
Group,
WMA JDN.
1
Cultural Competence
Cultural competence, broadly defined as
the ability to understand, communicate
with, and effectively interact with people
across cultures, has been linked to
improved healthcare outcomes and
enhanced patient satisfaction. The 2001
Institute of Medicine report emphasized
that healthcare professionals who cultivate
cultural competence are better equipped to
reduce health disparities and build trust
with patients from diverse backgrounds.
Medical students must recognize the
importance of respecting patients’ cultural
beliefs and avoiding stereotypes that could
hinder care. This aligns with existing
evidence highlighting the need for
healthcare professionals to understand the
cultural nuances that influence patient
behavior and treatment decisions. While
medical students are often eager to
embrace cultural competence, many lack
formal educational opportunities that
adequately prepare them for the complex
situations they may encounter. Evidence
indicates that students express a strong
desire for more comprehensive educational
frameworks to help them navigate cultural
differences effectively in clinical settings.
Structural Gaps in Current Medical
Education
Ethical Considerations in Culturally
Competent Care
Ethical dilemmas frequently arise in cross-
cultural interactions, particularly when
patients’ cultural or religious beliefs conflict
with standard medical practice. Medical
students may experience a tension when
confronted with such dilemmas, such as
when Jehovah’s Witness patients refuse
blood transfusions on religious grounds. For
medical students, navigating these complex
scenarios requires both cultural sensitivity
and ethical judgment, skills that are often
underdeveloped during their formal
education​
.
Medical educators must not only teach
cultural competence but also foster critical
thinking and ethical decision-making.
Incorporating real-life ethical dilemmas into
the curriculum, where students can practice
resolving conflicts between medical ethics
2
Dr. Merlinda
Shazellenne
Medical
Education
Director,
WMA JDN.
Chair, Medical
Education
Working Group,
WMA JDN.
2
WMA JDN Special Edition Bulletin on Medical Education and Medical Ethics
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WMA JDN Special Edition Bulletin on AMR
and patient autonomy, is a crucial step in preparing
future doctors.
Actionable Recommendations for Policymakers
Below is a set of recommendations for enhancing
cultural competence training in medical education:
Integrate cultural competence into core
curriculum of medical training.
Expand simulation-based learning to develop
simulation scenarios involving diverse patient
backgrounds to help medical students practice
culturally competent care in a controlled
environment​
.
Foster multidisciplinary learning to encourage
collaboration between medical students and
students from other healthcare professions to
promote a holistic approach to culturally
competent care.
Offer language training programs and workshops
on working with interpreters to improve
communication with non-native speakers.
Develop case studies that focus on ethical
dilemmas involving cultural beliefs, helping
students learn to balance medical ethics with
patient autonomy.
Partner with hospitals and clinics that serve
diverse communities to give students practical
experience in culturally varied environments.
Promote self-reflection exercises that help
students identify their own cultural biases and
improve empathy in patient care.
Ensure that all medical educators are trained in
cultural competence so they can effectively model
and teach these skills to students​
.
Institute of Medicine Committee on Quality of Health
Care in, A. Crossing the quality chasm: a new health
system for the 21st century. Washington (DC):
National Academies Press (US). Copyright 2001 by the
National Acad emy of Sciences. All rights reserved;
2001.
1.
Walkowska A, Przymuszała P, Marciniak-Stępak P,
Nowosadko M, Baum E. To be culturally competent is
to be willing to learn about the differences and to
acknowledge them – A qualitative study on Polish
medical students’ attitudes towards cross-cultural
competence development. BMC Med Educ.
2024;24:833.
2.
Wear D, Zarconi J, Aultman JM, Chyatte MR, Kumagai
AK. Remembering Freddie Gray: Medical education for
social justice. Acad Med 2017;92:312‑7.
3.
Conclusion
Cultural competence is a critical skill for medical
students in today’s multicultural healthcare
environments. However, current medical education
often lacks the depth and breadth required to
effectively train future doctors in this area. By
implementing more structured cultural competence
training, incorporating ethical dilemma case studies,
and expanding simulation-based learning, medical
education can better prepare medical students to
provide compassionate, competent care to all
patients, regardless of their cultural background.
These reforms will not only enhance doctor-patient
relationships but also reduce health disparities and
improve patient outcomes.
WMA JDN Special Edition Bulletin on Medical Education and Medical Ethics
References
Ethical Dynamics of AI in Intensive Care: A
Compassionate Advance
1
Dr. Christopher Mathew
The infusion of Artificial Intelligence (AI)
within Intensive Care Units (ICU) marks a
pivotal shift towards a more informed and
precise healthcare paradigm. Through its
profound ability to monitor patient metrics
in real-time and project future health
outcomes, AI promises a leap towards
unprecedented levels of care. Despite its
vast potential, this leap forward is not
devoid of ethical mazes that call for
deliberate navigation to ensure AI’s boon
does not become a bane. Proactively
grappling with these ethical quandaries is
crucial for harmonizing AI’s technological
prowess with the fundamental ethos of
healthcare.
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Inherent biases in AI could perpetuate or
even exacerbate existing healthcare
discrepancies. Ethical integration of AI in
the ICU mandates vigilance in uncovering
and rectifying biases, ensuring the
technology promotes equity and provides
unbiased care to all patient groups.
WMA JDN Special Edition Bulletin on AMR
Dr. Christopher
Mathew
MBBS; MRCP(UK);
FCRS(ISCCM)
ICU registrar, Dept
of Medicine and
Intensive Care
Aster Dr. Moopen’s
Medical College
Hospital, Wayanad,
Kerala.
1
Ethical landscapes in the realm of AI-
enhanced ICU care:
Upholding patient autonomy, a core
principle of ethical medical practice,
becomes challenging due to the nuanced
and sometimes obscure nature of AI
decision-making processes. Reconciling this
involves a concerted effort to demystify AI
interventions for patients or their decision-
makers, facilitating an environment where
informed consent is not just a procedure but
a practice.
Curtailing bias, championing equity
Defining responsibility and transparent
decision making
The delineation of accountability in the
event of AI-driven errors poses a significant
ethical challenge. Establishing a
transparent and understandable framework
clarifies the symbiosis of human and
artificial intelligence in patient care,
emphasizing the development of AI systems
that can elucidate their decision-making
processes.
Preserving patient autonomy through
transparency
Safeguarding the sanctity of patient
data
The lifeline of AI’s functionality—extensive
data—poses significant privacy and security
considerations. The ICU’s rich data
environment, while beneficial for AI,
necessitates a robust approach to
protecting patient information. This involves
not just compliance with legal frameworks
but a dedication to treating personal health
information with the utmost care and
respect.
Enduring oversight and reflective re-
evaluation
Given the fluid nature of technological
advancement and the dynamics of ICU care,
AI applications demand continuous ethical
scrutiny. Adaptive regulatory mechanisms
are essential to keep AI tools consistently
aligned with patient care priorities and
ethical guidelines.
Formulating an ethical compass for AI
deployment in the ICU:
Establishing an ethical framework for AI in
ICUs requires a focus on core healthcare
ethics: beneficence, non-maleficence,
justice, and respect for persons.
1.Promoting AI understanding: Cultivating a
strong grasp of AI’s scope among clinicians
and patients facilitates shared decision-
making and fosters an environment of trust.
WMA JDN Special Edition Bulletin on Medical Education and Medical Ethics
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WMA JDN Special Edition Bulletin on AMR
2.Implementation of stringent data policies: Enforcing
rigorous policies on data handling ensures the
respectful and secure use of patient data, upholding
the principles of privacy and consent.
3.Application of bias reduction techniques:
Encouraging diversity in AI training data and inclusive
development approaches minimizes biases, paving
the way for fair and impartial care delivery.
4.Establishing accountability frameworks: Clear
guidelines should define the roles and responsibilities
of clinicians and AI tools to ensure transparent
integration into patient care.
5.Provision of continuous ethical supervision: Setting
up dedicated ethics committees to oversee AI
applications in healthcare supports ongoing
evaluation and adaptation, ensuring AI tools remain
ethically compliant and aligned with patient welfare.
REFERENCES
Conclusion
The amalgamation of AI in ICU settings is an exciting
frontier with the potential to drastically elevate care
standards. However, its journey must be paved with
ethical considerations at every step. By actively
addressing the ethical challenges presented by AI, the
field of healthcare can fully embrace the benefits of AI
technologies, ensuring these advancements are
utilized in a manner that is both ethically sound and
profoundly beneficial. In this pursuit, the ultimate
goal remains clear: to enhance the quality and
compassion of care for all, making AI an ally in the
noble quest of saving lives and nurturing health in the
heart of the ICU.
Shah NH, Milstein A. Ethics of using machine learning in
healthcare. Am Med Assoc J Ethics. 2019;21(2).
doi:10.1001/amajethics.2019.121.
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Beauchamp TL, Childress JF. Principles of Biomedical
Ethics. 7th ed. Oxford University Press; 2013.
2.
Morley J, Machado CC, Burr C, Cowls J, Joshi I, Taddeo
M, et al. The ethics of AI in health care: A mapping
review. Soc Sci Med. 2020;260:113172.
doi:10.1016/j.socscimed.2020.113172.
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Celi LA, Fine B, Stone DJ. An awakening in medicine: The
partnership of humanity and artificial intelligence. PLoS
Med. 2019;16(11). doi:10.1371/journal.pmed.1002735.
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Lin P, Abney K, Jenkins R. Robot Ethics 2.0: From
Autonomous Cars to Artificial Intelligence. Oxford
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5.
Topol E. Deep Medicine: How Artificial Intelligence Can
Make Healthcare Human Again.
6.
WMA JDN Special Edition Bulletin on Medical Education and Medical Ethics
Integrating Ethics into Medical Curriculum and
Training
1
Dr. Bikash Bhandari
In the ever-evolving landscape of
healthcare, the significance of ethical
considerations in medical practice cannot
be overstated. As medical professionals
navigate complex decisions that impact
both patient care and societal well-being,
integrating ethics into the medical
curriculum and training is increasingly
imperative. This article delves into the
importance of this integration and explores
practical strategies to achieve it.
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integration of ethics into clinical rotations
offers students the opportunity to apply
ethical principles in real-world scenarios
under the supervision of experienced
practitioners. This hands-on experience
fosters experiential learning, allowing
students to confront and navigate ethical
challenges in a practical setting, thereby
strengthening their decision-making skills.
3. Interprofessional Education for Ethical
Awareness : Interprofessional education
(IPE) presents a valuable opportunity to
enhance ethical awareness among future
healthcare professionals. Collaborative
learning experiences with students from
diverse healthcare disciplines—such as
nursing, pharmacy, and physiotherapy—
encourage interdisciplinary dialogue and
cultivate a holistic understanding of ethical
issues in healthcare delivery. By engaging in
shared learning, students from various
professions develop a common language
and appreciation for ethical considerations
within their respective roles.
WMA JDN Special Edition Bulletin on AMR
Dr. Bikash
Bhandari
MBBS, Nepal.
1
The Importance of Ethics in Medical
Education
Ethical dilemmas are inherent in healthcare,
ranging from end-of-life decisions to the
allocation of limited resources. By
incorporating ethics into medical education,
aspiring physicians are equipped with the
essential tools needed to address these
challenges with responsibility and integrity.
This integration fosters a culture of ethical
awareness and critical reflection,
establishing a foundation for sound moral
decision-making that will guide them
throughout their careers.
Introduction
Strategies for Integrating Ethics into
Medical Curriculum
1. Dedicated Courses and Modules in
Bioethics : One effective approach to
integrating ethics into the medical
curriculum is through the inclusion of
dedicated courses or modules focused on
bioethics. These courses explore ethical
theories, principles, and real-world case
studies relevant to medical practice,
providing students with a structured
framework to analyze and resolve ethical
dilemmas. This foundation in ethical
reasoning helps students develop a deeper
understanding of the complexities of
medical practice.
2. Incorporating Ethics into Clinical
Rotations : Beyond theoretical learning, the
Integrating Ethics into Everyday
Learning
Ethics should not be treated as a
standalone subject but rather woven
throughout the entire medical curriculum.
Integrating ethics into case-based learning
activities, problem-solving exercises, and
simulations reinforces its relevance to
clinical practice. This ensures that students
perceive ethics as an integral part of their
training, rather than as an isolated
component.
WMA JDN Special Edition Bulletin on Medical Education and Medical Ethics
Moreover, fostering a culture of ethical
reflection through mentorship, peer
discussions, and faculty-guided sessions
encourages lifelong learning and
professional development. This reflective
practice helps students internalize ethical
principles, enabling them to apply these
values consistently in their future clinical
encounters.
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WMA JDN Special Edition Bulletin on AMR
REFERENCES
Evaluation and Continuous Improvement of Ethics
Education
To ensure the successful integration of ethics into
medical training, robust evaluation mechanisms are
essential. Surveys, standardized assessments, and
reflective portfolios can effectively gauge students’
ethical reasoning skills, attitudes, and behavioral
changes over time. This feedback loop enables
educators to refine and improve ethics education
strategies, ensuring they remain relevant to the
evolving needs of healthcare practice.
Conclusion
Integrating ethics into the medical curriculum and
training is crucial for cultivating healthcare
professionals who are not only clinically competent
but also ethically responsible and compassionate. By
equipping students with the knowledge, skills, and
reflective practices necessary to navigate ethical
dilemmas, medical education institutions contribute
to the development of practitioners committed to
upholding the highest standards of patient care and
professional integrity.
As the healthcare landscape continues to evolve, the
integration of ethics into medical education will
remain a vital component in preparing future
physicians to address the moral challenges they will
encounter, ensuring that they approach patient care
with empathy, respect, and ethical judgment.
Beauchamp TL, Childress JF. Principles of Biomedical
Ethics. Oxford University Press; 2019.
1.
Branch WT Jr, Kern D, Haidet P, et al. Teaching the
human dimensions of care in clinical settings. JAMA.
2001;286(9):1067-1074.
2.
Cruess RL, Cruess SR, Steinert Y. Role modelling—
making the most of a powerful teaching strategy. BMJ.
2008;336(7646):718-721.
3.
Dzeng E, Wachter RM. Ethics in conflict: moral distress
as a root cause of burnout. J Gen Intern Med.
2020;35(12):3665-3669.
4.
Magelssen M, Pedersen R, Førde R, et al. Importance of
attitudes and values in medicine. Bioethics.
2019;33(3):304-311.
5.
WMA JDN Special Edition Bulletin on Medical Education and Medical Ethics
Surgical Ethics: An In-Depth Exploration
1
Dr. Preeti Sawant
Ethics, in simple terms, refers to principles
of right conduct or moral integrity. It
embodies certain values that are
considered appropriate or just within a
particular culture or group of people.
Surgeons today face more ethical dilemmas
than in the past, due to the rapid growth in
scientific knowledge, advancements in
medical technology, the shift towards a
more balanced relationship between
patients and surgeons, and changes in the
organizational structure and financing of the
healthcare system. These evolving
circumstances highlight the need for a solid
understanding of ethics, ensuring that
patient care remains a priority in medical
practice.
The renowned French poet Paul Valéry, in
his 1938 address to the College of
Surgeons, profoundly remarked, “All of the
science in the world cannot make an
accomplished surgeon. It is the doing that
consecrates it.” This statement
encapsulates the essence of surgical
practice, where the act of surgery is not
merely a technical skill but also a deeply
ethical endeavor.
The foundations of surgical ethics can be
traced back to ancient texts, with
Sushruta’s treatise being one of the earliest
to extensively discuss surgical principles
and ethical guidelines. In the 19th century,
John Gregory and Thomas Percival began
articulating the moral values expected of a
surgeon, marking the formal inception of
surgical ethics as a distinct branch of
medical ethics. The American College of
Surgeons took a pioneering step in 1913 by
advocating for ethical surgical practices,
followed by the Australasian Surgeons
Association’s comprehensive Code of
Conduct in 1993, which emphasized
professionalism as a core attribute. Today,
surgical ethics has evolved into a
specialized discipline within medical ethics.
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At its core, ethics is the practice of
righteousness and moral conduct. Modern
medical ethics is grounded in four
fundamental principles proposed by
Beauchamp and Childress in their seminal
work Principles of Biomedical Ethics:
Autonomy
Beneficence
Non-maleficence
Justice
While these principles have become the
cornerstone of medical ethics, it is worth
noting their distinction from the Belmont
Principles, which were established
specifically for research ethics and include
respect for persons, beneficence, and
justice, as outlined in the Belmont Report.
Building upon these ethical foundations, the
English surgeon Miles Little proposed five
key elements that define surgical ethics
within the surgeon-patient relationship:
Rescue
Proximity
Ordeal
Aftermath
Presence
For a surgeon, ethical competence is not
just about technical proficiency but also
about demonstrating qualities such as
clinical acumen, sound judgment,
humanism, and moral integrity. A truly
proficient surgeon must embody not only
the scientific and technical aspects of
surgery but also maintain ethical reliability
and moral fortitude. Surgical decision-
making, therefore, is a dual process: the
“how to treat” aspect, grounded in surgical
science, and the “why to treat” aspect,
rooted in surgical ethics, which draws from
moral philosophy.
Patients undergoing surgery possess
fundamental rights, which include:
The right to be fully informed about the
benefits and risks of proposed surgical
treatments
WMA JDN Special Edition Bulletin on AMR
Dr. Preeti Sawant
DNB General
Surgery Trainee
National Board of
Examination, New
Delhi
KG Hospital,
Coimbatore, India
1
WMA JDN Special Edition Bulletin on Medical Education and Medical Ethics
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WMA JDN Special Edition Bulletin on AMR
The right to be treated by a competent and skilled
surgeon
The right to have their health prioritized above the
surgeon’s financial or personal interests
The right to make autonomous decisions
regarding their treatment
The right not to be harmed, killed, or neglected,
either intentionally or through negligence
The right to honesty and transparency from their
healthcare providers
The surgeon-patient relationship is inherently
fiduciary, wherein the surgeon holds a position of
authority based on their expertise, training, and
commitment to the patient’s welfare, while the patient
retains autonomy by providing informed consent.
With the rapid advancements in surgical techniques,
technology, and innovations, the ethical challenges
facing modern surgery have become increasingly
complex. The introduction of Artificial Intelligence,
Robotics, and Telesurgery has expanded the
possibilities for surgical interventions, but it has also
raised critical ethical questions and debates regarding
appropriate and responsible use.
In conclusion, the future of surgical care requires a
dynamic and adaptable international ethical
framework to guide practice in this evolving
landscape. Such a framework will be essential to
ensure that technological advancements continue to
serve the fundamental principles of surgical ethics,
maintaining the highest standards of care, integrity,
and professionalism in an era marked by rapid change
and innovation.
REFERENCES
Valery P. Discours aux chirurgiens. Congrès français de
chirurgie. 1938. St Amand: Editions Gallimard; 2010. p.
587.
1.
Vallabha T. Ethics in Surgery [Internet]. unknown. 2019.
Available from:
https://www.researchgate.net/publication/332072679_Et
hics_in_Surgery
2.
Ferreres AR. Surgical Ethics: Principles and Practice.
Springer; 2019.
3.
Pellegrini CA, Ferreres A. Surgical Ethics Symposium
“Ethical Dilemmas in Surgical Practice.” World Journal of
Surgery. 2014 Apr 21;38(7):1565–6.
4.
ACKNOWLEDGEMENT
Author would like to express sincere gratitude to her
mentor Dr. N.M.Balakrishnan, Consultant Urologist,
for his unwavering guidance, insightful feedback and
constant encouragement throughout. His exemplary
ethics have been an inspiration for this article’s
fruition.
WMA JDN Special Edition Bulletin on Medical Education and Medical Ethics
Open access Editorial
WMA JDN Special Edition Bulletin on AMR
Integrating Ethics in Medical Education: India’s
AETCOM Approach and the Global Implications
1
Dr Venkatesh Karthikeyan , Dr Shamshad Ahmad
Medical ethics is fundamental to practicing
medicine. It provides a framework that
ensures patient care is delivered with
integrity, respect, and compassion.
Integrating ethical principles into medical
education is essential, as it prepares future
doctors to navigate the complex moral
dilemmas they will face in their careers.
Globally, there’s been a growing focus on
ethics training in medical education(1),
recognizing that understanding ethics is as
important as clinical skills for quality
healthcare(2).
30
From the first year of medical school,
AETCOM focuses on building the right
attitudes, communication skills, and ethical
standards.
AETCOM is designed on the understanding
that cognitive attitudes. Emphasize that a
person’s deep beliefs and values are central
to their ethical behavior and decision-
making. In the context of medical
education, the ethical dimensions of
decision-making and patient care are not
just supplementary but foundational to the
practice of medicine.
AETCOM teaches that ethical behavior in
healthcare is inseparable from effective
communication, which is rooted in respect
for the uniqueness and inherent value of
every human being. It integrates ethical
principles across multiple stages of the
medical curriculum via specific
competencies, ensuring that students
develop a consistent and deeply ingrained
sense of ethical responsibility. This
approach leads the way for broader,
competency-based medical education
reform in India.
Dr Venkatesh
Karthikeyan MD,
Medical Education
Director,
Young Doctors’
Forum,
Commonwealth
Medical
Association.
1
Introduction
Medical Ethics in Indian Medical
Education
India is a major contributor to the global
healthcare workforce, with over 1.3 million
modern medicine doctors(3). This makes it
essential for India’s medical curriculum to
address local needs while preparing doctors
for global standards. In the past, Indian
medical training hasn’t given enough
attention to ethics, communication, and
leadership(4). These areas were
inconsistently covered, leaving a gap in how
well-rounded doctors were prepared. The
introduction of the Attitude, Ethics, and
Communication (AETCOM) module by the
National Medical Commission (NMC)
represents a significant step forward in
addressing this gap(5).
Attitude, Ethics, and Communication
(AETCOM)
The AETCOM program aims to create well-
balanced training for medical students. It’s
based on the five key roles of an ‘Indian
Medical Graduate (IMG)’:
1. Clinician
2.Leader of healthcare team
3. Communicator
4. Life-long learner, and
5. Professional(5).
WMA JDN Special Edition Bulletin on Medical Education and Medical Ethics
Dr Shamshad
Ahmad,
Department of
Community and
Family Medicine,
All India Institute
of Medical
Sciences,
Patna, Bihar,
India.
2
2
Our Experience
To assess how students perceive ethics in
real-world clinical settings, an interactive
activity was conducted using the ClassPoint
app during an AETCOM session at AIIMS
Patna. Students were asked: “Based on
your hospital experience over the past three
years, describe one situation you personally
observed that you felt was unethical.”
Responses from 21 students revealed that a
large proportion (~62%) identified
communication-related lapses—such as
rude behavior, lack of explanation, skipping
consent, and inadequate time given to
patients—as unethical. Several also cited
attitude-related concerns, including
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WMA JDN Special Edition Bulletin on AMR
The integration of ethics into medical education
is not just a useful addition but a fundamental
necessity. India’s AETCOM exemplifies how
ethics can be effectively embedded into the
core of medical training, shaping future doctors
who are not only technically skilled but also
ethically sound.
The potential long-term benefits of such an
approach are profound, as it prepares medical
professionals to navigate the moral
complexities of modern healthcare with
integrity and compassion. Globally,
organizations like the World Medical
Association – Junior Doctors Network (WMA
JDN) can play a pivotal role in promoting the
inclusion of ethics in medical education,
ensuring that future doctors are ready for the
challenges ahead.
REFERENCES
Roy S, Shah MH, Ahluwalia A, Harky A. Analyzing the
Evolution of Medical Ethics Education: A Bibliometric
Analysis of the Top 100 Cited Articles. Cureus.
15(7):e41411.
1.
Andersson H, Svensson A, Frank C, Rantala A, Holmberg
M, Bremer A. Ethics education to support ethical
competence learning in healthcare: an integrative
systematic review. BMC Med Ethics. 2022 Mar 19;23:29.
2.
Government has taken multiple steps to further increase
availability of doctors in the country [Internet]. [cited
2024 Aug 29]. Available from:
https://pib.gov.in/pib.gov.in/Pressreleaseshare.aspx?
PRID=1845081
3.
Gupta A. Low Ethical Standards Are Common in Medical
Education in India – The Wire Science [Internet]. 2021
[cited 2024 Aug 29]. Available from:
https://science.thewire.in/health/india-low-ethical-
standards-common-medical-education/
4.
AETCOM_book.pdf [Internet]. [cited 2024 Aug 29].
Available from: https://www.nmc.org.in/wp-
content/uploads/2020/01/AETCOM_book.pdf
5.
WMA JDN Special Edition Bulletin on Medical Education and Medical Ethics
Conclusion
Global Implications: Inspiring Ethics in
Medical Education Worldwide
India’s AETCOM module is an innovative
approach to integrating ethical principles into
the medical curriculum, serving as a model that
other countries can learn from. It addresses
local needs while offering a framework that can
be scaled internationally. As healthcare
challenges grow more complex, the need for
ethically trained doctors becomes more urgent.
insensitivity, lack of empathy, and hierarchical
abuse. Interestingly, many students
instinctively framed these interpersonal issues
as breaches of ethics, reflecting an evolving but
blurred understanding of the distinctions
between attitude, ethics, and communication in
patient-doctor interactions. This underscores
the critical role of the AETCOM framework—not
only in sensitizing students to real-world ethical
challenges, but also in helping them navigate
the thin but significant boundaries between
these domains through structured reflection,
dialogue, and competency-based training.
Navigating Ethical Waters: The Junior Doctors’ Strike
in South Korea and Its Implications for Healthcare
Professionalism
1
Yujin Song
This strike placed the nation’s largest
hospitals, which rely heavily on interns and
residents, in a difficult position. They had to
reduce the number of inpatients and
surgeries by half, leading to the reduction in
the usual level of medical services provided
to patients. The junior doctors found
themselves in a profound ethical quandary,
balancing their commitment to patient care
against their right to advocate for improved
working conditions.
The essence of medical professionalism, as
outlined in medical ethics, is rooted in the
principles of beneficence, non-maleficence,
autonomy, and justice. The strike, by
impacting patient care and access to
healthcare services, challenged the ethical
principles of non-maleficence—the duty to
do no harm—and beneficence—the
obligation to promote the well-being of
patients.
In the short term, the strike led to
immediate disruptions in patient care,
causing inconvenience for patients.
However, the long-term effects could be
more profound, potentially leading to
positive changes in the healthcare delivery
system. The unintended positive outcomes
of the restructuring of dependence on junior
doctors in teaching hospitals and the
decrease in patient admissions with milder
symptoms at tertiary university hospitals in
urban areas are already happening. With the
number of medical professionals and
patients at large hospitals dropping to less
than half of normal levels, a noticeable
decrease in health insurance spending has
taken place.
While disruptive initially, the strike could
serve as an initiator for a general
reevaluation of how medical services are
provided and prioritized, leading to
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Open access Editorial
improvements in healthcare delivery and
working conditions that align more closely
with the principles of medical
professionalism.
WMA JDN Special Edition Bulletin on AMR
Yujin SONG, MD
(JDN-Korea,
Republic of Korea)
1
Ethical Dilemmas and Professionalism
To resolve this crisis, dialogues among
stakeholders must be facilitated, aiming at
solutions that uphold the ethical standards
of medical practice and ensure that our
healthcare system remains responsive to
the needs of both patients and medical
professionals. The government’s ongoing
threats to suspend the medical licenses of
junior doctors and maintaining a militant
attitude will only serve to prolong the
healthcare crisis.
It is imperative that all parties involved
acknowledge the legitimate concerns of the
junior doctors while also considering the
long-term implications for patient care and
the integrity of the healthcare system. By
fostering an environment where medical
professionals feel valued and supported, we
can ensure the delivery of high-quality care
to all members of society, paving the way
towards a resilient and equitable healthcare
future.
Towards a Resilient and Equitable
Healthcare Future
WMA JDN Special Edition Bulletin on Medical Education and Medical Ethics
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WMA JDN Special Edition Bulletin on AMR
REFERENCES
Ha K-D. The conviction for medical malpractice is tenfold
difference … 239 cases in Korea and only 32 cases in
Japan. Medigate News. 2024 [cited 2024 April 7]. Available
from: https://medigatenews.com/news/2040171346
1.
Kim H-J. Seoul gives young doctors 4 days to end walkouts,
threatening suspended licenses and prosecutions.
2.
AP News. 2024 [cited 2024 April 7]. Available from:
https://apnews.com/article/south-korea-doctors-walkout-
medical-school-17c805f9e5280419ac7273258dd03440
3.
WMA JDN Special Edition Bulletin on Medical Education and Medical Ethics
Patient-Centered Care and Shared Decision-Making:
Navigating Ethical Complexities in the Treatment of
Suicidal Patients
1
Dr. Yassine Bahr
At the outset of this reflection on ethics, I’d
like to introduce a clinical case that vividly
illustrates some of the intricate ethical
dilemmas frequently encountered in
medical practice.
The case involves a 50-year-old patient who
was admitted to the Intensive Care Unit
(ICU) of a small French town following a
suicide attempt by hanging. The patient had
a history of depression but no other
significant medical conditions. He was a
father of three children and was married.
Before the attempt, he left a letter
explaining the reasons behind his actions.
His wife found him unconscious but still
breathing and immediately called
emergency services.
The French Mobile Emergency and
Resuscitation Service (SMUR) arrived
approximately 10 minutes later and
provided initial care. The patient was
intubated to protect his airway and
transported to the hospital. Subsequent
examination revealed significant cerebral
edema and a hyoid bone fracture, indicating
a poor prognosis. At this point, we
encounter an ethical dilemma that compels
us to reflect on the broader complexities
involved in caring for patients at risk of
suicide.
34
Open access Editorial
Respecting a patient’s autonomy means
acknowledging their right to make informed
decisions about their health and treatment.
However, this principle becomes
particularly challenging when dealing with
suicidal patients, as their capacity for sound
decision-making may be compromised by
their mental state. As Beauchamp and
Childress outline, autonomy is a
cornerstone of medical ethics, but it must
be balanced with the principles of
beneficence and non-maleficence,
especially when a patient is at risk of self-
harm.
WMA JDN Special Edition Bulletin on AMR
Dr. Yassine BAHR,
MD in
Anesthesiology and
Intensive Care
Medicine
Patient-Centered
Care and Shared
Decision-Making
Professionalism
and Ethics in
Healthcare Delivery
1
Introduction to Ethical Reflection: A
Clinical Case Study
Confidentiality vs. Duty to Warn
Although not directly encountered in this
particular case, the issue of confidentiality
often arises in the care of suicidal patients.
Maintaining patient confidentiality is a
fundamental tenet of medical ethics, but
this duty can be superseded by the
obligation to protect the patient or others
from imminent harm. The ethical dilemma
lies in balancing the need for confidentiality
with the duty to warn, especially when there
is a credible risk of self-harm or danger to
others. For instance, healthcare
professionals might be ethically required to
inform potential victims or authorities if
there is a direct threat, despite the patient’s
right to privacy.
Ethical Considerations in the Care of
Suicidal Patients
The ethics surrounding the treatment of
suicidal patients are complex and
multifaceted, requiring a delicate balance
between respecting patient autonomy and
ensuring their safety. This topic is
particularly sensitive, given the vulnerable
state of such patients and the profound
impact of suicide on families and
communities. Key ethical considerations
include:
Respect for Autonomy
Beneficence and Non-Maleficence
Healthcare professionals have an obligation
to act in the best interest of their patients
(beneficence) while also avoiding harm
(non-maleficence). In the context of
suicidal patients, this often necessitates
interventions aimed at preventing self-
harm, even if it means overriding the
patient’s immediate wishes. In such
situations, the ethical principles of
beneficence and non-maleficence
frequently justify actions that might limit
patient autonomy to prevent imminent
danger.
WMA JDN Special Edition Bulletin on Medical Education and Medical Ethics
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WMA JDN Special Edition Bulletin on AMR
The potential long-term benefits of such an approach
are profound, as it prepares medical professionals to
navigate the moral complexities of modern healthcare
with integrity and compassion. Globally, organizations
like the World Medical Association – Junior Doctors
Network (WMA JDN) can play a pivotal role in
promoting the inclusion of ethics in medical
education, ensuring that future doctors are ready for
the challenges ahead.
Involuntary Treatment
Ethical Decision-Making Frameworks
Utilizing ethical decision-making frameworks is
essential for healthcare providers when navigating the
complexities associated with caring for suicidal
patients. These frameworks offer a structured
approach, often involving steps such as identifying the
ethical issues, understanding the perspectives of all
stakeholders (patients, families, healthcare
professionals, and society), and evaluating the
potential outcomes of different actions. By
systematically applying such a process, healthcare
professionals can gain clarity and direction in
balancing competing ethical principles, particularly in
situations as delicate as caring for suicidal individuals.
In the case presented, especially given the patient’s
relatively young age and lack of significant
comorbidities, the principle of Beneficence guided the
decision to provide intensive medical care. The aim
was to act in the best interest of the patient by
offering life-saving interventions. However, despite
our efforts, the patient’s condition deteriorated due to
worsening cerebral edema over several days. After
thorough discussions with the family, we reached the
difficult decision to discontinue artificial life support,
acknowledging the inevitability of the outcome and
respecting the patient’s dignity in his final moments.
Balancing Ethical Principles in the Care of Suicidal
Patients
The ethical care of suicidal patients necessitates a
careful equilibrium between respecting patient
autonomy and ensuring safety. Healthcare providers
must navigate the intricate interplay of Beneficence,
Non-Maleficence, and Confidentiality, often facing the
reality that involuntary interventions might be
required to prevent immediate harm. Employing
structured ethical decision-making frameworks helps
ensure that these interventions remain grounded in
compassion, respect, and moral integrity, allowing
professionals to make informed and ethically sound
decisions.
The complexity of ethical dilemmas encountered in
the care of suicidal patients highlights the critical
need for comprehensive training in medical ethics for
all healthcare professionals. Medical education should
extend beyond the development of clinical
competencies to include a strong emphasis on ethical
principles, decision-making frameworks, and real-
world applications. By integrating robust ethical
training into medical curricula, future healthcare
providers will be better equipped to handle the
challenging decisions they will inevitably face and
ensure that their approach to care is both effective
and ethically grounded.
Enhanced training programs and ongoing professional
development in medical ethics can empower
healthcare providers with the knowledge and skills
necessary to navigate the moral complexities inherent
in caring for suicidal patients. This, in turn, will
contribute to improved patient outcomes and foster a
more compassionate and ethically aware healthcare
environment.
The Role of Medical Education in Ethical Decision-
Making
The Need for International Collaboration and
Legal Considerations
Addressing the ethical complexities of caring for
suicidal patients is a challenge that transcends
borders, highlighting the need for international
collaboration in developing ethical guidelines and
training programs. However, it is crucial to recognize
that legal systems vary significantly across different
countries, influencing how ethical principles are
applied in practice. As we work toward establishing a
more unified approach to medical ethics at an
international level, these legal differences must be
carefully considered to ensure that ethical guidelines
are both applicable and adaptable to diverse
healthcare settings.
By fostering global dialogue and cooperation, the
medical community can work together to enhance
ethical standards in the care of suicidal patients,
ultimately contributing to a more compassionate and
ethically responsible approach to healthcare
worldwide.
WMA JDN Special Edition Bulletin on Medical Education and Medical Ethics
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REFERENCES
Jean Leonetti, at the general assembly of InterSyndicale
Nationale des Internes (ISNI) – French junior doctor
national union
1.
Stanford Encyclopedia of Philosophy –
https://plato.stanford.edu/entries/utilitarianism-history/
2.
Montreuil M, Séguin M, P Gros C, Racine E. Everyday
ethics of suicide care: Survey of mental health care
providers’ perspectives and support needs. PLoS One.
2021 Apr 22
3.
4.Sharan, Pratap. Ethical Challenges in Clinical Care of
Suicidal Patients. Indian Journal of Social Psychiatry
39(4):p 319-324, Oct–Dec 2023. | DOI:
10.4103/ijsp.ijsp_271_23
5.https://www.researchgate.net/publication
287538529_Practicing_medicine_and_ethics_integratin
g_wisdom_conscience_and_goals_of_care
WMA JDN Special Edition Bulletin on Medical Education and Medical Ethics
Ethical Considerations of Healthcare Technology
Advancements
1
Dr Sai Charan Sharma
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Open access Editorial
Another ethical consideration is the
potential for bias and discrimination
inherent in healthcare algorithms and
artificial intelligence (AI) systems.
These technologies rely on vast datasets to
train algorithms and make predictions, yet
these datasets may be biased or
incomplete, leading to unfair outcomes. For
example, algorithms trained on data
primarily from certain demographic groups
may produce inaccurate results when
applied to more diverse populations,
perpetuating disparities in diagnosis and
treatment.
Addressing bias in healthcare algorithms
requires transparency in data collection,
rigorous testing, and ongoing monitoring to
ensure fairness and equity.
Additionally, the rapid pace of technological
innovation in healthcare raises questions
about the appropriate regulatory framework
and oversight mechanisms. Balancing the
need to foster innovation with ensuring
patient safety and ethical standards
presents a complex challenge. While
regulatory bodies play a crucial role in
evaluating the safety and efficacy of new
technologies, they must also be agile
enough to keep pace with rapid
advancements. Moreover, involving
stakeholders from diverse backgrounds,
including patients, healthcare providers
ethicists, and policymakers, in the decision-
making process can help ensure that ethical
considerations are adequately addressed.
In conclusion, while healthcare technology
advancements hold tremendous promise for
improving patient care and outcomes, they
also raise significant ethical concerns that
cannot be overlooked. Addressing these
concerns requires a multifaceted approach
that considers the impact of technology on
health disparities, patient privacy, bias and
discrimination, and regulatory oversight. By
WMA JDN Special Edition Bulletin on AMR
Dr Sai Charan
Sharma,
Nepal.
1
The integration of technology into
healthcare has accelerated in recent years,
offering promising solutions to improve
patient care, diagnosis, and access to
medical services. However, alongside these
advancements come ethical considerations
that warrant careful examination. As we
navigate the rapidly evolving landscape of
healthcare technology, it is crucial to
address these ethical implications to ensure
that technology serves the best interests of
patients and society as a whole.
One of the primary ethical concerns
associated with healthcare technology
advancements is the potential exacerbation
of existing health disparities. While these
innovations hold the promise of expanding
access to healthcare services, there is a risk
that certain populations, particularly
marginalized communities, may be left
behind. Factors such as cost, digital
literacy, and access to infrastructure can
create barriers to adoption, widening the
gap between those who can benefit from
technology and those who cannot. As we
embrace new technologies, it is essential to
consider how they can be leveraged to
reduce, rather than perpetuate, health
inequalities.
Furthermore, the widespread adoption of
digital health technologies raises significant
concerns about patient privacy and data
security. With the digitization of health
records, the proliferation of wearable
devices, and the use of telemedicine
platforms, vast amounts of sensitive health
data are being collected, stored, and
transmitted. Ensuring the confidentiality
and security of this data is paramount to
maintaining patient trust and safeguarding
individual privacy rights. Moreover, the
ownership, control, and consent
surrounding the use of health data for
research, commercial purposes, and
algorithmic decision-making must be
carefully addressed to prevent exploitation
and misuse.
WMA JDN Special Edition Bulletin on Medical Education and Medical Ethics
38
Open access Editorial
WMA JDN Special Edition Bulletin on AMR
prioritizing ethical considerations in the development,
implementation, and evaluation of healthcare
technologies, we can harness the full potential of
technology to enhance healthcare delivery while
safeguarding the well-being and rights of patients.
REFERENCES
Topol, E. (2019). Deep Medicine: How Artificial
Intelligence Can Make Healthcare Human Again.
1.
Floridi, L. (2016). The ethics of information and
communication technologies.
2.
WHO publications on digital health ethics.
3.
WMA JDN Special Edition Bulletin on Medical Education and Medical Ethics
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