{"id":10747,"date":"2018-04-20T13:43:40","date_gmt":"2018-04-20T12:43:40","guid":{"rendered":"https:\/\/www.wma.net\/wp-content\/uploads\/2018\/04\/201804_CS_English.pdf"},"modified":"2018-04-20T13:43:40","modified_gmt":"2018-04-20T12:43:40","slug":"201804_cs_english-2","status":"inherit","type":"attachment","link":"https:\/\/www.wma.net\/es\/seccion-de-miembros\/documentos-de-trabajo\/201804_cs_english-2\/","title":{"rendered":"201804_CS_English"},"author":5,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"acf":[],"description":{"rendered":"

\"\"<\/a><\/p>\n

12\/03\/2018 WMA 209th Council Session, Riga 2018 – Provisional Schedule | Online Registration by Cvent
\nhttp:\/\/www.cvent.com\/events\/wma-209th-council-session-riga-2018\/agenda-879abdce4c6f40d2ad07b3b4b810676d.aspx 1\/2
\nAGENDA
\nTuesday,\u00a0April\u00a024,\u00a02018
\n\u00a0
\n9:00\u00a0AM\u00a0\u00a0\u00ad\u00a0\u00a06:00\u00a0PM Potential\u00a0workgroup\u00a0meetings \u00a0\u00a0\u00a0\u00a0
\nWednesday,\u00a0April\u00a025,\u00a02018
\n\u00a0
\n9:00\u00a0AM\u00a0\u00a0\u00ad\u00a0\u00a06:00\u00a0PM Potential\u00a0workgroup\u00a0meetings \u00a0\u00a0\u00a0\u00a0
\n11:30\u00a0AM\u00a0\u00a0\u00ad\u00a0\u00a012:30\u00a0PM Finance\u00a0Group \u00a0\u00a0\u00a0\u00a0
\n12:30\u00a0PM\u00a0\u00a0\u00ad\u00a0\u00a02:30\u00a0PM Executive\u00a0Committee \u00a0\u00a0\u00a0\u00a0
\n7:00\u00a0PM\u00a0\u00a0\u00ad\u00a0\u00a010:00\u00a0PM Meet\u00a0the\u00a0Associate\u00a0Members\u00a0of\u00a0the\u00a0World\u00a0Medical\u00a0Association
\nInformal\u00a0Dinner\u00a0sponsored\u00a0by\u00a0the\u00a0Latvian\u00a0Medical\u00a0Association
\n\u00a0\u00a0
\nThursday,\u00a0April\u00a026,\u00a02018
\n\u00a0
\n7:30\u00a0AM\u00a0\u00a0\u00ad\u00a0\u00a04:00\u00a0PM Registration\u00a0\u00ad\u00a0Radisson\u00a0Blu\u00a0Latvija\u00a0Conference\u00a0&\u00a0SPA\u00a0Hotel
\n9:00\u00a0AM\u00a0\u00a0\u00ad\u00a0\u00a010:30\u00a0AM Opening\u00a0Plenary\u00a0Session\u00a0of\u00a0the\u00a0Council
\n10:30\u00a0AM\u00a0\u00a0\u00ad\u00a0\u00a010:45\u00a0AM Coffee\u00a0Break
\n10:45\u00a0AM\u00a0\u00a0\u00ad\u00a0\u00a012:30\u00a0PM Finance\u00a0and\u00a0Planning\u00a0Committee
\n12:30\u00a0PM\u00a0\u00a0\u00ad\u00a0\u00a02:00\u00a0PM Lunch\u00a0break \u00a0\u00a0\u00a0\u00a0
\n2:00\u00a0PM\u00a0\u00a0\u00ad\u00a0\u00a03:30\u00a0PM Finance\u00a0and\u00a0Planning\u00a0Committee\u00a0(continuation)
\n3:30\u00a0PM\u00a0\u00a0\u00ad\u00a0\u00a03:45\u00a0PM Coffee\u00a0Break
\n3:45\u00a0PM\u00a0\u00a0\u00ad\u00a0\u00a05:00\u00a0PM Finance\u00a0and\u00a0Planning\u00a0Committee\u00a0(if\u00a0needed)\u00a0\/\u00a0Socio\u00adMedical\u00a0Affairs\u00a0Committee
\n6:30\u00a0PM\u00a0\u00a0\u00ad\u00a0\u00a07:30\u00a0PM Welcome\u00a0Reception
\nOffered\u00a0by\u00a0the\u00a0Latvian\u00a0Medical\u00a0Association
\n\u00a0\u00a0
\nFriday,\u00a0April\u00a027,\u00a02018
\n\u00a0
\n9:00\u00a0AM\u00a0\u00a0\u00ad\u00a0\u00a010:30\u00a0AM Socio\u00adMedical\u00a0Affairs\u00a0Committee\u00a0(continuation)
\n10:30\u00a0AM\u00a0\u00a0\u00ad\u00a0\u00a010:50\u00a0AM Coffee\u00a0Break
\n10:45\u00a0AM\u00a0\u00a0\u00ad\u00a0\u00a012:30\u00a0PM Socio\u00adMedical\u00a0Committee\u00a0(continuation)
\n12:30\u00a0PM\u00a0\u00a0\u00ad\u00a0\u00a02:00\u00a0PM Lunch\u00a0break \u00a0\u00a0\u00a0\u00a0
\n2:00\u00a0PM\u00a0\u00a0\u00ad\u00a0\u00a03:30\u00a0PM Medical\u00a0Ethics\u00a0Committee
\n3:30\u00a0PM\u00a0\u00a0\u00ad\u00a0\u00a03:45\u00a0PM Coffee\u00a0Break
\n3:45\u00a0PM\u00a0\u00a0\u00ad\u00a0\u00a05:00\u00a0PM Medical\u00a0Ethics\u00a0Committee\u00a0(continuation)
\n7:00\u00a0PM\u00a0\u00a0\u00ad\u00a0\u00a09:30\u00a0PM Council\u00a0Gala\u00a0Dinner
\nOffered\u00a0by\u00a0the\u00a0World\u00a0Medical\u00a0Association
\n\u00a0\u00a0
\nSaturday,\u00a0April\u00a028,\u00a02018
\n\u00a0
\n8:00\u00a0AM\u00a0\u00a0\u00ad\u00a0\u00a09:30\u00a0AM Council\u00a0Plenary\u00a0Session
\n9:30\u00a0AM\u00a0\u00a0\u00ad\u00a0\u00a09:45\u00a0AM Coffee\u00a0Break
\n9:45\u00a0AM\u00a0\u00a0\u00ad\u00a0\u00a012:30\u00a0PM Council\u00a0Plenary\u00a0Session\u00a0(continuation)
\n12:30\u00a0PM\u00a0\u00a0\u00ad\u00a0\u00a02:00\u00a0PM Lunch\u00a0break \u00a0\u00a0\u00a0\u00a0
\nWMA\u00a0209TH\u00a0COUNCIL\u00a0SESSION,\u00a0RIGA\u00a02018
\n12\/03\/2018 WMA 209th Council Session, Riga 2018 – Provisional Schedule | Online Registration by Cvent
\nhttp:\/\/www.cvent.com\/events\/wma-209th-council-session-riga-2018\/agenda-879abdce4c6f40d2ad07b3b4b810676d.aspx 2\/2
\n2:00\u00a0PM\u00a0\u00a0\u00ad\u00a0\u00a02:30\u00a0PM Conclusion\u00a0of\u00a0Council\u00a0Session
\n3:00\u00a0PM\u00a0\u00a0\u00ad\u00a0\u00a09:00\u00a0PM Sightseeing\u00a0tour\u00a0and\u00a0informal\u00a0dinner
\nOffered\u00a0by\u00a0the\u00a0Latvian\u00a0Medical\u00a0Association
\n\u00a0\u00a0
\n1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument
\nno:
\nCouncil 209\/Agenda\/Apr2018 Original:
\nEnglish
\nTitle: Agenda of the 209th
\nCouncil Session
\nDestination: 209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nFor
\nconsideration
\nNote: The Council will convene on Thursday, 26 April 2018,
\nbefore the meetings of the Standing Committees. It will then
\nre-convene on Saturday, 28 April 2018, to consider the
\nreports of the Standing Committees.
\nThursday, 26 April 2018, 9:00 am \u2013 10:30 am
\nSaturday, 28 April 2018, 8:00 am \u2013 2:30 pm
\nMembership of the Council
\nDr David O. Barbe Dr Kenji Matsubara
\nDr MooJin Choo Dr Mari Michinaga
\nDr Andrew Dearden (Treasurer) Dr Frank-Ulrich Montgomery (Vice Chair)
\nDr Louis Francescutti Dr Ramin Parsa-Parsi
\nDr Michael B. Gannon Dr Mark Porter
\nDr Mzukisi Grootboom Dr Seraf\u00edn Romero
\nDr Andrew W. Gurman Dr Andreas Rudkoebing
\nDr Ren\u00e9 H\u00e9man Dr Heidi Stensmyren
\nDr Ardis Dee Hoven (Chair) Dr Thomas Szekeres
\nDr Miguel Roberto Jorge Dr Julio Trostchansky
\nDr Toru Kakuta Dr Walter Vorhauer
\nDr Ajay Kumar Dr Shuyang Zhang
\nEx-officio (without voting rights)
\nDr Yoshitake Yokokura, President
\nDr Leonid Eidelman, President-Elect
\nDr Ketan Desai, Immediate Past President
\nDr Otmar Kloiber, Secretary General
\nMs Marie Collegrave-Juge, Legal Advisor
\nMr Adolf H\u00e4llmayr, Financial Advisor
\nMs Joelle Balfe, Facilitator
\n* All statutory meetings of the WMA will be recorded for preparing minutes and reports.
\nMarch 2018 Council 209\/Agenda\/Apr2018
\n2
\n1. GENERAL BUSINESS
\n1.1 Call to order by the Chair of Council
\n1.2 Receive apologies for absence
\n1.3 Welcome new Council Member(s)
\n1.4 Chair\u2019s opening remarks
\n1.5 Secretary General\u2019s announcements
\n2. MINUTES OF THE PREVIOUS MEETINGS
\nApprove: Summary Minutes of the 207th
\nand 208th
\nCouncil Sessions
\nheld in Chicago, United States, 10-14 October 2017
\n(Council 207\/Minutes\/Oct2017 and Council 208\/Minutes\/Oct2017)
\n3. INTERIM REPORT OF THE PRESIDENT
\nReceive: Report by the WMA President on presidential activities
\nfrom October 2017 to March 2018 (Council 209\/President Report\/Apr2018)
\n4. REPORT OF THE SECRETARY GENERAL
\nReceive: Report of the Secretary General to the Council
\n(Council 209\/SecGen Report\/Apr2018)
\n5. REPORT OF THE CHAIR OF COUNCIL
\nReceive: Report by the WMA Chair of Council
\n(Council 209\/Chair of Council Report\/Apr2018)
\n6. CONSIDERATION OF ITEMS TO BE CONSIDERED AS A MATTER OF
\nURGENCY BY THIS COUNCIL
\n7. COMMITTEE REPORTS
\n7.1 Medical Ethics Committee
\nConsider: Report of the Medical Ethics Committee (*MEC 209\/Report\/Apr2018)
\nMarch 2018 Council 209\/Agenda\/Apr2018
\n3
\n7.2 Finance and Planning Committee
\nConsider: Report of the Finance and Planning Committee (*FPL 209\/Report\/Apr2018)
\n7.3 Socio-Medical Affairs Committee
\nConsider: Report of the Socio-Medical Affairs Committee (*SMAC
\n209\/Report\/Apr2018)
\n8. ADVOCACY
\nConsider: Oral Report of WMA Advocacy and Communications Advisory Panel
\n9. WORK OF THE WORLD HEALTH ORGANIZATION (WHO)
\n9.1 71st
\nWorld Health Assembly
\nReceive: Oral Report on the Agenda of the upcoming 71st
\nWHA
\nReceive: Oral Report of WMA Activities at the WHO 71st
\nWHA
\n10. ANY OTHER BUSINESS
\n11. ANNUAL CEO REVIEW SESSION (CLOSED SESSION FOR COUNCIL MEMBERS
\nONLY)
\n12. ADJOURNMENT
\n\u00a7\u00a7\u00a7
\n* Indicates document to be distributed in Riga.
\n12.03.2018<\/p>\n

1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument
\nno:
\nCouncil 207\/Minutes\/Oct2017 Original:
\nEnglish
\nTitle: Minutes of the 207th
\nCouncil Session
\nDestination: 209th
\nCouncil Session
\nRadisson Blu Hotel Latvija
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nFor
\nconsideration
\nWednesday, 11 October 2017, 8:00 am \u2013 8:15 am
\nFriday, 13 October 2017, 8:00 am \u2013 10:30 am
\nMembership of the Council
\nDr David O. Barbe Dr Kenji Matsubara
\nDr MooJin Choo Dr Mari Michinaga
\nDr Andrew Dearden (Treasurer) Prof. Dr med. Frank-Ulrich Montgomery (Vice Chair)
\nDr Leonid Eidelman Dr Ramin Parsa-Parsi
\nDr Louis Francescutti Dr Mark Porter
\nDr Michael B. Gannon Dr Seraf\u00edn Romero
\nDr Mzukisi Grootboom Dr Andreas Rudkoebing
\nDr Andrew W. Gurman Dr Heidi Stensmyren
\nDr Ren\u00e9 H\u00e9man Dr Thomas Szekeres
\nDr Ardis Dee Hoven (Chair) Dr Julio Trostchansky
\nDr Miguel Roberto Jorge Dr Walter Vorhauer
\nDr Toru Kakuta Dr Shuyang Zhang
\nDr Ajay Kumar
\nEx-officio (without voting rights)
\nDr Ketan Desai, President
\nSir Michael Marmot, Immediate Past President
\nDr Yoshitake Yokokura, President-Elect
\nDr Otmar Kloiber, Secretary General
\nMs Marie Colegrave-Juge, Legal Advisor
\nMr Adolf H\u00e4llmayr, Financial Advisor
\nProf. Vivienne Nathanson, Facilitator
\n1. GENERAL BUSINESS
\n1.1 The meeting was called to order by the Chair of Council at 8:10 am on October 11,
\n2017.
\nOctober 2017 Council 207\/Minutes\/Oct2017
\n2
\n1.2 The Secretary General welcomed new members, from Dr David O. Barbe (United
\nStates), Dr MooJin Choo (Korea), and Dr Seraf\u00edn Romero (Spain). Apologies for
\nabsence were received from Dr Thomas Szekeres (Austria; replaced by Dr Herwig
\nLindner), Dr Julio Trostchansky (Uruguay; replaced by Dr Alarico Rodriguez), and
\nformer WMA Presidents; Sir Michael Marmot, Dr Yank Coble, Dr Dana Hanson and
\nDr Wonchat Subhachaturas.
\n1.3 Chair\u2019s opening remarks. The Chair reminded participants that live tweeting (Twitter)
\nduring the meeting regarding WMA finances, draft policies, and internal matters was
\nnot allowed. Debates on policies that had not been adopted by the General Assembly
\nshould be kept confidential. She also explained that participants who are not Council
\nmembers are welcome to participate in the meeting.
\n2. MINUTES OF THE PREVIOUS MEETINGS
\nThe Council approved the Summary Minutes of the 206th
\nCouncil Sessions held in
\nLivingstone, Zambia, 20-22 April 2016 (Council 206\/Minutes\/Apr2017).
\n3. APPOINTMENT OF A CREDENTIALS COMMITTEE
\nThe Council accepted the recommendation from the Secretary General that the Credentials
\nCommittee be composed of one delegate each from the following NMAs: Kenya, Belgium,
\nPanama.
\n4. INTERIM REPORT OF THE PRESIDENT
\nThe Council received the report of WMA President, Dr Ketan Desai, on presidential activities
\nfrom May to September 2017. Dr Desai delivered his report as written in document Council
\n207\/Presidential Report\/Oct2017.
\n5. REPORT OF THE SECRETARY GENERAL
\nThe Council received the oral Report of the Secretary General to the Council which
\ncomplements the Council Report (GA 2017-Council Report-Oct2017). Dr Kloiber explained
\nthe structure of the Report of the Council to the General Assembly. He thanked all members
\nwho participated in the work of the WMA between meetings, noting in particular the One
\nHealth Conference attended by more than 600 and hosted by the Japan Medical Association
\nand meetings on End of Life issues, held in Latin America, hosted by the Brazilian Medical
\nAssociation and also in Japan, hosted by the Japan Medical Association in collaboration with
\nthe Confederation of Medical Associations of Asia and Oceania (CMAAO). The Secretary
\nGeneral stressed that this type of cooperation and support for the regional work of NMAs is
\nessential.
\nDr Kloiber reminded the Council that he had reported to last Council session the automatic
\ntermination of membership of Russian Medical Society (RMS) for non-payment of Dues. He
\ninformed the Council that the RMS had sent a letter challenging that decision and threatening
\nto litigate if WMA accepted another constituent member from Russia. The WMA was not
\nresponding to the letter sent from the RMS.
\nOctober 2017 Council 207\/Minutes\/Oct2017
\n3
\n6. REPORT OF THE CHAIR OF COUNCIL
\nThe Council received the Report by the WMA Chair of Council from May to September 2017
\n(Council 207\/Chair of Council Report\/Oct2017). Dr Hoven stressed the importance of
\neveryone participating and feeling welcome and able to provide their viewpoints on the issues
\ndiscussed by the Council. She encouraged participants to ask for clarifications if they had
\nquestions about the process. She reiterated that everyone\u2019s participation was valued and
\ndesired.
\nThe Council Adjourned at 8:45 for the meetings of the Standing Committees.
\nThe Council reconvened to consider the reports of the Standing Committees at 8:06 on Friday 13
\nOctober 2017.
\n7. NEW ITEM TO BE CONSIDERED AS A MATTER OF URGENCY
\nThe Chair informed the Council of a new proposed WMA Resolution submitted after the
\nCouncil had adjourned for the Standing Committee meetings and that the Council would have
\nto decide whether to accept it as a matter of urgency. The proposal was entitled \u201cCouncil
\nResolution on Poland (Council 207\/Poland\/Oct2017). She read the text of the proposed
\nresolution aloud to enable interpretation in French, Spanish and Japanese.
\nDr Kloiber informed the Council that representatives from the Polish Chamber of Physicians
\nand Dentists had asked the WMA for help on this matter and Dr Kloiber proposed that this
\nhelp consists of the proposed Resolution as well as an immediate press release. He reviewed
\nthe issues covered by the Resolution. Dr Mazur, representative of the Chamber, stated that
\nthere was not enough public expenditure for health\u2014not enough for patients and not enough
\nfor adequate salaries of physicians, especially young physicians. Following ten days of
\nhunger strikes by some junior doctors, the Chamber had declared a Day of Solidarity with the
\nprotesters and hoped that the WMA would show its support by approving the resolution. The
\naddition of an explicit statement of solidarity was accepted as a friendly amendment to the
\nResolution.
\nThe Council accepted the Resolution of Poland (Council 207\/Poland REV\/Oct2017), as
\namended, as matter of urgency and approved it.
\n8. COMMITTEE REPORTS
\nThe Council used a consent calendar to consider the Committee reports.
\n8.1 Medical Ethics Committee
\nThe Council considered the report of the Medical Ethics Committee (MEC
\n207\/Report\/Oct2017). No extractions were requested and the Council approved the
\nreport.
\n8.2 Finance and Planning Committee
\nThe Council considered the Report of the Finance and Planning Committee (FPL
\n207\/Report\/Oct2017). No extractions were requested and the Council approved the
\nreport.
\nOctober 2017 Council 207\/Minutes\/Oct2017
\n4
\n8.3 Socio-Medical Affairs Committee
\nThe Council considered the Report of the Socio-Medical Affairs Committee SMAC
\n206\/Report\/Apr2017). No extractions were requested and the Council approved the
\nreport.
\n9. REPORT OF THE ENVIRONMENTAL CAUCUS
\nDr Vivienne Nathanson reported that the Caucus had met the previous evening and discussed
\nthe next phase of the climate negotiations (COP23) to take place in Bonn, Germany. The
\nWMA delegation to the conference had discussed their inputs to the meeting, including the
\nexpected revised Declaration of Delhi on Health and Climate Change, which would be voted
\non by the General Assembly at its plenary session. The Caucus had discussed efforts by
\nNMAs in areas related to climate change and the possibility of bringing all WMA policies
\nrelated to the environment together into a single document in the future. Dr Nathanson noted
\nthat she had finished her term as Chair of this caucus.
\n10. OUTREACH
\nThe Chair informed the Council that the following reports had been referred to the Council by
\nthe Finance and Planning Committee, which had not had time to receive them.
\n10.1 Report of the Chair of Associate Members
\nThe Chair of Associate Members, Dr Joseph Heyman, referred to the written report
\n(FPL 207\/Chair of AM Report\/Oct2017). He reminded Council members that after their
\nterms had ended they could stay involved with WMA as associate members.
\n10.2 Report of the Past Presidents and Chairs of Council Network (PPCN)
\nDr J\u00f3n Sn\u00e6dal referred to the written report, noting that the activities of this group had
\nbeen increasing.
\n10.3 Report of the Junior Doctors Network (JDN)
\nDr Caline Mattar, Chair of the Junior Doctors Network presented the report (FPL
\n207\/JDN Report\/Oct2017). She noted in particular that the JDN had recently decided to
\ntackle the topics of working conditions and mental health of junior doctors. She thanked
\nthe AMA for hosting the two-day meeting of the JDN prior to the General Assembly.
\n10.4 Report from the World Medical Journal
\nDr Peteris Apinis reported that the WMJ continues to publish after 65 years. He
\nthanked Dr Elmar Dopplefeld, assistants Maira Sudraba and Velta Poz, and WMA
\nPublic Relations Advisor, Mr Nigel Duncan, for their support.
\n10.5 Public Relations Report
\nWMA Public Relations Advisor, Mr Nigel Duncan, explained that it was his job to
\nassess what WMA matters would be of interest to the profession and to the public to
\ngenerate publicity for the WMA. At this meeting, he anticipated that the revised WMA
\nOctober 2017 Council 207\/Minutes\/Oct2017
\n5
\nDeclaration of Geneva would be likely to generate the most publicity and he intended to
\nissue a press release immediately upon its adoption by the General Assembly. All
\nNMAs would receive the press release and should adapt it by including a welcome of
\nthe policy by the NMA President or Chair, which would increase its interest to the
\nnational press in each country. NMAs have a role to play in increasing the profile of the
\nWMA. He offered his assistance to any NMA that wanted help drafting press releases.
\n11. ANY OTHER BUSINESS
\nThere were no other items of business for the Council.
\n12. ADJOURNMENT
\nThe meeting was adjourned at 8:53 am.
\n\u00a7\u00a7\u00a7
\n27.11.2017<\/p>\n

1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument
\nno:
\nCouncil 208\/Minutes\/Oct2017 Original:
\nEnglish
\nTitle: Minutes of the 208th
\nCouncil Session
\nDestination: 209th
\nCouncil Session
\nRadisson Blu Hotel Latvija
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nFor
\nconsideration
\nSaturday, 14 October 2017, 4:40 pm \u2013 4:45 pm
\nMembership of the Council
\nDr David O. Barbe Dr Kenji Matsubara
\nDr MooJin Choo Dr Mari Michinaga
\nDr Andrew Dearden (Treasurer) Prof. Dr med. Frank-Ulrich Montgomery (Vice Chair)
\nDr Leonid Eidelman Dr Ramin Parsa-Parsi
\nDr Louis Francescutti Dr Mark Porter
\nDr Michael B. Gannon Dr Seraf\u00edn Romero
\nDr Mzukisi Grootboom Dr Andreas Rudkoebing
\nDr Andrew W. Gurman Dr Heidi Stensmyren
\nDr Ren\u00e9 H\u00e9man Dr Thomas Szekeres
\nDr Ardis Dee Hoven (Chair) Dr Julio Trostchansky
\nDr Miguel Roberto Jorge Dr Walter Vorhauer
\nDr Toru Kakuta Dr Shuyang Zhang
\nDr Ajay Kumar
\nEx-officio (without voting rights)
\nDr Yoshitake Yokokura , President
\nDr Ketan Desai, Immediate Past President
\nDr Leonid Eidelman, President-Elect
\nDr Otmar Kloiber, Secretary General
\nMs Marie Colegrave-Juge, Legal Advisor
\nMr Adolf H\u00e4llmayr, Financial Advisor
\nProf. Vivienne Nathanson, Facilitator
\n1. GENERAL BUSINESS
\n1.1 The meeting was called to order by the Chair of Council at 4:40 pm on 14 October 2017.
\n1.2 Apologies for absence: Dr Thomas Szekeres (Austria; replaced by Dr Herwig Lindner),
\nDr Julio Trostchansky (Uruguay; replaced by Dr Alarico Rodriguez)
\nOctober 2017 Council 208\/Minutes\/Oct2017
\n2
\n2. BUSINESS ARISING FROM THE GENERAL ASSEMBLY
\n2.1 Reproductive Technologies
\nThe Council received the proposed revision of the WMA Statement on Reproductive
\nTechnologies (MEC 206\/Reproductive Technologies REV2\/Apr2017; Final annex \u00edtem
\n2.4) which was sent back to Council.
\nThe document is to be read again by the MEC.
\n3. ANY OTHER BUSINESS
\nThere were no other items of business for the Council
\n4. ADJOURNMENT
\nThe meeting was adjourned at 4:45 pm.
\n\u00a7\u00a7\u00a7
\n27.11.2017
\n1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument
\nno:
\nCouncil 209\/President Report\/Apr2018 Original:
\nEnglish
\nTitle: Report of the Chair of Council (October
\n2017 \u2013 April 2018)
\nDestination: 209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nTo be
\nreceived
\nMy major mission as WMA President is, as I stated in my inaugural speech in Chicago in October
\n2017, to make all-out effort to advance the initiative and assist the past related activities to realize
\nthe Universal Health Coverage (UHC) as well as strengthening of the health system of each
\ncountries of the world. As the UHC is a very important concept to bring health to all the people in
\nthe world, I will continue activities focusing on the developing of this concept.
\nIn the past half-year activities as WMA President, I have worked concentrating my efforts on this
\nimportant theme in various meetings inside and outside of Japan as mentioned below.
\n1. The meetings and other events related to promotion of the UHC.
\nThe 2017 Global Health Forum in November 2017:
\nI was invited by the Taiwan authority to the 2017 Global Health Forum hosted by the Taiwan
\nHealth Ministry and Foreign Affairs. It was attended by 35 countries with 1000 people. The
\ndiscussion was mainly focused on SDGs and I told the forum about the importance of
\nattaining the UHC and strengthening of the health system.
\nThe UHC Forum 2017 in December 2017:
\nThe UHC Forum 2017 was held in Tokyo last December organized by the Japanese
\ngovernment, World Bank, UNICEF, UHC2030 and JICA. I was invited to the forum and
\njoined the high level opening session. It was attended by some global leadership such as
\nPrime Minster Shinzo Abe, UN Secretary General Mr. Ant\u00f3nio Guterres, Chair of World
\nBank Mr. Jim Yong Kim, and WHO Director General Dr. Tedros Adhanom. I told the
\nmeeting that a unity of the cross-over physicians is increasingly needed for infectious diseases
\nand disaster preparedness in progressing borderlessness with globalization. In this forum, one
\nof the highlights is that the WMA and WHO agreed to make an official MOU on
\ncollaboration for establishing the UHC on global level and strengthening disaster
\npreparedness. As you know, I and Dr. Tedros signed the MOU on April 5 in Geneva.
\nJMA Harvard Taro Takemi Memorial International Symposium in February 2018:
\nThe JMA held at its headquarters in Tokyo \u201cJMA Harvard Taro Takemi Memorial
\nInternational Symposium\u201d The subtheme is \u201cCommunity Health Systems and Innovations:
\nBuilding the Foundation for Universal Health Coverage\u201d. The symposium was attended by
\nabout 350 people with a lecture by Sir Michael Marmot from the WMA. The JMA has an
\nApril 2018 Council 209\/President Report\/Apr2018
\n2
\ninternational health program at the Harvard School of Public Health in Boston working for
\nmany years to nurture the middle-career researchers from the world. This symposium was set
\nup to celebrate its 35th anniversary.
\nSignature of the MOU with the WHO in April 2018:
\nOn April 5, as I mentioned above, I attended the signature ceremony to sign the MOU on
\nUHC and disaster preparedness between the WMA and WHO in Geneva. I believe that this
\nsignature of the MOU will surely contribute to further enhance the presence of the WMA in
\nthe global community. After the signature, I had a meeting with the leaders of some major
\ninternational organizations such as The Global Fund to Fight AIDS, Tuberculosis and Malaria,
\nGAVI The Vaccine Alliance, International Committee of the Red Cross, Medicins Sans
\nFrontieres and UN Office for Disaster Risk Reduction.
\nGlobal Ministerial Summit on Patient Safety in April 2018:
\nIn this month as well, the Global Ministerial Summit on Patient Safety was held in Tokyo
\nattended by 46 countries. I joined the summit as WMA President and chaired the key-note
\nspeech by Dr. G\u00fcnther Jonitz, President of the Berlin Medical Association. I also delivered a
\nshort comment on the activities of the WMA about patient safety during the round table
\nsession as well as the UHC which may be closely linked to patient safety activities.
\n2. Other major activities
\nUnited Nations Office for Disaster Risk Reduction
\nIn November 2017, I attended the WMA European Regional Meeting on End-of-Life
\nQuestions in Vatican. The regional meeting in the Asian and Oceanian region was already
\nfinished in Tokyo in September of 2017 and I reported the results of the meeting. I felt some
\ndifferences in ideas between the European, Asian and Oceanian regions. I hope that we will
\nhave a deep discussion about this theme in Riga.
\nAlso in December 2017, I was invited by the Medical Association of Thailand and
\nTammathat University to attend the One Health International Conference 2017 Scientific
\nProgram attended by about 400 people. The conference aimed to contribute to the
\nimprovement of humans, animals and global health through discussion of specialists for
\nfurther collaboration between medicine and veterinary medicine.
\n2018 CMA Annual Scientific Meeting & The 2nd Pak-China Medical Congress & Belt
\nand Road Forum of Medical Associations was held in Beijing, China. The conference I
\nattended was entitled \u00abLifestyle diseases: Current situation and countermeasures in Japan and
\nChina\u00bb. I emphasized that this theme is one of the extremely serious problems confronted by
\ncountries around the world. I also told that all the physicians of the world must make
\ncontinuing efforts to address this problem.
\nIn February of this year, I was appointed a member of the WHO Civil Society Working
\nGroup on the Third High Level Meeting of the UN General Assembly on NCDs.
\nIn the same month, the JMA accepted the specialist group of the Taiwan Medical Association
\nto investigate the present status of the long-term care insurance system in Japan. The JMA
\nhelped the group to visit some of the related institutions under the long-term care for the
\nelderly.
\nApril 2018 Council 209\/President Report\/Apr2018
\n3
\nIn early this month, the JMA invited Professor Ronit Katz, member and former Chair AMA
\nGoverning Council to the CBRNE conference focusing the preparedness for the Tokyo
\nOlympic Paralympic Games in 2020. It was an active discussion about terrorism disaster
\ncountermeasures by specialists.
\nRespectfully submitted by Yoshitake Yokokura, MD, President of the WMA
\n\u00a7\u00a7\u00a7
\n17.04.18<\/p>\n

1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument: Council 209\/SecGen Report\/Apr2018 Original:
\nEnglish
\nTitle: Secretary General\u2019s Report to the
\n209th
\nWMA Council Session
\n(October 2017 \u2013 March 2018)
\nDestination: 209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nTo be
\nreceived
\nChapter I Ethics, Advocacy & Representations
\n1. Ethics
\n1.1 Declaration of Taipei
\n1.2 Declaration of Geneva
\n1.3 Regional discussions on End-of-Life issues
\n2. Human Rights
\n2.1 Right to health
\n2.2 Protecting patients and doctors
\n2.3 Prevention of torture and ill-treatment
\n2.4 Pain treatment
\n2.5 Health through peace
\n3. Public Health
\n3.1 Non-communicable diseases
\n3.2 Communicable diseases
\n3.3 Health and populations exposed to discrimination
\n3.4 Social determinants of health
\n3.5 Counterfeit medical products
\n3.6 Food security and nutrition
\n3.7 Health and the environment
\n4. Health Systems
\n4.1 Comparing healthcare systems using PROMS & PREMS
\n4.2 Patient safety
\n4.3 One Health
\n4.4 Antimicrobial resistance
\n4.5 Health workforce
\nApril 2018 Council 209\/SecGen Report\/Apr2018
\n2
\n4.6 Violence in the health sector
\n4.7 Caring Physicians of the World Initiative Leadership Course
\n5. Health Policy & Education
\n5.1 Medical and health policy development and education
\n5.2 Support for national constituent members
\nChapter II Partnership & Collaboration
\n1. World Health Organization (WHO)
\n2. UNESCO Conference on Bioethics, Medical Ethics and Health Law
\n3. Other UN agencies
\n4. World Health Professions Alliance (WHPA)
\n5. WMA Cooperating Centers
\n6. Other partnerships or collaborations
\nChapter III Communication & Outreach
\n1. WMA newsletter
\n2. WMA social media (Twitter and Facebook)
\n3. The World Medical Journal
\n4. WMA African Initiative
\n5. Meeting with Arab Medical Union leaders
\n6. Secondments \/ internships
\nChapter IV Operational Excellence
\n1. Advocacy
\n2. Paperless meetings
\n3. Governance
\nChapter V Acknowledgement
\nApril 2018 Council 209\/SecGen Report\/Apr2018
\n3
\nCHAPTER I ETHICS, ADVOCACY & REPRESENTATIONS
\n1. Ethics
\n1.1 Declaration of Taipei
\nThe Declaration of Taipei on Ethical Considerations Regarding Health Databases and
\nBiobanks provides guidance for the protection of persons who allow their health data
\nand\/or specimens to be used for future research or other uses. In some aspects, this is a
\nlogical continuation of the safeguards provided by the Declaration of Helsinki; extending
\nthem into virtual environments and scenarios such as administrative or commercial uses.
\nAn important focus of the Declaration of Taipei is maintaining the protection provided by
\ninformed consent. Since information about potential future uses of data or specimens is
\nnaturally incomplete, the Declaration offers a multi-step mechanism to replace part of
\ninformed consent. This is achieved through a predetermined governance structure and an
\nassessment by an ethics committee.
\nAs regulations on health and medical databases are currently under discussion, the
\ndissemination of the Declaration is being actively pursued with urgency. We are grateful
\nto our members and partner organisations which already use the Declaration or advocate
\nfor it.
\n1.2 Declaration of Geneva
\nBoth before and since its adoption at the General Assembly in Chicago, the Declaration
\nof Geneva has encountered a remarkable and overwhelmingly positive reception. The
\nWMA will use upcoming ethics conferences and other events to promote this revised
\nphysicians\u2019 pledge. We offer to explain the revision process and provide an in depth
\nanalysis of the wording that has been used. Again, we are grateful to the early adopters of
\nthe Declaration of Geneva and thank our members and partners for using and
\ndisseminating it.
\n1.3 Regional Discussions on End of Life issues
\nAt the 200th
\nCouncil Session in Oslo in April 2015 the WMA policies on
\nphysician-assisted suicide (PAS) and euthanasia were reaffirmed. However, a
\ncontroversial discussion about the wording and effect of the current policies led to the
\nsubmission of a policy document by the Royal Dutch and the Canadian medical
\nassociations to the 201st
\nCouncil Session in Moscow in October 2015. The authors of the
\ndocument ultimately requested its withdrawal at the 203rd
\nCouncil Session in Buenos
\nAires in April 2016. Instead, the Council mandated the Executive Committee to come
\nback with a plan for discussing end-of-life issues, including palliative care, living wills,
\nphysician-assisted suicide (PAS) and euthanasia. At the 204th
\nCouncil Session in Taipei
\nin October the Executive Committee invited its members, especially those from Latin
\nAmerica, Africa and Asia to hold regional meetings to discuss these issues. This took into
\naccount the observation that the previous discussion was dominated mainly by voices
\nfrom Europe and North America.
\nApril 2018 Council 209\/SecGen Report\/Apr2018
\n4
\nSince then four regional discussions have been held in Latin America, (Rio de Janeiro,
\nMarch 2017 in cooperation with CONFEMEL), Asia and the Pacific (Tokyo, September
\n2017, in cooperation with CMAAO), Europe (Vatican City, November 2017 in
\ncooperation with the Pontifical Academy for Life) and in Africa (Abuja,
\nJanuary-February 2018).
\nReports from those meetings are attached to this document. The discussions will be
\ncontinued on the global level at the joint WMA-Iceland Medical Association Ethics
\nConference in Reykjavik next October.
\n2. Human Rights
\n2.1 Right to health
\nThe WMA Secretariat follows the activities of the UN Special Rapporteur on the right of
\neveryone to the enjoyment of the highest attainable standard of physical and mental
\nhealth, Dr Dainius Puras, as well as health related matters addressed by the UN Human
\nRights Council. Further to a meeting between Dr Puras, Dr O. Kloiber and C. Delorme in
\nSeptember 2017 (see item 2.3.3), it was agreed to maintain contact with a regular
\nexchange of views on current topics of mutual interest.
\n2.2 Protecting patients and doctors
\n2.2.1 Actions of support
\nCountry Case
\nTURKEY
\nJanuary- February
\n2017
\nSources:
\nTMA,
\nHuman Rights
\nFoundation of
\nTurkey,
\nAmnesty
\nInternational
\nFollowing a public statement by the Turkish Medical Association (TMA)
\nin mid-January stressing that war is a public health problem and calling
\nfor peace its leaders have been confronted with a campaign of
\nintimidation and threats. The Turkish Ministry of Internal Affairs filed a
\ncriminal complaint against the TMA and the Ankara head prosecutor
\nopened an investigation. In addition, the Minister of Health filed another
\nlawsuit demanding all TMA\u2019s Central Council members to be dismissed
\nfrom their position on the grounds that they are acting beyond the scope
\nof the mission of the TMA. The 11 members of the Central Council of
\nTMA were arrested and the TMA office was searched.
\nThe WMA issued an immediate press release and a joint letter with other
\nhealth and human rights organisations (PHR, CPME, IRCT, EFMA) was
\nsent to the Turkish authorities (Link to the letter:
\nhttps:\/\/www.wma.net\/wp-content\/uploads\/2018\/01\/Joint-letter-of-support-
\nTMA-January-2018-final.pdf). A second press release was issued
\n(https:\/\/www.wma.net\/news-post\/global-medical-bodies-in-joint-call-to-p
\nresident-erdogan\/).
\nThe UN Special Rapporteur on the Right to Health was alerted.
\nThe Secretariat sent a call for support to all WMA members and partners.
\nMany national medical associations reacted immediately with letters,
\ntweets and other social media support. The TMA Council members were
\nfinally released on the 2nd
\nand the rest on 5th
\nFebruary, but an official
\ninvestigation is continuing on the basis of the charges of \u00abMaking
\npropaganda in favour of a terrorist organization\u201d and \u00abProvoking people
\nto be rancorous and hostile\u201d.
\nApril 2018 Council 209\/SecGen Report\/Apr2018
\n5
\nIn the latest developments, the Turkish authorities have announced their
\nintention to amend legislation pertaining to professional organisations
\n(including the TMA, and organisations of lawyers, architects, etc.), which
\nused to enjoy relative autonomy from government. The amendments
\nenvisaged include scrapping compulsory membership; making it possible
\nto have more than one organisation representing a specific profession,
\nflexible and changed election procedures. This amounts to abolishing
\nthese organisations\u2019 authority and function to supervise compliance with
\nprofessional ethics and makes these organisations weaker.
\nIn addition, Prof. Onur Hamzaoglu – an internationally renowned
\nresearcher and practitioner, recently re-elected to the Executive Board of
\nthe International Association of Health Policy in Europe at its 18th
\nInternational Conference held at the end of September 2017 \u2013 was
\narrested on 9th
\nFebruary by the Turkish police. Prof. Hamzaoglu is also the
\neditor of Society and Physicians journal, a scientific journal on health
\npolicies published by the TMA. He is being prosecuted for complicity in
\nterrorism.
\nThe WMA Secretariat remains mobilized and ready to take further action.
\nETHIOPIA
\nSeptember 2017 –
\nFebruary 2018
\nSource:
\nSwedish Medical
\nAssociation
\nAmnesty
\nInternational
\nThe Secretariat received a call to sign a petition in support of the
\nEthiopian-born Swedish cardiologist, Dr Fikru Maru, who has been in
\ndetention for 4 years in Ethiopia. In May 2017, he was cleared of all prior
\ncharges, but instead of releasing him, new charges were brought against
\nhim and 37 other prisoners for being involved in a prison fire and revolt
\n(Dr Fikru was in hospital with a life-threatening condition when the fire
\noccurred). The Secretariat contacted the Swedish Medical Association,
\nwhich confirmed the case and was positive about the WMA taking action.
\nDr Ketan Desai signed the petition on behalf of the WMA. The
\ninformation was shared on Facebook and Twitter.
\nThe situation having not changed since the Summer, the Secretariat
\ndiscussed taking further actions with the Swedish Medical Association
\n(SwMA) and Amnesty\u2019s Ethiopian desk officer. The WMA wrote to the
\nEthiopian Prime minister and President (with copies and an
\naccompanying letter sent to the new Ethiopian WHO Director General Dr
\nTedros Adhanom Ghebreyesus). On its part, the SwMA wrote to the
\nSwedish embassy in Ethiopia.
\nIRAN
\nFebruary 2018
\nSource:
\nAmnesty
\nInternational
\nPhysicians for
\nHuman Rights
\nDr Ahmadreza Djalali, an Iranian-born Swedish resident and academic,
\nhas been sentenced to death for \u201ccorruption on earth\u201d after a grossly
\nunfair trial. His conviction was based on torture-tainted \u201cconfessions\u201d that
\nhe was forced to make while in solitary confinement without access to his
\nlawyer or family. Amnesty International and Physicians for Human
\nRights consider him a prisoner of conscience. The Secretariat wrote an
\ninitial letter last November and issued a press release
\n(https:\/\/www.wma.net\/news-post\/wma-urges-immediate-release-of-jailed-
\nphysician\/).
\nDr Djalali\u2019s last appeal was rejected by the Supreme Court in February. A
\nsecond press release was issued on 13th
\nFebruary calling for his immediate
\nrelease
\n(https:\/\/www.wma.net\/news-post\/wma-appeals-for-immediate-release-of-j
\nailed-physician\/).
\nApril 2018 Council 209\/SecGen Report\/Apr2018
\n6
\n2.2.2 Protection of health professionals in areas of armed conflict and other situations of
\nviolence
\nICRC \u201cHealth Care in Danger\u201d (HCiD) initiative
\nThe WMA Secretariat has a close working relationship with the International
\nCommittee of the Red Cross (ICRC) headquarters within the context of the HCiD
\ninitiative, which has been prolonged by the ICRC for a second phase.
\nIn early November 2016, a Memorandum of Understanding (MoU) between the
\nWMA and the ICRC was formally signed by Yves Daccord, Director-General of
\nthe ICRC, and Dr Otmar Kloiber, WMA Secretary General. This MoU develops
\nand consolidates the long-standing cooperation between the WMA and the ICRC
\nand fosters understanding on topics of common interest, including on the
\nprotection of health professionals and patients in situations of violence, on the role
\nof physicians in addressing sexual violence, as well as torture and ill-treatment in
\ndetention, and more generally in addressing Social Determinants of Health in the
\ncontext of insecurity.
\nOn 22 November 2017, the ICRC and the University of Geneva organised an
\nevent on the MOOC (massive Open Online Courses) on Violence Against
\nHealth Care (https:\/\/www.coursera.org\/learn\/violence-against-healthcare) to
\ndiscuss the best ways to promote and disseminate this tool within our networks.
\nM. Mihaila and C. Delorme from the WMA Secretariat attended the meeting.
\nThe ICRC and the WMA are again planning a side-event during this year\u2019s World
\nHealth Assembly in May, possibly with the Permanent Missions of Switzerland,
\nCanada and Nigeria, the World Health Organization (WHO), M\u00e9decins Sans
\nFronti\u00e8res (MSF) and other partners such as the International Committee of
\nMilitary Medicine (ICMM) and the International Hospital Federation (IHF). The
\nevent will focus on Health Care in Danger best practices with a vareity of country
\nexamples.
\nDuring the reporting period, C. Delorme established contact with the Disaster
\nRisk Management Focal Point at WHO to discuss ways to promote and support
\nthe role of the health workforce in reducing risks to health from emergencies,
\nstrengthening emergency preparedness and building the resilience of
\ncommunities.
\nDuring the 142nd
\nWHO Executive Board meeting, the WMA presented a public
\nstatement
\n(https:\/\/www.wma.net\/wp-content\/uploads\/2017\/05\/3.3-Public-health-preparednes
\ns-and-response-WHPA.pdf) on behalf of the World Health Professions Alliance
\n(WHPA) on WHO\u2019s work in Health Emergencies.
\n2.3 Prevention of torture and ill-treatment
\nThe WMA Secretariat follows relevant international activities in this area, in particular
\nthose of the Human Rights Council.
\n2.3.1 Cooperation with the International Rehabilitation Council for Torture Victims
\n(IRCT)
\nApril 2018 Council 209\/SecGen Report\/Apr2018
\n7
\nThe Secretariat exchanged information on a regular basis with the IRCT during
\nthe reporting period, in particular regarding the recently adopted WMA proposed
\nStatement on forced anal examinations to substantiate same-sex sexual activity
\nand on the role of physicians in preventing torture
\n2.3.2 Role of physicians in preventing torture and ill-treatment
\nLast May, the WMA Secretariat was contacted by the Health Care in Detention
\nUnit of the International Committee of the Red Cross (ICRC) to discuss an
\nopportunity to update the online course for physicians working in prisons.
\nDiscussions are ongoing, including with the Norwegian Medical Association,
\nwhich played a key role in developing and hosting the original courses.
\nIn February, the WMA was invited to participate in a one-year project on the
\ndevelopment of a supplement to the Manual on Effective Investigation and
\nDocumentation of Torture and Other Cruel, Inhuman or Degrading
\nTreatment or Punishment, commonly called the Istanbul Protocol (IP). The
\ninitiative is headed jointly by Physicians for Human Rights (PHR), the IRCT, the
\nHuman Rights Foundation of Turkey, REDRESS, the UN Committee against
\nTorture, the UN Subcommittee for the Prevention of Torture, the UN Special
\nRapporteur on Torture and the UN Voluntary Fund for Victims of Torture. The
\npurpose of the Project is to strengthen the IP with updates and clarifications based
\non practical experience from users. C: Delorme participate in the working group
\non ethical codes as one of the drafters.
\n2.3.3 Psychiatric treatment \u2013 Mental Health
\nLast June, the WMA Secretariat prepared written comments on the recent report
\non mental health by the United Nations Special Rapporteur on Health, Dr Dainius
\nPurras (Report A\/HRC\/35\/21). These comments were prepared with a key
\ncontribution by Dr Miguel Jorge (Brazilian Medical Association), psychiatrist and
\nChair of the WMA Socio-Medical Affairs Committee, with the aim of providing
\nthe physicians’ perspective in the global discussion on the challenges and
\nopportunities related to the promotion of mental health as a global priority and a
\nfundamental human right. The written comments were then shared with the World
\nPsychiatric Association. Dr Puras replied by welcoming our report and a meeting
\ntook place in September to discuss the matter further. The WMA Secretariat was
\nrepresented at this meeting by Dr O. Kloiber and C. Delorme.
\n2.4 Pain treatment
\nThe WMA continues to be active in the field of palliative care in cooperation with the
\nWHO and civil society organisations working in this area. Within the context of the
\ncurrent global discussion and the Special Session of the UN General Assembly on the
\nworld drug problem, the WMA made a public statement at the session of the WHO
\nExecutive Board (January 2017) on the public health dimension of the issue, underlining
\nthe need for a committed public health approach encompassing the availability and access
\nto medicines for effective treatment and related healthcare services.
\nOn 1st
\nMarch, the advisory group on palliative care of the Pontifical Academy for Life
\nissued a White Paper on Global Palliative Care Advocacy including a set of \u201cSelected
\nrecommendations\u201d calling on various stakeholders in the health care sector to step up
\nApril 2018 Council 209\/SecGen Report\/Apr2018
\n8
\nadvocacy for health. As a representative of professional associations, they called upon the
\nWMA to especially foster the human rights aspect of access to palliative care.
\n2.5 Health through peace
\nOn 7July 2017, country representatives meeting at a United Nations conference in New
\nYork adopted the Treaty on the Prohibition of Nuclear Weapons, the first multilateral
\nlegally-binding instrument for nuclear disarmament to have been negotiated in 20 years.
\nIn September, the WMA Secretariat met with a representative of the International
\nPhysicians for the Prevention of Nuclear War (IPPN) to explore possible ways of
\ncollaboration on the global health imperative to eliminate nuclear weapons in line with
\nthe WMA Statement on Nuclear Weapons by using the momentum of the Treaty
\nadoption. The WMA and IPPN are exchanging views on a regular basis within this
\nframework. IPPN offered its assistance on the revision of WMA Statement on Nuclear
\nWeapons in order to include reference to the recently adopted Treaty.
\nOn the occasion of the opening for signature of the Treaty on the Prohibition of Nuclear
\nWeapons in New York on 20th
\nSeptember, the IPPN together with the WMA, the
\nInternational Council of Nurses and the World Federation of Public Health Associations,
\nadopted a joint Statement urging Member States to sign the Treaty and to ratify it as soon
\nas possible thereafter so that it can enter into force.
\n3. Public Health
\n3.1 Non-communicable diseases (NCDs)
\n3.1.1 General
\nMember States and the WHO have made progress in fulfilling their commitments
\naccording to the 2011 UN Political Declaration on Prevention and Control of
\nNCDs and adopted a Global Monitoring Framework with a set of global NCD
\ntargets, a Global NCD Action Plan 2013-2020, and a formalized UN Interagency
\nTask Force on NCDs, which will coordinate a UN system-wide response to
\nNCDs.
\nIn response to the first UN Political Declaration on Prevention and Control of
\nNon-communicable Diseases from 2011, the WHO also established the Global
\nMonitoring Framework as a Global Coordination Mechanism (GCM) on the
\nPrevention and Control of Non-communicable Diseases. The scope and purpose
\nof the coordination mechanism is to facilitate and enhance the coordination of
\nactivities, multi-stakeholder engagement and action across sectors at the local,
\nnational, regional and global levels. The WMA is an official member of this
\ncoordination mechanism, which was launched in March 2015, and has attended
\nseveral WHO GCM\/NCD meetings. Dr Bente Mikkelsen, head of the GCM
\nsecretariat, is planning to present their work and achievements at the WMA
\nGeneral Assembly in Reykjav\u00edk. The purpose of this presentation is also to
\ndiscuss possible cooperation with the WMA and how physicians can support
\nactivities against NCDs.
\nApril 2018 Council 209\/SecGen Report\/Apr2018
\n9
\nDuring the WHO Executive Board meeting the WMA made an intervention for
\nthe preparation of the next high-level meeting on NCDs during the 2018 UN
\nGeneral Assembly in New York and empgasised the strong commitment of the
\nWMA in the fight against NCDs. Following the long engagement of WMA with
\nthe WHO GCM secretariat, WHO appointed Dr Yokokura, WMA president, to be
\na member of the WHO Civil Society Workgroup to advise the Director General
\non the planning and advocacy of the high level meeting on NCDs and on the
\nmobilization of civil society.
\nDr Julia Tainijoki was invited by WHO to present WMA\u2019s perspective and
\nexperience on health literature and education at the third meeting of the WHO
\nGCM\/NCD Working Group on Health Education and Health Literacy for
\nNCDs in February in Geneva. The Working Group was established to recommend
\nways and means of encouraging Member States and non-State actors to promote
\nhealth education and health literacy for NCDs, with a particular focus on
\npopulations with low health awareness and\/or literacy.
\nAt the same time, the WMA supported the launch of the publication of a new
\nspeaking book for children with cancer. Previously, and together with other
\npartners, the WMA has supported the publication of speaking books on high
\nblood pressure, tobacco use cessation, kids in hospital and clinical trials.
\nOn the occasion of the 20th
\nEuropean Health Forum in Gastein, Austria in October
\n2017 WHO invited WMA to speak at the WHO workshop \u00abinvesting in healthy
\ncities: \u00abinsuring\u201d prevention\u00bb. The workshop focused on investing in healthy
\ncities as a means to improve population health and well-being.
\nAt the Global Dialogue on Partnerships for Sustainable Financing of NCD
\nPrevention and Control in Copenhagen Denmark from 9-11 April 2018 the
\nWMA organised a session on \u2018A vital investment: Scaling up health workforce for
\nNCDs\u2019. The aim of this session was to highlight the importance of the health
\nworkforce in the fight against NCDs and the investment needs and roles of
\nvarious stakeholders in strengthening countries\u2019 capacities to develop HRH
\npolicies and plans in line with national health strategies to achieve UHC and
\nSDG3.4.
\n3.1.2 Tobacco
\nThe WMA is involved in the implementation process of the WHO Framework
\nConvention on Tobacco Control (FCTC). The FCTC is an international treaty
\nthat condemns tobacco as an addictive substance, imposes bans on advertising and
\npromotion of tobacco, and reaffirms the right of all people to the highest standard
\nof health. The WMA attends every Conference of the Parties meeting. The next
\nConference of the Parties to the FCTC meeting will take place from 1-6 October
\n2018 in Geneva.
\n3.1.3 Alcohol
\nThe Secretariat maintains regular contact with the WHO staff in charge of this
\ntopic, as well as with the Global Alcohol Policy Alliance (GAPA). During the 70th
\nsession of the World Health Assembly last May, the WMA took part in a Civil
\nApril 2018 Council 209\/SecGen Report\/Apr2018
\n10
\nSociety consultation meeting organised by GAPA and the NCD Alliance in order
\nto discuss strategies to put alcohol back on the agenda of the WHO governing
\nbodies. The WMA was also invited by GAPA to an informal meeting on the same
\ntopic with interested Member States.
\nIn June, Clarisse Delorme represented the WMA at the WHO Forum on Alcohol,
\nDrugs and Addictive Behaviours, which took place at WHO headquarters in
\nGeneva. A statement was made recommending the development of all-inclusive
\npolicies addressing the root causes of alcohol patterns as well as strengthening
\nhealth systems to improve countries’ capacity to develop policy and lead actions
\nthat target alcohol problems.
\nLast February, the Secretariat received a request from IOGT International and
\nGAPA to support a joint letter sent on 1st
\nFebruary to the Global Fund denouncing
\ntheir partnership with Heineken and emphasizing the dangers inherent in
\ncollaborating with the producers and marketers of hazardous products such as
\nalcohol.
\n(http:\/\/iogt.org\/open-letters\/joint-open-letter-concern-regarding-global-fund-partn
\nering-heineken\/). The letter was endorsed by a number of regional and national
\norganisations and networks. The WMA joined the mobilisation and decided to
\nsupport the initiative as well. The news was shared on Twitter and Facebook.
\n3.1.4 Physical Activity
\nThe WHO is in the process of developing a draft global action plan to promote
\nphysical activity. The WMA was invited to be member of the strategic advisory
\nnetwork to support and guide the WHO Secretariat in the development of this
\nGlobal Action Plan on Physical Activity, and attended the first technical advisory
\nmeeting in June 2017. Recognising the importance of physical activity to
\nwellbeing and the attainment of the sustainable development goals, the action plan
\noffers the global community a unique opportunity to elevate the profile and set a
\nnew ambitious agenda for united action in creating physical activity opportunities
\nfor all. The WHO Secretariat hosted an open web-based consultation on a first
\ndraft of the report from August to mid-September.
\n3.2 Communicable diseases
\n3.2.1 Multidrug-Resistant Tuberculosis Project
\nThe WMA participated in the development of the WHO guidance document
\nentitled \u2018Guidance on Ethics of Tuberculosis Prevention, Care and Control\u2019 in
\n2010. Building on this document, the WHO is now in the processes of revising the
\nexisting document with the aim of speaking more directly to the challenges faced
\nby healthcare workers (HCW) and decision-makers across the globe in helping
\nfulfil the third principle of the End TB Strategy, namely the protection of human
\nrights, ethics and equity. A first workgroup meeting has taken place with the
\nWMA delivering a presentation on health workers\u2019 rights and obligations.
\n3.2.2 Influenza
\nThe WMA was invited by Ms Fran\u00e7oise Grosset\u00eate, Member of the European
\nApril 2018 Council 209\/SecGen Report\/Apr2018
\n11
\nParliament, and Prof. Thomas Szucs to be a members of the steering group to
\ndevelop an EU Manifesto on Influenza Vaccination, which aims to help shift the
\nagenda at European and national level in support of influenza vaccination. The
\nManifesto confirms the need for stronger policy-driven actions to reduce the
\nburden of influenza and emphasises the importance of the health workforce in this
\ntopic. The digital launch was on 6th
\nMarch 2018 with the physical launch planned
\nfor 24th
\nMarch 2018.
\n3.3 Health and populations exposed to discrimination
\n3.3.1 Women and health
\nThe WMA continues to follow global activities on women and health and aims to
\nmonitor the implementation phase of the \u201cGlobal plan of action on strengthening
\nthe role of the health system in addressing interpersonal violence, in particular
\nagainst women and girls, and against children\u201d, which was adopted by the World
\nHealth Assembly in May 2016.
\nLast August, in conformity with WMA’s related policy, the WMA Executive
\nCommittee decided to support the United to End FGM knowledge platform. This
\nPlatform is a new, free, online training tool to train professionals dealing with
\nthose affected by female genital mutilation. It is currently available in nine
\nEuropean languages, with two modules specifically for health professionals. The
\nSecretariat shared this information through social media.
\n3.3.2 Ageing
\nThe WMA participated in the WHO consultation on the Global Strategy and
\nAction Plan on Ageing and Health, which was adopted by Members States at the
\nlast World Health Assembly in May 2016, and is monitoring the implementation
\nphase of the Global Strategy.
\nFor more activities in the area of ageing, please see Chapter III, section 4.
\n3.3.3 Zero HIV-related stigma & discrimination in health care settings
\nIn March 2017, the Secretariat shared with WMA members the UNAIDS
\nreference document on eliminating discrimination in health care. This report aims
\nto serve as a reference for policy-makers and other key stakeholders engaged in
\nshaping policies and programmes to regulate healthcare and eliminate
\ndiscrimination and other structural barriers to achieving healthy lives for all. The
\nWMA has been involved in this initiative since it started in November 2015.
\n3.3.4 Refugees, migrants & access to health
\nIn response to the WHO initiative on migrants\u2019 health, the WMA made a public
\nstatement on behalf of the World Health Professions Alliance (WHPA) at the 70th
\nWorld Health Assembly (May 2017) welcoming WHO\u2019s efforts in promoting
\nmigrant health and highlighting that late or denied treatment is discriminatory and
\ncontravenes a fundamental human right.
\nApril 2018 Council 209\/SecGen Report\/Apr2018
\n12
\nClarisse Delorme was invited to present the WMA’s views on migrants’ health at
\nthe Youth Pre-World Health Assembly Workshop organised by the International
\nFederation of Medical Students Association (IFMSA) on 19 May in Geneva.
\nIn July, the WMA Secretariat, represented by Dr O. Kloiber, C. Delorme and M.
\nMihaila, met with representatives of the Migration Health Division of the
\nInternational Organisation for Migration (IOM) to explore potential cooperation
\nand exchange information.
\nFurther to this meeting, the WMA has been invited to join a working group led by
\nthe IOM and WHO to ensure that the health needs of refugees and migrants are
\nadequately addressed in the \u201cGlobal Compact for Migration\u201d (GCM), the global
\nUN process currently taking place, which will culminate in a final outcome
\nagreement by the UN General Assembly further to intergovernmental negotiations
\nin 2018. The working group \u2013 composed of representatives from WHO and IOM
\nin close cooperation with ILO, OHCHR, UNFPA, UNAIDS1
\n, the World Bank and
\nother stakeholders including the International Federation of the Red Cross (IFRC),
\nthe Platform for International Cooperation on Undocumented Migrants (PICUM)
\nand WMA – met in September and agreed on a Proposed Health Component,
\nwhich should feed the discussion around the zero draft GCM. The Proposed
\nHealth Component for the GCM is available on the GCM website for Member
\nStates and partners.
\n3.4 Social determinants of health (SDH) and Universal Health Coverage (UHC)
\nThe WMA is actively engaged with the WHO Department of Health Workforce and is
\nparticipating in a Steering Committee to develop an eBook on the Social Determinants
\nof Health Approach to health workforce education and training. The project is part of the
\nWHO\u2019s work to implement the guidelines on \u201cTransforming and scaling up health
\nprofessionals\u2019 education and training\u201d, launched in Recife in 2013. The project also
\nsupports World Health Assembly Resolution WHA66.23 \u201cTransforming health
\nworkforce education in support of universal health coverage\u201d. The collaboration involves
\nparticipation in meetings organized by WHO and providing technical assistance and
\nguidance for the eBook.
\nDuring the Universal Health Coverage Forum in December 2017 in Tokyo, Japan Dr.
\nYokokura, WMA president, spoke at the opening session. The goal of the Forum was to
\nmobilize broad political support for accelerating progress towards UHC and the SDGs,
\nincluding health security and pandemic preparedness. This forum brought together over
\n300 participants, including heads of government, ministers of finance and health, and
\nsenior representatives from bi- and multi-lateral institutions, civil society organizations,
\nthink tanks, and academia. At the forum WHO Director General Dr Tedros Adhanom
\nGhebreyesus and WMA President Dr Yoshitake Yokokura agreed to strengthen the
\ncollaboration of both organizations on Universal Health Coverage and Emergency
\npreparedness. A Memorandum of Understanding is planned to be signed on 5th
\nApril
\n2018 in Geneva.
\n3.5 Counterfeit medical products
\n1
\nILO: International Labour Organisation \u2013 OHCHR: Office of the High Commissioner for Human Rights \u2013
\nUNFPA: United Nations Population Funds \u2013 UNAIDS: United Nations Programme on HIV\/AIDS
\nApril 2018 Council 209\/SecGen Report\/Apr2018
\n13
\nCounterfeit medicines are manufactured below established standards of safety, quality
\nand efficacy. They are deliberately and fraudulently mislabelled with respect to identity
\nand\/or source. Counterfeiting can apply to both brand name and generic products, and
\ncounterfeit medicines may include products with the correct ingredients but fake
\npackaging, products with the wrong ingredients, products without active ingredients, or
\nproducts with insufficient active ingredients. Counterfeit medical products threaten
\npatient safety, endanger public health, e.g. by increasing the risk of antimicrobial
\nresistance, and undermine patients\u2019 trust in health professionals and health systems. The
\ninvolvement of health professionals is crucial to combating counterfeit medical products.
\nThe WMA has joined the Fight the Fakes campaign that aims to raise awareness about
\nthe dangers of fake medicines. Coordination among all actors involved in the
\nmanufacturing and distribution of medicines is vital to tackle this public health threat.
\nThe website also serves as a resource for organisations and individuals who are looking
\nto support this effort by outlining opportunities for action and sharing what others are
\ndoing to fight fake medicines.
\n3.6 Food security and nutrition
\nThe Food and Agriculture Organization of the United Nations (FAO) and the World
\nHealth Organization (WHO) have received a mandate to develop a Declaration on
\nNutrition and an accompanying Framework for Action (FFA) to guide its
\nimplementation. They will organise several preparatory meetings and conferences during
\nthe development process. The WMA is observing this process. One main criticism is the
\nshort timeline and the low involvement of civil society in the process. NGOs also
\ncomplain that problems concerning the use of antibiotics in foodstuffs are not well
\naddressed in the current discussion.
\nThe focus so far is on: Social protection to protect and promote nutrition,
\nnutrition-enhancing agriculture and food systems and the contribution of the private sector
\nand civil society to improving nutrition.
\n3.7 Health and the environment
\n3.7.1 Climate change
\nThe WMA continues to be involved in the UN climate change negotiations,
\nparticularly the implementation of the Paris agreement adopted at COP21 in
\nDecember 2015. For this purpose, a WMA delegation followed the two weeks of
\nnegotiations during the COP 23, which took place from 6-17 November 2017 in
\nBonn, Germany. The Secretariat liaised with WHO and the Global Climate and
\nHealth Alliance (GCHA) to ensure coordinated actions during these negotiations.
\nThe WMA made a public statement
\n(https:\/\/www.wma.net\/wp-content\/uploads\/2017\/05\/3.5-Health-environment-and-
\nclimate-change-WMA.pdf) at the 142nd
\nsession of the WHO Executive Board on
\nthe global strategy on health, environment and climate change.
\nDuring the reporting period, discussions were started with WHO and the GCHA
\non setting up a regular mechanism of cooperation in the area of climate change.
\nApril 2018 Council 209\/SecGen Report\/Apr2018
\n14
\nThe WHO\u2019s First Global Conference on Air Pollution and Health is scheduled
\nfrom 30th
\nOctober to 1st
\nNovember in Geneva. It will bring together global, national
\nand local partners to share knowledge and mobilize action for cleaner air and
\nbetter health. The WMA is in contact with WHO to discuss its involvement in the
\nevent.
\n3.7.2 Chemicals safety
\nIn December 2009, the WMA joined the Strategic Approach to International
\nChemicals Management (SAICM) of the Chemicals Branch of the United Nations
\nEnvironment Programme (UNEP), which aims to develop a strategy for
\nstrengthening the engagement of the health sector in the implementation of
\nthe Strategic Approach.
\nFurther to the 2016 World Health Assembly Resolution on the Role of the Health
\nSector in the Strategic Approach to International Chemicals Management
\ntowards the 2020 goal and beyond, the 70th
\nWorld Health Assembly last May
\napproved the Chemicals Roadmap (http:\/\/www.who.int\/ipcs\/saicm\/roadmap\/en\/)
\nwhich identifies actions where the health sector has either a lead or important
\nsupporting role to play, recognizing the need for multi-sectoral and
\nmulti-stakeholder cooperation. The roadmap was developed in consultation with
\nMember States, United Nations agencies, and other relevant stakeholders. The
\nWMA participated in the consultation phase through electronic consultation and
\nmeetings.
\n3.7.3 WMA Green Page
\nThe WMA is partnered with the Florida Medical Association (FMA) on a joint
\nproject \u201cMy Green Doctor\u201d. This project is a medical office environmental
\nmanagement service offered free of charge to members of the World Medical
\nAssociation (WMA) and the Florida Medical Association (FMA). The initial
\nversion of My Green Doctor was launched by the FMA on World Earth Day
\n2010. In June 2014, the WMA and FMA agreed to work together on this project.
\nMy Green Doctor provides a free practice management tool designed by doctors
\nto make medical offices more environmentally friendly. It provides everything
\nneeded to assist practice or clinic managers in establishing their own
\nenvironmental sustainability programme: office policies, PowerPoints, a
\nstep-by-step guide for your Green Teams, and even free advice by telephone. The
\nMy Green Doctor website is now available in the \u201cWhat we do – Education\u201d
\nsection of the WMA website.
\n4. Health Systems
\n4.1 Patient safety
\nTo address the global problems of unsafe medication practices, the WHO has launched
\na Global Patient Safety Challenge on Medication Safety with the overall goal to \u201creduce
\nthe avoidable harm due to unsafe medication practices by 50% worldwide by 2020\u201d. In
\norder to develop this initiative, the WHO invited the WMA and other relevant
\nstakeholders to several consultations this year.
\nApril 2018 Council 209\/SecGen Report\/Apr2018
\n15
\nUnder this overarching topic the WMA was invited by the WHO to participate in a
\nGlobal Consultation for Setting Priorities for Global Patient Safety in collaboration
\nwith the Centre for Clinical Risk Management and Patient Safety, Department of Health.
\nThis high-level global event brought together key international experts and senior policy
\nmakers from ministries of health from both developed and developing countries. The
\nobjective of this consultation was to identify the main challenges and barriers to
\nimproving patient safety for patients, health-care providers and the environment of care,
\nand define priorities for future action by the WHO and countries.
\nSome years ago, the WMA, together with the WHO and the other health professions,
\nwrote the \u2018Patient Safety Curriculum Guide- Multi Professional Edition\u2019, and also
\nparticipated in its update a few years later. Now the WHO would like to carry out a
\nsecond revision of this curriculum guide in several steps. As the first step, the chapter
\n\u2018Improving Medication Safety\u2019 should be updated in such a way that it can also stand
\nalone as a single document. At a first meeting in December 2017 we discussed the topics,
\norder and priorities of this chapter. Based on this discussion the WHO will develop a first
\nrevised version to be commented on by the WMA and other health professionals.
\n4.2 One Health
\nIn May 2015, the World Veterinary Association (WVA) and the World Medical
\nAssociation (WMA) in collaboration with the Spanish medical (SMA) and veterinary
\n(SVA) associations organized the Global Conference on ‘One Health’ Concept with the
\ntheme: \u201cDrivers towards One Health – Strengthening collaboration between Physicians
\nand Veterinarians\u201d. The Global Conference brought together 330 delegates from 40
\ncountries around the world. Veterinarians, physicians, students, public health officials
\nand NGO representatives listened to presentations by high-level speakers and had the
\nopportunity to learn, discuss and address critical aspects of the One Health concept. The
\nmain objectives of the conference were to strengthen links and communications between
\nthe professions and to achieve closer collaboration between physicians, veterinarians and
\nall relevant stakeholders to improve different aspects of the health and welfare of
\nhumans, animals and the environment. A summary of the conference is available on the
\nWMA website.
\nThe second conference was hosted by the Japan Medical Association and the Japan
\nVeterinary Association together with the World Veterinary and the World Medical
\nAssociation in Kitakyushu City, Fukuoka Prefecture, Japan on 10-11 November 2016.
\nThe conference was attended by more than 600 participants from 44 countries around the
\nworld with approximately 30 lectures covering different One Health issues. A summary
\nof the conference is available on the WMA website.
\n4.3 Antimicrobial resistance
\nAntimicrobial Resistance (AMR) is a growing concern and an important challenge to
\npublic health. It has various aspects and different actors contribute to the problem.
\nThe WHO developed the Global Action Plan on Antimicrobial Resistance, which
\narticulated five main objectives, with the healthcare workforce being a key player in their
\nattainment. Most notably, Objective 1 strives to \u201cimprove awareness and understanding
\nof antimicrobial resistance through effective communication, education and training.\u2019\u2019
\nThe WHO established an AMR secretariat whose purpose is to link the various
\nApril 2018 Council 209\/SecGen Report\/Apr2018
\n16
\nstakeholders, get them involved and coordinate the activities of the Action Plan. One
\nemphasis will be on the education of medical students and physicians.
\nThe WMA participated in a WHO expert consultation meeting on health workforce
\neducation and AMR. The outcome of this meeting was the development of the first draft
\nof the Global Interprofessional AMR Competency Framework for Health Workers\u2019
\nEducation. This tool will assist health policy planners and decision makers in countries
\nto work towards achieving the first objective of the WHO Global Action plan on AMR,
\nwhich aims to improve awareness and understanding of AMR through effective
\ncommunication, education and training. It is also intended to serve as the basis for the
\ndevelopment of a global prototype AMR curriculum for health workers\u2019 education and
\nscheduled training. The WMA commented on the first draft version together with the
\nWorld Federation for Medical Education. Our comments included the knowledge and
\ntraining aspects required to carry out a proper diagnosis and the importance of
\ndifferentiating between different origins and severity of infections, i.e. it is of utmost
\nimportance to have a deep knowledge of diagnosis before prescribing an antibiotic in
\norder to reduce the burden of AMR. Together with the School for Public Policy at the
\nGeorge Mason University, the WMA has been providing a free online learning tool on
\nAntimicrobial Resistance for nearly a decade now.
\nThe WMA participated in the ninth Meeting of the Strategic and Technical Advisory
\nGroup on Antimicrobial Resistance (STAG – AMR) and the Meeting of the Technical
\nCoordination Group (TCG) in February 2018 in Geneva.
\n4.4 Health workforce
\nIn May 2016, the World Health Assembly adopted the Global Strategy on Human
\nResources for Health. One new and important statement in the WHO strategy is the
\nemphasis that investment in HRH has a growth-inducing effect and health care itself is a
\nlarge pillar of the economy. The argument that the health sector has a growth inducing
\neffect on the economy is now being adopted by more and more UN agencies. As a result,
\nthe UN Secretary General appointed a High Level Commission on Health Employment
\nand Economic Growth, which launched its report \u2018Working for Health and Growth –
\nInvesting in the health workforce\u2019 in September 2016. The report gives 10
\nrecommendations on areas such as job creation, gender and women\u2019s rights, education
\ntechnology and crisis and humanitarian settings. The Commission\u2019s goal is to stimulate
\nand guide the creation of at least 40 million new jobs in the health and social sectors and
\nto reduce the projected shortfall of 18 million health workers, primarily in low and lower
\nmiddle income countries, by 2030.
\nFollowing the conclusion of its 10 year mandate, the Global Health Workforce Alliance
\nhas transitioned into the Global Health Workforce Network (GHWN). The Global Health
\nWorkforce Network aims to facilitate evidence generation and exchange, foster
\nintersectoral and multilateral policy dialogue, including providing a forum for
\nmulti-sector and multi-stakeholder agenda setting, sharing of best practices, and
\nharmonization and alignment of international support for human resources for health. The
\noverall goal is to enable the implementation of Universal Health Coverage and the
\nSustainable Development Goals. The WHO, together with the GHWN and Ireland,
\norganised the Fourth Global Forum on Human Resources for Health in November
\n2017 and adopted the outcome document Dublin Declaration on Human Resources for
\nHealth.
\nApril 2018 Council 209\/SecGen Report\/Apr2018
\n17
\nDuring this forum the WMA and the International Federation of Pharmacists (FIP)
\norganised a side session on: How can regulation ensure quality health care,
\nprofessional autonomy and protect the public\u2019s interest?
\nCommercialised health care models may affect professional autonomy and the delivered
\nquality of care. The purpose of health care regulation is to protect the public\u2019s interest
\nand ensure patient-centred quality care based on ethical principles, as opposed to
\nprofit-oriented models of care. Professional autonomy through self-regulation defines
\nstandards and ensures quality for health care models. Therefore, regulation has an
\nimportant role in the implementation of strategies such as the WHO Global Strategy on
\nHuman Resources for Health to accelerate UHC and ensure a sustainable health
\nworkforce.
\nDr Julia Tainijoki, WMA Medical Advisor, spoke at another side event during this forum
\nentitled: \u201cAddressing discrimination in health care settings through a focus on the
\nrights, roles and responsibilities of health workers\u201d and presented the physician\u2019s
\nperspective and WMA policies on this issue.
\n4.5 Violence in the health sector
\nBuilding on the success of the previous conference in Dublin, preparatory work has
\nstarted for the sixth International Conference on violence in the health sector, which will
\ntake place in Toronto, Canada on 24 – 26 October 2018. The WMA is a member of the
\norganisation and scientific committees in charge of the preparations for the event. Two
\nmeetings of the organisation committee took place during the reporting period. C.
\nDelorme, as member of the Committee, liaised with the ICRC so that a representative of
\nthe Health Care in Danger initiative will be invited to the conference as a keynote
\nspeaker.
\n4.6 Caring Physicians of the World Initiative Leadership Course
\nThe CPW Project began with the Caring Physicians of the World book, published in
\nEnglish in October 2005 and in Spanish in March 2007. Some hard copies (English and
\nSpanish) are still available from the WMA Secretariat upon request.
\nRegional conferences were held in Latin America, the Asia-Pacific region, Europe and
\nAfrica between 2005 and 2007. The CPW Project was extended to include a leadership
\ncourse organised by the INSEAD Business School in Fontainebleau, France in December
\n2007, in which 32 medical leaders from a wide range of countries participated. The
\ncurriculum included training in decision-making, policy work, negotiating and coalition
\nbuilding, intercultural relations and media relations. Please visit the WMA website for
\nmore readings and videos which reflect some experiences of previous course alumni.
\nThe eighth course was held at the Mayo Clinic in Jacksonville, Florida, USA from 3 – 8
\nDecember 2017. The courses were made possible by educational grants provided by
\nBayer HealthCare and Pfizer, Inc. This work, including the preparation and evaluation of
\nthe course, is supported by the WMA Cooperating Center, the Center for Global Health
\nand Medical Diplomacy at the University of North Florida.
\n5. Health Policy & Education
\n5.1 Medical and health policy development and education
\nApril 2018 Council 209\/SecGen Report\/Apr2018
\n18
\nIn recent years, the Center for the Study of International Medical Policies and Practices at
\nGeorge Mason University, which is one of the WMA\u2019s Cooperating Centers, has studied
\nthe need for educational support in the field of policy creation. Surveys performed in
\ncooperation with the WMA found a demand for education and exchange. The Center
\ninvited the WMA to participate in the creation of a scientific platform for international
\nexchange on medical and health policy development. In autumn 2009, the first issue of a
\nscientific journal, World Medical & Health Policy, was published by Berkeley Electronic
\nPress as an online journal. It has now been moved to the Wiley Press. The World Medical
\n& Health Policy Journal can be accessed at:
\nhttp:\/\/onlinelibrary.wiley.com\/journal\/10.1002\/(ISSN)1948-4682
\n5.2 Support for national constituent members
\nSee item 2.2.1
\nApril 2018 Council 209\/SecGen Report\/Apr2018
\n19
\nCHAPTER II PARTNERSHIP & COLLABORATION
\nDuring the reporting period, the WMA Secretariat held bilateral meetings with the WHO and staff
\nof other UN agencies on the following areas: Prevention of alcohol abuse, mental health, violence
\nagainst women, the environment, the migration of health professionals and the prevention of torture.
\nIn addition, the Secretariat voiced the WMA\u2019s concerns in various public settings as follows2
\n:
\n1. World Health Organization (WHO)
\nWHO Governance
\nWHO Executive Board, January 2018:
\nThe 142nd
\nsession of the WHO Executive Board took place in January 2018 in Geneva, Switzerland.
\nThe WMA made public statements on a series of issues. For more information (agenda, working
\ndocuments and resolutions), see http:\/\/apps.who.int\/gb\/e\/e_eb142.html
\nWHO Public Health Events
\nFourth Global Forum on Human Resources for Health in November 2017 organised by WHO,
\nGHWN and Ireland in November 2017
\nWHO Meeting of the Strategic and Technical Advisory Group on Antimicrobial Resistance (STAG
\n– AMR) and Meeting of the Technical Coordination Group (TCG) in February 2018 in Geneva
\nWHO Global Consultation for Setting Priorities for Global Patient Safety in collaboration with the
\nCentre for Clinical Risk Management and Patient Safety, Department of Health
\nWHO workshop \u00abinvesting in healthy cities: \u00abinsuring prevention\u00bb at the 20th
\nEuropean Health
\nForum Gastein, Austria in October 2017
\nWHO GCM\/NCD Working Group on Health Education and Health Literacy for NCDs, in February
\nin Geneva
\n2. UNESCO Conference on Bioethics, Medical Ethics and Health Law
\nIn recent years, the WMA has supported the \u201cUNESCO Chair in Bioethics World Conference
\non Bioethics, Medical Ethics and Health Law\u201d organised by the UNESCO Bioethics Chair,
\nProf. Dr Amnon Carmi. In October 2015, the conference convened in Naples, Italy. The WMA
\nparticipated again by structuring sessions on end-of-life issues and the (at that time) draft of a
\nnew policy on Ethical Guidelines for Health Databases and Biobanks. WMA Past-Presidents,
\nDr Yoram Blachar and Dr Jon Sn\u00e6dal, WMA Ethics Advisor Prof. Vivienne Nathanson, WMA
\nLegal Counsel, Ms Annabel Seebohm and the Secretary General served in preparing these
\nsessions. Immediate Past President, Dr Xavier Deau, held a keynote speech at the opening of
\nthe conference.
\nThe WMA was again invited to arrange two scientific sessions at the 12th
\nUNESCO Chair of
\nBioethics Conference held in Limassol, Cyprus from 21-23 March 2017. The first discussed the
\n2
\nMore information on the activities mentioned is set out under the relevant section of the report.
\nApril 2018 Council 209\/SecGen Report\/Apr2018
\n20
\nongoing revision process of the \u00abDeclaration of Geneva, the physicians\u2019 oath\u00bb. This session
\nwas moderated by Dr Ramin Parsa-Parsi, Chair of the WMA work group, and Prof. Urban
\nWiesing, Director at our cooperating institute, the University of T\u00fcbingen. The second session
\nwas moderated by WMA Past President Dr Jon Sn\u00e6dal and Dr Otmar Kloiber, with
\ncontributions by Dr Emmanuell Rial-Sibag from our cooperating Center at the University of
\nNeuchatel and Ms Annabel Seebohm, Secretary General of the Standing Committee of
\nEuropean Doctors (CPME).
\nThe WMA is invited to the 13th
\nWorld Conference on Bioethics, Medical Ethics and Health
\nLaw, which will take place from 27-29 November 2018 in Jerusalem, Israel. Please visit the
\nconference page for more details.
\n3. Other UN agencies
\nAGENCY ACTIVITIES
\nHuman Rights Council of the United
\nNations, in particular:
\nUN Special Rapporteur (SR) on the right of
\neveryone to the enjoyment of the highest
\nattainable standard of physical and mental
\nhealth (Dr D. Puras)
\nMonitoring the SRs\u2019 activities
\nOngoing exchange of information
\nMeeting with the SR in September 2017
\nfurther to WMA written contribution to SR\u2019s
\nreport on mental health
\nSpecial Rapporteur on torture and other cruel,
\ninhuman or degrading treatment or
\npunishment (Dr Nils Melzer)
\nMonitoring the SR\u2019s activities
\nContact to be made with new SR
\nSpecial Rapporteur on the Rights of Persons
\nwith Disabilities (Ms Catalina Devandas
\nAguilar)
\nMonitoring the SR\u2019s activities
\nContact made late 2016
\nHigh Commissioner for Human Rights (Mr
\nZeid Ra\u2019ad Al Hussein)
\nThe WMA is part of the consultation process
\nwithin the framework of the UN Resolution on
\nmental health and human rights adopted in
\nSeptember 2016
\nUNAIDS Campaign on Zero HIV-related stigma &
\ndiscrimination in health care settings day
\nSee item 3.3.3
\nOECD Meeting with Mrs Francesca Colombo, Head
\nof the Health Section,\tand her team.
\nDiscussion about the new work strategy on
\nhealth system reporting and the use of Patient
\nReported Outcome Measurements (PROMS).
\nNovember 2016 (see also item 6.1 and 10)
\nInternational Organisation for Migration
\n(IOM)
\nThe WMA is part of the IOMWHO working
\nGroup on Migrants\u2019 Health. (see point 3.3)
\nWHO and World Bank Dr Yokokura gave one of the keynote speeches
\nat the Universal Health Coverage Forum
\nDecember 2017 in Tokyo, Japan
\nApril 2018 Council 209\/SecGen Report\/Apr2018
\n21
\n4. World Health Professions Alliance (WHPA)
\nAfter over ten years, the World Federation of Dentists FDI took over the secretariat of the
\nWorld Health Professions Alliance Leadership from the WMA at the beginning of 2018.
\nWorld Health Professions Regulation Conference
\nSave the date: 19-20 May 2018 in Geneva, prior to the World Health Assembly
\nHealth professional regulation faces many challenges in a world characterised by political,
\nsocial, economic and technological change. Widespread reform of health professional
\nregulation reflects policy initiatives by many governments to ensure sustainable, efficient and
\neffective health service delivery. But what are the implications of these challenges, and how do
\nwe ensure the public\u2019s best interests are met?
\nScheduled to run over one-and-a-half days immediately before the World Health Assembly in
\nMay 2018, the 6th
\nWorld Health Professions Regulation Conference (WHPRC) will provide
\nparticipants with insights, perspectives and discussion on current challenges in health
\nprofessional regulation.
\nThere are three main themes that will be addressed during the conference:
\n1. A call to set the right standards in regulation
\nTopics will include: setting the right standards, who is regulating the regulators, ethics and
\nprofessional autonomy, barriers to implementation, and reimbursement.
\n2. Safety, quality and compliance: Benefiting patients, communities and populations
\nTopics will include: best practice guidelines, the role of regulation in sustainable prevention,
\nfacilitation of migration, the cost of maintaining licenses, use of big data and case studies of
\noutcome-oriented models.
\n3. Supporting the quality of lifelong learning
\nTopics will include: continuing professional development (CPD) and a discussion on the need
\nfor global standards, fostering innovation, improving patient treatment, the shift in CPD of
\nassessment vs independence, and regulation of specialization.
\n5. WMA Cooperating Centers
\nThe WMA is now proud to enjoy the support of five academic cooperating centres. The WMA
\nCooperating Centers bring specific scientific expertise to our projects and\/or policy work,
\nimproving our professional profile and outreach.
\nWMA Cooperating Center Areas of cooperation
\nCenter for the Study of International
\nMedical Policies and Practices,
\nGeorge-Mason-University, Fairfax,
\nVirginia, USA
\nPolicy development, microbial resistance,
\npublic health issues (tobacco), publishing the
\nWorld Medical and Health Policy Journal.
\nCenter for Global Health and Medical
\nDiplomacy, University of North Florida,
\nUSA
\nLeadership development, medical diplomacy
\nInstitute of Ethics and History of Medicine,
\nUniversity of T\u00fcbingen, Germany
\nRevising the Declaration of Geneva, medical
\nethics
\nInstitut de droit de la sant\u00e9, Universit\u00e9 de International health law, developing and
\nApril 2018 Council 209\/SecGen Report\/Apr2018
\n22
\nNeuch\u00e2tel, Switzerland promoting the Declaration of Taipei, medical
\nethics, deontology, sports medicine
\nSteve Biko Center for Bioethics, University
\nof Witwatersrand, Johannesburg, South
\nAfrica
\nRevising the Declaration of Helsinki, medical
\nethics, bioethics
\nInstitute for Environmental Research,
\nYonsei University College of Medicine,
\nSouth Korea
\nEnvironmental health, climate change and
\nhealth issues
\n6. World Continuing Education Alliance (WCEA)
\nThe World Medical Association signed an agreement with the WCEA to provide an online
\neducation portal that will not only enable the WMA to host its online education, but also offers
\nan opportunity for member associations to develop their own portals and online content. This
\noffer is directed specifically at medical associations and societies that wish to engage in
\nproviding online education. Interested groups, medical schools or academies are invited to
\ncontact the WMA Secretary General (secretariat@wma.net) for more information. This
\neducational platform will be launched in May 2018.
\n7. Other partnerships or collaborations with Health and Human Rights Organizations
\nOrganisation Activity
\nAmnesty International Ongoing contacts (exchange of information and support)
\nduring the reporting period, in particular on the situations in
\nTurkey, Ethiopia and Iran.
\nHuman Rights Watch Regular contact on issues of common interest.
\nGlobal Alliance on Alcohol
\nPolicy (GAPA) and its
\nmembers
\nRegular exchange of information.
\nInternational Committee of
\nthe Red Cross (ICRC)
\nPartners on the Health Care in Danger (HCiD) project since
\nSeptember 2011.
\nPermanent cooperation with the Health in Detention and
\nHCiD Departments.
\nMemorandum of understanding between the ICRC and the
\nWMA signed in November 2016.
\nInternational Council of
\nMilitary Medicine (ICMM)
\nA Memorandum of Understanding between the ICMM and the
\nWMA was signed at the WMA General Assembly in October
\n2017 (Chicago).
\nCouncil for International
\nOrganizations of Medical
\nSciences (CIOMS)
\nDevelopment of guidance for the scientific community in
\nmedicine and health care in general. The WMA is a member
\nand currently represented on the Executive Board.
\nInternational Federation of
\nHealth and Human Rights
\nOrganisations (IFHHRO)
\nRegular exchange of information on human rights and health
\nmatters.
\nInternational Federation of
\nMedical Students
\nAssociations (IFMSA)
\nInternship program since 2013 (3 students in 2013 and 2
\nstudents in 2014).
\nRegular collaboration, mostly in relation to WHO statutory
\nmeetings.
\nParticipation of WMA officers and officials in the pre-World
\nHealth Assembly conference of IFMSA in Geneva.
\nApril 2018 Council 209\/SecGen Report\/Apr2018
\n23
\nInternational Federation of
\nAssociations of
\nPharmaceutical Physicians
\n(IFAPP)
\nCooperation on issues of human experimentation and
\npharmaceutical development, the role of physicians in that
\nprocess. A memorandum of understanding has been signed at
\nthe WMA General Assembly, October 2017 (Chicago).
\nUniversity of Pennsylvania
\nInternational Internship
\nProgram
\nAnnual Internship program on health policy, public health,
\nhuman rights, project management. Usually 2-3 students come
\nas interns to our office for the summer. The programme has
\nbeen running since 2014.
\nInternational Rehabilitation
\nCouncil for Torture Victims
\n(IRCT)
\nRegular exchange of information and joint actions on specific
\ncases or situations.
\nGlobal Climate & Health
\nAlliance (GCHA)
\nRegular exchange of information and ad hoc collaboration
\nwithin the context of the UN climate change negotiations.
\nNew Jersey Medical School
\nGlobal TB Institute
\nThe WMA is working with the New Jersey Medical School
\nGlobal TB Institute and the University Research Company
\n(URC) to update its online TB refresher course for physicians
\nwith the support of the US Agency for International
\nDevelopment (USAID).
\nSafeguarding Health in
\nConflict Coalition
\nObserver status in the coalition.
\nRegular exchange of information.
\nWorld Coalition Against
\nThe Death Penalty
\nRegular exchange of information, in particular regarding
\nindividual cases requiring international support.
\nWorld Veterinary
\nAssociation
\nCo-organisation of the Global Conference on One Health,
\n21-22 May 2015 in Madrid, Spain in collaboration with the
\nSpanish medical and veterinary associations. 2nd
\nGlobal
\nConference on One Health, Kitakyushu City, Fukuoka
\nPrefecture, Japan, 10-11 November 2016.
\nUS Defense Health Board \u2013
\nEthics Subcommittee
\nWMA Past President, Dr Cecil Wilson, represented the WMA
\nat two sessions of the Defense Health Board \u2013 Ethics
\nSubcommittee in 2014 and 2015 advocating for always
\nallowing physicians in military service to respect medical
\nethics, even in conflict. The report of the Board is available on
\nour website.
\nAssociation for the
\nPrevention of Torture
\nExchange of information on the implementation of the
\nConvention against Torture with regard to the role of
\nphysicians in preventing torture and ill treatment.
\nPhysicians for Human
\nRights
\nRegular exchange of information and joint actions on specific
\ncases or situations.
\nInternational Physicians for
\nthe Prevention of Nuclear
\nWar (IPPN)
\nExchange of information and joint actions, in particular in the
\ncontext of the UN Treaty on the Prohibition of Nuclear
\nWeapons.
\nApril 2018 Council 209\/SecGen Report\/Apr2018
\n24
\nCHAPTER III COMMUNICATION & OUTREACH
\nIn July 2017 a new member of staff joined the WMA Secretariat. Ms Magda Mihaila is a journalist
\nand communications specialist who is now helping our team improve the way we get out messages
\nto our members and into our social media stream.
\n1. WMA Newsletter
\nIn April 2012, the WMA Secretariat started a bi-monthly e-newsletter for its members. The
\nSecretariat appreciates any comments and suggestions for developing this service and making it
\nas useful for members as possible.
\n2. WMA social media (Twitter and Facebook)
\nIn 2013, the WMA launched its official Facebook and Twitter accounts (@medwma). The
\nSecretariat encourages members to spread the word within their associations that they can
\nfollow the WMA\u2019s activities on Twitter and via Facebook.
\n3. The World Medical Journal
\nThe World Medical Journal (WMJ) is issued every 3 months and includes articles on WMA
\nactivities and feature articles by members and partners. The 60th
\nanniversary edition was
\npublished as a final printed copy in 2014. It transferred to an electronic format in 2015, which
\nis available on the WMA website.
\n4. WMA African Initiative
\nWMA President 2013-2014, Dr Margaret Mungherera, started an initiative to bring African
\nmedical associations closer to the WMA. The idea was that stronger inclusion of organised
\nmedicine in international cooperation should not only help to get the African voice better heard,
\nbut would also leverage national visibility and standing.
\nDr Mungherera brought together medical associations from various parts of Africa in small
\nregional meetings to discuss issues around their current work, what obstacles they face and
\nwhere they have had success. Invitations are open to all African medical associations,
\nregardless of whether they are already members of the WMA.
\nDr Mungherera set up regional consultative meetings with African NMAs in Kenya, South
\nAfrica, Tunisia and Nigeria. This initiative has been supported by the medical associations of
\nSouth Africa and Tunisia, WMA President 2014-2015, Dr Xavier Deau, Past Chair of Council,
\nDr Mukesh Haikerwal, as well as the Chairman of the Past-Presidents and Chairs of Council
\nNetwork, Dr Dana Hanson.
\nImmediate Past-President Dr Mungherera delivered presentations at the 4th
\nInternational
\nConference on Violence in the Health Sector in Miami from 22-24 October 2014, the African
\nHealth Conference in London from 27-28 February 2015, and at the 6th
\nWorld Congress on
\nWomen’s Mental Health in Tokyo from 22-25 March 2015, among others.
\nSadly, Dr Mungherera passed away on 4 February 2017 after a brave battle with cancer over
\nrecent years. As a psychiatrist by education, a public health activist by nature, and a determined
\nApril 2018 Council 209\/SecGen Report\/Apr2018
\n25
\nadvocate for the people of Africa by conviction she was a marvellous physician leader on the
\nglobal stage. For many of us she was more than a colleague, she became a friend, teacher and
\ncompanion.
\nMargaret was with us for every meeting she could arrange for. The WMA remains grateful for
\nher service to our community.
\n5. Meeting with Arab Medical Union leaders
\nUpon the invitation of the President of the Kuwait Medical Association, who at the time also
\nchaired the Arab Medical Union, the WMA Chair of Council, Dr Ardis Hoven, and the
\nSecretary General had an opportunity to attend the Scientific Conference of the Kuwait
\nMedical Association and the coinciding meeting of Arab Medical Union leaders. The Chair
\ndelivered a presentation on the WMA to the leaders of the Arab Medical Union, most of which
\nare not members of the WMA, and invited them to join. Later the Chair was given the
\nopportunity to participate in a panel discussion about End-of-Life issues, which mainly dealt
\nwith the provision of palliative care, the withdrawal or withholding of futile treatment and the
\nrespect for patient will (denial of treatment).
\nIn another section, the Secretary General presented the WMA Declarations of Taipei and
\nGeneva.
\n6. Secondments \/ internships
\nThe Danish Medical Association seconded Ms Eva Rahbek to the WMA Secretariat at the
\nCouncil Session in Riga. We have been running an internship programme with the IFMSA
\nsince 2013 (3 Interns in 2017 from Poland, Spain and Rwanda), with the University of
\nPennsylvania since 2014 (2 Interns in 2017) and last year we started an internship programme
\nwith the Palack University Olomouc in the Czech Republic (1 intern in 2017).
\nA call was sent out to IFMSA members in February for two interns for the 2018 spring\/summer
\nperiod and 2 UPENN interns have been accepted for the period from May to August 2018.
\nCHAPTER IV OPERATIONAL EXCELLENCE
\n1. Advocacy
\nIn April 2017, the Council decided to discontinue the Advocacy Workgroup and to replace it
\nwith a new Advocacy and Communications Advisory Panel with the mission to provide input
\nand guidance to:
\n\u009f Enhance the promotion of WMA policies and positions among the NMAs and to
\nrelevant external organisations, associations, and institutions; and
\n\u009f Recommend advocacy and communications strategies to increase the visibility and
\npositive impact of WMA policies and activities.
\nThe Panel is chaired by Dr Ashok Zachariah Philip, Malaysian Medical Association and
\ncomposed of the following members: Israel Medical Association (IsMA), South African
\nMedical Association (SAMA), Spanish Medical Association (CGCoM), American Medical
\nAssociation (AMA), Japanese Medical Association (JMA), French Medical Association
\n(CNOM), Junior Doctors Network (JDN).
\nApril 2018 Council 209\/SecGen Report\/Apr2018
\n26
\n2. Paperless meetings
\nAt its 188th
\nmeeting, the WMA Council expressed its desire to reduce its environmental impact
\nby going paperless. Since the 189th
\nCouncil meeting, documents posted on the website before
\nthe meeting have no longer been provided at the venue in print. Council members and officials
\nare responsible for downloading documents from the members\u2019 area of the WMA website and
\nbringing them to the meeting via electronic media or on paper, if desired. Documents
\ndeveloped on site during the meeting are available online via a WiFi connection or in print. The
\nSecretariat introduced box.com at the 197th
\nCouncil meeting as a parallel sharing and
\nsynchronizing tool for official WMA documents. In October 2016, the WMA General
\nAssembly in Taipei decided to introduce entirely paperless meetings provided a suitable WiFi
\nconnection is available.
\n3. Governance
\nA Workgroup on Governance Review was set up at the Council Session in Moscow in 2015
\nunder the chair of Dr Rutger Jan van der Gaag. The Workgroup delivered its final report to the
\n207th
\nCouncil in Chicago after extended discussions with Constituent Members. Based on this
\nreport, the Secretary General drafted a discussion document for a new Strategic Plan to be
\nconsidered at the Council Session in Riga.
\nCHAPTER V ACKNOWLEDGEMENT
\nThe Secretariat wishes to record its appreciation of member associations and individual members
\nfor their interest in, and cooperation with, the World Medical Association and its Council during the
\npast year. We thank all those who have represented the WMA at various meetings and gratefully
\nacknowledge the collaboration and guidance received from the officers, as well as the association’s
\neditors, its legal, public relations and financial advisors, staff of constituent members, council
\nadvisors, associate members, friends of the association, cooperating centres, partner organizations
\nand officials.
\nWe wish to mention the excellent working relationships we have with colleagues and experts in
\ninternational, regional and national organizations, be they (inter-)governmental or private. We
\nhighly appreciate their willingness and efforts to enable our cooperation.
\n\u00a7\u00a7\u00a7
\n09.04.2018
\n1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument
\nno:
\nCouncil 209\/Chair of Council
\nReport\/Apr2018
\nOriginal:
\nEnglish
\nTitle: Report of the Chair of Council (October
\n2017 \u2013 March 2018)
\nDestination: 209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nTo be
\nreceived
\nAs we approach the Council meeting in Riga this month, I pause to reflect on the considerable
\namount of work that has been accomplished by our members and by the WMA. Most recently at the
\nWHO headquarters in Geneva, a Memorandum of Understanding between the WHO and the WMA
\nwas signed confirming co-operation on topics of mutual interest including action of the social
\ndeterminants of health, universal health coverage and the improvement of emergency preparedness.
\nMy special thanks to our President, Dr. Yokokura and our Secretary General Dr. Otmar Kloiber on
\nbringing this to fruition.
\nA very important accomplishment regarding regional meetings on End of Life Care has been
\nachieved, and let me express my personal thanks to those countries who hosted and organized these
\nevents. We will be discussing the outcomes of these meetings in Riga and I look forward to this. On
\na more personal note, I was privileged to be able to attend the meeting at the Vatican and being the
\nbeneficiary of the hospitality and kindness afforded to those in attendance by Archbishop Vincenzo
\nPaglia, President of the Pontifical Academy for Life. The diversity of knowledge as presented by
\nmedical professionals, legal authorities, experts in palliative care and theologians provided for all of
\nus an extra ordinary experience. A special thank you to the German Medical Association for
\nproviding leadership and support for this very important activity.
\nDuring the latter part of November, I was the recipient of an invitation to attend the Second Kuwait
\nMedical Association (KMA) Scientific conference. Both Dr. Kloiber and I had the opportunity of
\nmeeting with the leadership of the KMA and discussing the value of the WMA thanks to the
\ninvitation of Dr. Mohammad Al-Mutairi, President of the Kuwait Medical Association. This was an
\nexcellent opportunity to represent the WMA in a part of the world where our representation has
\nbeen limited.
\nOf a more local nature, I was invited to speak at a regional Global Health meeting in Ohio,
\ndiscussing the work of the WMA as related to global health issues. The audience included
\nacademics, public health organizations, and medical and dental students many of whom had been
\nengaged in work in a variety of places related to public health and prevention. I had an opportunity
\nto address antimicrobial resistance, the role of the entire medical and veterinarian community in
\npreparedness, the need for educational and training programs in One Health that are
\nmultidisciplinary, and a focus on environmental health is necessary. The role that WMA plays in
\nsuch global work is indeed a challenge but absolutely necessary.
\nApril 2018 Council 209\/Chair of Council Report\/Apr2018
\n2
\nOn a final note, in recently writing a publication Foreword on Women\u2019s Health in Global
\nPerspective, I was reminded of the barriers to health care and clinical needs that constitute threats to
\nadequate health care for women. With increasing migrant streams caused by war, climate change
\nand economic disruption, women have become targets of abuse, violence and deprivation. Gender
\nbased health disparities intensify the need for our role in the Social Determinants of Health globally.
\nAs leaders in Medicine, we have the opportunity and responsibility to lay aside politics and
\nconcentrate on the needs of patients and our health care colleagues. As we enjoy the hospitality of
\nRiga, I encourage dialogue around even what we might consider difficult topics. Respect for and
\nencouraging the minority opinion is very desirable. We are diverse in many ways and that we must
\ncelebrate.
\nRespectfully submitted by Ardis Dee Hoven, MD, Chair of Council
\n\u00a7\u00a7\u00a7
\n06.04.18
\n1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument
\nno:
\nMEC 209\/Agenda\/Apr2018\/Rev Original:
\nEnglish
\nTitle: Agenda of the Medical Ethics Committee
\nDestination: Medical Ethics Committee
\n209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nFor
\nconsideration
\nNote: This agenda is revised on item 3.4 only.
\nThursday, 26 April 2018
\nMembership of the Committee
\nDr Andrew W. GURMAN
\nDr David O. BARBE
\nDr Michael Bryant GANNON
\nDr Thomas SZEKERS
\nDr Andrew DEARDEN
\nDr Mark PORTER
\nDr Shuyang ZHANG
\nDr Serafin ROMERO
\nDr Heidi STENSMYREN (Chair)
\nDr Andreas RUDKJOEBING
\nDr Frank-Ulrich MONTGOMERY
\nDr Ramin PARSA-PARSI
\nDr Ajay KUMAR
\nDr Kenji MATSUBARA
\nDr Mari MICHINAGA
\nDr Ren\u00e9 H\u00c9MAN
\nDr Mzukisi GROOTBOOM
\nEx-officio (with voting rights)
\nDr Ardis Dee Hoven, Chair of Council
\nDr Frank Ulrich Montgomery, Vice-Chair of Council
\nDr Andrew Dearden, Treasurer
\nEx-officio (without voting rights)
\nDr Yoshitake Yokokura, President
\nDr Leonid Eidelman, President-Elect
\nDr Ketan Desai, Immediate Past President
\nDr Otmar Kloiber, Secretary General
\nMs Marie Colegrave-Juge, Legal Advisor
\nMr Adolf H\u00e4llmayr, Financial Advisor
\nMs Joelle Balfe, Facilitator
\nDr Julia Tainijoki, Medical Advisor
\nMarch 2018 MEC 209\/Agenda\/Apr2018\/Rev
\n2
\n1. GENERAL BUSINESS
\n1.1 Call to order by the Chair of Council
\n1.2 Report of the previous meeting held in Chicago, USA, 11-14 October 2017
\nApprove: Report of the Medical Ethics Committee (MEC 207\/Report\/Oct2017)
\n1.3 Chair\u2019s Opening Remark
\n2. MONITORING REPORT (ORAL)
\n3. BUSINESS IN PROGRESS
\n3.1 Declaration of Therapeutic Abortion
\nConsider: Oral report from the working group.
\nProposed revision of WMA Declaration of Therapeutic Abortion
\n(MEC 209\/Therapeutic Abortion COM REV3\/Apr2018)
\n3.2 Ethics of Telemedicine
\nConsider: Proposed revision of the WMA Statement on the Ethics of Telemedicine
\n(MEC 209\/Ethics of Telemedicine COM REV\/Apr2018)
\n3.3 Licensing of Physicians Fleeing Prosecution for Serious Criminal Offences
\nConsider: Proposed revision of the WMA Statement Licensing of Physicians Fleeing
\nProsecution for Serious Criminal Offences
\n(MEC 209\/Licensing Physicians Fleeing Prosecution COM REV\/Apr2018)
\n3.4 Regional Meeting on End-of-Life Question (EoL workshops):
\nReceive: Oral report from the Secretary General
\nReport of the Symposium on End-of-Life Questions in Japan, September
\n2017 (MEC 209\/End of Life Japan\/Apr2018)
\nReport of the WMA African region meeting on End-of-Life Questions in
\nNigeria, September 2017 (MEC 209\/End of Life Nigeria\/Apr2018)
\nReport of the WMA South American region meeting on End-of-Life
\nQuestions in Brazil 2017 (MEC 209\/End of Life Brazil\/Apr2018)
\nReport on the WMA European Region Conference on End-of-Life
\nQuestions 2017 (MEC 209\/End of Life Europe\/Apr2018)
\nMarch 2018 MEC 209\/Agenda\/Apr2018\/Rev
\n3
\n4. NEW BUSINESS
\n4.1 Genetics and Medicine
\nConsider: Proposal for a major revision of the WMA Statement on Genetics and
\nMedicine
\n(MEC 209\/Genetic and Medicine\/Apr2018)
\n4.2 Biosimilar Medicinal Products
\nConsider: Proposed WMA Statement on Biosimilar Medicinal Products
\n(MEC 209\/Biosimilar Medicinal Products\/Apr2018)
\n5. CLASSIFICATION OF 2008 POLICIES
\nConsider: Recommendations received on MEC Document
\n(MEC 209\/Policy Review 2008\/Apr2018)
\n6. WMA HUMAN RIGHTS
\nReceive: Oral Report from the WMA Secretariat
\n7. ANY OTHER BUSINESS
\n8. ADJOURNMENT
\n\u00a7\u00a7\u00a7
\n05.04.2018<\/p>\n

1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument
\nno:
\nMEC 207\/Report\/Oct2017 Original:
\nEnglish
\nTitle: Report of the Medical Ethics Committee
\nDestination: Medical Ethics Committee
\n209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nFor
\nConsideration
\nWednesday, 11 October 2017
\nMembership of the Committee
\nDr. Andrew W. GURMAN
\nDr. David O. BARBE
\nDr. Michael Bryant GANNON
\nDr. Thomas SZEKERS
\nDr. Andrew DEARDEN
\nDr. Mark PORTER
\nDr. Shuyang ZHANG
\nDr. Serafin ROMERO
\nDr. Heidi STENSMYREN (Chair)
\nDr. Andreas RUDKJOEBING
\nDr. Frank-Ulrich MONTGOMERY
\nDr. Ramin PARSA-PARSI
\nDr. Ajay KUMAR
\nProf. Leonid EIDELMAN
\nDr. Kenji MATSUBARA
\nDr. Mari MICHINAGA
\nDr. Ren\u00e9 H\u00c9MAN
\nDr. Mzukisi GROOTBOOM
\nEx-officio (with voting rights)
\nDr. Ardis Dee Hoven, Chair of Council
\nProf. Dr. Frank Ulrich Montgomery, Vice-Chair of Council
\nDr. Andrew Dearden, Treasurer
\nEx-officio (without voting rights)
\nDr Ketan Desai, President
\nDr. Yoshitake Yokokura, President-Elect
\nSir Michael Marmot, Immediate Past President
\nDr Otmar Kloiber, Secretary General
\nMs. Marie Colegrave-Juge , Legal Advisor
\nMr. Adolf H\u00e4llmayr, Financial Advisor
\nProf. Vivienne Nathanson, Facilitator
\n1. GENERAL BUSINESS
\nOctober 2017 MEC 207\/Report\/Oct2017
\n2
\n1.1 The Chair of the Council called the meeting to order at 08:45 on Wednesday October
\n11, 2017.
\n1.2 The Committee approved the report of the previous meeting held in Livingstone,
\nZambia, 20-22 April 2017 (MEC 206\/Report\/Apr2017).
\n1.3 Dr Thomas SZEKERES was replaced by Dr Herwig LINDNER.
\n2. MONITORING REPORT (ORAL)
\nThe General Secretary highlighted the importance of including all members in discussions of
\nethical issues at WMA, especially those who do not regularly attend WMA Council or
\nGeneral Assembly meetings. The recently held regional meetings are a good way to involve
\nthese members.
\nDr Kloiber noted that there are a number of important issues emerging that impact the medical
\nprofession and encouraged members to submit proposed policies on the following topics:
\nclinical independence, commercialisation of health care, artificial intelligence, and new
\ntechnologies to modify the genome of humans and nano-technology.
\n3. BUSINESS IN PROGRESS
\n3.1 Declaration of Geneva
\nThe Committee received an oral report from the Chair of the Workgroup on the
\nDeclaration of Geneva, Dr Ramin PARSA-PARSI. He reported on the open
\nconsultation in May\/June this year and the workgroup meeting in Sweden in September.
\nWMA ethics advisor, Prof Urban WIESING, gave an overview of the history of the
\ndeclaration and explained the changes proposed by the workgroup.
\nRECOMMENDATION
\n3.2.1 That the proposed WMA Declaration of Geneva (MEC 207\/ Declaration of
\nGeneva\/Oct2017) be approved by Council and forwarded to the General
\nAssembly for adoption.
\nOn the recommendation of the Committee, the Chair of Council agreed to read the
\nDeclaration of Geneva at the beginning of each ceremonial session of future General
\nAssemblies. For this year, it will be read at the conclusion of the General Assembly,
\nfollowing adoption of the revision during the plenary session. Further it was decided to
\npresent the new version in the conference UNESCO Chair in Bioethics World
\nConference Bioethics, Medical Ethics & Health Law and 14th
\nWorld Congress of
\nBioethics.
\n3.2 Declaration of Therapeutic Abortion
\nThe Committee received the oral report of Dr Selealo MAMETJA, the chair of the
\nworkgroup, and considered the Proposed WMA Declaration of Therapeutic Abortion
\n(MEC 207\/Therapeutic Abortion REV2\/Oct2017). The workgroup had a meeting
\nshortly before the committee meeting and proposed some additional adjustments to the
\nOctober 2017 MEC 207\/Report\/Oct2017
\n3
\ndocument and also that the name of the document be changed from \u201ctherapeutic
\nabortion\u201d to \u201cmedically indicated abortion\u201d.
\nRECOMMENDATION
\n3.2.1 That the proposed WMA Declaration of Therapeutic Abortion (MEC
\n207\/Therapeutic Abortion REV2\/Oct2017), be circulated to constituent
\nmembers for comments
\n3.3 Person Centered Medicine
\nThe Committee considered the proposed WMA Statement on Person Centered Medicine
\nand comments (MEC 207\/Person Centered Medicine COM REV\/Oct2017)
\nRECOMMENDATION
\n3.3.1 That the Council recognize the work on the topic of person centered medicine
\nbut that the policy not be pursued at this time.
\n3.4 Child Abuse
\nThe Committee considered the proposed WMA Statement on Child Abuse and
\ncomments (MEC 207\/Child Abuse COM REV\/Oct2017)
\nRECOMMENDATION
\n3.4.1 That the revision of the proposed WMA Statement on Child Abuse and
\ncomments (MEC 207\/Child Abuse COM REV\/Oct2017) be approved by
\nCouncil and forwarded to the General Assembly for adoption.
\n3.5 Organ and Tissue Donation
\nThe Committee considered the proposed revision of the WMA Statement on Organ and
\nTissue and comments (MEC 207\/Organ and Tissue Donation COM REV\/Oct2017). The
\nCommittee will present the statement to the Council for consideration, with an
\nadditional proposed amendment to paragraph 17 to clarify language regarding donor
\nconsent.
\nRECOMMENDATION
\n3.5.1 That the proposed WMA Statement on Organ and Tissue and comments (MEC
\n207\/Organ and Tissue Donation REV2\/Oct2017) be approved by Council and
\nforwarded to the General Assembly for adoption, pending agreement of the
\nCouncil on language in paragraph 17 regarding donor consent.
\n3.6 Declaration of Hamburg
\nThe Committee considered the proposed minor revision of the WMA Declaration of
\nHamburg (MEC 207\/Declaration of Hamburg\/Oct2017)
\nOctober 2017 MEC 207\/Report\/Oct2017
\n4
\nRECOMMENDATION
\n3.6.1 That the proposed WMA Declaration of Hamburg (MEC 207\/Declaration of
\nHamburg\/Oct2017), be approved by Council and forwarded to the General
\nAssembly for information.
\n3.7 United Nations Rapporteur on the Independence and Integrity of Health
\nProfessionals
\nThe Committee considered the proposed WMA Proposal for a United Nations
\nRapporteur on the Independence and Integrity of Health Professionals
\n(MEC 207\/UN Rapporteur\/Oct2017) and the oral report of Ms Clarisse DELORME,
\nWMA Advocacy Advisor, who had met with the ICRC to discuss the relevance of the
\nexisting statement.
\nRECOMMENDATION
\n3.7.1 That the revision of the proposed WMA Proposal for a United Nations
\nRapporteur on the Independence and Integrity of Health Professionals
\n(MEC 207\/UN Rapporteur\/Oct2017) be rescinded and achieved.
\n3.8 Ethics of Telemedicine
\nThe Committee considered the proposed WMA Statement on the Ethics of
\nTelemedicine (MEC 207\/Ethics of Telemedicine\/Oct2017)
\nRECOMMENDATION
\n3.8.1 That the revision of the proposed WMA Statement on the Ethics of
\nTelemedicine (MEC 207\/Ethics of Telemedicine\/Oct2017) be circulated to
\nconstituent members for comments.
\n3.9 Licensing of Physicians Fleeing Prosecution for Serious Criminal Offences
\nThe Committee considered the proposed WMA Statement Licensing of Physicians
\nFleeing Prosecution for Serious Criminal Offences (MEC 207\/Licensing Physicians
\nFleeing Prosecution\/Oct2017)
\nRECOMMENDATION
\n3.9.1 That the revision of the proposed WMA Statement Licensing of Physicians
\nFleeing Prosecution for Serious Criminal Offences (MEC 207\/Licensing
\nPhysicians Fleeing Prosecution\/Oct2017) be circulated to constituent members
\nfor comments.
\n3.10 Regional meetings on End-of-Life Question (EoL workshop)
\nOctober 2017 MEC 207\/Report\/Oct2017
\n5
\nThe Committee received an oral report from the Secretary General on the regional
\nmeeting in Japan held in September 2017 in conjunction with the CMAAO meeting and
\nwith the support of the JMA. He reported that the appetite for discussing euthanasia and
\nphysician assisted suicide in the Asia region is very low among most countries, with the
\nexception of Australia and New Zealand. He noted that no medical association
\nattending the meeting has policy that supports euthanasia or physician assisted suicide.
\nHe also noted that discussion of unwanted or futile treatment is a topic that is often
\ndiscussed regionally.
\nProf. Ulrich MONTGOMERY informed the Committee about the upcoming End of
\nLife conference in the Vatican in November this year. He stressed that the conference is
\nnearly full and that members interested in attending should contact the German Medical
\nAssociation immediately.
\n4. WMA HUMAN RIGHTS
\nThe WMA Advocacy Advisor referred to the Council report (Council 207\/SecGen
\nReport\/Oct2017) and highlighted the meeting with the UN Special Rapporteur on Health, Dr
\nDainius PURAS, regarding his latest report on mental health, human rights, and attacks on
\nhealth professionals. The Executive Committee recommends to invite him to either the next
\nCouncil meeting or General Assembly in 2018.
\nIn July 2017, the Treaty on the Prohibition of Nuclear Weapons, the first multilateral legally-
\nbinding instrument for nuclear disarmament, was adopted. On the occasion of the opening for
\nsignature of the Treaty, the IPPN together with the WMA, the International Council of Nurses
\nand the World Federation of Public Health Associations, adopted a joint Statement urging
\nMember States to sign the Treaty and to ratify it as soon as possible so that it can enter into
\nforce.
\n5. ANY OTHER BUISNESS
\n5.1 The Secretary General reminded the committee that WMA has three policies related to
\ncapital punishment:
\n\u2022 WMA Resolution on Physician Participation in Capital Punishment
\n\u2022 WMA Resolution to Reaffirm the WMA\u2019s Prohibition of Physician Participation in
\nCapital Punishment
\n\u2022 WMA Statement on the United Nations Resolution for a Moratorium on the Use of
\nthe Death Penalty
\n6. ADJOURNMENT
\nThe meeting was adjourned at 11:40 on Wednesday 11th
\nOctober to report back to the
\nCouncil.
\n\u00a7\u00a7\u00a7
\n12.10.2017<\/p>\n

1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument
\nno:
\nMEC 209\/Therapeutic Abortion COM REV3\/Apr2018 Original:
\nEnglish
\nTitle: Proposed revision of WMA Declaration on Therapeutic Abortion
\nDestination: Medical Ethics Committee
\n209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nFor
\nConsideration
\nNote: As part of the annual policy review process, the Council in Buenos Aires (April 2016) decided that
\nthe WMA Declaration on Therapeutic Abortion should be reaffirmed with minor revision. The
\nWMA secretariat submitted a revision to the 204th
\nCouncil session in Taipei (October 2016). The
\nCouncil decided to circulate this version to WMA members for comments. Given the controversies
\nof opinions reflected in the comments from members, the Council appointed a workgroup with
\nSouth Africa as the chair. This version is the compilation from the working group.
\nThe 207th Council session in Chicago (October 2017) considered the version proposed by the
\nworkgroup and decided to circulate it within WMA membership for comments.
\nAbbreviation key:
\nAM Associate Members
\nAMA American Medical Association
\nAMV Associazione Medica del Vaticano
\nBMA British Medical Association
\nApril 2018 MEC 209\/Therapeutic Abortion COM REV3\/Apr2018
\n2
\nCGCM Consejo General de Colegios M\u00e9dicos de Espana
\nCMA Canadian Medical Association
\nCNOM Conseil National de l’Ordre des M\u00e9decins, France
\nDMA Danish Medical Association
\nFMA Finnish Medical Association
\nGMA Bundes\u00e4rztekammer (German Medical Association)
\nIsMA Israeli Medical Association
\nNMA Norwegian Medical Association
\nPCPD Polish Chamber of Physicians and Dentists (Naczelna Izba Lekarska)
\nRDMA Royal Dutch Medical Association
\nSwMA Swedish Medical Association
\nTuMA Turkish Medical Association
\nGENERAL COMMENTS
\nAM The Associate Members had a lively and respectful discussion about this difficult topic. We believe limiting it to medically-indicated abortion may
\nmake it easier to come to a satisfactory conclusion. The Associate Members are divided about a single issue in this document. It is the issue about
\nreferral. All of us believe physicians who are not comfortable or capable performing abortions should not have to do so. Some physicians feel that it is
\nagainst their personal moral convictions to have to refer someone for a procedure the referring physician feels is immoral. Alternative language
\nacceptable to these physicians is proposed as an alternative paragraph 8 (1). We are also including an additional alternative (2) that further defines
\nmedically-induced abortions using the terms \u201cdirect\u201d and \u201cindirect\u201d.
\nOther AMs feel just as strongly that these physicians, with a moral objection to medically-indicated abortion, should still have to help the patient get the
\nnecessary medical treatment. Those physicians feel the alternative language allows physicians to behave unethically to their patients because of their
\npersonal moral beliefs, not necessarily shared by the patient. They feel that the disagreeing physician has to help the patient find needed care. We do
\nnot endorse either version of paragraph 8, but leave it to the rest of the process to make the final decision on how to word paragraph 8.
\nOther minor suggestions are included for consistency and clarity.
\nAMV As we have previously stressed, the medical establishment should work towards protecting and promoting every human life (born and unborn).
\nConsidering the importance of the mother\u2019s interests, we cannot accept the interruption of pregnancy before viability outside the case of a risk for the
\nwoman\u2019s life or a grave health problem. This declaration also undermines the physician\u2019s right to conscientious objection by forcing referrals to other
\nphysicians.
\nBMA We welcome this revision of the declaration which addresses our previous comments on MEC 204. We have reservations regarding the changed title of
\nthe declaration to \u2018medically-indicated abortion\u2019 which is potentially ambiguous and value laden in terms of grounds for an abortion. For example,
\nsome might argue that abortion is rarely and only in extremis \u2018medically-indicated\u2019 when the health risks of pregnancy and childbirth are over and
\nabove that which would normally be expected; not taking into account the inherent risks of pregnancy and childbirth for women, and\/or the particular
\ncircumstances of a woman and her family (for example, the pregnancy is a consequence of rape). The BMA currently refers to \u2018induced abortion\u2019, and
\nwould suggest this becomes the title.
\nApril 2018 MEC 209\/Therapeutic Abortion COM REV3\/Apr2018
\n3
\nKeywords: Abortion, Pregnancy, Mother, Respect, Autonomy, Fundamental Right [Within the context of abortion, the term \u2018mother\u2019 can be seen as
\nemotive. A pregnant woman is not a mother until she gives birth.]
\nCNOM The CNOM (French Medical Council) thanks the working group for this new version but cannot support it as it is.
\nDMA The Danish Medical Association supports the revised version of this declaration. We have two minor suggestions: In section 2, we would suggest
\ndeleting \u201cbetween the patient and the physician\u201d so that the sentence ends after \u201cmatter\u201d. And, in light of the change in title, in section 9 we would
\nsuggest changing \u201ctherapeutic abortion\u201d to \u201cmedically indicated abortion\u201d. [Note: those comments have been added in the table below]
\nFMA FMA can accept the revised document. We have one minor comment to the text: Para 9: to change wording to medically-indicated instead of
\ntherapeutic. [Note: this comment has been added in the table below]
\nGMA The GMA has incorporated a small number of suggested editorial revisions below. [Note: those comments have been added in the table below]
\nNMA NMA supports this document, but suggest one new item under Recommendations
\nPCPD The Polish Chamber of Physicians and Dentists is of the opinion that physicians have a right to conscientious objection to providing certain medical
\nservices and those medical doctors who do not provide certain services may not be disciplined or discriminated against which should be safeguarded by
\nnational laws by the so called \u201cconscience clause\u201d.
\nAbortion is one of the medical procedures that is most often associated with the issue of conscientious objection. The Polish Chamber, therefore
\nwelcomes clear reference to the physicians\u2019 right to conscientious objection to providing abortion.
\nAs the Polish Constitutional Court stated in its judgment of 7 October 2015 in the proceedings initiated by the Polish Chamber it is not only the
\nphysician\u2019s right but it is the physician\u2019s duty to act according to his \/ her conscience. Acting against physician\u2019s conscience may be required only in
\ncases where a delay in providing medical assistance would result in posing danger to life or serious harm.
\nAt the same time the Constitutional Court said that it is against the Polish constitution to require that a doctor who objects to provide abortion has to
\nrefer the woman to another easily accessible physician or health facility willing to perform abortion. As the Court indicated this would unproportionally
\ninfringe the physician\u2019s conscience. Also it is not a duty of a physician to gather and provide information about other physicians who do not object to
\nperform abortion \u2013 in fact gathering such information by a physician could constitute a breach of other laws. This kind of information should be
\nprovided to patients by those who are in charge of running the healthcare system (public authorities, healthcare facility management, National Health
\nFund) and not by individual doctors whose conscience does not allow them to participate in abortion.
\nThe reasoning of this verdict should be fully supported, therefore the Polish Chamber proposes to amend points 8 and 9 by deleting second sentence in
\npoint 8, rephrasing the third sentence in point 8 and deleting point 9 which puts an obligation on all doctors despite their ethical convictions.
\nIn those cases where medically-indicated abortion is legally allowed it should be performed by a competent physician in approved healthcare facilities \u2013
\nthese procedures should not be delegated to other health care professions. Therefore the Polish Chamber proposes to amend point 5 of the draft by
\ndeleting the part \u201cor other health care worker\u201d. [Note: this specific comment about paragraphs 5, 8 and 9 have been added in the table below]
\nRDMA Preliminary question:
\nHow does this declaration relate to the declaration on the WMA-website,
\nWMA Declaration of Oslo on Therapeutic Abortion
\nAdopted by the 24th World Medical Assembly, Oslo, Norway, August 1970
\nand amended by the 35th World Medical Assembly, Venice, Italy, October 1983
\nand the 57th WMA General Assembly, Pilanesberg, South Africa, October 2006
\n1. The WMA requires the physician to maintain respect for human life.
\nApril 2018 MEC 209\/Therapeutic Abortion COM REV3\/Apr2018
\n4
\n2. Circumstances bringing the interests of a mother into conflict with the interests of her unborn child create a dilemma and raise the question
\nas to whether or not the pregnancy should be deliberately terminated.
\n3. Diversity of responses to such situations is due in part to the diversity of attitudes towards the life of the unborn child. This is a matter of
\nindividual conviction and conscience that must be respected.
\n4. It is not the role of the medical profession to determine the attitudes and rules of any particular state or community in this matter, but it is our
\nduty to attempt both to ensure the protection of our patients and to safeguard the rights of the physician within society.
\n5. Therefore, where the law allows therapeutic abortion to be performed, the procedure should be performed by a physician competent to do so
\nin premises approved by the appropriate authority.
\n6. If the physician\u2019s convictions do not allow him or her to advise or perform an abortion, he or she may withdraw while ensuring the
\ncontinuity of medical care by a qualified colleague.
\nIs there a more recent version? Otherwise we don\u2019t understand the changes made to this declaration being \u2018reaffirmed with minor revision\u2019.
\nSwMA This is a proposed revision of the existing WMA Declaration on therapeutic abortion. The existing policy is not entirely clear as to whether its scope is
\nonly abortions performed due to medical reasons or if it also covers other situations where a pregnancy is terminated following a request by the
\npregnant woman.
\nThe SMA would like to stress that it is of utmost importance that the change of terminology \u2013 from \u201ctherapeutic abortion\u201d to \u201cmedically-indicated
\nabortion\u201d \u2013 in the revised version must not in any way be interpreted as if the WMA opposes other abortions than strictly medically-indicated ones.
\n*Numbering will be deleted (or adjusted) when the revised text is adopted.
\nNo Proposed Text:
\nMEC 207\/Therapeutic Abortion
\nREV2\/Oct2017
\nSpecific Comments
\nAdditions: bold\/underlined
\nDeletions: lined-out
\nComments only: [italic]
\nProposed Revised Text by:
\nRapporteur
\nMEC 209\/ Therapeutic Abortion
\nREV3\/Apr2018
\nTitle WMA Declaration on Medically-
\nIndicated Abortion
\nWMA Declaration on therapeutic Medically-Indicated
\nTermination [CNOM]
\nMedically-Indicated Termination of
\nPregnancy: (most of peer-review
\nliterature around medical indications
\nuses the term)
\nPREAMBLE
\n[New paragraph]: The doctor should always bear in
\nmind that the first moral principle imposed upon him is
\nto respect human life (born and unborn) [AMV]
\n1. Medically-indicated abortion refers to
\ninterruption of pregnancy due to health
\nreasons, in accordance with evidence-
\nMedically-indicated abortion refers to interruption of
\npregnancy due to serious health reasons, in accordance
\nwith evidence-based medicine principles and good current
\nMedically-indicated termination of
\npregnancy refers to interruption of
\npregnancy due to health reasons, in
\nApril 2018 MEC 209\/Therapeutic Abortion COM REV3\/Apr2018
\n5
\nbased medicine principles and good
\nclinical practice.
\nclinical practice. [AMV]
\nFor the purpose of this declaration medically-indicated
\nabortion refers to interruption of pregnancy due to health
\nreasons, in accordance with evidence-based medicine
\nprinciples and good clinical practice. [SwMA]
\nMedically-indicated abortion refers to interruption of
\npregnancy due to health reasons [It is necessary to explain
\nthe term \u2018medically indicated abortion\u2019 (the same holds for
\ntherapeutic abortion, since that term is unclear also).
\nDoes \u2018medically indicated\u2019 include: abortion induced
\nbecause of the mother’s physical or mental health, of social
\nreasons and to prevent the birth of an affected child?] \u2026
\n[RDMA]
\nMedically-indicated abortion refers to interruption of
\npregnancy due to health reasons, in accordance with
\nevidence-based medicine medical principles and good
\nclinical practice. [CMA]
\nMedically-indicated abortion refers to interruption of
\npregnancy due to health reasons, in accordance with
\nprinciples of evidence-based medicine principles and good
\nclinical practice. [GMA]
\nMedically-indicated abortion refers to interruption of
\npregnancy due to health reasons for the mother, in
\naccordance with evidence-based medicine principles and
\ngood clinical practice. [CGCM]
\nMedically-indicated abortion refers to interruption of
\npregnancy due to health reasons \u2026 [IsMA: are you
\nreferring to the health of the fetus, mother or both ?]
\naccordance with principles of
\nevidence-based medicine and good
\nclinical practice
\nApril 2018 MEC 209\/Therapeutic Abortion COM REV3\/Apr2018
\n6
\n2. Abortion is a medical matter between
\nthe patient and the physician. Attitudes
\ntoward abortion are a matter of
\nindividual conviction and conscience
\nthat must be respected.
\n[Delete paragraph] [SwMA]
\n[Delete paragraph; abortion is not only about \u201cindividual
\nconviction and conscience\u201d. Medicine has a lot to say
\nconcerning fetal life] [AMV]
\nMedically-indicated Aabortion is a medical matter
\nbetween the patient and the physician \u2026[AM]
\nAbortion is a medical matter between the patient and the
\nphysician \u2026 [DMA]
\n\u2026 Attitudes toward abortion are a matter of individual
\nconviction and conscience that mustshould be respected.
\n[BMA]
\n[The BMA supports the right of doctors to have a
\nconscientious objection to abortion and believes that such
\ndoctors should not be marginalised because of their beliefs.
\nThis is, however, a qualified right with some specific
\nlimitations. As noted in the new paragraph 8 – to save a
\nwoman\u2019s life \u2013 and, therefore, the term \u2018should\u2019 rather
\nthan \u2018must\u2019 would be preferable.] [BMA]
\nAbortionMedically-indicated abortion is a medical matter
\nbetween the patient and the physician. Attitudes toward
\nabortion are a matter of individual conviction and
\nconsciencevalues that must be respected. [CGCM]
\nAbortion is a medical matter between the patient and the
\nphysician. Attitudes toward abortion are a matter of
\nindividual conviction and conscience that must be
\nrespected. [CNOM]
\nTermination of pregnancy is a medical
\nmatter between the patient and the
\nphysician. Attitudes toward
\ntermination of pregnancy are a matter
\nof individual conviction and
\nconscience that should be respected.
\nApril 2018 MEC 209\/Therapeutic Abortion COM REV3\/Apr2018
\n7
\n3. Circumstances where the interest of a
\nwoman is in conflict with the interests
\nof her unborn fetus may create a
\ndilemma as to whether or not the
\npregnancy should be deliberately
\nterminated. The diversity of responses
\nto such situations is due in part to the
\ndiversity of attitudes towards the life of
\nthe fetus, for various reasons including
\ncultural, religious and traditional.
\nCircumstances where the interest of a woman is in conflict
\nwith the interests of her unborn fetus may create a dilemma
\nraise the question as to whether or not the pregnancy
\nshould be deliberately terminated. The diversity of
\nresponses attitudes to such situations is due in part to the
\ndiversity of attitudes differing views towards the woman\u00b4s
\nautonomy and the life of the fetus, for various reasons
\nincluding cultural, religious and traditional. [SwMA]
\nCircumstances where the interest life of a woman is in
\nconflict with the interestslife of her unborn fetus may
\ncreate a dilemma as to whether or not the pregnancy should
\nbe deliberately terminated. The diversity of responses to
\nsuch situations is due in part to the diversity of attitudes
\ntowards the life of the fetus, for various reasons including
\ncultural, religious and traditional. [AMV]
\nCircumstances – where the interest in pursuing a
\npregnancy which puts the woman\u2019s life at risk of a
\nwoman is in conflict with the interests of her unborn fetus
\n– may create a dilemma as to whether or not the pregnancy
\nshould be deliberately terminated. The diversity of
\nresponses to such situations is due in part to the diversity of
\nattitudes towards the life of the fetus, for various reasons
\nincluding medical, cultural, religious and traditional.
\n[CNOM]
\nA circumstance where the patient may
\nbe harmed by carrying the pregnancy
\nto term presents a conflict between the
\nlife of the foetus and the health of the
\npregnant woman. Diverse responses
\nto resolve this dilemma situation
\nreflect the diverse cultural, legal,
\ntraditional, and regional standards of
\nmedical care throughout the world
\nRECOMMENDATIONS RECOMMENDATIONS
\nApril 2018 MEC 209\/Therapeutic Abortion COM REV3\/Apr2018
\n8
\n4. Doctors should be aware of local
\nabortion laws, regulations and reporting
\nrequirements. National laws, norms,
\nstandards, and clinical practice related
\nto abortion should promote and protect
\nwomen\u2019s health and their human rights,
\nvoluntary informed consent, and
\nautonomy in decision-making,
\nconfidentiality and privacy. National
\nmedical associations should advocate
\nthat national health policy upholds these
\nprinciples.
\nDoctors should need to be aware of local abortion laws,
\nregulations and reporting requirements. National laws,
\nnorms, standards, and clinical practice related to abortion
\nshould must promote and protect women\u2019s health and their
\nhuman rights, voluntary informed consent, and autonomy
\nin decision-making, confidentiality and privacy. National
\nMmedical Aassociations should advocate that national
\nhealth policy upholds these principles. [SwMA]
\nDoctors should be aware of local abortion laws, regulations
\nand reporting requirements. National laws, norms,
\nstandards, and clinical practice should promote and
\nprotect every person\u2019s health related to abortion should
\npromote and protect women\u2019s health and their human
\nrights, voluntary informed consent, and autonomy in
\ndecision-making, confidentiality and privacy. National
\nmedical associations should advocate that national health
\npolicy upholds these principles. [AMV]
\nDoctors Physicians should be aware of local abortion laws,
\nregulations and reporting requirements. National laws,
\nnorms, standards, and clinical practice related to abortion
\nshould promote and protect women\u2019s health, dignity, and
\ntheir human rights, voluntary informed consent, and
\nautonomy in decision-making, confidentiality and
\nprivacy\u2026 [AM]
\nDoctors should be aware of local abortion laws and ethical
\nnorms, regulations and reporting requirements thereof.
\nNational laws, norms, standards, and clinical practice
\nrelated to abortion should promote and protect women\u2019s
\nhealth and their human rights, as well as respect voluntary
\ninformed consent, and autonomy in decision-making,
\nPhysicians should be aware of local
\ntermination of pregnancy laws,
\nregulations and reporting
\nrequirements. National laws, norms,
\nstandards, and clinical practice related
\nto termination of pregnancy should
\npromote and protect women\u2019s health,
\ndignity and their human rights,
\nvoluntary informed consent, and
\nautonomy in decision-making,
\nconfidentiality and privacy. National
\nmedical associations should advocate
\nthat national health policy upholds
\nthese principles.
\nApril 2018 MEC 209\/Therapeutic Abortion COM REV3\/Apr2018
\n9
\nmaintaining medical confidentiality and privacy. National
\nmedical associations should advocate that national health
\npolicy upholds, promotes and complies with these
\nprinciples. [CGCM]
\nDoctors should be aware of local abortion laws, regulations
\nand reporting requirements relating to medically-
\nindicated termination. National laws, norms, standards,
\nand clinical practice related to medically-indicated
\ntermination should promote and protect women\u2019s health
\nand their human rights, voluntary informed consent, and
\nautonomy in decision-making, confidentiality and privacy.
\n\u2026 [CNOM]
\n[Added paragraph:] Women who decide to terminate
\npregnancy should not be punished. National Medical
\nAssociations and physicians should speak out against
\nlegislation and practices that are in opposition to this
\nfundamental right. [It is important that women are not
\npunished if they decide to terminate pregnancy] [NMA]
\n5. Where the law allows medically-
\nindicated abortion to be performed, the
\nprocedure should be performed by a
\ncompetent physician or other health
\ncare worker in accordance with
\nevidence-based medicine principles and
\ngood medical practice in an approved
\nfacility that meets necessary medical
\nstandards
\nWhere the law allows medically-indicated abortion to be
\nperformed, the procedure should be performed by a
\ncompetent physician or other health care worker in
\naccordance with evidence-based medicine principles and
\ngood medical practice in an approved facility that meets
\nnecessary medical standards. [SwMA]
\nWhere the law allows medically-indicated abortion to be
\nperformed, the procedure should be performed by a
\ncompetent physician or other health care worker in
\naccordance with evidence-based medicine principles and
\ngood current medical practice in an approved facility that
\nWhere the law allows medically-
\nindicated termination of pregnancy to
\nbe performed, the procedure should be
\nperformed by a competent physician
\nor other health care worker in
\naccordance with evidence-based
\nmedicine principles and good medical
\npractice in an approved facility that
\nmeets required medical standards
\nApril 2018 MEC 209\/Therapeutic Abortion COM REV3\/Apr2018
\n10
\nmeets necessary medical standards. [AMV]
\nWhere the law allows medically-indicated abortion to be
\nperformed, the procedure should be performed by a
\ncompetent physician or other health care worker in
\naccordance with \u2026 [PCPD]
\nWhere the law allows medically-indicated abortion to be
\nperformed, the procedure should be performed by a
\ncompetent physician or other health care worker in
\naccordance with principles of evidence-based medicine
\nprinciples and good medical practice in an approved
\nfacility that meets necessary medical standards. [GMA]
\nWhere the law allows medically-indicated abortion to be
\nperformed, the procedure should be performed by a
\ncompetent physician or other health care worker in
\naccordance with evidence-based medicine principles and
\ngood medical practice in an approved facilityappropriate
\nhealth centre that meets necessary medical standards.
\n[CGCM]
\nWhere the law allows medically indicated abortion to be
\nperformed, the procedure should be performed by a
\ncompetent physician or other health care worker in
\naccordance with evidence-based medicine principles and
\ngood medical clinical practice in an approved facility that
\nmeets necessary required medical standards. [AMA]
\n6. The convictions of both the doctors and
\nthe patient must be respected.
\n[Delete paragraph] [SwMA]
\nThe convictions of both the doctors and the patient and
\nphysician must be respected. [AM]
\nThe convictions of both the physician
\nand the patient should be respected
\nApril 2018 MEC 209\/Therapeutic Abortion COM REV3\/Apr2018
\n11
\nThe convictions of both the doctors and the patient
\nmustshould be respected. [BMA]
\n[See note on para 2.] [BMA]
\nThe convictions and values of both the doctors and the
\npatient must be respected. [CGCM]
\n[Delete paragraph; combined with 7] [AMA]
\n7. Patients with moral convictions must be
\nsupported appropriately and provided
\nwith necessary medical and
\npsychological treatment.
\n[Delete paragraph] [SwMA]
\nPatients with moral convictions must be supported
\nappropriately and provided with necessary medical and
\npsychological treatment along with appropriate
\ncounselling and spiritual support if desired. [AM]
\nPatients with moral convictions must be supported
\nappropriately and offered provided with necessary medical
\nand psychological treatment. [BMA]
\nPatients with moral convictions [Is meant: moral
\nconvictions against abortion?] must be supported
\nappropriately and provided with necessary medical and
\npsychological treatment. [RDMA]
\nPatients with moral convictions conflicts must be
\nsupported appropriately and provided with necessary
\nmedical and psychological treatment. [GMA]
\nPatients with moral convictions objections against
\nabortion that need to undergo this treatment must be
\nsupported appropriately and provided with necessarythe
\nPatients with moral convictions
\nagainst medically-indicated abortion
\nmust be supported appropriately and
\nprovided with necessary medical and
\npsychological treatment along with
\nappropriate spiritual support if desired
\nApril 2018 MEC 209\/Therapeutic Abortion COM REV3\/Apr2018
\n12
\nappropriate medical and psychological treatment.
\n[CGCM]
\nPatients and physicians with moral convictions must be
\nrespected, supported appropriately and provided with
\nnecessary medical and psychological treatments, including
\npsychological support. [AMA]
\nPatients with moral convictions must be supported
\nappropriately and provided with the necessary medical and
\npsychological treatment. [CNOM]
\nThe doctor must provide pregnant women with
\nadequate, reliable and complete information on the
\nevolution of pregnancy and fetal development. It is not
\nin accordance with medical ethics to deny, hide or
\nmanipulate information to influence the mother’s
\ndecision about the continuity of her pregnancy. [CGCM]
\nCovered under no.4 voluntary consent
\n8. Individual doctors have a right to
\nconscientious objection to providing
\nabortion, but that right does not entitle
\nthem to impede or deny access to lawful
\nabortion services because it delays care
\nfor women, putting their health and life
\nat risk. In such cases, the physician
\nmust refer the woman to a willing and
\ntrained health professional in the same,
\nor another easily accessible health-care
\nfacility, in accordance with national
\nlaw. Where referral is not possible, the
\nphysician who objects, must provide
\nsafe abortion or perform whatever
\nIndividual doctors have a right to conscientious objection
\nto providing abortion, but that right does not entitle them to
\nimpede or deny Physicians who, for reasons of
\nconscience, will not perform abortions must never in
\nany way let their personal convictions interfere with or
\ndelay a woman\u00b4s access to lawful abortion services
\nbecause it delays care for women, putting their health and
\nlife at risk. In such cases, the physician must without delay
\nrefer the woman to a willing and trained health professional
\nin the same, or another easily accessible health-care
\nfacility, in accordance with national law. Where referral is
\nnot possible, the physician who objects, must provide safe
\nabortion or perform whatever procedure is necessary to
\nsave the woman\u2019s life and to prevent serious injury to her
\nPhysicians have a right to
\nconscientious objection to advising or
\nperforming an abortion; therefore, they
\nmay withdraw while ensuring the
\ncontinuity of medical care by a
\nqualified colleague. In all cases,
\ndoctors physician must perform those
\nprocedures necessary to save the
\nwoman\u2019s life and to prevent serious
\ninjury to her health
\nApril 2018 MEC 209\/Therapeutic Abortion COM REV3\/Apr2018
\n13
\nprocedure is necessary to save the
\nwoman\u2019s life and to prevent serious
\ninjury to her health1
\n.
\nthe woman\u00b4s health1
\n. [SwMA]
\nIndividual doctorsphysicians have a right to conscientious
\nobjection to providing medically-indicated abortion, but
\nthat right does not entitle them to impede or deny access to
\nlawful medically-indicated abortion services because it
\ndelays care for women, putting their health and life at
\nrisk\u2026Where referral is not possible, the physician who
\nobjects, if capable, must provide safe abortion or perfom
\nwhatever procedure is necessary to save the woman\u2019s life
\nand to prevent serious injury to her health. [AM]
\n[Alternative language (1) also proposed for this paragraph,
\nsee the general comments at the top of the document:]
\nIndividual physicians have a right to conscientious
\nobjection to providing medically-indicated abortion, but
\nthat right does not entitle those physicians to impede or
\ndeny access to lawful medically-indicated abortion
\nservices. In such cases, the physician must make the
\nobjection known to their patient and leave her free to
\nconsult another physician or other health professional.
\nThe physician may withdraw while ensuring the
\ncontinuity of medical care by a qualified colleague. The
\nobjecting physician may also announce publically the
\nrefusal to participate in abortion, warning women not
\nto seek abortion services where they are not provided.
\n[AM]
\n[Alternative language (2)]: Individual physicians have a
\nright to conscientious objection to providing
\nelective abortions while supporting medically indicated
\n1
\nSafe abortion: technical and policy guidance for health systems. Second Ed. World Health Organization; 2012
\nApril 2018 MEC 209\/Therapeutic Abortion COM REV3\/Apr2018
\n14
\nindirect abortions to save the life of mother. However,
\nthat right does not entitle those physicians to impede or
\ndeny access to lawful elective abortion services. In such
\ncases, the physician must make the objection known to
\ntheir patient and leave her free to consult another
\nphysician or other health professional. The physician
\nmay withdraw while ensuring the continuity of medical
\ncare by a qualified colleague. The objecting physician
\nmay also announce publically the refusal to participate
\nin elective abortions, warning women not to seek
\nabortion services where they are not provided. [AM]
\nIndividual doctors have a right to conscientious objection
\nto advising or performing an abortion; therefore, they
\nmay withdraw while ensuring the continuity of medical
\ncare by a qualified colleague. In all cases, doctors must
\nperform those procedures necessary to save the
\nwoman\u2019s life and to prevent serious injury to her health
\nto providing abortion, but that right does not entitle them to
\nimpede or deny access to lawful abortion services because
\nit delays care for women, putting their health and life at
\nrisk. In such cases, the physician must refer the woman to a
\nwilling and trained health professional in the same, or
\nanother easily accessible health-care facility, in accordance
\nwith national law. Where referral is not possible, the
\nphysician who objects, must provide safe abortion or
\nperfom whatever procedure is necessary to save the
\nwoman\u2019s life and to prevent serious injury to her health2
\n.
\n[AMV]
\n\u2026 Where [Does this mean that if abortion is necessary to
\n2
\nSafe abortion: technical and policy guidance for health systems. Second Ed. World Health Organization; 2012
\nApril 2018 MEC 209\/Therapeutic Abortion COM REV3\/Apr2018
\n15
\nsave the woman\u2019s life or health, that in that case the
\nphysician has to perform the abortion nonetheless? If so, it
\nmay be better in that situation not to speak of \u2018abortion\u2019,
\nsince the aim is not to terminate the pregnancy, but to save
\nthe woman\u2019s life or to prevent serious injury to her. The
\nabortion is than a consequence of that procedure. A
\nproposal to redefine this therefore is: If, in order to save
\nthe woman\u2019s life or to prevent serious injury to her health
\n(maternal indication), it is necessary to perform a
\nprocedure that results in terminating the pregnancy, the
\nphysician who objects to providing abortion has to perform
\nthis procedure if referral to another physician is not
\npossible.] \u2026 [RDMA]
\n\u2026 In such cases, the physician must refer the woman to a
\nwilling and trained health professional in the same, or
\nanother easily accessible health-care facility, in accordance
\nwith national law. Where referral is not possible, tThe
\nphysician who objects, must may not refuse to provide
\nmedical care, including to provide safe abortion or
\nperform whatever procedure is necessary, only when a
\ndelay would result in posing danger to life or serious
\nharm to save the woman\u2019s life and to prevent serious
\ninjury to her health3
\n. [PCPD]
\n[Alternatively, the second sentence of point 8 may be
\namended as follows:] \u2026 In such cases, the physician
\nshould inform in due time the patient as well as the
\nphysician\u2019s employer of the objection to perform
\nabortion,must refer the woman to a willing and trained
\nhealth professional in the same, or another easily accessible
\n3
\nSafe abortion: technical and policy guidance for health systems. Second Ed. World Health Organization; 2012
\nApril 2018 MEC 209\/Therapeutic Abortion COM REV3\/Apr2018
\n16
\nhealth-care facility, in accordance with national law\u2026
\n[PCPD]
\nIndividual doctors have a right to conscientious objection
\nto providing abortion, [If the abortion is a medical
\nnecessity, then physician should provide that service, so
\nthere should be no right to refuse in this case] \u2026 [TuMA]
\nIndividual doctors have a right to conscientious objection
\nto providing abortion, but that right does not entitle them
\ntothey may not under any circumstances impede or deny
\naccess to lawful abortion services because it delays care for
\nwomen, putting their health and life at risk. [Second and
\nthird sentences of this paragraph deleted and replaced by:]
\nIf the physician\u2019s convictions do not allow him or her to
\nadvise or perform an abortion, he or she may withdraw
\nwhile ensuring the continuity of medical care by a
\nqualified colleague. [CMA: The CMA does not support
\nmandatory referral, as recommended in this draft. We are
\nunaware of any empirical evidence that such an approach
\nis required in order to ensure equitable access to care.
\nHowever, many physicians will see the obligation to refer
\nto a willing provider as being morally equivalent to the act
\nof performing the procedure itself.]
\nIndividual doctors have a right to conscientious objection
\nto providing regarding abortion, but that right does not
\nentitle them to impede or deny access to lawful abortion
\nserviceshealthcare services and professionals equipped
\nto carry out the legal abortion because it delays care for
\nwomen, putting their health and life at risk. … Where
\nreferral is not possible, the objecting physician who
\nobjects, must provide safe abortion or perfom whatever
\nApril 2018 MEC 209\/Therapeutic Abortion COM REV3\/Apr2018
\n17
\nprocedure is necessary to save the woman\u2019s life and to
\nprevent serious injury to her health4
\n. [CGCM]
\n[Delete paragraph and replace by:] Neither physician or
\nhospital personnel shall be required to perform any act
\nthat violates personally held moral principles. In
\ngeneral, physicians should refer a patient to another
\nphysician or institution to provide treatment the
\nphysician declines to offer. [AMA]
\n\u2026 In such cases, the physician must should refer the
\nwoman \u2026 [IsMA]
\nIndividual doctors have a right to conscientious objection
\nto providing abortion, but that right does not entitle them to
\nimpede or deny access to medically-indicated
\ntermination lawful abortion services because it delays care
\nfor women, putting their health and life at risk. In such
\ncases, the physician must refer the woman to a willing and
\ntrained health professional in the same, or another easily
\naccessible health-care facility, in accordance with national
\nlaw. Where referral is not possible, the physician who
\nobjects, must provide safe abortion or perfom whatever
\nprocedure is necessary to save the woman\u2019s life and to
\nprevent serious injury to her health5
\n. [Comment about this
\nlast sentence: This is not the case in France: French
\nMedical Ethics Code: Article 18 (article R.4127-18 of the
\nCSP): A doctor may only perform a voluntary termination
\nof pregnancy in accordance with the law. He is always free
\nto refuse to do so and, if so, must inform the person
\n4
\nSafe abortion: technical and policy guidance for health systems. Second Ed. World Health Organization; 2012
\n5
\nSafe abortion: technical and policy guidance for health systems. Second Ed. World Health Organization; 2012
\nApril 2018 MEC 209\/Therapeutic Abortion COM REV3\/Apr2018
\n18
\nconcerned of his decision in accordance with the law and
\nwithin the timeframe required by law.] [CNOM]
\n9. Physicians must work with society to
\nseek to ensure that no woman loses her
\nlife because therapeutic abortion
\nservices are unavailable, even in
\nextreme circumstances.
\nPhysicians must work with society to seek to ensure that
\nno woman loses her life suffers harm because therapeutic
\nabortion services are unavailable, even in extreme
\ncircumstances. [SwMA]
\nPhysicians must work with society to seek to ensure that no
\nwoman loses her life because therapeutic medically-
\nindicated abortion and pregnancy services are
\nunavailable, even in extreme circumstances. [AM]
\nPhysicians must work with society to seek to ensure that no
\nwoman loses her life because therapeutic abortion services
\nno person loses his\/her life because healthcare centers
\nare unavailable, even in extreme circumstances. [AMV]
\nPhysicians must work with society to seek to ensure that no
\nwoman loses her life because therapeutic medically-
\nindicated abortion services are unavailable, even in
\nextreme circumstances. [RDMA, FMA, CGCM, DMA]
\n[Delete paragraph] [PCPD]
\nPhysicians must work with the relevant institutions and
\nauthoritiessociety to seek to ensure that no woman loses
\nher life because therapeutic medically-indicated abortion
\nservices are unavailable, even in extreme circumstances.
\n[GMA]
\nPhysicians must work with society to seek to ensure that no
\nwoman loses her life because therapeutic medically
\nPhysicians must work with relevant
\ninstitutions and authorities to ensure
\nthat no woman is harmed because
\nmedically-indicated termination of
\npregnancy services are unavailable.
\nApril 2018 MEC 209\/Therapeutic Abortion COM REV3\/Apr2018
\n19
\nindicated abortion services are unavailable, even in
\nextreme circumstances. [AMA]
\n[Added paragraph:] Public health systems must develop
\nmedical care systems that enable medically-indicated
\nabortion in order to avoid putting the pregnant
\nwoman’s health at risk in cases where this treatment is
\nindicated. [CGCM]
\nCovered above
\n[Added paragraph:] In all his\/her actions the doctor is
\nobliged to safeguard the dignity and integrity of the
\nwomen under his\/her care. [CGCM]
\nCovered in number 4
\n\u00a7\u00a7\u00a7
\n08.03.2018<\/p>\n

1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument
\nno:
\nMEC 209\/Ethics of Telemedicine COM REV\/Apr2018 Original:
\nEnglish
\nTitle: Proposed revision of WMA Statement on the Ethics of Telemedicine
\nDestination
\n:
\nMedical Ethics Committee
\n209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nFor
\nConsideration
\nNote: As part of the annual policy review process, the Council in Livingstone (April 2017) decided that the
\nWMA Statement on the Ethics of Telemedicine should undergo a major revision. The South African
\nMedical Association (SAMA) volunteered to undertake that work. The 207th Council session in
\nChicago (October 2017) considered the proposal and decided to circulate it within WMA
\nmembership for comments.
\nRelated
\nWMA
\nstatements
\n\u2022 WMA Statement on Guiding Principles for the Use of Telehealth for the Provision of Health Care. Adopted by
\nthe 60th
\nWMA General Assembly, New Delhi, India, October 2009
\n\u2022 WMA Statement on Mobile Health Adopted by the 66th
\nWMA General Assembly, Moscow, Russia, October 2015
\nAbbreviation key:
\nAM Associate Members
\nAMA American Medical Association
\nMarch 2018 MEC 209\/Ethics of Telemedicine COM REV\/Apr2018
\n2
\nAMV Associazione Medica del Vaticano
\nBMA British Medical Association
\nCGCM Consejo General de Colegios M\u00e9dicos de Espana
\nCMA Canadian Medical Association
\nCNOM Conseil National de l’Ordre des M\u00e9decins, France
\nDMA Danish Medical Association
\nFMA Finnish Medical Association
\nIsMA Israel Medical Association
\nKMA Korean Medical Association
\nNMA Norwegian Medical Association
\nNZMA New Zealand Medical Association
\nRDMA Royal Dutch Medical Association
\nSAMA South African Medical Association
\nSwMA Swedish Medical Association
\nGENERAL COMMENTS
\nBMA It could be helpful if the document specified more clearly what kind of doctor-patient interaction it covers, for example does it include the
\nrange of phone apps for video consultations? If so, the document arguably limits the potential scope of circumstances in which teleservices
\nservices could be beneficial to patients and the wider health system. [Comments on specific paragraphs below]
\nCNOM The CNOM (French Medical Council) supports this proposal and thanks the SAMA for its excellent work
\nDMA The DMA supports this very relevant statement. We have two specific suggestions: Firstly, in section 4.1 \u2013 at the very end of that section \u2013
\nwe would suggest adding the phrase \u201cand increase social inequality on medicine\u201d. So that it read: \u201cTelemedicine technologies could be
\nunaffordable to patients and hence impede access and increase social inequality on medicine. Secondly, in section 7 \u2013 we would like to add
\n\u201cpatient competencies\u201d. So that it reads: Telemedicine should be tailor-made to patient competencies and local contexts, including
\nregulatory frameworks. [Note: those comments have been added in the table below]
\nFMA FMA thanks SAMA for the draft revision of this statement. We understand that countries are in different stages in utilizing telemedicine.
\nHowever, we see that the use of telemedicine will increase in the future and it will provide viable and cost-effective options in patient care.
\nTherefore, we propose some minor amendments to the text that would recognize this gradual change in health care practices.
\nKMA Regarding the liability of physicians, it is not realistic to impose the duty of confirming the use of telecommunication system and necessary
\ninstruments for telemedicine application by a patient, a medical expert, or family members caring for the patient on physicians since it is
\nnot their field of expertise. Therefore, it is necessary to amend the contents.
\nNMA The Norwegian Medical Association supports this document with one amendment in item 4.1.
\nNZMA We are generally supportive of the content in this revised statement and have no specific amendments. However, we note that the statement
\ndoes not address consultations across jurisdictions. We believe it would be useful for the next iteration to attempt to address the
\nMarch 2018 MEC 209\/Ethics of Telemedicine COM REV\/Apr2018
\n3
\ncomplexities and potential pitfalls of the long-distance provision of health care and advice when patient and doctor are in different
\ncountries.
\nRDMA Preliminary question:
\nThe RDMA does not see ANY changes in this Statement compared to the one that is adopted in 2007 and available on the WMA-website.
\nIt seems to be exactly the same. Is this the right version?
\nGeneral comment:
\nThis statement does not differentiate between 1) the situation that telemedicine is the one and only possible practice of medicine in a
\ncertain case, and 2) the situation that telemedicine is a choice\/preference of the physician, whereas a face-to-face is still possible \/
\navailable. This makes the Statement unclear with regard to wat CAN be done and what SHOULD be done.
\nSwMA We would like to suggest adding a reference to related WMA policies in the preamble (WMA Statement on mobile health, WMA
\nStatement on guiding principles for the use of telehealth for the provision of health care).
\nRegarding terminology, we are a bit unsure if telemedicine is the best and most up-to-date term. If not, perhaps it could be substituted for
\n\u201cdigital medicine\u201d, \u201ctele- and digital techniques in health care\u201d or something similar?
\nNumbering will be deleted (or adjusted) when the revised text is adopted.
\nNo Proposed Text:
\nMEC 207\/Ethics of
\nTelemedicine\/Oct2017
\nSpecific Comments
\nAdditions: bold\/underlined
\nDeletions: lined-out
\nComments only: [italic]
\nProposed Revised Text by:
\nRapporteur
\nMEC 209\/Ethics of Telemedicine REV\/Apr2018
\nTitle WMA Statement on the Ethics of
\nTelemedicine
\nWMA Statement on the Ethics of Telemedicine
\nDEFINITION DEFINITION
\n1. Telemedicine is the practice of medicine
\nover a distance, in which interventions,
\ndiagnostic and treatment decisions and
\nrecommendations are based on data,
\ndocuments and other information
\ntransmitted through telecommunication
\nsystems.
\nTelemedicine is the practice of medicine over a distance
\nand a new patient – physician relation instrument, in
\nwhich interventions, diagnostic and treatment
\ninterventionsdecisions and medical recommendations are
\nbased on data, documents and other information
\ntransmitted through telecommunication systems such as
\nthe internet, information networks, mobile telephones,
\nsocial media or other media not requiring a personal
\npresence of a similar nature as telemedicine refers to
\nboth the transfer of data between the physician and
\nTelemedicine is the practice of medicine over a
\ndistance, in which interventions, diagnoses,
\ntherapeutic decisions, and subsequent treatment
\nrecommendations are based on patient data,
\ndocuments and other information transmitted
\nthrough telecommunication systems.
\nTelemedicine can take place between a physician
\nand a patient or between two or more physicians
\nincluding other healthcare professionals.
\nMarch 2018 MEC 209\/Ethics of Telemedicine COM REV\/Apr2018
\n4
\nthe patient and the transfer of data between
\nphysicians. [CGCM]
\nTelemedicine is the practice of medicine over a distance,
\nin which interventions, diagnoses,tic and treatment
\ntherapeutic decisions, and subsequent treatment
\nrecommendations are based on patient data, documents
\nand other information transmitted through
\ntelecommunication systems. [AMA]
\nPREAMBLE PREAMBLE
\n2. The development and implementation of
\ninformation and communication
\ntechnology are creating new modalities
\nfor providing care for patients. These
\nenabling tools offer different ways of
\npractising medicine. The adoption of
\ntelemedicine is justified because of its
\nspeed, and its capacity to reach patients
\nwith limited access to medical
\nassistance, in addition to its power to
\nimprove health care.
\n[WE SUGGEST ANOTHER PARAGRAPH HERE:] The
\nface to face clinical encounter is the paradigm for good
\nMedicine. Doctors will try to protect this important
\naspect of the patient-doctor relationship. [AMV]
\n[Added text:]\u2026 It is used for patients who cannot see an
\nappropriate physician because of inaccessibility due to
\ndistance, physical disability, employment, family
\ncommitments (including caring for others), cost, and
\nphysician schedules. [AM]
\nThe development and implementation of information and
\ncommunication technology are creating new modalities
\nfor providing care for patients. These new methods of
\ncommunication with enabling tools that provide new
\noffer different ways of practising medicine. The adoption
\nof telemedicine and other telematic media is justified
\nbecause of its speed, and its capacity to reachcontact
\npatients with limited access to medical assistance, in
\naddition to its power to improvethe possibility of
\nimproving health care. [CGCM]
\nThe development and implementation of information and
\ncommunication technology are creating new ways
\nThe development and implementation of
\ninformation and communication technology are
\ncreating new and different ways for of practicing
\nmedicine. Telemedicine is used for patients who
\ncannot see an appropriate physician timeously
\nbecause of inaccessibility due to distance, physical
\ndisability, employment, family commitments
\n(including caring for others), patients\u2019 cost and
\nphysician schedules. It has capacity to reach
\npatients with limited access to medical assistance
\nand have potential to improve health care.
\nMarch 2018 MEC 209\/Ethics of Telemedicine COM REV\/Apr2018
\n5
\nmodalities for providing patient care. care for patients.
\nThese enabling tools This continuum of technologies
\noffers new and different ways of practising medicine.
\nThe adoption of telemedicine is justified should be
\nencouraged because of its speed, and its capacity to
\nreach patients with limited access to medical assistance,
\nTelemedicine has the potential to in addition to its
\npower to improve health care. [AMA]
\nNew Face-to -face consultation between physician and
\npatient remains the gold standard of clinical care.
\nTelemedicine may hinder the ability of a physician
\nto physically examine and may result in
\nunintended harm.
\nNEW The delivery of telemedicine services must be
\nconsistent with in-person services and supported
\nby evidence.
\nNew [Added paragraph:] Telemedicine is not only a patient –
\nphysician communication tool but also a patient –
\nphysician relationship tool, therefore distance
\nmedicine is a medical action with the same ethical
\nconsiderations and demands as a medical action in
\nperson. [CGCM]
\nThe principles of medical ethics that are
\nmandatory for the profession must also be
\nrespected in the practice of telemedicine
\n[Added paragraph:]. [CGCM] (Combined the two new added paragraphs)
\n3. Physicians must respect the following
\nethical guidelines when practising
\ntelemedicine.
\nPhysicians must respect the following ethical guidelines
\nwhen practisingpracticing telemedicine. [RDMA]
\n.
\nPRINCIPLES PRINCIPLES
\n4. Patient-physician Relationship and
\nConfidentiality
\nPhysicians must respect the following ethical
\nguidelines when practising telemedicine.
\n4.1 The patient-physician relationship must
\nbe based on a personal encounter and
\nThe patient-physician relationship must should ideally be
\nbased on a personal encounter and sufficient knowledge of
\nThe patient-physician relationship must be based
\non a prior personal examination and sufficient
\nMarch 2018 MEC 209\/Ethics of Telemedicine COM REV\/Apr2018
\n6
\nsufficient knowledge of the patient\u2019s
\npersonal history. Telemedicine should be
\nemployed primarily in situations in which
\na physician cannot be physically present
\nwithin a safe and acceptable time period.
\nPhysicians must be aware that certain
\ntelemedicine technologies could be
\nunaffordable to patients and hence
\nimpede access.
\nthe patient\u2019s personal history. [SwMA]
\n\u2026 Physicians must be aware that not all patients are
\ndata literate and that certain telemedicine technologies
\ncould be unaffordable to patients and hence impede
\naccess. [NMA]
\n[Not all patients have the competence to handle the
\ntechnology needed for performing telemedicine] [NMA]
\n4.1 The patient-physician relationship must be based on a
\npersonal encounter and sufficient knowledge of the
\npatient\u2019s personal history. Telemedicine must assure
\nthat the elements of this personal encounter include
\nthe ability to interview, examine, and test, in an
\nappropriately comprehensive manner. It should also
\nprovide for the diagnosis and treatment of the
\nidentified medical condition. [AM]
\n4.2 Telemedicine should be employed primarily in
\nsituations in which an appropriate physician cannot be
\nphysically presentavailable within a safe and acceptable
\ntime period. Physicians must be aware that certain
\ntelemedicine technologies could be unaffordable to
\npatients and hence impede access. [AM]
\n\u2026 Physicians must be aware that certain telemedicine
\ntechnologies could be unaffordable to patients and hence
\nimpede access and increase social inequality on
\nmedicine. [DMA]
\nThe patient-physician relationship must be based on a
\npersonal encounter and sufficient knowledge of the
\npatient\u2019s personal history. [Why is that necessary? What
\nin case this personal encounter has not yet taken place? I
\nwould say: is preferably based on a former personal
\nknowledge of the patient\u2019s medical history.
\nTelemedicine should be employed primarily in
\nsituations in which a physician cannot be
\nphysically present within a safe and acceptable
\ntime period. It could also be used in management
\nof chronic conditions or follow-up after initial
\ntreatment where it has been proven to be safe and
\neffective.
\nMarch 2018 MEC 209\/Ethics of Telemedicine COM REV\/Apr2018
\n7
\nencounter] \u2026 [RDMA]
\n\u2026 Telemedicine should be employed primarily in
\nsituations in which a physician cannot be physically
\npresent within a safe and acceptable time period\u2026 [This
\nstatement does not take account of the other
\ncircumstances in which telemedicine could be beneficial.
\nFor example, the long-term management of specific
\nconditions where a face to face consultation would not be
\nnecessary or where attending for an appointment in
\nperson may be difficult for a patient because of reduced
\nmobility.] [BMA]
\n\u2026 Telemedicine should be employed primarilycan be
\nemployed in increasing number of situations, although
\nin many settings it is primarily used in situations in
\nwhich a physician cannot be physically present within a
\nsafe and acceptable time period \u2026 [FMA]
\nThe patient-physician relationship must be based on a
\npersonal encounter a previous examination and sufficient
\nknowledge of the patient\u2019s medical records personal
\nhistory. Telemedicine should be employed primarily
\nabove all in situations in which a physician cannot be
\nphysically present within a safe and acceptable time
\nperiod. Physicians and medical institutions must be
\naware that certain telemedicine technologies could be
\nunaffordable to patients and hence impede access
\ninaccessible and therefore ineffective for certain
\npatients. [CGCM]
\nThe patient-physician relationship must be based on an
\npersonal encounter established through a prior in-
\npersonal relationship that provides and sufficient
\nknowledge of the patient\u2019s personal history \u2026[AMA]
\n(Evidence-based)
\nMarch 2018 MEC 209\/Ethics of Telemedicine COM REV\/Apr2018
\n8
\n\u2026. Physicians must be aware that certain telemedicine
\ntechnologies can generate too important costs for could
\nbe unaffordable to patients and hence impede access.
\n[CNOM]
\n4.2 The patient-physician relationship must
\nbe based on mutual trust and respect. It
\nis therefore essential that the physician
\nand patient be able to identify each other
\nreliably when telemedicine is employed.
\nThe patient-physician relationship must be based on
\nmutual trust and respect. It is therefore essential that the
\nphysician and patient be able to identify each other
\nreliably when telemedicine is employed. [Added text]
\nThis should be governed by the same ethical principles
\nthat regulate the practise of face-to-face medicine, with
\nthe defense of patient rights as well as due respect for
\nhealthcare professionals being guaranteed and in the
\nevent that the practice of telemedicine refers to a
\nmedical team, there must be a physician identified as
\nresponsible for the distance medical care. [CGCM]
\nThe patient-physician relationship must be based
\non mutual trust and respect. It is therefore essential
\nthat the physician and patient be able to identify
\neach other reliably when telemedicine is
\nemployed. In case of consultation between two or
\nmore professionals within or between different
\njurisdictions, the primary physician remains
\nresponsible for the care and coordination of the
\npatient with the distant medical team.
\n[Added paragraph:] The use of telemedicine should
\nalways be preceded by the express consent of the
\npatient, or, in the case of relatives or close friends with
\nthe prior identification of all the persons involved.
\n[CGCM]
\n(Consent has been addressed elsewhere)
\nNew [Added paragraph:] In the practice of telemedicine, it is
\nessential to preserve patient confidentiality and
\nprivacy. For this, the physician providing telemedicine
\nservices must adopt the appropriate technical and
\nmanagement measures to preserve the security of their
\nservices and patient rights. These measures must
\nguarantee an appropriate level of the existing risk, in
\naddition to the strictest protection of patient data and
\ncompliance with legal regulations on this matter. In
\nany case, the use of telemedicine should guarantee the
\npatient the same levels of protection as face-to-face
\nmedicine. [CGCM]
\n(Covered in 4.4)
\nMarch 2018 MEC 209\/Ethics of Telemedicine COM REV\/Apr2018
\n9
\n[Added paragraph:] The physician will exercise caution
\nto maintain his attitude and image in the use of new
\nsocial media, especially on the internet and social
\nnetworks, with language that is appropriate in form
\nand content.
\n[CGCM]
\n(This topic could be appropriately tended to
\nunder social media)
\n[Added paragraph:] When telemedicine is implemented
\nby the patient or by their relatives or close friends,
\nthey will always be attended and supervised by the
\nphysician responsible for their care.
\n[CGCM]
\n4.3 Ideally, telemedicine should be
\nemployed only in cases in which a prior
\nin-person relationship exists between the
\npatient and the physician involved in
\narranging or providing the telemedicine
\nservice.
\nIdeallyOriginally, telemedicine should beideally was
\nemployed only in cases in which a prior in-person
\nrelationship existsexisted between the patient and the
\nphysician involved in arranging or providing the
\ntelemedicine service. With changes in technology, this
\nrequirement is less necessary. [AM]
\n[This will depend on the needs of a patient, there are some
\ninteractions for which there is no specific need for a prior
\nin-person relationship to exist or where a patient may
\nprefer greater anonymity, without this engaging ethical
\nissues.] [BMA]
\nIdeally,In many cases the use of telemedicine should be
\nemployed only in cases in whichbenefits from a prior in-
\nperson relationship exists between the patient and the
\nphysician involved in arranging or providing the
\ntelemedicine service. [FMA]
\n\u2026 [Added text:] In emergencies, the use of telemedicine
\nis ethically acceptable. [CGCM]
\n[Delete paragraph; this is now in the first paragraph of
\n(Remove, this issue has been discussed earlier
\nin the statement)
\nMarch 2018 MEC 209\/Ethics of Telemedicine COM REV\/Apr2018
\n10
\nthis section] [AMA]
\nIdeally, but not necessarily, telemedicine should be
\nemployed only in cases in which \u2026 [CNOM]
\n4.4 The physician must aim to ensure that
\npatient confidentiality and data integrity
\nare not compromised. Data obtained
\nduring a telemedical consultation must
\nbe secured through encryption and other
\nsecurity precautions must be taken to
\nprevent access by unauthorized persons.
\nThe physician must aim to ensure that patient
\nconfidentiality and data integrity are not compromised.
\nData obtained during a telemedical consultation must be
\nsecured through encryption and other security precautions
\nmust be taken to prevent access by unauthorized persons
\nunauthorized access and breaches of identifiable
\npatient data. [AM]
\n[Delete paragraph and replace by:] The physician and
\nthe health institutions where the medicine is practised
\nmust take extreme measures to ensure patient
\nconfidentiality, secrecy and safety, with special
\nattention to the privacy configuration of the telematic
\nmedia and encryption of files, personal access codes
\nand security measures of a similar nature. [CGCM]
\n\u2026 Data obtained during a telemedical consultation must
\nbe secured through encryption and other appropriate
\nsecurity protocolssecurity precautions must be taken to
\nprevent access by unauthorized persons. [AMA]
\nThe physician must aim to ensure that patient
\nconfidentiality of the information exchanged during
\nthe consultation and data integrity are not compromised.
\n[CNOM]
\nThe physician must aim to ensure that patient
\nconfidentiality, privacy and data integrity are not
\ncompromised. Data obtained during a
\ntelemedicine consultation must be secured to
\nprevent unauthorized access and breaches of
\nidentifiable patient information through
\nappropriate and up to date security measures in
\naccordance with local legislation. Electronic
\ntransmission of information must also be
\nsafeguarded against unauthorized access.
\n4.5 [Added paragraph:] The physician who practices
\ntelemedicine must always consider the principle of
\npatient autonomy and have their informed consent.
\n[CGCM]
\nProper informed consent requires that all
\nnecessary information regarding the distinctive
\nfeatures of telemedicine visit be explained fully to
\npatients including, but not limited to:
\nMarch 2018 MEC 209\/Ethics of Telemedicine COM REV\/Apr2018
\n11
\n\u2022 explaining how telemedicine works,
\n\u2022 how to schedule appointments,
\n\u2022 privacy concerns,
\n\u2022 the possibility of technological failure
\nincluding confidentiality breaches,
\n\u2022 protocols for contact during virtual visits,
\n\u2022 prescribing policies, and
\n\u2022 coordinating care with other health
\nprofessionals in a clear and understandable
\nmanner, without influencing the patient\u2019s
\nchoices.
\n[Added paragraph:] When patient information is
\ntransmitted by telecommunication systems between
\nphysicians, the principles of confidentiality and
\nmedical secrecy in face-to-face patient-physician
\nrelationships must be maintained. [CGCM]
\nAddressed elsewhere
\nPhysicians must be aware that certain telemedicine
\ntechnologies could be unaffordable to patients and
\nhence impede access. Inequitable access to
\ntelemedicine can further widen the health
\noutcomes gap between the poor and the rich.
\nNew 5 5. Autonomy of the Physician
\n5.1 A physician is not obligated to provide
\ntreatment or counseling via telemedicine.
\n5.2 Telemedicine can potentially infringe on the
\nphysician\u2019s autonomy owing to 24\/7 virtual
\navailability. The physician\u2019s autonomy must take
\ninto consideration the limitations of the
\nphysician\u2019s ability to advise; provide care
\nremotely; availability and the extent of his or her
\n5. Autonomy and privacy of the Physician
\n5.1 A physician should not to participate in
\ntelemedicine if it violates the legal or ethical
\nframework of the country.
\n5.2 Telemedicine can potentially infringe on the
\nphysician privacy due to 24\/7 virtual availability.
\nThe physician need to inform patients about
\navailability and recommend services such as
\nemergency when inaccessible.
\n5.3 The physician should exercise their
\nMarch 2018 MEC 209\/Ethics of Telemedicine COM REV\/Apr2018
\n12
\nreferrals.
\n5.3 The physician will exercise discretion
\nregarding whether cases brought for consultation
\nare appropriate for telemedicine. In this context,
\nthe physician should consider the degree of prior
\nacquaintance with the patient and his or her
\nmedical history. In certain cases, the physician
\nmay choose to refer the patient to in-person
\nmedical treatment.
\n5.4 A physician may discontinue treatment via
\ntelemedicine, at his or her discretion, if he\/she
\nbelieves that the treatment or remote consultation
\nharms the quality of care provided to the patient.
\n[IsMA]
\nprofessional autonomy in deciding whether a
\ntelemedicine versus face-to-face consultation is
\nappropriate.
\n5.4 A physicians should exercise autonomy and
\ndiscretion in selecting the telemedicine platform
\nto be used
\n(new 6) Responsibilities of the Physician 6. Responsibilities of the Physician
\n5.1
\n(start
\n6.1)
\nA physician whose advice is sought
\nthrough the use of telemedicine should
\nkeep a detailed record of the advice
\nhe\/she delivers as well as the
\ninformation he\/she received and on
\nwhich the advice was based.
\nA physician whose advice is sought through the use of
\ntelemedicine shouldmust keep a detailed record of the
\nadvice he\/she delivers as well as the information he\/she
\nreceived and on which the advice was based. [SwMA]
\nA physician whose advice is sought through the use of
\ntelemedicine systems should keep a detailed record of the
\nadvice he\/she delivers as well as the information he\/she
\nreceived and on which the advice was based. [CGCM]
\nA physician whose advice is sought through the use of
\ntelemedicine should keep a detailed record of the advice
\nhe\/she delivers as well as the information he\/she received
\nand on which the advice was based in order to ensure
\ntraceability. [CNOM]
\nA physician whose advice is sought through the
\nuse of telemedicine should keep a detailed record
\nof the advice he\/she delivers as well as the
\ninformation he\/she received and on which the
\nadvice was based in order to ensure traceability.
\nMarch 2018 MEC 209\/Ethics of Telemedicine COM REV\/Apr2018
\n13
\n5.2 It is the obligation of the physician to
\nensure that the patient and the health
\nprofessionals or family members caring
\nfor the patient are able to use the
\nnecessary telecommunication system
\nand necessary instruments. The
\nphysician must seek to ensure that the
\npatient has understood the advice and
\ntreatment suggestions given and that the
\ncontinuity of care is guaranteed.
\nIt is the obligation ofThe physician need to ensure that
\nthe patient and the health professionals or family
\nmembers caring for the patient are able to use the
\nnecessary telecommunication system and necessary
\ninstruments\u2026 [SwMA]
\n\u2026 The physician, as in any other patient-physician
\nencounter, must seek to ensure that the patient has
\nunderstood the advice and treatment suggestions given
\nand that the continuity of care is guaranteed. [AM]
\nIt is the obligation of the physician to ensure [Only in case
\nthat this patient is his\/her responsibility and that the
\nphysician exclusively is reachable trough
\ntelecommunication.
\nPart from that: what does this obligation actually mean?
\nIt seems unreasonable and impossible that the physician
\nhas to buy \/ provide for the telecommunication system and
\nnecessary instruments for the patient.] \u2026 [RDMA]
\n\u2026 The physician must seek to ensure that the patient has
\nunderstood the advice and treatment suggestions given
\nand that the continuity of healthcare is guaranteed.
\n[CGCM]
\n\u2026 The physician must seek to ensure that the patient has
\nunderstood the advice and treatment suggestions given
\nand take steps to promote continuity of care. that the
\ncontinuity of care is guaranteed. [AMA]
\nIf a decision is made to use telemedicine it is
\nnecessary to ensure that the users (patients and
\nhealthcare professionals) are able to use the
\nnecessary telecommunication system.
\nThe physician must seek to ensure that the patient
\nhas understood the advice and treatment
\nsuggestions given and take steps in so far as
\npossible to promote continuity of care.
\n[Added paragraph:] The physician must always inform
\nthe patient of the risks of telemedicine services
\nregarding the security of their data, their privacy and
\nthe measures adopted to protect them. He\/She will
\nalso inform the patient about the data stored in his\/her
\nMarch 2018 MEC 209\/Ethics of Telemedicine COM REV\/Apr2018
\n14
\nmedical records and the security measures for
\nprotection and custody thereof. Likewise, the
\ncircumstances and deadlines for deleting this data
\nmust be foreseen. [CGCM]
\n5.3 The physician asking for another
\nphysician\u2019s advice or second opinion
\nremains responsible for treatment and
\nother decisions and recommendations
\ngiven to the patient.
\n[Delete paragraph] [SwMA]
\n\u2026 [Added text:] If the second opinion is requested of
\nanother physician through a telecommunications
\nsystem, the privacy and confidentiality of the patient’s
\nclinical and personal details should also be
\nsafeguarded in this system. [CGCM]
\nThe physician asking for another physician\u2019s
\nadvice or second opinion remains responsible
\nfor treatment and other decisions and
\nrecommendations given to the patient.
\n[Added paragraph:] The physician must adopt
\nmeasures to prevent unauthorised access to
\ncommunications in telemedicine in order to protect
\nconfidentiality and contents. [CGCM]
\n(Covered elsewhere)
\n5.4 A physician should be aware of and
\nrespect the special difficulties and
\nuncertainties that may arise when he\/she
\nis in contact with the patient through
\nmeans of tele-communication. A
\nphysician must be prepared to
\nrecommend direct patient-doctor contact
\nwhen he\/she feels that the situation calls
\nfor it.
\nA The physician should be aware of and respect the
\nspecial difficulties and uncertainties that may arise when
\nhe\/she is in contact with the patient through means of
\ntele-communication. A The physician must be prepared
\nto recommend direct patient-doctor contact when he\/she
\nfeels that the situation calls for it. [SwMA]
\n\u2026 A physician must be prepared to recommend direct
\npatient-doctor contact when he\/she feels that the situation
\ncalls for itappropriate and necessary. [AM]
\nA physician should be aware of and respect the special
\ndifficulties and uncertainties that may arise when using
\ntelemedicine technologies. he\/she is in contact with the
\npatient through means of tele-communication. A
\nphysician must be prepared to recommend direct patient-
\ndoctor contact when he\/she believes it is in the patient\u2019s
\nThe physician should be aware of and respect the
\nspecial difficulties and uncertainties that may arise
\nwhen he\/she is in contact with the patient through
\nmeans of tele-communication. A physician must
\nbe prepared to recommend direct patient-doctor
\ncontact when he\/she believes it is in the patient\u2019s
\nbest interests
\nMarch 2018 MEC 209\/Ethics of Telemedicine COM REV\/Apr2018
\n15
\nbest interests. feels that the situation calls for it. [AMA]
\n[Added paragraph]: The physician must make sure
\nthat they are aware of, and meet, any relevant
\nlicensing requirements that may exist under the
\ncircumstances. This might include those in the
\njurisdiction where the physician is located, as well as
\nthe jurisdiction where the patient is located. [CMA]
\nPhysicians should only practise telemedicine
\nin countries\/jurisdictions where they are
\nlicenced to practise. Cross-jurisdiction
\nconsultations should only be allowed between
\ntwo physicians.
\nPhysicians should ensure that their medical
\nindemnity cover include cover for
\ntelemedicine.
\n6. (new
\n7)
\nQuality of Care 6. Quality of Care
\n6.1
\n(start
\n7.1)
\nQuality assessment measures must be
\nused regularly to ensure the best
\npossible diagnostic and treatment
\npractices in telemedicine.
\nQualityHealthcare quality assessment measures must be
\nused regularly to ensure patient security and the best
\npossible diagnostic and treatment practices induring
\ntelemedicine procedures. Quality must be the
\ncornerstone of communications in telemedicine.
\nInformation regarding professional practice should
\nalways be clear and understandable and should be
\ndisseminated respecting the deontological principles
\nthat should prevail in all areas.
\n[CGCM]
\n\u2026 [Added text]: The delivery of telemedicine services
\nmust follow evidence-based practice guidelines to the
\ndegree they are available, to ensure patient safety,
\nquality of care and positive health outcomes. [AMA]
\nHealthcare quality assessment measures must be
\nused regularly to ensure patient security and the
\nbest possible diagnostic and treatment practices
\nduring telemedicine procedures. The delivery of
\ntelemedicine services must follow evidence-based
\npractice guidelines to the degree they are
\navailable, to ensure patient safety, quality of care
\nand positive health outcomes. Like all health care
\ninterventions, telemedicine must be tested for its
\neffectiveness, efficiency, safety, feasibility and
\ncost-effectiveness.
\n6.2 The possibilities and weaknesses of
\ntelemedicine in emergencies must be
\nacknowledged. If it is necessary to use
\ntelemedicine in an emergency situation,
\nthe advice and treatment suggestions are
\n\u2026 If it is necessary to use telemedicine in an emergency
\nsituation, the advice and treatment suggestions are
\ninfluenced by the level of threat toseverity of the patient\u00b4s
\nmedical condition and the know-how and capacity of the
\npersons who are with the patient. [SwMA]
\nThe possibilities and weaknesses of telemedicine
\nin emergencies must be duly identified. If it is
\nnecessary to use telemedicine in an emergency
\nsituation, the advice and treatment suggestions are
\ninfluenced by the severity of the patient\u00b4s medical
\nMarch 2018 MEC 209\/Ethics of Telemedicine COM REV\/Apr2018
\n16
\ninfluenced by the level of threat to the
\npatient and the know-how and capacity
\nof the persons who are with the patient
\n\u2026 are influenced by the level of threat to the patient and
\nthe know-how and capacity of the persons who are with
\nthe patient. [What does this mean for the physician\u2019s
\nresponsibility?] [RDMA]
\nThe possibilities and weaknesses of telemedicine in
\nemergencies must be duly identifiedacknowledged. If it is
\nnecessary to use telemedicine in an emergency situation,
\nthe advice and treatment suggestions must be
\nproportional. are influenced by the level of threat to the
\npatient and the know-how and capacity of the persons
\nwho are with the patient They will be adapted both to
\nthe patient’s level of vital risk and to the knowledge
\nand healthcare capabilities of the people with the
\npatient. [CGCM]
\n\u2026 If it is necessary to use telemedicine in an emergency
\nsituation, the advice and treatment suggestions are
\ninfluenced by the level of threat to the patient and the
\ncompetencies know-how and capacity of the persons who
\nare with the patient. [Added text]: Entities that deliver
\ntelemedicine services must establish protocols for
\nreferrals for emergency services. [AMA]
\ncondition and the competency of the persons who
\nare with the patient. Entities that deliver
\ntelemedicine services must establish protocols for
\nreferrals for emergency services.
\nRECOMMENDATION RECOMMENDATIONS [AMA] RECOMMENDATIONS
\n7. Telemedicine should be tailor-made to
\nlocal contexts including regulatory
\nframeworks.
\nTelemedicine should be tailor-made appropriately
\nadapted to local contexts including regulatory
\nframeworks. [SwMA]
\n[Added paragraph:] Physicians and other health care
\nprofessionals should be involved in the development of
\ntelemedicine tools, to ensure usability and that the
\ntools meet health care needs. Physicians and other
\nhealth care professionals should also receive sufficient
\neducation to ensure appropriate and efficient use of
\nTelemedicine should be appropriately adapted to
\nlocal regulatory frameworks, which may include
\nlicencing of telemedicine platforms in the best
\ninterest of patients.
\nMarch 2018 MEC 209\/Ethics of Telemedicine COM REV\/Apr2018
\n17
\ntelemedicine tools. [SwMA]
\n[Delete paragraph and replace by:] Telemedicine should
\naccommodate local cultures and traditions with
\ninternational, national and regional regulatory
\ncontrols to assure standards of quality medical care.
\n[AM]
\nTelemedicine should be tailor-made to patient
\ncompetencies and local contexts, including regulatory
\nframeworks. [DMA]
\nTelemedicine should be tailor-made to local contexts
\nincludingand should include regulatory frameworks.
\n[CGCM]
\n[This paragraph with the following changes should be the
\nthird item (currently numbered 9.) of the section
\n\u201cRECOMMENDATIONS\u201d; see below about the next
\nitems:] Telemedicine should adhere be tailor-made to
\nlocal medical practice laws and contexts including
\nregulatory frameworks. [AMA]
\n[Added paragraph]: NMAs will guarantee disciplinary
\nprocedures against physicians who violate the ethical
\nand deontological norms of the place where they
\nexercise remote, electronic communications regardless
\nof the place and country in which the patient with
\nwhom they are related is located. [CGCM]
\n8. The WMA and National Medical
\nAssociations should encourage the
\ndevelopment of national legislation and
\ninternational agreements on subjects
\nrelated to the practice of telemedicine.
\nThe WMA and National Medical Associations should
\nencourage the development of national legislation and
\ninternational agreements on subjects related to the practice
\nof telemedicine., while protecting the patient-physician
\nrelationship, confidentiality, and quality of medical
\ncare. [AM]
\nWhere appropriate the WMA and National
\nMedical Associations should encourage the
\ndevelopment of ethical norms, practice guidelines,
\nnational legislation and international agreements
\non subjects related to the practice of telemedicine,
\nwhile protecting the patient-physician relationship,
\nMarch 2018 MEC 209\/Ethics of Telemedicine COM REV\/Apr2018
\n18
\nWhere appropriate, Tthe WMA and National Medical
\nAssociations should encourage the development of
\nnational legislation and international agreements on
\nsubjects related to the practice of telemedicine. [FMA]
\n[FMA notes that separate legislation for the practice of
\ntelemedicine is not always necessary since it is covered by
\ngeneral legislation on practice of medicine.]
\n[This paragraph with the following changes should be the
\nfourth item (currently numbered 10.) of the section
\n\u201cRECOMMENDATIONS\u201d; see below about the next
\nitems:] The WMA and National Medical Associations
\nshould encourage the development of national legislation,
\npractice guidelines, and international agreements on
\nsubjects related to the practice of telemedicine. [AMA]
\nconfidentiality, and quality of medical care.
\n[Added paragraph:] National Medical Associations
\nshould urge prevention of outside agencies limiting
\npatient and physician choice of the specific technology
\nutilized, as long as it complies with national and
\nregional regulation and law. [AM]
\n9. Similar to all other medical practices,
\ntelemedicine must be backed up by
\nevidence.
\n[Delete paragraph] [SwMA]
\n[This paragraph with the following changes should be the
\nfifth item (currently numbered 11.) of the section
\n\u201cRECOMMENDATIONS\u201d; see below about the next
\nitems:] The delivery of telemedicine services must be
\nconsistent with in-person services and Similar to all
\nother medical practices, telemedicine must be backed up
\nsupported by evidence. [AMA]
\n(Move it into pre-amble and
\nrecommendations)
\n10. Telemedicine must not be viewed as a
\ncost-effective substitute for face-to-face
\nhealthcare.
\nTelemedicine mustshould not be viewed as a cost-
\neffective substitute forequal to face-to-face healthcare
\nand should not be introduced solely to cut costs.
\nTelemedicine should not be viewed as equal to
\nface-to-face healthcare and should not be
\nintroduced solely to cut costs or as a perverse
\nMarch 2018 MEC 209\/Ethics of Telemedicine COM REV\/Apr2018
\n19
\n[SwMA]
\n1. [Delete paragraph and replace by:] While
\nphysicians and supporting institutions need adequate
\ncompensation, telemedicine should not be used as an
\nintentional way to increase earnings and thereby
\nincrease cost to the medical system. [AM]
\n[This statement presumably seeks to protect against
\ninappropriate substitutions of telemedicine for face-to-
\nface healthcare on cost grounds alone. As currently
\ndrafted however, it could also be interpreted as ruling out
\nswitching the method of delivery where it might be cost-
\neffective and either have no substantive impact on the
\nquality of care offered or be beneficial to the patient.]
\n[BMA]
\nTelemedicine must not be viewed ascan be a cost-
\neffective substituteoption but it must not hinder
\npatient\u2019s access tofor face-to-face healthcare where
\nneeded. [FMA]
\nTelemedicine must not be viewed solely as a cost-
\neffective substitute for face-to-face healthcare. [CGCM,
\nAMA]
\n[This paragraph with the above change should be the
\nsixth item (currently numbered 12.) of the section
\n\u201cRECOMMENDATIONS\u201d; see below about the next
\nitems]
\n[Added text:] In addition to enabling immediate access
\nto certain patients, it makes it possible to cut waiting
\ntimes for healthcare. [CGCM]
\nincentive to over-service and increase earnings for
\ndoctors.
\n[Added paragraph:] Physician relationships and
\ncollegiality depend upon educational changes
\nUse of telemedicine requires the profession to
\nexplicitly identify and manage adverse
\nMarch 2018 MEC 209\/Ethics of Telemedicine COM REV\/Apr2018
\n20
\naddressing the appropriate use of telemedicine and the
\ncourtesies surrounding referrals. [AM]
\nconsequences on collegial relationships and
\nreferral patterns.
\n[Added paragraph:] New technologies and styles of
\npractice integration may require new guidelines and
\nstandards. [AM]
\nNew technologies and styles of practice
\nintegration may require new guidelines and
\nstandards.
\n11. Physicians should lobby for ethical
\ntelemedicine strategies in the best
\ninterest of patients.
\nPhysicians should lobby for also maintain the principles
\nof medical ethics when practicing ethical telemedicine
\nstrategies in the best interest of patients. [CGCM]
\n[Move this paragraph with the following changes to the
\nfirst item (currently numbered 7.) of the section
\n\u201cRECOMMENDATIONS\u201d:] Physicians should lobby for
\nethical telemedicine strategies practices that are in the
\nbest interests of patients. [AMA]
\nPhysicians should lobby for ethical telemedicine
\npractices that are in the best interests of patients.
\n12. Proper informed consent requires that all
\nnecessary information regarding the
\ntelemedicine visit be explained fully to
\npatients including explaining how
\ntelemedicine works, how to schedule
\nappointments, privacy concerns, the
\npossibility of technological failure
\nincluding confidentiality breaches,
\nprotocols for contact during virtual
\nvisits, prescribing policies, and
\ncoordinating care with other health
\nprofessionals in a clear and
\nunderstandable manner, without
\ninfluencing the patient\u2019s choices.
\nThe patient must consent to the use of telemedicine.
\nProper informed consent requires that all necessary
\ninformation regarding the telemedicine visit be explained
\nfully and in a clear and understandable manner, to
\npatients including explaining how telemedicine works,
\nhow to schedule appointments, privacy concerns, the
\npossibility of technological failure including
\nconfidentiality breaches, protocols for contact during
\nvirtual visits, prescribing policies, and coordinating care
\nwith other health professionals in a clear and
\nunderstandable manner, without influencing the patient\u2019s
\nchoices. [SwMA]
\n\u2026 confidentiality breaches [Why? What does this mean
\nfor the physician if this is beyond his control (as it in fact
\noften is\u2026)?] \u2026 [RDMA]
\n\u2026 without influencing the patient\u2019s choices [And if the
\npatient does not agree, does the physician have the
\nobligation to offer a face-to-face consult?] \u2026 [RDMA]
\n(Move between 4 and 5)
\nMarch 2018 MEC 209\/Ethics of Telemedicine COM REV\/Apr2018
\n21
\n[Added text:] \u2026 This information may be provided by
\nphysicians, technology providers, hospitals, academic
\ncenters, medical practice administrators and others
\ninvolved in providing care to the patient. [AM]
\n[Delete paragraph and replace by:] The use of
\ntelemedicine should always be conditional based on the
\nexistence of adequate information and patient consent.
\nThe functioning of telecommunication systems, the
\nmeans to request medical attention, the possible risks
\nof their use, the contact protocols during virtual visits,
\nthe means of prescription and the coordination of care
\nwith other health professionals should always be
\ntransmitted in a clear and understandable way without
\ninfluencing patient decisions. [CGCM]
\n[Move this paragraph with the following changes to the
\nsecond item (currently numbered 8.) of the section
\n\u201cRECOMMENDATIONS\u201d:] Proper informed consent
\nrequires that all necessary information regarding the
\ndistinctive features of telemedicine visit be explained
\nfully to patients including, but not limited to:
\n\u2022 explaining how telemedicine works,
\n\u2022 how to schedule appointments,
\n\u2022 privacy concerns,
\n\u2022 the possibility of technological failure including
\nconfidentiality breaches,
\n\u2022 protocols for contact during virtual visits,
\n\u2022 prescribing policies, and
\n\u2022 coordinating care with other health professionals in a
\nclear and understandable manner, without influencing
\nthe patient\u2019s choices.
\n[AMA]
\nMarch 2018 MEC 209\/Ethics of Telemedicine COM REV\/Apr2018
\n22
\n\u00a7\u00a7\u00a7
\n08.03.2018
\n1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument no: MEC 209\/Licensing of Physicians Fleeing Prosecution COM
\nREV\/Apr2018
\nOriginal:
\nEnglish
\nTitle: Proposed revision of WMA Statement on Licensing of Physicians
\nFleeing Prosecution for Serious Criminal Offences
\nDestination: Medical Ethics Committee
\n209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nFor
\nConsideration
\nNote: As part of the annual policy review process, the Council in Livingstone (April 2017)
\ndecided that the WMA Statement on Licensing of Physicians Fleeing prosecution for
\nSerious Criminal Offence should undergo a major revision. The French Medical
\nAssociation (CNOM) volunteered to undertake that work. The 207th Council session in
\nChicago (October 2017) considered the proposal and decided to circulate it within WMA
\nmembership for comments.
\nLegend:
\nAbbreviation key:
\nAM Associate Members
\nAMA American Medical Association
\nAMV Associazione Medica del Vaticano
\nBMA British Medical Association
\nApril 2018 MEC 209\/Licensing of Physicians Fleeing Prosecution COM REV\/Apr2018
\n2
\nCGCM Consejo General de Colegios M\u00e9dicos de Espana
\nCMA Canadian Medical Association
\nDMA Danish Medical Association
\nFMA Finnish Medical Association
\nGMA Bundes\u00e4rztekammer (German Medical Association)
\nNMA Norwegian Medical Association
\nRDMA Royal Dutch Medical Association
\nSAMA The South African Medical Association
\nSwMA Swedish Medical Association
\nGENERAL COMMENTS
\nAM There appears to be an inconsistency between paragraph 3 and paragraph 5. Paragraph 3 discusses those physicians who have been found
\nguilty as opposed to paragraph 5, which deals with those who have been alleged to have committed offenses. This inconsistency either
\nmust be made consistent, or be further explained. The new country should have the ability to independently evaluate the charges against
\nthe physician to be sure they were not politically invented, and that they are valid. We support this document after the inconsistency
\nbetween paragraphs 3 and 5 is clarified.
\nAMA The statement as written contains too many undefined concepts and terms. The statement uses terms \u201callegations\u201d and \u201cconvictions\u201d
\ninterchangeably even though they refer to different concepts.
\nTo focus the statement, we have eliminated the concepts related to war crimes and to allegations of crimes. If desired, a separate statement
\non licensure of physicians convicted of war crimes or crimes against humanity could be undertaken, but it should not co-exist with a
\nstatement on convictions for other crimes.
\nWe also propose changing the title of the statement:
\nWMA Statement on Licensure of Physicians with Criminal Convictions
\nAMV This document is accepted as it is.
\nBMA Overall we would support the main thrust of this document. From a UK perspective though, the responsibilities for licensing, and, for
\nensuring that a doctor from overseas is fit to practice in the UK, falls on the regulatory body, the GMC, not the national medical
\nassociation.
\nThis statement should be strengthened: it should be an obligation on any licensing authority to make reasonable and appropriate enquiries
\nwith regards to the former countries in which the doctor has been registered to practice medicine.
\nDMA The DMA has no comments to this document
\nFMA FMA supports the revision of this document. We have a few comments to the text. [Note: those comments have been added in the table
\nApril 2018 MEC 209\/Licensing of Physicians Fleeing Prosecution COM REV\/Apr2018
\n3
\nbelow]
\nGMA The GMA has incorporated a small number of suggested editorial revisions below. [Note: those comments have been added in the table
\nbelow]
\nKeywords: Crime, Licencse, Medical Associations, Medical Licensure, Prosecution, Regulation
\nNMA NMA supports this document as it is.
\nRDMA 1) This Declaration is not consistent with regard to the question what kind of offences it addresses: sometimes the Declaration mentions
\n\u201cserious criminal offences\u201d, other times it mentions \u2018war crimes or crimes against humanity\u2019. It is preferable to be consistent.
\n2) There is a difference between being accused of something (not sure if a person is guilty yet) and being convicted for something. Is it
\njustifiable to deny physicians to practice if it is still unclear if they are really guilty of what they have been accused of?
\nSAMA SAMA supports the statement in current format.
\nNumbering will be deleted (or adjusted) when the revised text is adopted.
\nNo Proposed Text:
\nMEC 208\/Licensing of Physicians
\nFleeing Prosecution\/Oct2017
\nSpecific Comments
\nAdditions: bold\/underlined
\nDeletions: lined-out
\nComments only: [italic]
\nProposed Revised Text by:
\nRapporteur
\nMEC 209\/Licensing of Physicians Fleeing Prosecution
\nREV\/Apr2018
\nTitle WMA Statement on Licensing of
\nPhysicians Fleeing Prosecution for
\nSerious Criminal Offences
\nWMA Statement on Licensingure of
\nPhysicians Fleeing Prosecution for
\nSerious with Criminal
\nOffencesConvictions [AMA]
\nWMA Statement on Licensure of Physicians with Serious
\nCriminal Convictions.
\nPREAMBULE PREAMBULE [SwMA, AMA] PREAMBLE
\n1. Physicians are bound by medical ethics
\nto dedicate themselves to the good of
\ntheir patients. Physicians who are
\nprosecuted for serious criminal offences
\nor who have participated in war crimes
\nor crimes against humanity are engaged
\nin a practice that violates medical ethics,
\nPhysicians are bound by medical ethics to
\ndedicate themselves to the good of their
\npatients. Physicians who are prosecuted for
\ninvolved in serious criminal offences or
\nwho have participated in war crimes or
\ncrimes against humanity are engaged in a
\npractice that violates medical ethics, human
\nPhysicians are bound by medical ethics to dedicate themselves
\nto the good of their patients. Physicians who have been
\nconvicted of serious criminal offences in particular genocide,
\nwar crimes or crimes against humanity* have violated medical
\nethics, human rights and international law and are therefore
\nunworthy of practising medicine.
\nApril 2018 MEC 209\/Licensing of Physicians Fleeing Prosecution COM REV\/Apr2018
\n4
\nhuman rights and international law.
\nPhysicians in such situations are
\nunworthy of practicing medicine.
\nrights and international law. Physicians in
\nsuch situations are unworthy of practicing
\nmedicine. [AM]
\nPhysicians are bound by medical ethics to
\ndedicate themselves to the good of their
\npatients. Physicians who are prosecuted for
\nhave committed serious criminal offences,
\nincluding or who have participated in war
\ncrimes or and crimes against humanity,
\nhave are engaged in a practices that violates
\nmedical ethics, human rights and
\ninternational law. Physicians in such
\nsituations are unworthy of practicing and
\nare unfit to practice medicine. [SwMA]
\nPhysicians are bound by medical ethics to
\ndedicate themselves to the good of their
\npatients. Physicians who are prosecuted
\nforengaged in [That they are prosecuted
\ndoes not mean that they are guilty of doing
\nso. Therefore, we prefer the other
\nformulation] serious criminal offences
\n[What are \u2018serious criminal offences\u2019?] or
\nwho have participated in war crimes or
\ncrimes against humanity are engaged in a
\npractice that violates medical ethics, human
\nrights and international law\u2026 [RDMA]
\n\u2026 Physicians in such situations are
\nunworthyineligible of practicing medicine.
\n[FMA]
\nIn accordance with the principle of the presumption of
\ninnocence, only physicians who have been convicted should be
\ndeclared unworthy of practising medicine.
\nFoot note:
\n*as defined by the Rome Statute of the International
\nCriminal Court
\nApril 2018 MEC 209\/Licensing of Physicians Fleeing Prosecution COM REV\/Apr2018
\n5
\n\u2026 Physicians in such situations are
\nunworthy of practiscing medicine. [GMA]
\n[Paragraph not numbered:]\u2026 Physicians
\nwho are convicted of prosecuted for serious
\ncriminal offences or who have participated
\nin war crimes or crimes against humanity
\nor are engaged in a practice that violates
\nmedical ethics, or human rights should not
\nbe allowed to practice medicine and
\ninternational law. Physicians in such
\nsituations are unworthy of practicing
\nmedicine. [AMA]
\nREFLECTION REFLECTION [GMA]
\nREFLECTION DISCUSSION [AMA]
\nDISCUSSION
\n2. Physicians seeking to work in any
\ncountry are subject to the licensing
\narrangements of that country. Physicians
\napplying for a license to practice must
\ndemonstrate their professional
\ncompetence, both technical and moral,
\nto the approved licensing bodies.
\nPhysicians seeking to work in any country
\nare subject to the licensing arrangements of
\nthat country. The duty to demonstrate
\nsuitability to practice medicine rests with
\nthe person seeking registration.
\nPhysicians applying for a license to practice
\nmust demonstrate their professional
\ncompetence, both technical and moral, to
\nthe approved licensing bodies. [SwMA]
\n\u2026 Physicians applying for a license to
\npractice must demonstrate their
\nprofessional competence, both technical
\nand moral [To prove that you did NOT do
\nsomething is very difficult. How does the
\nworking group think this should be
\nPhysicians seeking to work in any country are subject to the
\nlicensing arrangements of that country. The duty to
\ndemonstrate suitability to practice medicine rests with the
\nperson seeking registration.
\nApril 2018 MEC 209\/Licensing of Physicians Fleeing Prosecution COM REV\/Apr2018
\n6
\ndone?]… [RDMA]
\nPhysicians seeking to work in any country
\nare subject to the licensing
\narrangementsrequirements of that
\ncountry\u2026 [CMA]
\n\u2026 Physicians applying for a licencse to
\npractisce must demonstrate their
\nprofessional competence, both technical
\nand moral, to the approved licensing
\nbodies. [GMA]
\nPhysicians seeking to practice medicine
\nwork in any country are subject to the
\nlicensing arrangements of their local
\njurisdiction. that country. Physicians
\napplying for a license to practice must
\ndemonstrate their professional competence
\nand compliance with relevant ethical
\nstandards as required by both technical
\nand moral, to the approved licensing bodies
\nof the physician\u2019s country or jurisdiction
\nof origin. [AMA]
\n3. Physicians whose licences are revoked
\nby their licensing body after being found
\nguilty of serious professional
\nmisconduct, or following a criminal
\nconviction, cannot be allowed to
\npractise in a second country. The
\nrelevant licensing authorities must
\nrequire not only proof of qualification
\nPhysicians whose licences are have been
\nrevoked because of by their licensing body
\nafter being found guilty of serious
\nprofessional misconduct, or following a
\ncriminal conviction, cannot should not be
\nallowed to practise in a second country. The
\nrelevant licensing authorities must in all
\ncountries should require not only proof of
\nPhysicians who have been convicted of serious criminal
\noffences must not be allowed to practise in another
\ncountry. The relevant licensing authorities must ensure
\nboth that physicians have the required qualifications and
\nthat they have not been convicted of a serious criminal
\noffence.
\nApril 2018 MEC 209\/Licensing of Physicians Fleeing Prosecution COM REV\/Apr2018
\n7
\nbut also proof that the applicant
\ncontinues to be in good professional
\nstanding in his or her country of origin.
\nqualification but also proof that the
\napplicant continues to be is in good
\nprofessional standing in his or her country
\nof origin. [SwMA]
\nPhysicians whose licences are revoked by
\ntheir licensing body after being found guilty
\nof serious professional misconduct, or
\nfollowing a criminal conviction related to
\ntheir profession [Not any crime does make
\na physician unsuitable for his\/her job, does
\nit?], cannot be allowed to practise in a
\nsecond country \u2026[RDMA]
\nPhysicians whose licences are revoked by
\ntheir licensing body after being found guilty
\nof serious professional misconduct, or
\nfollowing a criminal conviction, cannot be
\nallowed to practise in a secondany other
\ncountry\u2026 [CMA]
\n[Move this paragraph with the following
\nchanges to next item (currently numbered
\n4.):] Physicians whose original licenses
\nlicences are revoked by their licensing
\nbody in their country or jurisdiction of
\norigin after being found guilty of serious
\nprofessional misconduct, or following a
\ncriminal conviction, cannot should not be
\nallowed to practise in another country or
\njurisdiction. in a second country. The
\nrelevant Relevant licensing bodies in the
\nnew country or jurisdiction authorities
\nmust require not only proof verification of
\nApril 2018 MEC 209\/Licensing of Physicians Fleeing Prosecution COM REV\/Apr2018
\n8
\ninitial qualifications for licensure, but also
\nproof verification that the applicant
\ncontinues to be in good professional
\nstanding in his or her country or
\njurisdiction of origin. [AMA]
\n4. Yet physicians who have been
\nprosecuted for serious criminal offences
\nor accused by international agencies of
\nwar crimes or crimes against humanity
\nhave sometimes been able to leave their
\ncountry and to obtain a licence to
\npractice medicine in a host country from
\nthe relevant licensing authority. This
\npractice is contrary to the public interest
\nand is detrimental to patient safety.
\nYet However, physicians who have been
\nprosecuted for serious criminal offences or
\naccused by international agencies of war
\ncrimes or crimes against humanity have
\nsometimes been able to leave their country
\nin which these suspected crimes were
\ncommitted and to obtain a licence to
\npractice medicine in a host country from the
\nrelevant licensing authority in another
\ncountry. This practice is contrary to the
\npublic interest, and is detrimental to patient
\nsafety and damaging the reputation of
\nand trust in physicians. [SwMA]
\nYet physicians who have been prosecuted
\nfor serious criminal offences … [BMA]
\nYet physicians who have been prosecuted
\nfor serious criminal offences [Sometimes
\nphysicians are in their countries prosecuted
\nfor criminal offences (e.g. the member of
\nthe Council of the Turkish Medical
\nAssociation right now), while the WMA
\nthinks this is not right. How to handle these
\ncases?] \u2026 [RDMA]
\nYet pPhysicians who have been prosecuted
\nPhysicians who have been convicted of serious criminal
\noffences, in particular of genocide, war crimes or crimes
\nagainst humanity, have sometimes been able to leave the
\ncountry in which these crimes were committed and obtain a
\nlicence to practise medicine from the relevant licensing
\nauthority in another country.
\nThis practice is contrary to the public interest, damaging to the
\nreputation of medical profession, and may be detrimental to
\npatient safety
\nApril 2018 MEC 209\/Licensing of Physicians Fleeing Prosecution COM REV\/Apr2018
\n9
\nfor serious criminal offences \u2026[CMA]
\n\u2026 This practice is contrary to the public
\ninterest, damaging to the reputation of
\nmedical profession, and ismay be
\ndetrimental to patient safety. [FMA]
\n\u2026 and to obtain a licence to practisce
\nmedicine in a host country from the
\nrelevant licensing authority\u2026 [GMA]
\n[Move this paragraph with the following
\nchanges to previous item (currently
\nnumbered 3.):] Yet physicians Physicians
\nwho have been prosecuted for serious
\ncriminal offences or accused by
\ninternational agencies of war crimes or
\ncrimes against humanity convicted of a
\ncrime have are sometimes been able to
\nleave their country and to relocate and
\nobtain a new licence license to practice
\nmedicine in another country or
\njurisdiction. in a host country from the
\nrelevant licensing authority. This practice is
\ncontrary to the public interest and puts
\npatients at risk. is detrimental to patient
\nsafety. [AMA]
\n[Added paragraph:]\u2026 Sometimes
\nallegations against physicians are
\npolitically motivated and do not reflect
\nactual misconduct. [AM]
\nRECOMMENDATION RECOMMENDATIONS [AMA] RECOMMENDATIONS
\nApril 2018 MEC 209\/Licensing of Physicians Fleeing Prosecution COM REV\/Apr2018
\n10
\nNEW [Added paragraph:] The WMA
\nrecommends that physicians who have
\nbeen involved in serious criminal
\noffences or who have participated in war
\ncrimes or crimes against humanity be
\ndenied membership in national medical
\norganizations. [AM]
\nThe WMA recommends that physicians who have been
\nconvicted of serious criminal offences, in particular of
\ngenocide, war crimes or crimes against humanity, be denied
\nmembership to national medical associations.
\n[Added paragraph]: Where possible,
\nnational medical organizations should be
\ngranted powers to revoke the licenses of
\nphysicians who have been involved in
\nserious criminal offences or who have
\nparticipated in war crimes or crimes
\nagainst humanity. [AM]
\n5. The WMA recommends that national
\nmedical associations use their own
\npowers to ensure that physicians against
\nwhom serious allegations of participation
\nin war crimes or crimes against humanity
\nhave been made, are not able to obtain
\nlicences to practise until they have
\nsatisfactorily responded to these
\nallegations. The WMA reminds the
\nnational medical associations of their
\nduty to ensure efficient communications
\namongst themselves and to inform the
\nrelevant national authorities of serious
\noffences in order for the latter to be able
\nto take appropriate action.
\nThe WMA recommends that national
\nmedical associations use their own powers
\nto ensure that physicians against whom
\nserious allegations of participation in war
\ncrimes or crimes against humanity have
\nbeen made, are not able to obtain licences
\nto practise until they have satisfactorily
\nresponded to these allegations. The WMA
\nreminds the national medical associations
\nof their duty to ensure efficient
\ncommunications amongst themselves and to
\ninform the relevant national licensing
\nauthorities of serious offences in order for
\nthe latter to be able to take appropriate
\naction. [AM]
\nThe WMA recommends that national
\nThe WMA recommends that national medical
\nassociations use their own authority to be informed, in so
\nfar as is possible, if serious allegations of participation in
\nwar crimes or crimes against humanity have been made
\nagainst physicians, while at the same time respecting the
\npresumption of innocence.
\nApril 2018 MEC 209\/Licensing of Physicians Fleeing Prosecution COM REV\/Apr2018
\n11
\nmedical associations use their own powers
\nwork to ensure that physicians against
\nwhom serious and credible allegations of
\nparticipation in war crimes or crimes
\nagainst humanity have been made, are not
\nable to obtain licences to practise until they
\nhave satisfactorily responded to these
\nallegations. Where evidence of
\ninvolvement in such abuses is compelling,
\nthe evidence should be drawn to the
\nattention of appropriate authorities. The
\nWMA reminds the national medical
\nassociations of their duty to ensure efficient
\ncommunications amongst themselves and to
\ninform the relevant national authorities of
\nserious offences in order for the latter to be
\nable to take appropriate action. [SwMA]
\nThe WMA recommends that national
\nmedical associations, or relevant
\nregulatory bodies, use \u2026 [BMA]
\n[Added text:] It should be an obligation
\non any licensing authority to make
\nreasonable and appropriate enquiries
\nwith regards to the former countries in
\nwhich the doctor has been registered to
\npractice medicine. [BMA]
\nThe WMA recommends that national
\nmedical associations use their own powers
\nto ensure that physicians against whom
\nserious allegations of participation in war
\ncrimes or crimes against humanity have
\nApril 2018 MEC 209\/Licensing of Physicians Fleeing Prosecution COM REV\/Apr2018
\n12
\nbeen made, are not able to obtain licences
\nto practise until they have satisfactorily
\nresponded to these allegations [What about
\n\u2018criminal offences\u2019? What is the difference
\nbetween \u2018allegations\u2019 and \u2018serious
\nallegations\u2019? Is there a difference between
\nallegations and prosecution? If not, please
\nbe consistent in formulating. Who has to
\ndecide that an allegation has been
\nsatisfactorily responded to? Is an allegation
\nenough? Shouldn\u2019t it be a conviction?] \u2026
\n[RDMA]
\nThe WMA recommends that nNational
\nmMedical aAssociations use their own
\npowers to ensure that physicians against
\nwhom serious allegations of participation in
\nwar crimes or crimes against humanity have
\nbeen made, are not able to obtain licences
\nto practise until they have satisfactorily
\nresponded to these allegations. The WMA
\nreminds the nNational mMedical
\naAssociations of their duty to ensure
\nefficient communications amongst
\nthemselves and to inform the relevant
\nnational regulatory and legal authorities of
\nserious offences in order for the latter to be
\nable to take appropriate action. [CMA]
\nThe WMA recommends that national
\nmedical associations use their own powers
\nto ensure that physicians who are
\nprosecuted for serious criminal offences
\nor against whom serious allegations of
\nApril 2018 MEC 209\/Licensing of Physicians Fleeing Prosecution COM REV\/Apr2018
\n13
\nparticipation in war crimes or crimes
\nagainst humanity have been made, \u2026
\n[FMA]
\nThe WMA recommends that national
\nmedical associations use their own
\ninfluence and, where applicable,
\nauthoritypowers to ensure that physicians
\nagainst whom serious allegations of
\nparticipation in war crimes or crimes
\nagainst humanity have been made, are not
\nable to obtain licences to practise until they
\nhave satisfactorily responded to these
\nallegations. \u2026 [GMA]
\nThe WMA recommends that national
\nmedical associations use their own powers
\nto ensure that physicians against whom
\nserious allegations of participation in war
\ncrimes or crimes against humanity have
\nbeen made, are not able to obtain licences
\nto practise until they have satisfactorily
\nresponded to these allegations or have a
\nfinal exculpatory sentence. \u2026 [CGCM]
\nThe WMA recommends that all national
\nmedical associations and relevant
\nlicensing bodies use their own powers to
\nensure that all physicians against whom
\nserious allegations of participation in war
\ncrimes or crimes against humanity have
\nbeen made, who have been convicted of a
\ncriminal offense, either locally or from
\nanother jurisdiction, be unable are not
\nApril 2018 MEC 209\/Licensing of Physicians Fleeing Prosecution COM REV\/Apr2018
\n14
\nable to obtain licences to practise
\nmedicine. until they have satisfactorily
\nresponded to these allegations. [Modify and
\nmove the next sentence of the original text
\nto a new paragraph as shown below:]
\n[AMA]
\nThe WMA reminds recommends that the
\nnational medical associations of their duty
\nto ensure efficient communications
\namongst themselves and to that they
\ninform the relevant national licensing
\nauthorities of physicians\u2019 criminal
\nconvictions. serious offences in order for
\nthe latter to be able to take appropriate
\naction. [AMA]
\nThe WMA recommends that national medical associations
\nensure that there is efficient communication amongst
\nthemselves and that they inform relevant national licensing
\nauthorities of physicians\u2019 criminal convictions.
\n*****
\nApril 2018
\n1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument
\nno:
\nMEC 209\/End of Life Japan\/Apr2018 Original:
\nEnglish
\nTitle: Report of the Symposium on End-of-Life
\nQuestions in Japan 2017
\nDestination: Medical Ethics Committee
\n209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nFor
\nconsideration
\nNote The Symposium on End-of-Life Questions was held in Japan
\non September 14 and 15, 2017, with participation of the
\nConfederation of Medical Associations in Asia and Oceania
\n(CMAAO) members and the two World Medical Association
\n(WMA) Asian regional members, namely, the Chinese
\nMedical Association and the Israel Medical Association. This
\nreport was prepared by Professor Tatsuo Kuroyanagi, lawyer
\nand the legal adviser of the Japan Medical Association
\n(JMA).
\nSymposium on End-of-Life Questions Result Report
\nThe Symposium on End-of-Life Questions was held on September 14 and 15, 2017, with
\nparticipation of the Confederation of Medical Associations in Asia and Oceania (CMAAO)
\nmembers and the two World Medical Association (WMA) Asian regional members, namely, the
\nChinese Medical Association and the Israel Medical Association. The symposium generated certain
\nachievements, and the following is the report of its results.
\n1. Introduction
\nThe main purpose of this symposium was to investigate different opinions that exist among the
\nWMA Asia-Pacific members and their home countries\/jurisdictions with regard to the three WMA
\npolicies, namely WMA Declaration on Euthanasia, WMA Statement on Physician-Assisted Suicide,
\nand WMA Resolution on Euthanasia.
\nThe Japan Medical Association (JMA) planned this symposium because the WMA
\nExecutive Committee referred the investigation to the JMA. The JMA also carried out a
\nquestionnaire survey on five items of \u201cEnd-of-Life Questions\u201d in July 2017 to ensure fruitful
\ndiscussion at the symposium and asked the member National Medical associations (NMAs) to
\npresent their views based on their answers to the questionnaire survey.
\nApril 2018 MEC 209\/End of Life Japan\/Apr2018
\n2
\nThe JMA sent the questionnaire to 21 NMAs, and 19 submitted their answers. At the
\nsymposium, 17 NMAs presented their reports by further elaborating or partially modifying their
\nanswers.
\nThis report of the questionnaire survey results was prepared based on the answers that the
\nJMA received and the presentations made by each NMA during the symposium.
\n2. Target NMAs for the questionnaire survey
\n21 WMA members in the Asia-Pacific region were the target of the questionnaire survey, namely,
\n19 CMAAO members, the Chinese Medical Association and the Israel Medical Association. The
\nJMA sent out the questionnaire to these 21 NMAs via e-mail, and asked them to submit their
\nanswers.1
\nThe 19 NMAs that submitted their answers in writing were; Australia, Bangladesh,
\nCambodia (absent), Hong Kong, India, Indonesia, Japan, Korea, Malaysia, Myanmar, Nepal, New
\nZealand (absent), Pakistan, Philippines, Singapore, Taiwan, and Thailand, which are CMAAO
\nmembers, and China and Israel, which are non-CMAAO members. Two CMAAO members, Macau
\nand Sri Lanka, did not submit their answers. New Zealand and Cambodia were unfortunately unable
\nto attend the symposium but had submitted detailed answers via e-mail.
\n3. Background
\nThe WMA has made it clear that it is against euthanasia and physician-assisted-suicide (PAS).
\nHowever, legislations allowing these procedures have been enacted in Switzerland in the past and in
\nthe Netherlands, Belgium, Luxemburg, and some states in the United States in recent years. In
\nSwitzerland legislation has allowed PAS, but not euthanasia. In addition, on February 6, 2015, the
\nSupreme Court of Canada ruled that the crime of aiding suicide as stipulated in the Penal Code is
\nunconstitutional in view of respecting the patients\u2019 right of self-determination, and this ruling has
\nled to a legislation that approves PAS.
\nDuring the Meeting in Oslo in 2015, the WMA Council re-confirmed the opinions on the issue of
\nactive euthanasia and PAS. The overwhelming majority of the members wished to maintain the
\ncurrent position of opposing such practice. The Council Meeting in Taipei in 2016 decided to hold
\nregional discussions on this issue especially in the Asian, African and Latin American regions.
\n4. Questions addressed in the symposium (questionnaire items)
\nAs mentioned in the Introduction, the core purpose of the investigation and deliberation of this
\nsymposium was to study the reality concerning \u201cEuthanasia and Physician-assisted-suicide\u201d among
\nthe WMA Asia-Pacific members and their home countries\/jurisdictions. Upon consulting with the
\nWMA Secretariat in advance, the following four categories of questions were prepared.
\nQ-1 Questions regarding Euthanasia and Physician-assisted Suicide
\nQ-2 Questions regarding Advance directive (Living Will)
\nQ-3 Questions regarding Withholding or Withdrawing of Life-sustaining Treatment
\nQ-4 Questions regarding Palliative Care including End-of-life Care
\nIn order to prevent confusion due to different understandings of the terminology, the titles of
\nWMA policy documents related to each question were listed in marginal notes when preparing the
\n1
\nIt should be noted that the JMA also sent out the questionnaire to three other NMAs that are also the
\nWMA members in the Asia-Pacific region, namely, Fiji, Samoa, and Vietnam, and requested to submit
\ntheir answers. However, the JMA received no confirmation of reception nor any answers from them, so
\nthey were excluded from the survey.
\nApril 2018 MEC 209\/End of Life Japan\/Apr2018
\n3
\ntext of the questions; respondents were asked to follow the definitions provided in these policy
\ndocuments, if any. In referring to the policy documents, the Powerpoint file created and provided by
\nWMA General Secretary Otmar Kloiber, which he used at the Latin American symposium in March
\n2017, was used as a reference, and some relevant texts of the policy documents that were mentioned
\nin this Powerpoint file were extracted and noted in the questionnaire text as needed.
\nAfter these four questions were sent out, Question 5 that concerns the adult guardianship
\nprogram with the right of medical consent and other legal measures was added later, in light of poor
\nlegal interventions available in Japan in case of providing highly invasive treatment in daily
\nmedical practice for extremely aged patients with dementia who lost the ability of self-
\ndetermination or providing critical procedure involved in the end-of-life care.
\n5. Grouping at the symposium
\nThe original plan was to divide the participating NMAs alphabetically and have them orally discuss
\nthe written opinions of each in groups. However, after examining the pre-submitted answers and
\nreceiving considerably delayed answers from two NMAs, the JMA decided to divide the NMAs
\ninto four groups based on the similarities in legal systems and religions. CMAAO Council Chair
\nDr. Yeh Woei Chon (Singapore), Vice Chair Dr. Kar Chai Koh (Malaysia), and advisor Dr. Dong-
\nChun Shin (Korea) were asked to serve as the symposium chairs (facilitators), and they reviewed all
\nthe answers of NMAs the night before the symposium.
\nThe names and titles of the rapporteurs of the four groups are shown in the table in
\nAttachment 2.
\nStakeholders of the participating NMAs and other experts also joined the groups, including
\nWMA Secretary General Otmar Kloiber, German Medical Association President Prof. Dr. Frank
\nUlrich Montgomery, International Manager Dr. Ramin Parsa-Parsi, and the immediate past
\nAmerican Medical Association President Dr. Andrew Gurman. They had lively discussion during
\nthis 2-day symposium.
\nOn the second day of the symposium, a summary table of all answers by question, which the
\nJMA had prepared based on the submitted responses, was distributed to everyone involved so that
\neach could verify and\/or modify the answers by question item. The sorting (or classification)
\ncontained in the summary shown in Attachment 1 was produced through such a process.
\n6. Answers
\nThe answers to the above five questions are summarized below. Please refer to the report in
\nAttachment 1 for details.
\n6-1. Answer to Question 1
\nQuestion 1 asked if there is any law or court ruling that tolerates a physician\u2019s involvement in
\neuthanasia and\/or assisted suicide.
\nAll member associations answered \u201cNo\u201d to this question.
\nHowever, we learned from the Australian Medical Association that the State of Victoria will be
\nvoting on a euthanasia bill in coming months. There is an appetite for euthanasia and PAS in
\nnumerous Australian states and New Zealand where several parliamentary bills have been
\ndefeated.
\n6-2. Answer to Question 2
\nQuestion 2 asked whether legislation on Advanced Directive exists or not.
\nWe also asked about \u201cOrders Not to Attempt Resuscitation (DNAR)\u201d and the practice of
\nappointing a legal representative in relation to this question.
\nAs for the existence of legislation, the result showed half of the member countries and
\nparticipating countries have such legislation. It is worth noting that the practice of \u201cadvanced
\ncare planning\u201d with physicians at its core is becoming popular.
\n6-3. Answer to Question 3
\nApril 2018 MEC 209\/End of Life Japan\/Apr2018
\n4
\nQuestion 3 asked about withholding or withdrawing of a life support system. This question also
\nconcerns the WMA Declaration of Lisbon on Patient\u2019s Rights, in which death with dignity is
\nendorsed as a form of practicing the right of self-determination by a patient. We observed a
\nsubtle difference in opinion on the ideas of \u201cwithholding\u201d and \u201cwithdrawing,\u201d so we should
\ncarefully examine each answer over time.
\n6-4. Answer to Question 4
\nQuestion 4 asked about \u201cpalliative care.\u201d Enriched palliative care is expected to improve the
\npain management in the end-of-life care, which may resolve the issue raised in Question 1.
\nHowever, the uses of narcotic drugs such as morphine and opioids, which are commonly used
\nin palliative care, are strictly regulated by the authorities in many countries, and it appeared that
\nthis area of medical care is still being developed.
\nThe involvement of religion was also asked in relation to this question, and the response in
\ngeneral implied that religion plays a role in most countries and jurisdictions.
\n6-5. Answer to Question 5
\nThe responses from several member associations, namely Australia, Korea, New Zealand and
\nTaiwan, suggest that this problem is being addressed.
\n7. Summary
\nAt the CMAAO General Assembly Tokyo in 2017, all of the NMAs have opposed euthanasia and
\nPAS. With the exception of Australia and New Zealand, there is no significant desire in the civil
\nsociety of the Asia\/Oceania region to discuss the concept of euthanasia and PAS. All the NMAs
\nsupport the creation of Advanced Directive and advanced care planning with physicians for the
\nterminally-ill patients.
\nAdditional Note 1. Observations as the symposium organizer
\nThe main purpose of this symposium was not about consolidating opinions but finding facts. The
\ncore of the questions concerns the life or death at the end of life. Naturally, the natural environment,
\nculture, religion, and social structure of different countries\/jurisdiction are deeply involved in the
\nNMAs\u2019 answers in the survey. In terms of religion alone, there are Judaism, Christianity
\n(Catholicism and Protestantism), Islam, Hinduism, Buddhism (Hinayana and Mahayana), Taoism,
\nConfucianism, etc.\u2014some accept reincarnation, some believe in the absolute being, and their
\nbeliefs in life and death are very variable. When asked about the role of religion in the questions
\nrelating to palliative care, the NMAs\u2019 answers and explanations suggested strong influence of
\nreligion. The Bangladesh\u2019s answer was \u201cMost of the people believe one God and it helps.\u201d
\nIndonesia answered \u201cBelief in One and Only God,\u201d \u201cLife is given by God and cannot be taken
\naway except by Him or His permission,\u201d and \u201cImportant to save the soul, to be prepared for life
\nafter death.\u201d Pakistan, which adapts the Talqueen practice for every terminal Moslem patients
\n(Pukovisa 2017), answered \u201cPakistan, an orthodox religious country\u2013this issue not only can be
\ndiscussed but presently there is no room to make any kind of legislation in this regards.\u201d
\nCambodia\u2019s answer was \u201cBuddhism is major religion and any act to prolong survival is a good
\nthing.\u201d Nepal answered \u201cDominated by Hindu and Buddhist religion, people believe in afterlife in
\nhell or heaven.\u201d Thailand answered \u201cBuddhism plays an important role. Buddhists in Thailand
\nclaim suicide as sin.\u201d Again, these answers indicate that the answers to Question 1 are also strongly
\ninfluenced by religion.
\nIn addition, the oral reports and the Powerpoint slides used during presentation suggested
\nthat the family and community bonds are extremely firm in the island regions in Oceania such as
\nIndonesia, Philippines, Malaysia and the countries\/jurisdictions in the Southeast Asian region such
\nApril 2018 MEC 209\/End of Life Japan\/Apr2018
\n5
\nas Pakistan, India, Bangladesh, Myanmar, Thailand, and Cambodia. It was also indicated that the
\nidea of self-determination that developed in the Western countries has not necessarily fully
\ninfiltrated in these areas.
\nIn relation to Question 1, which was the main theme of this survey, a voice of question was
\nraised about the use of the word \u201c(active) euthanasia\u201d and the fact that the Supreme Court of India
\nused the word \u201cpassive euthanasia,\u201d which the Indian Medical Association quoted in their answers.
\nThe definitions and implications of the words \u201ceuthanasia = die Euthanasie\u201d and \u201cphysician-
\nassisted-suicide\u201d are often interpreted differently depending on the users, which suggests that they
\nneed to be set straight within the WMA to avoid confusion in future discussions. The WMA
\nResolution on Euthanasia that was adapted by the 2002 Washington General Assembly states \u201cThe
\nWorld Medical Association has noted that the practice of active euthanasia with physician
\nassistance, has been adopted into law in some countries\u201d in its third sentence. On this point, the
\nwell-established law dictionary in America, the Black\u2019s Law Dictionary, lists \u201cactive euthanasia\u201d
\nand \u201cpassive euthanasia\u201d as the antonym in its 7th edition (1999) and the latest edition (10th
\nedition; 2014) (Attachment 3). It should also be noted that although the word \u201cphysician-assisted-
\nsuicide\u201d was used in the questionnaire this time, a criminal type of\u2018murder at the victim\u2019s request\u2019
\nseparately from \u2018physician-assisted-suicide\u2019 exists in many jurisdictions including Japan. In the
\npresent wording of the policy documents, however, this criminal type is supposed to be excluded. If
\nthis type is to be included, perhaps the word \u201cphysician-assisted-dying\u201d could be introduced and
\nlisted together with \u201cphysician-assisted-suicide\u201d to indicate ascertainment. To note, putting its
\npropriety aside, the aforementioned dictionary by Black is using the word \u201cpassive euthanasia\u201d to
\nmean \u201cthe act of allowing a terminally ill person to die by either withholding or withdrawing life
\nsustaining support such as a respirator or feeding tube,\u201d as the Supreme Court of India did.
\nLastly, we are deeply grateful to Dr. Otmar Kloiber for his support throughout the planning
\nand holding of the symposium. We also thank Dr. Yeh Woei Chon, Chair of CMAAO, Dr. Kar
\nChai Koh, Vice-Chair and Dr. Dong Chun Shin, Advisor for overseeing the proceedings of the
\nsymposium and consolidating opinions.
\nThis report was prepared by JMA Legal Advisor Professor Tatsuo Kuroyanagi in
\ncooperation with the International Affairs Division staff of JMA, Mr. Yuji Noto, Mr. Hisashi
\nTsuruoka, Ms. Mieko Hamamoto, Ms. Rei Kobayashi and Ms. Michiyo Takano. It should be noted
\nthat Kuroyanagi solely bears the responsibility for wording and content of this report.
\nAdditional Note 2. Conflict of Interest Statement
\nThe author of this report is Professor Tatsuo Kuroyanagi, Legal Adviser of the Japan Medical
\nAssociation. There is no financial or commercial interest connected to this work.
\n\u00a7\u00a7\u00a7
\n09.03.2018<\/p>\n

1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument
\nno:
\nMEC 209\/End of Life Nigeria\/Apr2018 Original:
\nEnglish
\nTitle: Report of the WMA African region
\nmeeting on End-of-Life Questions in
\nNigeria 2017
\nDestination: Medical Ethics Committee
\n209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nFor
\nconsideration
\nNote The Symposium on End-of-Life Questions was hosted by the
\nNigerian Medical Association in Abuja, Nigeria on 1st
\nand 2nd
\nFebruary 2018. This report was prepared by Nigerian Medical
\nAssociation.
\nREPORT OF THE WMA AFRICAN REGION MEETING ON END OF LIFE ISSUES
\nPREAMBLE
\nAs part of the efforts of the World Medical Association (WMA) to generate open regional
\ndiscussions on the dilemmas related to End of Life issues, particularly with respect to Palliative
\ncare, Euthanasia and Physician assisted suicide, the WMA Council meeting held in Livingstone,
\nZambia in the month of April 2017, encouraged the African region of the WMA to organize an
\nAfrican Region meeting on End of Life issues.
\nArising from the foregoing, the Coalition of African Medical Associations gave the nod to the
\nNigerian Medical Association to host the WMA African Region Meeting on End of Life issues.
\nAccordingly, the WMA African Region meeting on End of Life issues (Palliative care, Euthanasia
\nand Physician assisted suicide) was hosted by the Nigerian Medical Association in Abuja, Nigeria
\non the 1st and 2nd of February 2018.
\nThe End of Life meeting which held at the Transcorp Hilton Hotel and Towers, Abuja, had as its
\ntheme \u2018An Excursion into the End of Life Spectrum: Defining the boundaries between Palliative
\ncare, Euthanasia and Physician assisted suicide\u2019. It was graced by some invited dignitaries as well
\nas the Secretary General of WMA (Dr. Otmar Kloiber) who made a presentation on WMA policy
\non End of Life issues. It also had in attendance Presidents and delegates of National Medical
\nAssociations from Nigeria, Zambia, Kenya, South Africa, Cote D\u2019Ivoire and Botswana.
\nActivities conducted during the meeting included Welcome cocktail, formal opening ceremony,
\nScientific sessions with presentations by various Guest speakers on End of Life issues, Breakout
\ntechnical sessions, sight-seeing\/visitations and a closing dinner.
\nApril 2018 MEC 209\/End of Life Nigeria\/Apr2018
\n2
\nThe formal opening ceremony was chaired by the Senate President, Senator Dr. Bukola Saraki (who
\nwas represented by Senator Dr. Lanre Tejuosho), while the Minister of Health, Prof. I.F. Adewole
\n(who was also in attendance) represented both Nigeria\u2019s President (Muhammadu Buhari GCFR)
\nand Nigeria\u2019s Vice President (Prof. Yemi Osinbajo).
\nOBSERVATIONS
\nThe meeting made the following observations:
\n1) There is no specific policy or legislation on Euthanasia and Physician assisted suicide in Africa.
\n2) Aside from countries such as Nigeria, Zambia, Kenya, Uganda, South Africa and Botswana with
\nsome initiatives, policies, guidelines and practices on palliative care, there is a dearth of policy
\nguidelines and legislation on palliative care in most African countries.
\n3) In African culture, tradition and religion, life is held sacred and families never abandon their
\nloved ones at the end of life.
\n4) Palliative care is generally accepted in African culture, tradition, and religion.
\n5) Involvement of Physicians in Euthanasia and Physician assisted suicide flies in the face of the
\nPhysicians\u2019 Pledge and ethics governing the medical profession.
\n6) There is a low level of awareness on End of Life issues among African populations and
\nmedical\/health professionals.
\n7) There is a dearth of standard health care systems and medical personnel equipped to deliver
\npalliative care.
\n8) There is a high poverty rate; poor access to affordable, equitable and quality health care; and
\npoor access to palliative care in most African countries.
\nRESOLUTIONS
\n1) National Medical Associations in Africa are unanimously opposed to Euthanasia and Physician
\nassisted suicide in any form.
\n2) National Medical Associations in Africa support policies and legislations permitting and
\nstrengthening palliative care.
\n3) There is need for improved political will and commitment to palliative care by African
\nGovernments.
\n4) African National Medical Associations (NMAs), Non-Governmental Organizations (NGOs), etc.
\nneed to embark on enlightenment and advocacy campaigns to orientate various arms of government
\nand policy makers, as well as the general public on the importance and availability of palliative
\ncare.
\n5) There is need for increased awareness amongst care givers, patients and other stakeholders, with
\nthe capacity of Physicians and other relevant health professionals to deliver palliative care
\ncontinuously built.
\nApril 2018 MEC 209\/End of Life Nigeria\/Apr2018
\n3
\n6) There is great need for strengthening of African healthcare systems, universal health coverage,
\nimproved budgetary allocation to health, and integration of palliative care and other chronic
\nmedical conditions into the health care financing\/health insurance schemes of African countries.
\n\u00a7\u00a7\u00a7
\n09.03.2018<\/p>\n

1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument
\nno:
\nMEC 209\/End of Life Brazil\/Apr2018 Original:
\nEnglish
\nTitle: Report of the WMA South American
\nregion meeting on End-of-Life Questions
\nin Brazil 2017
\nDestination: Medical Ethics Committee
\n209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nFor
\nconsideration
\nNote The Symposium on End-of-Life Questions was hosted by the
\nBrazilian Medical Association in Rio de Janeiro in 2017. This
\nreport was prepared by Brazilian Medical Association.
\nLatin American Meeting on End-of-Life Ethical Dilemmas
\nCONCLUSIONS
\nMedicine in recent decades has had and continues to enjoy dizzying advances. However, they are
\nnot all successes. On the one hand, the life expectancy is greatly advanced, but on the other hand,
\nthe times of suffering, the trials and useless treatments, the solitude of the patient, the lack of
\nanswers, and in an endless way the suffering of the agony.
\nHuman dignity is linked to the life of each individual and the radical equality of all human beings
\nfrom the beginning, regardless of their concrete conditions. Life is always dignified, unworthy are
\nthe conditions in which many human beings live and are unworthy the decisions and behaviors that
\nprovoke them, produce or cause them.
\nThe medical science put at the service of suffering and sick who are no longer cured, is where
\npalliative care is developed when trying to give the technical and human attention that the patients
\nneed in terminal situation, with the best possible quality and looking for the professional excellence.
\nAfter palliative medicine emerges with force, it does not seek to lengthen or shorten life, it only
\nseeks the patient’s greater well-being respecting the moment of death, but accompanying to the end.
\nToday its services must be a right or at least an attainable service for all patients.
\nIt is well known that hope is energy to live, on the contrary, contempt, lack of affection, marginality
\nannul the interest in life, are the prelude to death that especially affects the most disadvantaged and
\nweakest on which often society, far from offering comfort and understanding, multiplies the
\nfeelings of uselessness, incapacity, dependence and, consequently, it worsens its state and now
\noffers the way out to end up in an organized manner with life.
\nApril 2018 MEC 209\/End of Life Brazil\/Apr2018
\n2
\nDeath occurs at a certain moment in life, so it can neither be worthy nor unworthy, what can be
\nworthy or unworthy are the conditions of life that have preceded it.
\nVolunteering is not enough to guarantee the freedom and dignity of the person. The human being will
\noften find himself in situations of vulnerability where he can manifest his will, but he does not do it freely.
\nThat is why his dignity must be defended against third parties and even against their own decisions.
\nPity and compassion must be the engine for all lives to make sense, that no one dies in solitude, or
\nmobilize so that no one suffers avoidable pains. However, if the doctor is prepared not only to cure
\nbut also to kill, the ethics of medical practice and the trust that the patient must have in his doctor
\nwill be very battered.
\nWith euthanasia, a social message is sent to the most severely disabled patients, who can be morally
\ncoerced, even if it is silent and indirectly, to request a faster end, since they are considered a useless
\nburden for their families and for society. In such a way that patients weaker or in worse
\ncircumstances would be the most pressured to request euthanasia.
\nThe request for euthanasia by the patients is reduced by improving the training of professionals in the
\ntreatment of pain and in palliative care. A permissive legislation with euthanasia would restrain the
\ninvolvement, both scientific and care, of some doctors and health professionals in the care of patients
\nwith no possibility of cure that require a considerable dedication in time and human resources.
\nSocieties should be aware of the risks of legislation allowing euthanasia where the social climate
\ncan lead doctors and family members to slip into its application in cases of unconscious or
\nincapable patients who have not expressed their authorization, this is the phenomenon of the
\n\u00abslippery slope\u00bb that has led in the Netherlands to its application in people who had not requested it
\nor did not meet the legal requirements.
\nAt present it is not that there is a legal vacuum in relation to the regulation of this matter, but what
\nis regulated is the duty of the physician to preserve life, as correlative to the fundamental right of all
\ncitizens. That duty of the physician must be exercised in accordance with the rules that indirectly
\nregulate the Lex Artis, which refers to the laws that order the health professions and the rigorous
\nfulfillment of the ethical obligations.
\nThe medical profession faced to the social debate on euthanasia has agreed to recognize that cases of
\npetition for euthanasia are exceptional when providing quality medical care and that the debate on the
\ndecriminalization of euthanasia revolves around the social consequences of legislating for these cases.
\nBy vocation, training and mentalization, he or she who chooses medicine as a reason for being
\nknows that all his\/her efforts, all the knowledge, are to save the lives of their patients and save as
\nmuch suffering as possible, cannot be dedicated simultaneously to end someone’s life for whose life
\nhe\/she has fought. Euthanasia in any case should be a medical activity.
\nThe sick at the end of life need a helping hand not to precipitate their death, nor to prolong their
\nagony with the therapeutic obstinacy, but to be with them and relieve their suffering with palliative
\ncare while their death arrives.
\nRio de Janeiro, 18 March 2017
\n\u00a7\u00a7\u00a7
\n09.03.2018
\n1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument
\nno:
\nMEC 209\/End of Life Europe\/Apr2018 Original:
\nEnglish
\nTitle: Report on the WMA European Region
\nConference on End-of-Life Questions
\n2017
\nDestination: Medical Ethics Committee
\n209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nFor
\nconsideration
\nNote The WMA together with the German Medical Association
\nand the Pontifical Academy for Life organized a two-day
\nWMA European Region Conference on End-of-Life
\nQuestions, which took place in the Vatican\u2019s Aula Vecchia
\ndel Sinodo on 16 and 17 November 2017
\nReport on the WMA European Region Conference on End-of-Life
\nQuestions
\nThe\ttwo-day\tWMA\tEuropean\tRegion\tConference\ton\tEnd-of-Life\tQuestions\ttook\tplace\tin\tthe\tVatican\u2019s\tAula
\nVecchia\tdel\tSinodo\ton\t16\tand\t17\tNovember\t2017.\tAround\t150\tparticipants\tgathered\tfrom\tEurope\tand\tbeyond,
\nincluding\tWMA\tleaders\tand\tmembers,\texperts\tin\tpalliative\tcare,\tethicists,\tlawyers\tand\treligious\tleaders.\tThe
\npresentations\ton\teuthanasia\tand\tphysician\tassisted\tsuicide\t(PAS)\tand\tthe\tviews\texpressed\tcovered\tthe\tfull
\nspectrum\tof\topinion.\tThe\tpurpose\tof\tthe\tevent,\twhich\twas\tco-organised\tby\tthe\tWMA,\tthe\tGerman\tMedical
\nAssociation\tand\tthe\tPontifical\tAcademy\tfor\tLife,\twas\tto\texplore\tethical\tdilemmas\trelating\tto\tend-of-life\tissues\tto
\nassist\tthe\tWMA\tin\tdeciding\twhether\tor\tnot\tto\tamend\tits\tpolicy\ton\tthese\tissues.\t\t<\/p>\n

In\tan\taddress\tprepared\tby\tPope\tFrancis\tand\tread\tby\tCardinal\tPeter\tTurkson,\tthe\tPope\tsaid\tit\twas\tclear\tthat\tnot
\nadopting,\tor\telse\tsuspending,\tdisproportionate\tmeasures,\tmeant\tavoiding\toverzealous\ttreatment.\tFrom\tan
\nethical\tstandpoint,\tthis\twas\tcompletely\tdifferent\tfrom\teuthanasia,\twhich\twas\talways\twrong,\tin\tthat\tthe\tintent\tof
\neuthanasia\twas\tto\tend\tlife\tand\tcause\tdeath.\t\t<\/p>\n

In\this\tintroductory\tremarks,\tProfessor\tDr.\tFrank\tUlrich\tMontgomery,\tPresident\tof\tthe\tGerman\tMedical
\nAssociation,\texplained\tthat\tthe\tWMA\thad\talways\thad\ta\tvery\tclear\tposition\ton\tend-of-life\tissues\t\u2013\tit\tcondemned
\neuthanasia\tand\tPAS\tas\tunethical.\tHe\tlater\tadded\tthat\the\tfound\tnone\tof\tthe\targuments\tin\tfavour\tof\tPAS
\ncompelling.\tLike\teuthanasia,\tPAS\twas\tunethical\tand\tmust\tbe\tcondemned\tby\tthe\tmedical\tprofession.\tMedical
\nethics\tshould\tnot\tsimply\tfollow\tpublic\topinion.\t\t<\/p>\n

Archbishop\tVincenzo\tPaglia,\tPresident\tof\tthe\tPontifical\tAcademy\tfor\tLife,\treiterated\tthat\tPope\tFrancis\u2019s\tmessage
\nreaffirmed\tand\tadded\tprecision\tto\tprevious\tpapal\ttexts\tabout\tend-of-life\tcare.\t<\/p>\n

WMA\tPresident\tDr.\tYoshitake\tYokokura\treferred\tto\tthe\tsymposium\ton\tend-of-life\theld\tby\tthe\tConfederation\tof
\nMedical\tAssociations\tin\tAsia\tand\tOceania\tin\tTokyo\tin\tSeptember,\twhere\tmost\tnational\tmedical\tassociations\thad
\nopposed\teuthanasia\tand\tPAS.\t\t<\/p>\n

April 2018 MEC 209\/End of Life Europe\/Apr2018
\n2
\nBut\tDr.\tRen\u00e9\tH\u00e9man,\tChairman\tof\tthe\tRoyal\tDutch\tMedical\tAssociation,\ttook\ta\tdifferent\tview.\tHe\tquoted\tthe
\nrecently\trevised\tDeclaration\tof\tGeneva\tand\tthe\tpledge\tthat\t\u2018I\twill\trespect\tthe\tautonomy\tand\tdignity\tof\tmy
\npatient\u2019.\tHe\texplained\tthe\tsituation\tin\tthe\tNetherlands,\twhere\teuthanasia\twas\tstill\ta\tpunishable\toffence\tand\twas
\nforbidden\tunless\tspecific\trequirements\twere\tmet.\tThese\tinclude\tinstances\twhere\tthere\thas\tbeen\ta\tvoluntary\tand
\nwell\tconsidered\trequest,\twhere\tthere\tis\tunbearable\tsuffering\tand\tno\tprospect\tof\timprovement\tand\twhere\tone
\nother\tindependent\tphysician\thas\tbeen\tconsulted.\tAlso,\tthere\thas\tto\tbe\ta\tconviction\tthat\tno\tother\treasonable
\nsolution\tfor\tthe\tpatient\u2019s\tsituation\tis\tavailable\tand\tthat\tthe\ttermination\tof\tlife\tor\tassisted\tsuicide\tare\tperformed
\nwith\tdue\tcare.\tDr\tH\u00e9man\tsaid\tit\twould\tnever\tbe\tgood\tto\tend\ta\tperson\u2019s\tlife,\tbut\tsometimes\tit\twould\tbe\tworse\tnot
\nto.\tHe\targued\tthat\teuthanasia\twas\tbased\ton\tthe\tprinciples\tof\trespect\tfor\ta\tpatient\u2019s\tautonomy\tand\ton
\ncompassion.\t\t<\/p>\n

Dr.\tYvonne\tGilli,\tfrom\tthe\tSwiss\tMedical\tAssociation,\toutlined\tthe\tsituation\tin\tSwitzerland,\twhere\tthere\thad\tbeen
\nan\tincrease\tin\tthe\trate\tof\tassisted\tsuicides\tin\tthe\tlast\tten\tyears.\tShe\treferred\tto\trevised\tguidelines\tjust\tissued\tby
\nthe\tSwiss\tAcademies\tof\tArts\tand\tSciences,\twhich\tincluded\tmore\tfocus\ton\tguiding\tphysicians\tthrough\ta
\nprofessional\tdialogue\twith\ta\tdying\tpatient.\tThey\tmade\tmore\tspecific\trecommendations\ton\tpalliative\tsedation\tand
\non\tassisted\tsuicide.\t<\/p>\n

A\tdiscussion\ton\ttheological\tapproaches,\tfeaturing\trepresentatives\tof\tthe\tCatholic,\tJewish,\tIslamic\tand\tOrthodox
\nChristian\tfaiths,\tall\tof\twhom\texpressed\topposition\tto\teuthanasia\tand\tPAS,\twas\tfollowed\tby\tpresentations\ton\tthe
\nlegal\taspects\tof\tend-of-life\tissues.\t<\/p>\n

Prof.\tJohn\tKeown,\tProfessor\tof\tChristian\tEthics\tat\tthe\tKennedy\tInstitute\tof\tEthics,\tGeorgetown\tUniversity,
\nexplained\tthe\tcommon\tand\tcriminal\tlaw\trelating\tto\teuthanasia\tand\tPAS\tand\trelating\tto\twithholding\tand
\nwithdrawing\tlife-preserving\ttreatment\tfor\tcompetent\tand\tincompetent\tpatients.\tProf.\tDr.\tVolker\tLipp,\tProfessor
\nof\tCivil\tLaw,\tProcedural\tLaw,\tMedical\tLaw\tand\tComparative\tLaw,\tat\tGeorg-August-Universit\u00e4t,\tG\u00f6ttingen\tspoke
\nabout\tthe\tdiversity\tin\tvarious\tlegal\tsystems.\tHe\texamined\tthe\tvarious\tdefinitions\tof\tthe\tterm\t\u201ceuthanasia\u201d\tand
\nsaid\tcare\tshould\tbe\ttaken\tabout\tusing\tit\tas\tit\twas\tan\tambiguous\tconcept.\t<\/p>\n

Dr.\tLaurence\tLwoff,\tHead\tof\tthe\tBioethics\tUnit,\tHuman\tRights\tDirectorate,\tCouncil\tof\tEurope,\ttalked\tabout\tthe
\nCouncil\tof\tEurope\tGuide\ton\tthe\tdecision-making\tprocess\tregarding\tmedical\ttreatment\tin\tend-of-life\tsituations.
\nThis\tgave\trise\tto\tcomplex\tsituations\trelating\tto\tequity\tof\taccess\tto\thealth\tcare,\tprofessional\tobligations,\tfree\tand
\ninformed\tconsent\tand\tpreviously\texpressed\twishes.\t<\/p>\n

Presentations\twere\tfollowed\tby\tlively\tpanel\tdiscussions\tand\trobust\tquestion\tand\tanswer\tsessions.\tDr.\tJeff
\nBlackmer,\tfrom\tthe\tCanadian\tMedical\tAssociation,\tdefended\tthe\trole\tof\tdoctors\tin\tCanada,\twhere\tmedically
\nassisted\tdying\tbecame\tlegal\tin\t2016.\t<\/p>\n

The\tfirst\tday\tconcluded\twith\tspeeches\tfrom\tProf.\tDr.\tLeonid\tEidelman,\tPresident\tof\tthe\tIsraeli\tMedical
\nAssociation\tand\tPresident\telect\tof\tthe\tWMA,\tand\tProf.\tPablo\tRequena,\tProfessor\tof\tMoral\tTheology\tat\tthe
\nPontifical\tUniversity\tof\tthe\tHoly\tCross,\tand\tthe\tdelegate\tof\tthe\tVatican\tMedical\tAssociation\tat\tthe\tWMA.\t\t<\/p>\n

Dr.\tEidelman\treferred\tto\tthe\texperience\tof\tthe\tNetherlands\tand\tsaid\tthat\tone\tof\tthe\tmost\timportant\tfactors
\nseparating\tphysicians\twho\tdid\tor\tdid\tnot\taccept\tPAS\tand\teuthanasia\twas\twhether\tthey\tsaw\ttheir\tactions\tas
\nsimilar\tto\tor\tdifferent\tfrom\tother\tregular\tmedical\ttreatments\tthey\tgave\ttheir\tpatients.\tWas\tit\ta\tregular\tmedical
\nintervention\tlike\ttreatment\twith\tantibiotics\tor\twas\tit\tsomething\textraordinary\tdemanding\ta\tdifferent\tattitude?\tIn
\nhis\tview\tphysicians\tshould\tnot\tbe\tinvolved\tin\tPAS\tor\teuthanasia\tfor\tseveral\treasons.\tMany\trequests\tdisappeared
\nwith\tsymptom\tcontrol\tand\tpsychological\tsupport.\t\t<\/p>\n

Prof.\tRequena\tsaid\tthat\tcompassion\twas\tnot\ta\tgood\treason\tfor\teuthanasia\tand\tunbearable\tsuffering\twas\tnot\ta
\nmedical\treason.\tHe\tsaid\the\tdoubted\tthat\tsociety\thad\tthe\tmoral\tsense\tto\tprotect\tphysicians\ton\tthis\tissue.\tThat\twas
\nwhy\tit\twas\timportant\tthat\tphysicians\tprotected\tthemselves\tand\tthat\tmedical\tsocieties\tand\tthe\tWMA\tcontinued\tto
\noppose\teuthanasia\tas\ta\tmedical\taid.\tFinally,\the\tquoted\tthe\tHippocratic\tOath,\twhich\tstated\t\u2018I\twill\tnot\tgive\ta\tlethal
\ndrug\tto\tanyone\tif\tI\tam\tasked\tnor\twill\tI\tadvise\tsuch\ta\tplan\u2019.\t\t<\/p>\n

The\tsecond\tday\tbegan\twith\tthe\tquestion\t\u2018Is\tthere\ta\tright\tto\tdetermine\tone\u2019s\town\tdeath?\u2019\tThe\topening\tspeaker
\nwas\tProf.\tDr.\tUrban\tWiesing,\tfrom\tthe\tInstitute\tfor\tEthics\tand\tHistory\tof\tMedicine\tat\tthe\tUniversity\tof\tTuebingen
\nin\tGermany,\twho\targued\tfor\tthe\tconcept\tof\tplurality,\tsaying\tthat\tthere\twas\tno\tconsensus\ton\tend-of-life\tissues
\nfrom\tan\tethical\tpoint\tof\tview.\tHe\tsaid\tthe\tanswer\tto\tethical\tplurality\twas\ta\tpolitical\tone.\tHe\targued\tthat\tthere\twas
\nno\tslippery\tslope\tinvolved\tas\ta\tresult\tof\tPAS.\tNor\twas\tthere\tany\tloss\tof\ttrust\tin\tphysicians.\t\t<\/p>\n

April 2018 MEC 209\/End of Life Europe\/Apr2018
\n3
\nProf.\tDr.\tChristiane\tDruml,\tChairperson\tof\tthe\tAustrian\tBioethics\tCommission\tand\tUNESCO\tChair\tof\tBioethics\tat
\nthe\tMedical\tUniversity\tof\tVienna,\tsaid\tit\twas\ta\tclear\tand\tundisputed\tprinciple\tthat\ttreatments\twhich\twere\tnot\tor
\nno\tlonger\tindicated\tor\ttreatments\twhich\tthe\tpatient\trefused\tmust\tnot\tbe\tperformed.\tBut\tthere\twere\tstill\tcases
\nwhere\tdisproportionate\ttreatment\twas\tinitiated.\tMedical\tinterventions\twhich\tprovided\tno\tbenefit\tfor\tthe\tpatient
\nor\twhich\twere\tmore\tburdensome\tthan\tpotentially\tbeneficial\tto\tthe\tpatient\twere\tethically\tand\tmedically
\nunjustified\tbecause\tthey\tcame\tat\ta\tdisproportionate\tburden.\t\t<\/p>\n

Dr.\tAnne\tde\tla\tTour,\tPresident\tof\tthe\tFrench\tSociety\tof\tPalliative\tCare\tspoke\tabout\tend\tstage\tdecisions\ton
\nmedication,\tfeeding\tand\tterminal\tsedation,\tand\tthe\tdifferences\tbetween\tsedation\tand\teuthanasia.\t\t<\/p>\n

Dr.\tGunnar\tEckerdal,\tfrom\tthe\tDepartment\tof\tOncology\tat\tSahlgrenska\tUniversity\tHospital\tin\tSweden,\ttalked\tin
\nmore\tdetail\tabout\tthe\trole\tof\tnutrition.\tHe\tsaid\tthat\ttreatment\twithout\tclinical\tindication\tshould\tbe\tstopped.
\nTreatment\tthat\twas\tnot\tgoing\tto\tgive\teffect\tshould\tnot\tbe\tstarted.\tHe\targued\tthat\tPAS\tand\teuthanasia\twere\tnot
\nsecure\tand\tinvolved\twrong\tdiagnoses\tand\twrong\tprognoses,\tas\twell\tas\tunderdiagnosed\tand\tundertreated
\ndepression.\t\t<\/p>\n

Dr.\tMarco\tGreco,\tPresident\tof\tthe\tEuropean\tPatients\u2019\tForum,\tsaid\this\torganisation\tdid\tnot\thave\tan\tofficial
\nposition\ton\teuthanasia\tand\tPAS.\tBut\tempowerment\twas\ta\tmulti-dimensional\tprocess\tthat\thelped\tpeople\tgain
\ncontrol\tover\ttheir\town\tlives\tand\tincreased\ttheir\tcapacity\tto\tact\ton\tissues\tthat\tthey\tthemselves\tdefined\tas
\nimportant.\tHe\temphasised\tthe\timportance\tof\tthe\tpartnership\tbetween\tpatients\tand\tthose\tcaring\tfor\tthem.\tShared
\ndecision-making\twas\tabsolutely\tfundamental.\t\t<\/p>\n

Dr.\tHeikki\tP\u00e4lve,\tformer\tCEO\tof\tthe\tFinnish\tMedical\tAssociation,\tspoke\tabout\tdealing\twith\tpublic\topinion\tfrom
\nhis\trecent\texperience\tin\tFinland.\tHe\tsaid\tthat\tpublic\topinion\thad\tbeen\tstrongly\tin\tfavour\tof\teuthanasia\tas\twere
\n46\tper\tcent\tof\tphysicians.\tBut\tthe\tnational\tmedical\tassociation\twas\topposed.\tThis\tcreated\tdifficulties.\tHe\tbelieved
\nthat\teuthanasia\tfundamentally\tchanged\tand\tto\tsome\tdegree\talso\tdamaged\ttrust\tin\tthe\thealth\tcare\tsystem\tand
\nsaid\tthat\tthe\tslippery\tslope\targument\twas\ta\tfact,\tand\ta\tvery\tundesirable\tone.\t\t<\/p>\n

The\tconference\tconcluded\twith\ta\tlively\tpanel\tdiscussion\ton\twhether\tthere\twas\ta\tneed\tto\tchange\tWMA\tpolicy,
\nfeaturing\tspeakers\ton\tboth\tsides\tof\tthe\targument\tand\tquestions\tfrom\tthe\taudience.\t<\/p>\n

Summary\t\t<\/p>\n

Throughout\tthe\tmeeting,\tproponents\tof\tright-to-die\tpolicies\temphasised\tthat\ttheir\tintention\twas\tto\tprotect
\nphysicians\tin\ttheir\town\tcountries\twho\tare\tacting\twithin\tthe\tlaw,\tnot\tto\tchange\tor\tinfluence\tpolicies\tin\tother
\ncountries.\tThey\tbased\ttheir\targuments\ton\tthe\tconcepts\tof\tpatient\tself-determination,\tdignity\tand\tcompassion.
\nThose\twho\twere\topposed\tto\teuthanasia\tand\tPAS,\trepresenting\tthe\tmajority\tof\tattendees,\trejected\tthese
\nprocedures\tas\tbeing\tdiametrically\topposed\tto\tthe\tethical\tprinciples\tof\tmedicine\tand\texpressed\tconcern\tthat\tthey
\ncould\tlead\tto\tmisuse\tor\tabuse,\te.g.\tin\tthe\tcase\tof\tmentally\tor\tpsychologically\tincapacitated\tpeople.\tThey\talso
\nexpressed\tconcern\tthat\tthese\tprocedures\tcould\tcause\tdamage\tto\tthe\tcomplete\ttrust\twhich\tcharacterises\tthe
\npatient-physician\trelationship\tor\tlead\tto\tsocial\tpressure\tfor\tthe\telderly\tor\tthose\twith\tchronic\tillness\tto\tend\ttheir
\nlives.\t\t<\/p>\n

The\tmajority\tof\tattendees\tultimately\tadvocated\tfor\tthe\tretention\tof\tthe\texisting\tpolicies\tof\tthe\tWMA\ton
\neuthanasia\tand\tPAS.\t\t<\/p>\n

Despite\tdisagreements\tduring\tthe\tmany\tintentionally\ttransparent\tand\topen\tdebates\theld\tthroughout\tthe\tevent,
\nparticipants\twere\tunited\tin\ttheir\tsupport\tfor\thigh-quality,\taccessible\tpalliative\tcare\tand\ttheir\tbelief\tthat\tPAS\tand
\neuthanasia\tshould\tnever\tbe\tseen\tas\ta\tcost-saving\tmeasure.\t\t<\/p>\n

This\treport\tis\tbased\ton\tan\tarticle\tby\tNigel\tDuncan,\twhich\toriginally\tappeared\tin\tthe\tDecember\t2017\tissue\tof\tthe
\nWorld\tMedical\tJournal,\tand\tcontains\tsupplementary\tmaterial.
\n\u00a7\u00a7\u00a7
\n04.04.2018<\/p>\n

1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument
\nno:
\nMEC 209\/Genetic and Medicine\/Apr2018 Original:
\nEnglish
\nTitle: Proposal for a major revision of the
\nWMA statement on Genetics and
\nMedicine
\nDestination: Medical Ethics Committee
\n209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nFor
\nconsideration
\nThe Danish Medical Association believes that it would be timely for the WMA to initiate a major
\nrevision of the WMA Statement on Genetics and Medicine. The main reason for our proposal is that
\nthe current version of the statement does not deal sufficiently with the ethical issues that arise
\nthrough the development and use of NGS in personalized medicine.
\nThe goal of a major revision would be to develop the statement to:
\n– include a thorough treatment of the ethical implications of using NGS for personalized
\nmedicine
\n– be up-to-date with regards to the ethical issues of genetics and medicine that are included in
\nthe current statement
\n– be aligned with the principles of the WMA Declaration of Taipei on Ethical Considerations
\nregarding Health Databases and Biobanks
\nEthically relevant features of personalized medicine
\nThere is no universally recognized definition of personalized medicine1
\nbut the salient feature is
\nthat it aims to adapt treatment to individual patients. This is often done by identifying genetic
\ncharacteristics of either the patient or the illness and then adapting the treatment in accordance with
\nthe significance of those characteristics. The goal is to improve our ability to diagnose and classify
\nillnesses in order to prevent or treat them more precisely, effectively and with fewer, less severe
\nside effects.2
\nPersonalized medicine entails ethical issues both through its development and in its use. The key
\nreason for this is that both the development and application of personalized medicine often involves
\nextensive genome sequencing.
\n1
\nSometimes also referred to as precision medicine or genomic medicine.
\n2
\nPersonalizing medicine can also be sought by adapting the treatment to other relevant person-specific features than
\ngenetic ones. In this context, we will however attention on the relevance of genetic features as is it is mainly increased
\nattention to those features that generates the ethically relevant issues.
\nMarch 2018 MEC 209\/Genetic and Medicine\/Apr2018
\n2
\nA key feature in relation to developing personalized medicine is that large groups of participants
\nhave their whole genomes sequenced and that data from that process is analyzed exploratively in
\ncombination with other types of health care data to identify correlations and patterns that might be
\nof clinical relevance.
\nThe information generated by extensive genome sequencing, including whole genome sequencing,
\noften has the following characteristics:
\n– Very large volumes of health care data are generated about each participating person and the
\ndevelopment of personalized medicine requires the sequencing genomes from large number
\nof persons
\n– The full significance of the data is not known at the time of the sequencing, which means that,
\nat a later time, the data could be used to generate much more information about the individual
\n– There is a significant risk of secondary or incidental findings which might include
\ninformation about health care risks
\n– The data generated from the sequencing of one person\u2019s genome contains information about
\nother genetically related persons
\n– Due to the nature of the data generated by genome sequencing, the data cannot be fully
\nanonymized
\n– The genetic information generated by the sequencing is permanent for each participating
\nperson
\nIndividually, each of these characteristics could also be found in other types of health care
\ninformation. For example, incidental findings regularly occur in relation to radiological
\nexaminations.
\nHowever, the combination of the characteristics makes data from extensive genome sequencing
\nparticularly sensitive and therefore detailed ethical guidelines are appropriate.
\nA working group to revise the current statement
\nIn light of this \u2013 and that the development and use of personalized medicine is expected to
\naccelerate in the coming years \u2013 we believe that it would be relevant to initiate a major revision of
\nthe WMA-Statement on Genetics and Medicine. Specifically, we propose that the WMA establishes
\na working group to be responsible for the revision and the DMA would be happy to responsible for
\nsuch a working group.
\nWe are aware that the current statement is up for review in 2019 but given the speed of the
\ndevelopment of personalized medicine and the use of NGS, we believe that a revision should be
\ninitiated now.
\n\u00a7\u00a7\u00a7
\n19.03.2018
\n1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument
\nno:
\nMEC 209\/Biosimilar Medicinal
\nproduct\/Apr2018
\nOriginal:
\nEnglish
\nTitle: Proposed WMA Statement on Biosimilar
\nMedicinal Products
\nDestination: Medical Ethics Committee
\n209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nFor
\nconsideration
\nNote This WMA Statement is proposed to the Committee by the Israeli
\nMedical Association.
\nPREAMBLE
\n1. The expiry of patents for the first original biotherapeutics has led to the development and
\nauthorization of copy versions, called \u2018similar biological medicinal products\u2019’ or biosimilars.
\nthat are highly similar to an already approved biological medicine, known as the reference
\nmedicine.
\n2. In light of the fact that biosimilars are made in living organisms, there may be some minor
\ndifferences from the reference medicine. The manufacture of biosimilars tends to be more
\ncomplex than for chemically derived molecules. Therefore, the active substance in the final
\nbiosimilar can have an inherent degree of minor variability. Biosimilars are not always
\ninterchangeable with the reference products even after regulatory approval.
\n3. Biosimilars are not the same as generics. A generic drug is an identical copy of a currently
\nlicenced pharmaceutical product that has an expired patent protection and must contain the
\n\u2018same active ingredients as the original formulation\u2019. A biosimilar is a different product with a
\nsimilar, but not identical, structure that elicits a similar clinical response. As a result,
\nbiosimilars medicines have the potential to cause an unwanted immune response. Whereas
\ngenerics are interchangeable, biosimilars are not.
\n4. Biosimilars have been available in Europe for almost a decade following their approval by the
\nEuropean Medicines Agency (EMA) in 2005. The first biosimilar was approved by the FDA
\nfor use in the U.S. during 2015.
\n5. Biosimilar medicines have transformed the outlook for patients with chronic and debilitating
\nconditions, as similar efficacy as that of the innovator product can be obtained at a lower cost.
\n6. Biosimilars will also increase access for patients without access to the bio-originator. Greater
\nglobal access to effective biopharmaceuticals can reduce disability, morbidity, and mortality
\nassociated with various chronic diseases.
\nMarch 2018 MEC 209\/Biosimilar Medicinal Products\/Apr2018
\n2
\n7. Nonetheless, the potentially lower cost of biosimilars raises the risk that insurers may favor
\nthem over the original reference medicine, even when they may not be appropriate for an
\nindividual patient.
\nRECOMMENDATIONS
\n8. National medical associations should work with their governments to cultivate national
\nguidance on safety of biosimilars.
\n9. National medical associations should advocate for delivering biosimilar therapies that are as
\nsafe and effective as their reference products.
\n10. National medical associations should lobby against allowing insurers and health funds to
\npromote biosimilar and reference medicine\u2019s interchangeability and automatic substitution, that
\ncan be to the detriment of patients.
\n11. Physicians must ensure that patient medical records accurately reflect the biosimilar medicine
\nthat is being taken.
\n12. Physicians shouldn\u2019t prescribe a biosimilar to patients already showing success with the
\nreference medicine.
\n13. Physicians should raise awareness of the issues surrounding biosimilars and promote clearly
\ndelineated labelling of biosimilars.
\n19.03.2018
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument
\nno:
\nMEC 209\/Policy Review 2008\/Apr2018 Original:
\nEnglish
\nTitle: Annual Policy Review 2008:
\nRecommendations received on MEC
\ndocuments
\nDestination: Medical Ethics Committee
\n209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nFor
\nConsideration
\nThe ongoing policy review process adopted by the WMA requires a review of every policy for which
\nit had been ten years since adoption or last revision.
\nThe first step in the review process is to survey Constituent Members for their advice on whether a
\npolicy requires (a) reaffirmation, (b) minor or editorial changes before reaffirmation (c) a major
\nrevision, or (d) rescinding and archiving. On 6 February 2018, a memo was sent to Constituent
\nMembers asking them to recommend the classifications of the 2008 policies. The result of this
\nconsultation is as follows:
\n1) List of Respondents (26):
\nAustralian Medical Association (AuMA) Norway Medical Association (NMA)
\nBangladesh Medical Association (BMA) Netherlands medical Association(RDMA)
\nCanadian Medical Association (CMA) Consejo General de Colegios Medicos de Espa\u00f1a
\n(CGCM)
\nConseil National de l\u00b4Ordre des M\u00e9decins
\nFrance (CNOM)
\nSwedish Medical Association (SwMA)
\nDanish Medical Association (DMA) Taiwan Medical Association (TMA)
\nIsraeli Medical Association (IsMA) Medical Association of Thailand (MAT)
\nJapan Medical Association (JMA) Turkish Medical Association (TuMA)
\nKorean Medical Association (KMA) British Medical Association (BMA)
\nKuwait Medical Association (KuMA) Vatican Medical Association (AMV)
\nGerman Medical Association (GMA) Pakistan Medical Association (PkMA)
\nAustrian Medical Chamber (AMC) Finnish Medical Association (FMA)
\nRwanda Medical Association (RMA) American Medical Association (AMA)
\nColegio Medico de Mexico (CMM) South African Medical Association (SAMA)
\nMarch 2018 MEC 209\/Policy Review 2008\/Apr2018
\n2) Policies abbreviations:
\nCapital punishment: Resolution on Physician Participation in Capital Punishment
\nTorture : Resolution on the Responsibility of Physicians in the Denunciation of Acts of
\nTorture or Cruel, Inhuman or Degrading Treatment of Which They are
\nAware
\nCode of ethics: International Code of Medical Ethics (MEC)
\n3) Specific comments from NMAs:
\nCapital punishment *
\n(JMA) JMA believes that \u00abResolutions\u00bb should not undergo a major revision because they are
\nsupposed to have been adopted reflecting the times when they were adopted. This resolution should
\nbe also reaffirmed without changes.
\n(KMA) Merging this resolution with the WMA Resolution to reaffirm the WMA’s Prohibition of
\nPhysician Participation in Capital Punishment.
\n(SwMA) We agree with the Secretariat\u00b4s suggestion to merge this resolution with the \u00abWMA
\nResolution to reaffirm the WMAs prohibition of physician participation in capital punishment\u00bb.
\n(BMA) We agree that is makes little sense to have two documents saying much the same thing.
\nTorture
\n(JMA) Citing the other related documents will lead to an endless, unnecessary procedure.
\n(KMA) If a doctor recognizes that a patient has been under torture and other cruel, inhuman or
\ndegrading treatment, it should be accurately recorded and kept with the ethical obligation to report
\nto an authorized institution. However, since there are concerns about patients and doctors being
\nunder retaliation, or the infringement of personal information, it is necessary to take extra caution.
\n(SwMA) This resolution has a long introduction, in which a large number of declarations,
\nconventions and resolutions are mentioned. To put greater focus on the actual recommendations,
\nperhaps the introduction could be shortened and, if necessary, reference to the different documents
\nplaced in an annex or footnotes?
\n(RDMA) We also think that it is important to qualify in this Resolution the relation with the other
\nones. More in general should the WMA be careful to have several resolutions, statements and
\nDeclarations on the same subject
\n(DMA) The DMA recommends a major revision for this resolution. While the document contains
\nmany important messages, these messages are not well communicated. For example, the documents
\nshould not open with 15 references to other documents without a clear statement on the relevance of
\nthose messages.
\n(AMA) We recommend a major revision. The policy would benefit from re-formatting to the
\ncustomary WMA style and has too many extraneous references at the beginning of the document.
\nCode of Ethics
\nMarch 2018 MEC 209\/Policy Review 2008\/Apr2018
\n(JMA) agrees to the viewpoints of the WMA Secretariat. It is true that ICME is now complemented
\nby the other ethics policies, and requires a thorough review. WMA should start working on this
\nreview process internally while paying due consideration to the DoG.
\n(RDMA) At first glance we don’t see a need for complete re-writing. We do however think it is very
\nuseful to compare all the different documents of the WMA dealing with medical ethics and conduct
\nof physicians. Maybe it is possible to merge some of them? Also it is very important that they
\ncontain consistent messages. Therefore, we suggest that a broader project, comparing the
\nWMA-documents may, may be useful. Apart from that and because of that we do agree with
\npostponing the revision process of this particular Code of Medical Ethics, with the implementation
\nof the DoG still going on.
\n(DMA) The WMA-secretariat recommends that decision on this document be postponed to avoid
\nconfusion during the ongoing reception of the DoG. While the DMA certainly agrees that such
\nconfusion must be avoided, we do believe that a decision to start a major revision is appropriate –
\nand that the revision process could be initiated after the meeting in Riga. The revision of this
\nimportant document must be very thorough indeed and will require a substantial internal WMA
\nprocess. By the time a public consultation may be appropriate, we believe that the risk of confusion
\nwith the DoG will be minimal. The DMA would be proud to participate in the reviewing process as
\nwe have just finalized a reviewing process of our own ethical principles.
\n(TuMA) It could be useful to review it thoroughly after updating DoGeneva.
\n(FMA) Agree with postponing by one year. Internal work could start even earlier.
\n4) Constituent Members\u2019 classification
\nName of Policy
\nConstituent Members
\nCapital
\nPunishment
\nTorture Code of ethics
\nAMA Merge C Postpone
\nAMC Merge B Postpone
\nAMV Merge B Postpone
\nAuMA C B Postpone
\nBaMA A A A
\nCMA A B Postpone
\nCGCM B Postpone
\nCMM B Postpone
\nCNOM C B Postpone
\nDMA B C C
\nFMA Merge B Postpone
\nGMA A B C
\nIsMA Merge B Postpone
\nJMA A A Postpone
\nKMA Merge B Postpone
\nKuMA Merge A C
\nNMA Merge B
\nPkMA A B Postpone
\nRDMA Merge B Postpone
\nRMA A B B
\nMarch 2018 MEC 209\/Policy Review 2008\/Apr2018
\nSAMA B A
\nSwMA Merge B Postpone
\nTMA A B
\nMAT A A A
\nTuMA Merge B C
\nBMA Merge B C
\nTOTAL 24 26 23
\n5) Summary of classification
\nName of Policy
\nClassification
\nCapital Punishment Torture Code of Ethics
\nReaffirm (a) 8 5 2
\nReaffirm with minor
\nrevision (b)
\n1 19 1
\nMajor revision (c) 2 2 5
\nRescind and archive (d)
\n12 (merge) 15 (postpone
\ndecision)
\nProposed
\nclassification based on
\nmembers\u2019
\nrecommendations
\nMerge with WMA
\nResolution to reaffirm the
\nWMA\u2019s Prohibition of
\nPhysician Participation in
\nCapital Punishment *
\nB Postpone decision
\nIn the light of this response, the Committee is asked to recommend to Council a classification for
\nthis policy in MEC.
\nThe Secretariat can take care of a policy requiring minor revision, which will be circulated to the
\nmember associations for comment and considered at the October 2018 Committee and Council
\nmeetings. Constituent Members are invited to volunteer, either individually or in workgroups, to
\nundertake any major policy revision. Recommendations for rescinding and archiving will go to the
\nAssembly in October 2018 for final decision.
\n\u00a7\u00a7\u00a7
\n09.04.2018
\n1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument
\nno:
\nFPL 209\/Agenda\/Apr2018\/Rev Original:
\nEnglish
\nTitle: Agenda of the Finance and Planning
\nCommittee
\nDestination: Finance and Planning Committee
\n209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nFor
\nconsideration
\nNote: This agenda has been revised on the items 3.1, 3.3 and 5.2.
\nThursday, 26 April 2018
\nMembership of the Committee
\nDr Moojin Choo Dr Toru Kakuta
\nDr Louis Francescutti Dr Mari Michinaga
\nDr Andrew W. Gurman Dr Andreas Rudkjoebing
\nDr Ren\u00e9 H\u00e9man (Chair) Dr Julio Trostchansky
\nDr Miguel Roberto Jorge Dr Walter Vorhauer
\nEx-officio (with voting rights)
\nDr Ardis Dee Hoven, Chair of Council
\nDr Frank Ulrich Montgomery, Vice-Chair of Council
\nDr Andrew Dearden, Treasurer
\nEx-officio (without voting rights)
\nDr Yoshitake Yokokura, President
\nDr Leonid Eidelman, President-Elect
\nDr Ketan Desai, Immediate Past President
\nDr Otmar Kloiber, Secretary General
\nMs Marie Collegrave-Juge, Legal Advisor
\nMr Adolf H\u00e4llmayr, Financial Advisor
\nMs Joelle Balfe, Facilitator
\nMs Sunny Park, Head of Operations
\nMarch 2018 FPL 209\/Agenda\/Apr2018
\n2
\n1. GENERAL BUSINESS
\n1.1 Call to order by the Chair of the Council
\n1.2 Report of the previous meeting held in Chicago, United States, 11-14 October 2017
\nApprove: Report of the Finance and Planning Committee
\n(FPL 207\/Report\/Oct2017)
\n1.3 Chair\u2019s Opening Remarks
\n2. FINANCE
\n2.1 Membership Dues Payments
\nConsider: Report on Membership Dues Payments for 2018
\n(FPL 209\/Dues Report\/Apr2018)
\nReceive: Oral Report on Dues Arrears
\n2.2 Financial Statement
\nConsider: Pre-audited Financial Statement for 2017
\n(FPL 209\/FinStat 2017\/Apr2018)
\n3. PLANNING
\n3.1 WMA Strategic Plan
\nConsider: Oral report by the Secretary General on the Draft Strategic Plan 2020
\n3.2 WMA Statutory Meetings
\nConsider: Planning of Future WMA Meetings
\n(FPL 209\/WMA Future Meetings\/Apr2018)
\n3.3 WMA Special Meetings
\nReceive: Oral Report
\n1) WMA Meetings in Geneva during WHA, 21-26 May 2018
\n2) Icelandic Medical Association \/ WMA Medical Ethics Conference
\nOctober 1-4, 2018 in Reykjavik, Iceland
\n3) 13th UNESCO World Conference on Bioethics, Medical Ethics and
\nHealth Law in Jerusalem, Israel, 27-29 November 2018
\n4) 14th
\nWorld Congress of Bioethics and 7th National Bioethics Conference,
\nBangalore, India, December 3-7, 2018, Potential WMA participation
\nMarch 2018 FPL 209\/Agenda\/Apr2018
\n3
\n4. MEMBERSHIP
\n4.1 Constituent membership
\nConsider: Applications for Constituent members, if any
\n4.2 Associate Membership
\nConsider: Report of the WMA Associate Membership for 2017
\n(FPL 209\/AM Membership\/Apr2018)
\nReceive: Report of Chair of Associate Members
\n(FPL 209\/Chair of AM Report\/Apr2018)
\nReceive: Report of the Junior Doctors Network (JDN)
\n(FPL 209\/JDN Report\/Apr2018)
\nReceive: Report of the Past Presidents and Chairs of Council Network (PPCN)
\n(FPL 209\/PPCN Report\/Apr2018)
\n5. GOVERNANCE
\n5.1 Review Committee
\nReceive: Oral report of the Chair of Review Committee
\n5.2 Nominating process for senior posts
\nConsider: Proposal to introduce a self-declaration statement to the nominating process
\nfor WMA Presidency (FPL 209\/Nominating process\/Apr2018)
\n6. OUTREACH
\n6.1 World Medical Journal
\nReceive: Report of WMJ Editor
\n(FPL 209\/WMJ Report\/Apr2018)
\n6.2 Public Relations
\nReceive: Public Relations Report for October 2017 \u2013 March 2018
\n(FPL 209\/PR Report\/Apr2018)
\n7. ANY OTHER BUSINESS
\n8. ADJOURNMENT
\n\u00a7\u00a7\u00a7
\n29.03.2018<\/p>\n

1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument
\nno:
\nFPL 207\/Report\/Oct2017 Original:
\nEnglish
\nTitle: Report of the Finance and Planning
\nCommittee
\nDestination: Finance and Planning Committee
\n209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nFor
\nconsideration
\nWednesday, 11 October 2017
\nMembership of the Committee
\nDr Moojin Choo Dr Toru Kakuta
\nDr Louis Francescutti Dr Mari Michinaga
\nDr Andrew W. Gurman Dr Andreas Rudkjoebing
\nDr Ren\u00e9 H\u00e9man (Chair) Dr Julio Trostchansky
\nDr Miguel Roberto Jorge Dr Walter Vorhauer
\nEx-officio (with voting rights)
\nDr Ardis Dee Hoven, Chair of Council
\nProf. Dr med. Frank Ulrich Montgomery, Vice-Chair of Council
\nDr Andrew Dearden, Treasurer
\nEx-officio (without voting rights)
\nDr Ketan Desai, President
\nSir Michael Marmot, Immediate Past President
\nDr Yoshitake Yokokura, President-Elect
\nDr Otmar Kloiber, Secretary General
\nMs Marie Colegrave-Juge, Legal Advisor
\nMr Adolf H\u00e4llmayr, Financial Advisor
\nProf Vivienne Nathanson, Facilitator
\n1. GENERAL BUSINESS
\n1.1 The Chair of the Council called the meeting to order at 11:40 am.
\nOctober 2017 FPL 207\/Report\/Oct2017
\n2
\n1.2 The Committee approved the report of the previous meeting held in Livingstone from
\n20-22 April 201 (FPL 206\/Report\/Apr2017).
\n1.3 The Chair thanked the American Medical Association for hosting the meeting. He
\nnoted the very full agenda and the fact that the work of the Finance and Planning
\nCommittee enables the health of the organization and its ability to pursue its mission.
\n2. FINANCE
\n2.1 Financial Statement
\n2.1.1 The Committee considered the Audited Financial Statement for 2016 (FPL
\n207\/FinStat 2016\/Oct2017). The WMA Treasurer, Dr Andrew DEARDEN,
\nhighlighted several key points from the Statement.
\nThe Treasurer also addressed concerns about accepting funding from the
\npharmaceutical industry. He stressed that we must be transparent about where
\nall funding comes from, the amounts, and the projects or activities to which
\nthey are applied. The Secretary General stated that it is WMA\u2019s policy to
\navoid any undue influence on the work of the WMA and that information about
\nsponsorship is available in the Secretary General Report to the Council.
\nAccording to US law, it is also published on the websites of the donors. The
\nTreasurer stressed that funding from outside sources is not used for the core
\nwork of the WMA, including the cost of statutory meetings. This funding is
\nused exclusively for special projects, including educational efforts and other
\nmeetings.
\nRECOMMENDATION
\n2.1.1.1 That the Audited Financial Statement for 2016 (FPL 207\/FinStat
\n2016\/Oct2017) be approved by the Council and be forwarded to the
\nGeneral Assembly for approval and adoption.
\n2.1.2 The Committee received the oral report on 2016 Dues Arrears. The Treasurer
\nannounced that 99.35 % of 2016 contributions had been received.
\n2.2 WMA Budget and Membership Dues Payments
\n2.2.1 The Committee considered the Proposed WMA Budget for 2018 vs. Actual
\n2016 Expenditures (FPL 207\/Budget 2018\/Oct2017).
\nThe Treasurer reviewed the details of the report, including some of the new
\nproposed activities that would be possible due to the WMA\u2019s strong financial
\nsituation. The Canadian Medical Association asked the Treasurer to clarify
\nwhether the proposed new projects would be accomplished within the existing
\nstaff resources or would require hiring additional staff at the WMA Secretariat.
\nThe Secretary General responded that some of the activities would be
\naccomplished by existing staff, but that there was a plan to add new staff to
\nsupport the expanded work. He introduced the newest WMA Staff member,
\nCommunication and Information Manager Ms. Magda MIHAILA.
\nOctober 2017 FPL 207\/Report\/Oct2017
\n3
\nRECOMMENDATION
\n2.2.1.1 That the Proposed WMA Budget for 2018 (FPL 207\/Budget
\n2018\/Oct2017) be approved by the Council and be forwarded to the
\nGeneral Assembly for adoption.
\n2.2.2 The Committee received the Report on Membership Dues Payments for 2017
\n(FPL 207\/Dues Report\/Oct2017) including the dues in arrears. This document
\nwill be forwarded to the General Assembly for information.
\n2.2.3 The Committee received WMA Dues Categories 2018 (FPL 207\/Dues
\nCategories 2018\/Oct2017). This document will be forwarded to the General
\nAssembly for information.
\n2.2.4 The Committee received the oral report of Finance Workgroup. The Treasurer
\nreported that the workgroup would review the WMA sponsorship policy,
\nwhich should be done periodically to ensure that it is clear and current. He
\nnoted the launch of the educational platform that would occur late in 2017 or
\nearly 2018, which was possible due to the accumulated financial surplus.
\nThe Secretary General reported on the situation in Venezuela and asked the
\nCommittee to support the Finance Group\u2019s request that the WMA waive the
\ndues for the Venezuelan Medical Association for 2017 and consider them in
\ngood standing.
\nRECOMMENDATION
\n2.2.4.1 That the Council waive the membership dues of the Venezuela
\nMedical Association.
\n2.3 Auditor
\nThe Committee considered an oral report and the recommendation of the Treasurer to
\nreappoint KPMG as the auditor for the 2017 WMA Financial Statement.
\nRECOMMENDATION
\n2.3.1 That the Council appoint KPMG as auditor of the 2017 WMA Financial
\nStatement.
\n3. PLANNING
\n3.1 WMA Strategic Plan
\nThe Secretary General reported that he had been instructed by Council to delay
\ndevelopment of the next Strategic Plan, pending the outcomes from the Governance
\nworkgroup, which has now concluded its mandate. The recommendations in the
\nworkgroup\u2019s final report will be integrated into the next Strategic Plan. The draft
\nStrategic plan will be presented at the Council Session in April 2018.
\nOctober 2017 FPL 207\/Report\/Oct2017
\n4
\n3.2 WMA Statutory Meetings
\nThe Committee considered the planning and arrangements for future WMA meetings
\n(FPL 207\/WMA Future Meetings\/Oct2017).
\n3.2.1 The Secretary General informed the committee that the recent unrest and the
\ntreatment of physicians, human rights defenders, and persons critical of the
\ngovernment in Turkey has led to a recommendation by the ExCo that WMA
\nreverse last year\u2019s decision to hold the 2019 General Assembly in Istanbul. The
\nSecretary General recognized that this is unfortunate, as it was WMA\u2019s hope to
\nbe able to support the TMA by holding the meeting there. Several members
\nechoed their regret at the situation. He proceeded to explain that the Georgian
\nMedical Association had agreed to host the General Assembly in 2019 instead
\nof 2020. Therefore, the ExCo is recommending that WMA postpone
\nindefinitely the invitation of the Turkish Medical Association and accept the
\nGeorgian Medical Association\u2019s offer to host the 2019 General Assembly.
\nThe Secretary General clarified that this postponement will be reconsidered
\nwhen the situation in Turkey stabilizes. He added that the WMA would release
\na press statement explaining the WMA\u2019s decision not to go to Istanbul in 2019
\nand expressing our continued strong support for the TMA.
\nRECOMMENDATION
\n3.2.1.1 That the Council recommend to the Assembly that the WMA
\npostpone indefinitely the invitation of the Turkish Medical
\nAssociation to host a meeting in 2019 and accept the Georgian
\nMedical Association\u2019s offer to host the 2019 General Assembly.
\n3.2.2 The Committee considered the invitation of the Portuguese Medical
\nAssociation to host the 215th
\nCouncil session in 2020.
\nRECOMMENDATION
\n3.2.2.1 That the invitation of the Portuguese Medical Association to host the
\n215th
\nCouncil Session in Porto in April 2020 be accepted.
\n3.2.3 The Committee considered the invitation of the German Medical Association
\nto host the 73rd General Assembly in 2022.
\nRECOMMENDATION
\n3.2.3.1 That the invitation of the German Medical Association to host the 73rd
\nGeneral Assembly in Berlin in October 2022 be accepted.
\n3.2.4 Regarding the Council\u2019s decision in April 2017 to recommend that the 2021
\nGeneral Assembly be held in China, the Secretary General informed the
\nCommittee that he had remaining concerns regarding free access by the press
\nduring the meeting as well as issues related to electronic communications, the
\nmethod by which WMA organizes and shares documents. He noted that he
\nOctober 2017 FPL 207\/Report\/Oct2017
\n5
\nbelieved both concerns could be resolved but that they currently represented
\nissues that need to be addressed.
\nAt the direction of the ExCo, the Secretary General informed the Committee
\nthat the World Heart Federation had been denied permission at the last minute
\nto hold a meeting in China unless its member from Taiwan agreed to change its
\nname. If this happened to the WMA, both the WMA and participants would
\nrisk losing money spent on the meeting, travel arrangements, and registration
\nfees, which could amount to more than 500,000 Euros. In discussion, it was
\nclear that the divergence of positions between the Chinese Medical Association
\nand the Taiwan Medical Association regarding the name of the Taiwan
\nMedical Association remained unresolved. The Secretary General reminded
\nthe Committee that the WMA has previously made a decision not to interfere
\nin this internal political situation and stressed that the WMA has no mandate or
\nstatute that gives us the right to make any demands regarding the name of a
\nmember. Several members supported this decision in their comments during
\ndiscussion. The Secretary General informed the Committee of the ExCo\u2019s
\nrecommendation that the two medical associations, possibly with help from the
\nWMA providing a moderator, use the next year to reach an agreement on this
\nmatter and that the Committee wait until 2018 to consider any changes to our
\nplan to hold the 2021 General Assembly in China.
\nThe medical associations from China and Taiwan agreed to discuss the issue of
\nthe name of the Taiwan Medical Association between themselves, possibly
\nwith support from the WMA.
\nThe April 2017 decision of the Council to recommend to the 2017 General
\nAssembly that WMA accept the invitation of the Chinese Medical Association
\nto host the meeting in 2021 remains on the agenda (GA Council Report-
\nProvisional Annex\/Oct2017, Item 4.1) and will be presented to the Assembly
\nduring the plenary session.
\n3.3 WMA Special Meetings
\nThe Committee received the oral report from the Secretary General concerning two
\nmeetings:
\n3.3.1 Dr Jon SN\u00c6DAL informed the Committee that the Icelandic Medical
\nAssociation and the WMA will hold a Medical Ethics Conference October in
\nconjunction with the WMA General Assembly in Reykjavik, Iceland, 1-4
\nOctober, 2018 in Reykjavik, Iceland
\n3.3.2 13th UNESCO World Conference on Bioethics, Medical Ethics and Health
\nLaw in Jerusalem, Israel, 27-29 November 2018.
\n3.3.3 Nominations are closed for the WMA CPW Leadership course, which will be
\nheld from 3-8 December 2017. This meeting will be held in cooperation with
\nthe Mayo Clinic and receives financial support from Bayer and Pfizer.
\nOctober 2017 FPL 207\/Report\/Oct2017
\n6
\n4. MEMBERSHIP
\n4.1 Constituent membership
\n4.1.1 The Committee considered the Application from the Czech Medical Chamber
\n(FPL 207\/Apply-Czech\/Oct2017). The Secretary General explained that the
\nCzech Medical Association, a longtime WMA member, recently terminated its
\nmembership in WMA in recognition of the fact that the Czech Medical
\nChamber is a more representative of physicians in the country and more
\nappropriate organization to be the WMA member from the Czech Republic.
\nRECOMMENDATION
\n4.1.1.1 That the Czech Medical Chamber be admitted to the WMA
\nConstituent Membership.
\n4.1.2 The Committee considered the Application from the Belarusian Association of
\nPhysicians (FPL 207\/Apply-Belarus\/Oct2017). The Secretary General
\nexplained that WMA has been in contact with this Association for many years
\nand now welcomes their application for membership in WMA. The
\norganization does have a legal advisor who is a member of their board and
\ntherefore a member of their association, but this does not create an issue with
\nour bylaws and should not preclude their membership in WMA.
\nRECOMMENDATION
\n4.1.2.1 That the Belarusian Association of Physicians be admitted to the
\nWMA Constituent Membership.
\n4.1.3 The Committee considered the Application from the Pakistan Medical
\nAssociation (FPL 207\/Apply-Pakistan\/Oct2017). The Secretary General
\ninformed the Committee that the Pakistan Medical Association was previously
\na WMA member. Thanks to the work of WMA President, Dr. Ketan Desai,
\nthey have been persuaded to re-join WMA. The Pakistan Medical Association
\ndoes have six non-physician \u201chonorary members\u201d for specific merits, but we
\ndo not believe this creates any conflict with our ability to support their
\napplication for WMA membership.
\nRECOMMENDATION
\n4.1.3.1 That the Pakistan Medical Association be admitted to the WMA
\nConstituent Membership.
\n4.1.4 The Committee considered the Application from the National Medical
\nChamber of Russia (NMC) (FPL 207\/Apply-Russia\/Oct2017)
\nThe Secretary General explained that the Russian Medical Chamber includes
\norganizations from 79 of the 82 regions in Russia, with the remaining three
\nscheduled to join the NMC later this year. He considered the NMC the most
\nrepresentative of the national-level physician organizations in Russia, with a
\nstrong focus on self-governance, aiming to steer and supervise physician
\nOctober 2017 FPL 207\/Report\/Oct2017
\n7
\nconduct and develop ethical standards. Following careful review of their
\napplication by the WMA Legal Advisor, Mr. Marie COLEGRAVE, it was his
\nrecommendation that WMA approve their application. In response to a request
\nfrom the Danish Medical Association, the Secretary General provided an
\noverview of the assessments WMA had done to learn about the NMC and the
\nreasons the NMC appears to be the most representative association in Russia.
\nIn response to a question from the Canadian Medical Association, the
\nSecretary General explained that the amount of dues paid by the NMC would
\nbe low at first. He had made it clear to the President of the NMC that he
\nexpected the dues payments to increase incrementally as the financial strength
\nof the organization grows. Dr. Peteris Apinis, President of the Latvian Medical
\nAssociation, stated that he was familiar with the organization and its very well-
\nrespected leader.
\nThe Secretary General noted that there remains an issue of former WMA
\nmember, the Russian Medical Society (RMS), which apparently believes it still
\nhas standing in WMA, despite being automatically terminated early in 2017 for
\nnon-payment of the subscription due. The RMS had sent a letter to WMA,
\nessentially threatening legal action if the WMA accepts another member from
\nRussia. The ExCo discussed this in depth and concluded that this should not
\ninterfere with the decision to admit the NMC into membership.
\nRECOMMENDATION
\n4.1.4.1 That the National Medical Chamber of Russia be admitted to the
\nWMA Constituent Membership.
\n5. GOVERNANCE
\n5.1 Governance Review
\nThe Committee received the Report of the Governance Review Workgroup (FPL
\n207\/Governance Review\/Oct2017) by Prof. Dr Rutger J. van der GAAG, the Chair of
\nWorkgroup.
\nProf. van der GAAG reported that the mandate and the work of the workgroup had
\nconcluded. He reviewed some additional recommendations resulting from the
\nworkgroup meeting the previous day that are not contained in the written report.
\nSeveral NMAs and the Chair of Council commended the workgroup Chair for his
\nexceptional leadership of the group, noting the progress made and trust built over time
\nas the workgroup considered numerous difficult issues.
\nThe Chair recognized that there remains work to do in order to implement the changes
\nrecommended by the workgroup. She informed the Committee that she would take the
\nWorkgroup report to the ExCo to discuss and develop a plan for moving forward,
\ndeciding what incremental, short term, and long-term activities WMA should undertake
\nto continue to make progress on the topics and issues identified. She stressed the
\nimportance of tying this work to the Strategic Plan and to be creative, forward thinking,
\nand deliberative about enacting change. The Chair of Council thanked the Workgroup
\nChair and its members for their hard work.
\nOctober 2017 FPL 207\/Report\/Oct2017
\n8
\nRECOMMENDATION
\n5.1.1 That the Council accept the report of the Workgroup and that it be presented to
\nthe General Assembly for information and discussion.
\n5.2 Review Committee
\nThe Chair of the Review Committee, Dr. Mark PORTER, reported that, following the
\nformation of the Committee in Livingstone, the Committee had reviewed the new
\nproposed policies for this meeting and was beginning cooperation with the Secretariat in
\nthe 10-year policy review process.
\n5.3 Revision of WMA Articles and Bylaws \/ Rules
\n5.3.1 The Committee considered the Proposed Revision of the Rules Applicable to
\nWMA Associate Membership (FPL 207\/AM Rules\/Oct2017).
\nThe Secretary General recommended that Medical Students and Junior Doctors
\nbe granted free Associate Membership for a period of five years, with the
\nunderstanding that they would not receive any products other than online
\naccess to the WMA members area and would not have voting rights in the
\nAssociate Members meeting.
\nRECOMMENDATION
\n5.3.1.1 That the Proposed Revision of the Rules Applicable to WMA
\nAssociate Membership (FPL 207\/AM Rules\/Oct2017) be approved by
\nthe Council and be forwarded to the General Assembly for approval.
\n5.3.2 The Committee considered the Appendix of the JDN Terms of Reference
\n(FPL 207\/JDN ToR Appendix\/Oct2017), which addressed election procedures
\nnecessitated by the increased membership of the group.
\nRECOMMENDATION
\n5.3.2.1 That the Appendix of the JDN Terms of Reference (FPL 207\/JDN
\nToR Appendix\/Oct2017) be approved by the Council.
\n6. OUTREACH
\n6.1 Associate Members Report
\nThe Committee deferred the Report of the Chair of Associate Members (FPL
\n207\/Chair of AM Report\/Oct2017) by Dr. Joseph HEYMAN, to the Council.
\n6.2 Past Presidents\u2019 and Chairs\u2019 Network
\nThe Committee deferred the Report of the Past Presidents and Chairs of Council
\nNetwork (PPCN) (FPL 207\/PPCN Report\/Oct2017) to the Council.
\nOctober 2017 FPL 207\/Report\/Oct2017
\n9
\n6.3 JDN Report
\nThe Committee deferred the Report of the Junior Doctors Network (JDN) (FPL
\n207\/JDN Report\/Oct2017) by Dr. Caline MATTAR, to the Council.
\n6.4 World Medical Journal
\nThe Committee deferred the Report by the WMJ Editor (FPL 207\/WMJ\/Oct2017) by
\nDr. Peteris APINIS, to the Council.
\n6.5 Public Relations
\nThe Committee deferred the Public Relations Report for May \u2013 September 2017 (FPL
\n207\/PR Report\/Oct2017) by WMA Press Officer Mr. Nigel DUNCAN, to the Council.
\n7. ANY OTHER BUSINESS
\nNo other business was raised.
\n8. ADJOURNMENT
\nThe meeting was adjourned at 14:55.
\n\u00a7\u00a7\u00a7
\n12.10.2017<\/p>\n

1
\nCOMPARISON OF MEMBERSHIP DUES PAID IN 2018, 2017 AND 2016
\nCONSTITUENT MEMBERS – COUNTRY
\nMembership rate per member
\nCategory A – 0,40 2018 2017 2018\/2017 2016
\nCategory B – 0,95 Euro Euro Euro Euro
\nCategory C – 1,60 Rate Classes Rate Classes Rate Classes
\nCategory D – 2,15 A-D\/member A-D\/member A-D\/member
\n1. Current year
\nAFRICA
\nANGOLA B – C – – C
\nCABO-VERDE B – B – – B
\nCAMEROON B – B – – B
\nCONGO A 6 000 A -6 000 – A
\nC\u00d4TE D\u2019IVOIRE B 95 B -95 95 B
\nEGYPT B – B – – B
\nETHIOPIA A – A – – A
\nGHANA 1 055 B 1 055 B – 1 055 B
\nGUINEA A 120 A – A
\nKENYA B 713 B – B
\nLESOTHO B – B – B
\nMALAWI A – A – 40 A
\nMALI A – A – – A
\nMOZAMBIQUE A – A – – A
\nNAMIBIA C – C – – C
\nNIGERIA 14 250 B 14 250 B – 1 285 B
\nRWANDA 80 A A – A
\nS\u00c9N\u00c9GAL A 544 A -544 – B
\nSOMALIA *** A – A – – A
\nSOUTH AFRICA 14 040 C 14 040 C – 14 040 C
\nSUDAN B – B – – B
\nDestination: Finance and Planning Committee
\n209th Council Session
\nRadisson Blu Latvija Hotel
\nAction(s)
\nrequired:
\nThis document is composed of two parts, comparison of
\nmembership dues paid and number of declared members paid
\n(Annex 1) for 2016, 2017 and 2018 as of 5 April 2018.
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nTitle:
\nFPL 209\/Dues Report\/Apr2018
\nReport on Membership Dues Payment for
\n2018
\nOriginal:
\nDocument no:
\nEnglish
\n26-28 April 2018
\nRiga, Latvia
\nFor
\nInformation
\nNote:
\n2
\nMembership rate per member
\nCategory A – 0,40 2018 2017 2018\/2017 2016
\nCategory B – 0,95 Euro Euro Euro Euro
\nCategory C – 1,60 Rate Classes Rate Classes Rate Classes
\nCategory D – 2,15 A-D\/member A-D\/member A-D\/member
\nTANZANIA A – A – – A
\nTUNISIA 433 B 633 B -200 – C
\nUGANDA A 40 A -40 40 A
\nZAMBIA 950 B 950 B 950 B
\nZIMBABWE *** – A – A – – A
\nSub-total 30 809 38 440 -6 879 17 505
\nASIA
\nBANGLADESH 570 B 570 B – 412 B
\nCHINA *** 20 000 C 80 000 C -60 000 3 555 C
\nINDIA 71 250 B 71 250 B – 71 250 B
\nISRAEL 53 750 D 52 500 D 1 250 52 500 D
\nKUWEIT 2 150 D 2 100 D 50 2 102 D
\nMYANMAR 380 B 285 B 95 285 B
\nNEPAL A 163 A -163 163 A
\nPAKISTAN 475 B ** 475 **
\nSRI LANKA B – B – – B
\nVIETNAM B 422 B -422 – B
\nSub-total 148 575 207 290 -58 715 130 267
\nEUROPE
\nALBANIA 3 200 C 3 200 C – 1 920 C
\nANDORRA D – D – – D
\nARMENIA B – B – – B
\nAUSTRIA 15 093 D 14 742 D 351 14 742 D
\nAZERBAIJAN C – C – – C
\nBELARUS C **
\nBELGIUM 4 934 D 4 820 D 115 4 820 D
\nBULGARIA C – C – – C
\nCROATIA 1 500 D – D 1 500 1 575 D
\nCYPRUS D – D – – D
\nCZECH REP. *** 12 900 D ** D 12 900 1 680 D
\nDENMARK 32 250 D 31 500 D 750 31 500 D
\nESTONIA 1 075 D 1 050 D 25 1 050 D
\nFINLAND 27 950 D 27 300 D 650 27 300 D
\nFRANCE 107 715 D 105 210 D 2 505 105 210 D
\nGEORGIA 259 B 437 C -177 272 B
\nGERMANY *** 112 875 D 220 500 D -107 625 220 500 D
\nGREECE 10 750 D 10 500 D 250 10 500 D
\nHUNGARY 6 450 D 6 300 D 150 6 300 D
\nICELAND 1 828 D 1 785 D 43 1 785 D
\nIRELAND 1 505 D 1 470 D 35 1 470 D
\nITALY D 12 600 D -12 600 12 600 D
\nKAZAKHSTAN C 240 C -240 240 C
\nLATVIA 3 118 D 3 045 D 73 3 045 D
\n3
\nMembership rate per member
\nCategory A – 0,40 2018 2017 2018\/2017 2016
\nCategory B – 0,95 Euro Euro Euro Euro
\nCategory C – 1,60 Rate Classes Rate Classes Rate Classes
\nCategory D – 2,15 A-D\/member A-D\/member A-D\/member
\nLIECHTENSTEIN D – D – – D
\nLITHUANIA D – D – – D
\nLUXEMBOURG D 1 275 D -1 275 1 296 D
\nMACEDONIA C – C – – C
\nMALTA 1 075 D 1 050 D 25 1 050 D
\nMONTENEGRO C – C – – C
\nNETHERLANDS 128 153 D 124 121 D 4 032 33 128 D
\nNORWAY 32 250 D 31 500 D 750 31 500 D
\nPOLAND 897 D 876 D 21 876 D
\nPORTUGAL D 5 250 D -5 250 5 250 D
\nROMANIA 16 000 C 15 040 C 960 14 400 C
\nRUSSIA *** C 11 200 C -11 200 – D
\nSERBIA C 16 002 C -16 002 – C
\nSLOVAKIA D 479 D -479 479 D
\nSLOVENIA 6 927 D 6 829 D 98 – D
\nSPAIN *** D 105 000 D -105 000 105 000 D
\nSWEDEN 43 215 D 42 210 D 1 005 42 210 D
\nSWITZERLAND 38 732 D 36 863 D 1 869 36 863 D
\nTURKEY 1 600 C 1 600 C – 1 600 C
\nUKRAINE 95 B 95 B – B
\nUNITED KINGDOM 219 300 D 214 200 D 5 100 214 200 D
\nUZBEKISTAN B – B – 67 B
\nVATICAN 108 D 105 D 3 105 D
\nSub-total 831 753 1 058 392 -226 639 934 531
\nLATIN AMERICA
\nARGENTINA D 700 D -700 4 200 D
\nBAHAMAS D – D – – D
\nBELIZE 160 C **
\nBOLIVIA B 422 B -422 422 B
\nBRAZIL 80 800 C 80 800 C – 80 800 C
\nCHILE 4 504 D 4 400 D 105 4 400 D
\nCOLOMBIA C – C – – C
\nCOSTA RICA C 600 C -600 1 609 C
\nEL SALVADOR B – B – – B
\nHAITI A – A – 100 A
\nMEXICO C 533 C -533 533 C
\nPANAMA 566 C 803 C -237 – C
\nPERU C – C – – C
\nTRINIDAD AND TOBAGO D 420 D -420 420 D
\nURUGUAY D 4 110 D -4 110 5 273 D
\nVENEZUELA *** C – C – – D
\nSub-total 86 030 92 788 -6 917 97 757
\nNORTH AMERICA
\n4
\nMembership rate per member
\nCategory A – 0,40 2018 2017 2018\/2017 2016
\nCategory B – 0,95 Euro Euro Euro Euro
\nCategory C – 1,60 Rate Classes Rate Classes Rate Classes
\nCategory D – 2,15 A-D\/member A-D\/member A-D\/member
\nCANADA 64 715 D 63 210 D 1 505 63 210 D
\nUSA 260 150 D 254 100 D 6 050 254 100 D
\nSub-total 324 865 317 310 7 555 317 310
\nPACIFIC
\nAUSTRALIA 44 406 D 45 555 D -1 149 39 297 D
\nFIJI C – C – – C
\nHONG KONG 2 043 D 1 995 D 48 1 995 D
\nINDONESIA B – B – – B
\nJAPAN *** D 317 100 D -317 100 317 100 D
\nKOREA 37 625 D 36 750 D 875 36 750 D
\nMALAYSIA 2 400 C 2 400 C – 2 400 C
\nNEW ZEALAND 400 D 2 100 D -1 700 2 100 D
\nPHILIPPINES B 713 B -713 661 B
\nSAMOA B – B – – B
\nSINGAPORE 516 D 504 D 12 504 D
\nTAIWAN D 23 125 D -23 125 23 125 D
\nTHAILAND 1 066 C 1 066 C – 1 066 C
\nSub-total 88 455 431 307 -342 852 424 998
\nTOTAL 1 510 487 2 145 527 -634 447 1 922 369
\n2. Previous years
\nBelgium (2006-2012) 2 002 D 2 002 D 2 002 D
\nPanama (2015-2016) 1 556 C
\nRussia (2015) 5 250 D
\nRwanda (2015-2017) 44 A
\nTunisia (2015-2016) 2 066 B
\nUkraine (2015, 2016) 185 B
\nUzbekistan (2013-2015) 189 D
\nVietnam (2016) 422 B
\nSub-total 2 046 6 231 7 441
\nTOTAL 1 512 533 2 151 758 -639 225 1 929 810
\n** Not member at that time
\n*** Note by the Secretary General:
\nThe following statutory members have formal special arrangements with the WMA:
\n\u2022 Due to the current impossibility to transfer money out of Zimbabwe, the technical inability to collect our dues, the
\nextreme inflation rate in the country and after having consulted with the Zimbabwe Medical Association the
\nSecretary General considers the Zimbabwe Medical Association in Good Standing without having received dues so
\nfar but considers that ZiMA pays its annual dues (20 EUR) till the financial situation changes.
\n5
\nMembership rate per member
\nCategory A – 0,40 2018 2017 2018\/2017 2016
\nCategory B – 0,95 Euro Euro Euro Euro
\nCategory C – 1,60 Rate Classes Rate Classes Rate Classes
\nCategory D – 2,15 A-D\/member A-D\/member A-D\/member
\n\u2022 German Medical Association pays its dues in two equal parts on January 1st and July 1st.
\n\u2022 Japan Medical Association pays its dues in with its new business year in April.
\n\u2022 Spanish Medical Association pays its dues in two equal parts on February 1st and August 1st.
\n\u2022 The Czech Medical Association resigned in April 2017 and the Czech Medical Chamber joined the membership in
\nOctober2017.
\n\u2022 The membership of the Russian Medical Society was terminated in April 2017 following procedure accroding to
\nWMA Bylaws, Chapter 1, Section 5B and the National Medical Chamber of Russia joined the membership in Octboer
\n2017.
\n\u2022 Due to the financial crises in Venezuela, the membership dues of Venezuela Medical Association was waived for
\nthe years 2013 to 2017.
\n\u2022 Chinese Medical Association pays its dues by three installments. 1st installment was received on 4 April 2018.
\n\u2022 Due to the war in Somalia, the Secretary General considers the Somalia Medical Association is in good standing
\nand waived the membership dues since 2011.
\nANNEX
\n6
\nCOMPARISON OF DECLARED MEMBERS IN 2018, 2017 AND 2016
\nCONSTITUENT MEMBERS – COUNTRY
\n2018 2017 2018\/2017 2016
\n1. Current year
\nAFRICA
\nANGOLA – – – –
\nCABO-VERDE – – – –
\nCAMEROON – – – –
\nCONGO – 15 000 -15 000 –
\nC\u00d4TE D\u2019IVOIRE – 100 -100 100
\nEGYPT – – – –
\nETHIOPIA – – – –
\nGHANA 1 111 1 111 – 1 111
\nGUINEA – 300 -300 –
\nKENYA – 750 -750 –
\nLESOTHO – – – –
\nMALAWI – – – 100
\nMALI – – – –
\nMOZAMBIQUE – – – –
\nNAMIBIA – – – –
\nNIGERIA 15 000 15 000 – 1 352
\nRWANDA 200 – 200 –
\nS\u00c9N\u00c9GAL – 1 360 -1 360 –
\nSOMALIA – – – –
\nSOUTH AFRICA 8 775 8 775 – 8 775
\nSUDAN – – – –
\nTANZANIA – – – –
\nTUNISIA 456 666 -210 –
\nUGANDA – 100 -100 100
\nZAMBIA 1 000 1 000 – 1 000
\nZIMBABWE 50 50 – 50
\nSub-total 26 592 44 212 -17 620 12 588
\nASIA
\nBANGLADESH 600 600 – 434
\nCHINA 12 500 50 000 -37 500 2 222
\nINDIA 75 000 75 000 – 75 000
\nISRAEL 25 000 25 000 – 25 000
\nKUWEIT 1 000 1 000 – 1 000
\nMYANMAR 400 300 100 300
\nNEPAL – 407 -407 407
\nPAKISTAN 500 ** 500 **
\nSRI LANKA – – – –
\nVIETNAM – 444 -444 –
\nSub-total 115 000 152 751 -37 751 104 363
\nEUROPE
\nANNEX
\n7
\n2018 2017 2018\/2017 2016
\nALBANIA 2 000 2 000 – 1 200
\nANDORRA – – – –
\nARMENIA – – – –
\nAUSTRIA 7 020 7 020 – 7 020
\nAZERBAIJAN – – – –
\nBELARUS – ** **
\nBELGIUM 2 295 2 295 – 2 295
\nBULGARIA – – – –
\nCROATIA 697 – 697 750
\nCYPRUS – – – –
\nCZECH REP. 6 000 ** 6 000 800
\nDENMARK 15 000 15 000 – 15 000
\nESTONIA 500 500 – 500
\nFINLAND 13 000 13 000 – 13 000
\nFRANCE 50 100 50 100 – 50 100
\nGEORGIA 273 273 – 286
\nGERMANY 52 500 105 000 -52 500 105 000
\nGREECE 5 000 5 000 5 000
\nHUNGARY 3 000 3 000 – 3 000
\nICELAND 850 850 – 850
\nIRELAND 700 700 – 700
\nITALY – 6 000 -6 000 6 000
\nKAZAKSTAN – 150 -150 150
\nLATVIA 1 450 1 450 – 1 450
\nLIECHTENSTEIN – – – –
\nLITHUANIA – – – –
\nLUXEMBOURG – 607 -607 617
\nMACEDONIA – – – –
\nMALTA 500 500 – 500
\nMONTENEGRO – – – –
\nNETHERLANDS 59 606 59 105 501 15 775
\nNORWAY 15 000 15 000 – 15 000
\nPOLAND 417 417 – 417
\nPORTUGAL – 2 500 -2 500 2 500
\nROMANIA 10 000 9 400 600 9 000
\nRUSSIA – 7 000 -7 000 –
\nSERBIA – 10 001 -10 001 –
\nSLOVAKIA – 228 -228 228
\nSLOVENIA 3 222 3 252 -30 –
\nSPAIN – 50 000 -50 000 50 000
\nSWEDEN 20 100 20 100 – 20 100
\nSWITZERLAND 18 015 17 554 461 17 554
\nTURKEY 1 000 1 000 – 1 000
\nUKRAINE 100 100 – –
\nUNITED KINGDOM 102 000 102 000 – 102 000
\nUZBEKISTAN – – – 70
\nVATICAN 50 50 – 50
\nSub-total 390 395 511 152 -120 757 447 912
\nLATIN AMERICA
\nANNEX
\n8
\n2018 2017 2018\/2017 2016
\nARGENTINA – 333 -333 2 000
\nBAHAMAS – – – –
\nBELIZE 100 ** 100 **
\nBOLIVIA – 444 -444 444
\nBRAZIL 50 500 50 500 – 50 500
\nCHILE 2 095 2 095 – 2 095
\nCOLOMBIA – – – –
\nCOSTA RICA – 375 -375 1 005
\nCUBA – – – –
\nEL SALVADOR – – – –
\nHAITI – – – 250
\nMEXICO – 333 -333 333
\nPANAMA 353 502 -149 –
\nPERU – – – –
\nTRINIDAD AND TOBAGO – 200 -200 200
\nURUGUAY – 1 957 -1 957 2 522
\nVENEZUELA – – – –
\nSub-total 53 048 56 739 -3 691 59 349
\nNORTH AMERICA
\nCANADA 30 100 30 100 – 30 100
\nUSA 121 000 121 000 – 121 000
\nSub-total 151 100 151 100 – 151 100
\nPACIFIC
\nAUSTRALIA 20 653 21 692 -1 039 18 712
\nFIJI – – – –
\nHONG KONG 950 950 – 950
\nINDONESIA – – – –
\nJAPAN – 151 000 -151 000 151 000
\nKOREA 17 500 17 500 – 17 500
\nMALAYSIA 1 500 1 500 – 1 500
\nNEW ZEALAND 186 1 000 -814 1 000
\nPHILIPPINES – 750 -750 696
\nSAMOA – – – –
\nSINGAPORE 240 240 – 240
\nTAIWAN – 11 011 -11 011 11 011
\nTHAILAND 666 666 – 666
\nSub-total 41 695 206 309 -164 614 203 275
\nTOTAL 777 830 1 122 263 -344 433 978 587
\n1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument
\nno:
\nFPL 209\/WMA Future Meetings\/Apr2018 Original:
\nEnglish
\nTitle: Planning and Arrangements for future
\nWMA Meetings
\nDestination: Finance and Planning Committee
\n209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nFor
\nconsideration
\n1. ITEMS TO BE CONSIDERED
\n1.1 Meeting dates
\nSurvey was sent out to the members in January 2018 and the following dates are most
\npreferable dates for upcoming meetings in 2021\/2022:
\n1.1.1 218th
\nCouncil session (venue is not decided): 22-24 April 2021
\n1.1.2 72nd
\nGeneral Assembly (venue is not decided): 13-16 October 2021
\n1.1.3 221st
\nCouncil session (venue is not decided): 7-9 April 2022
\n1.2 New invitations received from
\n1.2.1 Rwanda Medical Association (RMA) in Kigali1
\n\u2022 Preferably for the 71st
\nGeneral Assembly in October 2020
\n\u2022 or nearby future vacant years for Council Session, i.e. April 2021 or 2022
\n1.2.2 British Medical Association (BMA) in London2
\n\u2022 for the 71st
\nGeneral Assembly in October 2020
\n\u2022 or future years including 2021 and 2022
\n1.2.3 Ordre National des Medecins Conseil National de l\u2019Ordre (CNOM France) in
\nParis3
\n\u2022 for the 221st
\nCouncil Session in April 2022
\n1
\nSecretariat received a completed questionnaire and see the city Kigali is eligible as a venue for the WMA Council
\nSession or General Assembly.
\n2
\nSecretariat received a completed questionnaire and see the city London is eligible as a venue for the WMA General
\nAssembly. Only concern would be that there may be some difficulty for Russian representatives for visa issuing due to
\nthe recent political situation.
\n3
\nSecretariat received a completed questionnaire and see the city Paris is eligible as a venue for the WMA Council
\nSession.
\nApril 2018 FPL 209\/WMA Future Meetings\/Apr2018
\n2
\nThe Secretariat will proceed an on-going survey on meeting dates and call for invitation
\nof future meetings during July 2018. For consideration by the 210th
\nCouncil Session in
\nReykjavik in October 2018, invitations shall be submitted to the secretariat until 31
\nAugust 2018.
\n1.3 GA Beijing (or Shanghai) 2021
\nFollowing to the decision made by the General Assembly in October 2017, the
\ninvitation of the Chinese Medical Association was postponed until the 2018 General
\nAssembly.
\n2. DATES\/VENUES OF WMA ASSEMBLIES AND COUNCIL SESSIONS 2005-2021
\nThe venues of WMA General Assembly meetings are determined by a global rotation system
\nideally, whereby the WMA General Assembly is held in each of the six regions of the WMA
\nover a period of six years.
\nYear Dates Region Venue Note
\n2005 12-15 October Latin America Santiago, Chile
\n2006 12-15 October Africa Sun City, South Africa
\n2007 3-6 October Europe Copenhagen, Denmark 150th
\nAnniversary
\n2008 15-18 October Pacific Seoul, Korea 100th
\nAnniversary
\n2009 13-15 May Asia Tel Aviv, Israel
\n14-17 October Asia New Delhi, India
\n2010 20-22 May Europe Evian-les-Bains, France
\n13-16 October North America Vancouver, Canada
\n2011 7-9 April Pacific Sydney, Australia
\n12-15 October Latin America Montevideo, Uruguay
\n2012 26-28 April Europe Prague, Czech Republic
\n10-13 October Pacific Bangkok, Thailand
\n2013 4-6 April Pacific Bali, Indonesia
\n16-19 October Latin America Fortaleza, Brazil
\n2014 24-26 April Pacific Tokyo, Japan
\n8-11 October Africa Durban, South Africa
\n2015 16-18 April Europe Oslo, Norway
\n14-17 October Europe Moscow, Russia
\n2016 28-30 April Latin America Buenos Aires, Argentina
\n19-22 October Pacific Taipei, Taiwan
\n2017 20-22 April Africa Livingston, Zambia
\n11-14 October North America Chicago, United States
\n2018 26-28 April Europe Riga, Latvia
\n3-6 October Europe Reykjavik, Iceland 100th
\nAnniversary
\n2019 25-27 April Latin America Santiago, Chile
\n23-26 October Europe Tbilisi, Georgia 30th
\nAnniversary in
\n2019
\n2020 16-18 April Europe Porto, Portugal
\n21-24 October
\nApril 2018 FPL 209\/WMA Future Meetings\/Apr2018
\n3
\n2021 22-24 April4
\n13-16 October5
\nAsia Beijing, China6
\n106th
\nAnniversary
\nin 2021
\n2022 7-9 April7
\n5-8 or 12-15
\nOctober8
\nEurope Berlin, Germany 75th
\nAnniversary in
\n2022
\n\u2022 All future meetings are listed in the WMA website.
\n3. ARRANGEMENTS OF STATUTORY MEETINGS
\n3.1 General Assembly, Reykjavik 2018
\n\u2022 Dates: Wednesday 3 to Saturday 6 October 2018
\n\u2022 Venue for meeting rooms: Harpa conference center
\n\u2022 Hotel for accommodation: Hilton Reykjavik Nordica
\n\u2022 Preliminary schedule
\n– The pre-meetings of Executive Committee, workgroups and JDN meeting will be
\nheld on Monday 1 October and\/or Tuesday 2 October, prior to the meeting.
\n– The three Standing Committees and the Credentials Committee will meet on
\nWednesday 3 October.
\n– Scientific Session: Icelandic Medical Association\/WMA Medical Ethics
\nConference will take place in Harpa conference center from 1- 4 October. The
\nscientific session on 4 October will be replaced by joining the Medical Ethics
\nConference.
\n– There will be a half-day Tour for accompanying persons on Thursday 4 October.
\n– The main meeting of the Council will take place on Friday 5 October.
\n– The Assembly Ceremonial Session will take place after the Council Session on
\nFriday 5 October.
\n– There will be a half-day Tour for all participants on Friday 5 October.
\n– The Assembly Plenary Session will be held on Saturday 6 October.
\n1 Oct 2 Oct 3 Oct 4 Oct 5 Oct 6 Oct
\nMon Tue Wed Thu Fri Sat
\nIcMA
\nConference on
\nMedical Ethics
\n1st
\nday of
\nconference
\n2nd
\nday of
\nconference
\n3rd
\nday of
\nconference (full
\nday)
\nWMA pre-
\nmeetings (ExCo
\nand other
\npossible WGs)
\nWMA pre-
\nmeetings (Open
\nWG meetings
\nare planned in
\nconjunction
\nWMA Council WMA
\nScientific
\nsession
\nWMA GA and
\nsocial
\nWMA GA
\nplenary
\n4
\nPending Council\u2019s approval
\n5
\nPending Council\u2019s and GA\u2019s approval
\n6
\nPending GA\u2019s approval (see consideration item 1.3)
\n7
\nPending Council\u2019s approval
\n8
\nPending Council\u2019s and GA\u2019s approval: The German Medical Association has requested to hold off the decision until
\nOctober 2018 for them to have some time to search the most preferable venue.
\nApril 2018 FPL 209\/WMA Future Meetings\/Apr2018
\n4
\nwith the Ethics
\nconference)
\n\u2022 Interpretation
\nSimultaneous Interpretations in English, Spanish, French and Japanese will be
\nprovided.
\n\u2022 Social events
\n– The Welcome reception for all participants will be offered by the Icelandic
\nMedical Association on Wednesday 3 October.
\n– The Icelandic Medical Association will offer the dinner to all participants on
\nFriday 5 October.
\n– The WMA Assembly dinner for all participants will be offered by the World
\nMedical Association on Saturday 6 October.
\n\u009f More details will be available on the WMA website and the registration will be open
\nin May 2018.
\n3.2 212th
\nCouncil Session, April 2019
\n\u009f Dates: Thursday 25 to Saturday 27 April 2018
\n\u009f Hotel: Hotel Santiago (Mandarin Oriental) in Santiago, Chile
\n\u009f Preliminary schedule
\n– The pre-meetings of Executive Committee, workgroups and JDN meeting
\nwill be held on Wednesday 24 April, one day prior to the meeting.
\n– The meeting will begin with the Opening Plenary Session of the Council on
\nThursday 25 April.
\n– The three Standing Committees will meet on Thursday 25 April and Friday 26
\nApril.
\n– The Council Plenary Session will take place on Saturday 27 April.
\n\u009f Interpretation
\nSimultaneous interpretation in English, Spanish, French and Japanese will be provided.
\n\u009f Social events
\n– The Welcome reception for all participants will be offered by the Colegio
\nM\u00e9dico de Chile on Thursday 25 April.
\n– The Council dinner will be offered by the World Medical Association on Friday
\n26 April.
\n– The Half-day tour and dinner for all participants will be offered by the Colegio
\nM\u00e9dico de Chile on Saturday 27 April.
\n\u009f More details will be available on the WMA website and the registration will be open
\nin October 2018.
\n\u00a7\u00a7\u00a7
\n17.04.2018
\n1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument
\nno:
\nFPL 209\/AM Membership\/Apr2018 Original:
\nEnglish
\nTitle: Report on the Associate Membership
\nfor 2017
\nDestination: Finance and Planning Committee
\n209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nTo be received
\n1. This report covers the period up to 31 December 2017.
\n2. The total number of Associate Members who are in good standing is 1,115. The regional
\nbreakdown of the 1,115 Associate Members (including 25 as life members) is:
\nJapan: 647 in good standing
\nAll other countries: 468 members in good standing in the other regions, including 25 life
\nmembers and 137 IFMSA\/JDN members in free membership
\n3. Applications for Associate Membership shall be obtained only from the WMA directly, or from
\na National Medical Association that is a Constituent Member of the WMA. The application
\nshould be returned, with the proper amount of membership dues to the WMA General
\nSecretariat.
\n4. Medical students and junior doctors (on graduation as physicians for a period of five years) will
\nbe granted Associate Membership of the WMA. No membership fee will be charged, but no
\nproducts, services or publications (except electronic publications) will be provided to these
\nmembers. In addition, these members will not have the right to vote.
\n5. Online applications for the different member types have been implemented on the WMA
\nwebsite.
\n\u00a7\u00a7\u00a7
\n16.04.2018<\/p>\n

1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument
\nno:
\nFPL 209\/Chair of AM Report\/Apr2018 Original:
\nEnglish
\nTitle: Report of the Chair of the Associate
\nMembers (October 2017 \u2013 March 2018)
\nDestination: Finance and Planning Committee
\n209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nTo be
\nreceived
\nWhile in Chicago we had a very successful \u201cMeet the Associate Members\u201d informal dinner
\nsponsored by the American Medical Association. We will be enjoying another informal get-
\ntogether in Riga on the evening of April 25th
\nwhich was open to all attending the council meeting.
\nRegistration was required in advance. Special thanks to the Latvian Medical Association for
\nmaking this possible.
\nAt the end of our meeting in Chicago, there were 85 members of our active Google group. We have
\nmore than doubled in size to 195 members of this wonderful discussion platform. We had a very
\nrobust discussion of each of the circulated documents for this meeting. One document alone had
\nover fifty comments. The discussions are respectful and enlightening and are open to all associate
\nmembers. A summary of our comments appears on each document.
\nWe held a conference call on March 26 for the leaders of the Junior Doctors Network, the Past
\nPresidents and Chairs Network and the Chair of the AMs along with the Secretary General. We
\nwanted to connect to look for ideas for coordination of the three parts of the AMs and to make the
\nAM experience more valuable to the WMA and to the AMS themselves. A summary of the meeting
\nfollows:
\nAttendees:
\nDana Hanson, Chair, Past Presidents and Chairs Network (PPCN)
\nJon Sn\u00e6dal, PPCN Secretary
\nCaline Mattar, Chair, Junior Doctors Network (JDN)
\nYassen Tcholakov, JDN Socio-Medical Affairs
\nOtmar Kloiber, Secretary General, World Medical Association (WMA)
\nJoe Heyman, Chair, WMA Associate Members
\n1) There was a discussion about how to get more recognition for WMA policies among the rank
\nand file membership of national medical associations (NMAs). It would be great if an NMA
\nintroduced a resolution at the Council Meeting that suggested that NMAs review WMA policy
\nwhen considering new policy or reviewing existing policy.
\n2) We will try to come up with an agenda for a meeting in Iceland of all AMs with possible
\nbroadcast.
\nApril 2018 FPL 209\/Chair of AM Report\/Apr2018
\n2
\n3) We discussed a voluntary effort to include other associate members when a particular policy is
\nbeing developed among one of the groups in the AMs. We may have leadership communicate
\nwith each other between meetings briefly to keep everybody in the loop.
\n4) We may wish to bring subjects that are not policy, or are not policy currently under review, to
\nthe AMs at large for discussion in the Google Group.
\n5) We discussed the barriers to broadcast the Scientific Session to the AMs who cannot attend. At
\nleast for the time being we cannot broadcast it for everyone since speakers speak in several
\nlanguages and because there are software and financial barriers.
\n6) We discussed the relationships between the WMA and the international specialty societies. It
\nis healthy.
\n7) We discussed recruiting associate members. We have three types of members right now, a)
\nthose involved in international medicine, b) those involved in Public Health, and c) those who
\nare interested for other reasons. We should focus on recruiting people who are interested in
\npublic health and\/or medical ethics.
\n8) We discussed efforts to broadcast meetings with GoToMeeting, Zoom, and Adobe Connect in
\nthe hope we can more easily involve those members who can not attend in person.
\n9) We considered adding an additional hour or another meeting time for AMs where a panel
\ndiscussion might be possible.
\n10) We would like to find a periodic formal way in which the AM Chair could meet with the
\nexecutive committee to bring them up to date on what has happened with the AMs and for the
\nAM chair to learn more about the WMA activities and concerns.
\n11) We discussed a role for medical students that would not compete with the International
\nFederation of Medical Student Associations (IFMSA).
\n12) We discussed how we might interest Council members to join the AMs.
\n13) We ruled out regional meetings of AMs for now.
\nRespectfully submitted by Joe Heyman, MD, Chair of the Associate Members
\n\u00a7\u00a7\u00a7
\n03.04.18
\n1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument
\nno:
\nFPL 209\/JDN Report\/Apr2018 Original:
\nEnglish
\nTitle: Report of the Junior Doctors Network
\n(JDN) (October 2017 \u2013 March 2018)
\nDestination: Finance and Planning Committee
\n209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nTo be
\nreceived
\nDuring the reporting period, the JDN working groups (WG) have continued their activities, those
\nincluding Working conditions, and Medical care for the psychiatric patient.
\nAdditionally, the WG Global Medical Exchanges on surveying the membership on interest and
\nmapping existing initiatives. The survey is currently at its pilot stage.
\nThe working group on Antimicrobial Resistance (AMR) is gearing up towards another AMR social
\nmedia campaign in collaboration with the WMA secretariat to promote the WMA policy and AMR
\ncourse during Antibiotic Awareness Week in November, and is looking forward to the policy
\nrevision coming up.
\nAs part of a revision of the internal processes of the network, new terms of reference are now
\nproposed to regulate the JDN WGs. This will be presented for discussion at the Meeting in Riga.
\nJDN members participated in the 4th
\nGlobal Forum on Human Resources for Health which was held
\nin Dublin and contributed to the organization of the Youth forum portion of the event.
\nWe continue to have monthly management team meetings in addition to the general membership
\nteleconference to ensure coordination of activities and appropriate follow up. We continue to have a
\nreporting system with half yearly reports submitted by the JDN officers in April, and end of year
\nreports submitted in September. JDN working groups as well will start reporting on their activities
\ntwice yearly. The next report is due prior to the start of the Riga meeting.
\nWe have planned our JDN meeting in Riga and we are implementing a new format which includes
\ncapacity building. We will be having a climate change workshop as part of the meeting, as well as a
\nleadership in healthcare workshop in collaboration with the Alumni of the WMA Caring Physicians
\nof the World course.
\nJDN continues to support regional collaborations. There is an active group of Junior Doctors in
\nLatin America which continues to evolve and new members from the Eastern Mediterranean are
\njoining the network. JDN is also working on establishing close collaboration with the European
\nJunior Doctors EJD, on several topics of mutual interest.
\nApril 2018 FPL 209\/JDN Report\/Apr2018
\n2
\nWith regards to Medical Education, JDN continues its collaboration with the World Federation for
\nMedical Education, and the network will be represented at the WFME meeting by the JDN Chair,
\nDr Caline Mattar and the JDN Education Officer Dr Audrey Fontaine.
\nThe JDN continues to foster its partnership with the IFMSA through continued collaboration and
\ncoordination.
\nSince the last meeting, we have seen an increasing number of Junior Doctor representatives of
\nNational Associations join the network. We highly value close collaboration with NMAs in order to
\ncontinue to increase participation of young physicians from the national organizations.
\nThis report was prepared by Dr Caline Mattar, Chair of the Junior Doctors Network.
\n\u00a7\u00a7\u00a7
\n03.04.18
\n1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument
\nno:
\nFPL 209\/PPCN Report\/Apr2018 Original:
\nEnglish
\nTitle: Report of the Past Presidents and Chairs
\nof Council Network (October 2017 \u2013
\nMarch 2018)
\nDestination: Finance and Planning Committee
\n209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nTo be
\nreceived
\nThe PPCN has continued its work this year.
\nDr Dana Hanson has participated in the WMA AM Leadership conference call on 26 March with
\nDr J\u00f3n Snaedal, PPCN Secretary. (see FPL 209\/Chair of AM Report\/Apr2018)
\nDr Yank Coble has continued supporting and organising the WMA Leadership Course with Mayo
\nClinic Jacksonville campus for the course in December 2017.
\nDr Yoram Blachar has continued to engage to the UNESCO World conference on Bioethics,
\nMedical Ethics and Health Law in Limassol and next meeting (13th
\n) will be held in Jerusalem, Israel,
\n27-29 November 2018.
\nDr J\u00f3n Snaedal has been taking a lead to organise the Icelandic Medical Association\/WMA Medical
\nEthics Conference to be held in conjunction with the WMA General Assembly in Reikjavik in 2018.
\nHe has served as President of the International College for Person Centered Medicine (ICPCM)
\nwhich has been cooperating with the WMA on organising its annual Geneva conference on person
\ncentered medicine since 2006. The ICPCM conference was held on 8-11 April 2018.
\nDr Mukesh Haikerwal AC is continuing to raise WMA\u2019s profile in social media networks. He is
\nactively supporting our outreach to our African members and non-member Medical Associations.
\nDr. Haikerwal AC represented the WMA at the World Self-Medication Industry Assembly in
\nSydney October 2017.
\nAdvise on current questions has been and is being provided by members of the PPCN upon request
\nof the secretariat.
\nWe would thank Dr. Kloiber and staff for their support.
\nSubmitted by Dr. Dana Hanson, Chair of PPCN
\n\u00a7\u00a7\u00a7
\n04.04.18<\/p>\n

1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument
\nno:
\nFPL 209\/Nominating process\/Apr2018 Original:
\nEnglish
\nTitle: Proposal to introduce a self-declaration
\nstatement to the nominating process for
\nWMA Presidency
\nDestination: Finance and Planning Committee
\n209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nFor
\nconsideration
\nNote: This is submitted by the British Medical Association.
\nSummary: This proposal is to introduce a self-declaration statement
\nto the nominating process for WMA Presidency.
\nIt is necessary to conduct due diligence to establish
\nwhether the candidate may bring the Association into
\ndisrepute. Performing this exercise, ensures reputational
\nassurances for the Association and nominating
\nconstituent member, by exercising principles of
\ntransparency and openness.
\nThe proposal must consider capacity, resources and
\nsystem capability to ensure it is not unduly burdensome
\non the Association, nor the nominating body, and
\ntherefore must be proportionate.
\nRelated WMA policies: WMA Articles and Bylaws
\nWMA Nomination Form for the Election to the Office of
\nPresident
\nCurrent mechanism for appointment for President:
\n1. Extract from WMA articles & bylaws
\nB) Method of Nomination \u2028A Constituent Member of the World Medical Association may
\nnominate any qualified candidate for the office of President by submitting the said nomination
\nin writing to the WMA Secretariat, together with the candidate’s written acceptance of
\nnomination. Such nomination shall include a certification that the candidate is a member of
\nthe Constituent Member making the nomination, and that the candidate’s character,
\nMarch 2018 FPL 209\/Nominating process\/Apr2018
\n2
\nintegrity and competence are beyond reproach, thus qualifying the candidate to be
\nnominated for the office of President. Such assurance shall be made on forms provided by
\nthe Secretary General over the signature of the responsible officer of the Constituent
\nMember and the seal of the National Medical Association. Such nomination must reach the
\nSecretariat at least 3 weeks prior to the opening of the General Assembly at which the
\nelection is to be held. (see Annex 1; current declaration form for a constituent member of the
\nWMA to nominate candidate)
\n2. Mechanism for early termination\/dismal; extract from WMA articles & bylaws
\nF) Termination
\ni) The Council shall be empowered to take action to preserve the integrity and reputation of
\nthe World Medical Association, including, but not limited to, suspending the authority of the
\nPresident, President-Elect, or Immediate Past President to act as an officer of the WMA for
\ncause. A decision to suspend the authority of the individual to act as an officer of the WMA
\nshall require a 2\/3 majority of the Council members present and voting. Before voting on a
\nproposal to suspend the authority of the individual to act as an officer, the Council must:
\na) Provide an opportunity for the concerned individual to address the Council, in person
\nand\/or in writing
\nb) Consult with the Constituent Member of which the individual is a member
\nii) An affirmative vote to suspend the authority of the President, President-Elect, or
\nImmediate Past President from acting as an officer must be based on substantial evidence
\nand a reasonable degree of certainty that the individual no longer meets the criteria
\nestablished in section B) and D)(iv) to serve in the office or has neglected the duties of the
\noffice.
\niii) Between Council meetings, the Executive Committee shall be empowered to investigate
\naccusations made against the President, President-Elect, or Immediate Past President and
\nshall communicate with the Council, as appropriate, regarding the situation. The accused
\nindividual shall be excluded from participating in this process but shall be afforded the
\nopportunity to respond to the accusation(s). The Chair of Council shall report the findings of
\nthe Executive Committee to the Council at its next meeting. The Executive Committee shall
\nnot have the authority to suspend the authority of the individual to act as an officer.
\niv) In the event of the suspension of the authority of the President to act as an officer, the
\nCouncil, if it deems necessary, may make such appointment or provisions for the discharge of
\nduties of the office until the next meeting of the General Assembly.
\nv) Following the suspension by the Council of the authority of the President-elect or
\nPresident to act as an officer, at the next meeting of the General Assembly, the Council shall
\nprovide a recommendation to the General Assembly regarding permanent termination from
\noffice. The General Assembly may accept the Council\u2019s recommendation or reject it and take
\nsuch other action as it deems appropriate. Permanent termination from office shall require a
\n2\/3 majority of the delegates present and voting.
\n3. Proposed mechanism:
\nMarch 2018 FPL 209\/Nominating process\/Apr2018
\n3
\nThe following proposal draws on discussions with HR professionals and employment lawyers
\nwith extensive experience in conducting and advising on appointments processes.
\nTo include following declaration to the nomination form for WMA constituents:
\n\u2018I declare that the information given in this form and in any accompanying documentation is
\ntrue to the best of my knowledge and belief and permission is granted for enquiries to be
\nmade to confirm qualifications, experience, dates of employment\/ membership, for the release
\nby other people or organisations of necessary information to verify the content. I understand
\nthat the declaration of any conflict will not necessarily prevent the nominee being offered this
\nposition, however the nominee may be dismissed following appointment if any of information
\ngiven is false, misleading or if I, the nominating body, have withheld any relevant details\u2019.
\nThe nominating body will also have to declare any personal interests within the written
\nacceptance declaration.
\nIt is expected that the \u2018vetting\u2019 and \u2018screening\u2019 exercise will be conducted by the proposing
\nconstituent member, who will then be expected to sign a declaration. This process will
\nestablish the candidate\u2019s suitability to the role, in terms of skills and experience.
\n4. Further considerations:
\n-Public announcement to all WMA constituent members, of the proposed future mechanism.
\n-Include a role profile; therefore, candidate needs to demonstrate effective leadership
\nthrough:
\n[Example; extract from BMA Council chair appointment form]
\n1. The ability to command confidence and respect and exercise influence
\n2. Excellent communication skills, written and verbal with all potential audiences
\n3. Strategic leadership, chairing skills and negotiation capability
\n4. Promotion of effective relationships and open communication
\n5. Teamwork, influencing people and resources, and diplomacy
\n6. Personal integrity and a commitment to maintaining the highest standards of integrity
\nand probity
\nThe above list of principles will need to be adapted to suit the requirements of the WMA, for
\nexample, principle 2 as it is currently written may discourage nominations from non-anglophone
\ncountries. In addition, principle 3, is not applicable for the role of the WMA President.
\nWithin the WMA articles and bylaws under \u2018Procedure & Schedule\u2019, you will find a list of
\nprinciples scattered throughout the section. This could simply be pulled into one place, in the form
\nof a role profile.
\n\u00a7\u00a7\u00a7
\n29.03.2018
\nAnnex 1;
\nIf the nominee is successfully appointed, are there any conflicts that can be transported to
\nthe WMA Y\/N
\nIf you have answered yes, please provide details in the space below:
\n[allow space for free text]
\nMarch 2018 FPL 209\/Nominating process\/Apr2018
\n4
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nNOMINATION FORM FOR THE ELECTION TO THE
\nOFFICE OF PRESIDENT FOR 2017-2018
\nWe, the undersigned, on behalf of the ____________________________________________
\n(Name of the Constituent Member)
\ndo hereby place in nomination for the office of President of the World Medical
\nAssociation for 2017-2018 the name of Dr.\/Prof. ___________________________. The
\n(Physician’s name)
\nnominee has been endorsed for this office of President by our Association, of which he\/she
\nhas been a member for _________ years.
\n(number)
\nDr.\/Prof. ____________________________ has demonstrated total commitment to the
\n(Physician’s name)
\nhighest standards of medical ethics throughout his\/her professional life.
\nHe\/she is a ____________________who has served as _____________________________
\n(G.P.\/Specialty) (Office held)
\nof the ________________________________________________________. In all ways,
\n(Name of the Constituent Member)
\nDr.\/Prof. _______________________________ has been exemplary in professional and
\n(Physician’s name)
\npersonal conduct. Based on the personal knowledge of our colleagues, this Association
\nbelieves that Dr.\/Prof. ________________________________ is an individual of
\n(Physician’s name)
\nimpeccable integrity who will serve the World Medical Association with honor and
\ndistinction.
\nSigned and sealed on __________________
\n(Date)
\n_________________________ _________________________
\nPresident or Chairperson Secretary General
\nCandidate’s curriculum vitae and written acceptance are enclosed herewith.
\n1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument
\nno:
\nFPL 209\/WMJ Report\/Apr2018 Original:
\nEnglish
\nTitle: Report of WMJ Editor
\nDestination: Finance and Planning Committee
\n209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nTo be
\nreceived
\nThe World Medical Journal turns 64 this year. The majority of the leaders of the World Medical
\nAssociation and national medical associations are a little older or a little younger than the WMJ
\nitself. Over this period of time the world has changed; these years have seen several wars and
\nepidemics, the discovery of new medications, fantastic developments in medical technologies and,
\nultimately, people are now able to live their lives on this earth 20 years longer thanks to the efforts
\nof medical and public health professionals. Both for a journal and a person, 64 years of age have
\nconnotations of maturity, experience, stability, and also difficulties making changes. On the other
\nhand, 64 years is a perfect age to look back at past developments and make long-term forecasts for
\nthe future.
\nI have had the pleasure of being Editor in Chief of the WMJ since 2008 and year by year I am
\npreparing to leave this position. The maximum term for the President of the Latvian Medical
\nAssociation is running out for me and I will simply no longer belong to the WMA community.
\nIt was a great honour to take over the Journal from Mr Alan Rowe. This unique man was the leader
\nof our journal for many years and managed to unite doctors all over the globe, setting a great
\nexample writing excellent articles and through his fantastic mastery of the English language. I think
\nit is unlikely that our journal will again experience such English language skills combined with a
\ndeep sense of both medical and ethical issues anytime soon.
\nDuring all these years Professor Elmar Doppelfeld has been by my side to support me with ideas,
\nopinions and experience. I would like to thank my assistants, Maira Sudraba and Velta Poz\u0146aka,
\nwho worked on the journal with great devotion. It is they who do most of the work. And I am
\ngrateful to Otmar Kloiber who can be counted on for an opinion and a critical view on every single
\narticle. If it were not for him, we would have a much more cumbersome journal; it would be a much
\nlesser WMA journal. And, of course, I thank Nigel Duncan who prepares excellent materials about
\nWMA activities.
\nThe World Medical Journal is essentially a newsletter meant for the leaders of medical associations
\nall over the world. The primary goal of the journal, as I see it, is to inform these leaders about key
\nevents, documents, movements and the direction in which the WMA is going, as well as to deliver
\ninformation about the events of different national medical associations. After all, the earth is small
\nand we can be proud that our people are represented in every country.
\nApril 2018 FPL 209\/WMJ Report\/Apr2018
\n2
\nNot only does every country in the world have its own medical association, it also has a national
\nmedical journal. We are clearly very different. In large countries with hundreds of thousands of
\nworking doctors these journals are thick, issued weekly and pharmaceutical companies gladly place
\nillustrative information on their products in them, thus maintaining the journals\u2019 financial well-
\nbeing and allowing them to reach every doctor free of charge. In smaller countries and those with
\ntighter healthcare budgets the journals are published less frequently, they are thinner and not
\navailable to every doctor.
\nThe World Medical Journal is an excellent brand; it is the journal of the WMA. We can think of the
\nWMA as a country of the world’s doctors, the global medical community, and the WMJ as the
\nmouthpiece of this country, exactly as large and powerful as a country of this size deserves.
\nAdmittedly, the printed media is leaving the global information space. Views on received
\ninformation differ around the globe, but most experts agree that more than 70% of this information
\ncomes from electronic sources (TV, video, internet etc.) and only 10-15% comes from printed
\nmedia. A large part of the world’s population sends the contents of their advertisement-stuffed
\nmailboxes straight into the trashcan.
\nFor a couple of years already the WMJ has also been prevailingly published in digital form. We
\nonly mail printed journals to the world\u2019s leading libraries. The articles are delivered to us in digital
\nform and we send the journal to national medical associations in digital form. The World Medical
\nJournal is issued four times per year. Each issue is supposed to contain forty pages, while issues no.
\n2 and no. 4 are thicker as we complement these with materials from the WMA Council Meeting and
\nGeneral Assembly.
\nThe WMJ has a neuroprotective function: writing to a medical journal is an operation which
\nincreases the number of neuronal cells and the activity of synopsis in the central nervous system.
\nThe journal is also a record of history, which is the present day from a viewpoint in the future. I am
\nnot certain that in 4 years from now one will still be able to read about the World Medical
\nAssociation via the wmj.net portal, whereas I am absolutely sure that all issues of the journal,
\nstarting from the 1950s, will be accessible in the University of Washington Library in Seattle. This
\nis why I encourage the leaders of all national medical associations to contribute their articles to the
\nWMJ. There may possibly remain no other historical evidence of the activities performed by your
\nnational association under your leadership at the global level.
\n\u00a7\u00a7\u00a7
\n19.04.18
\n1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument
\nno:
\nFPL 209\/PR Report\/Apr2018 Original:
\nEnglish
\nTitle: Public Relations Report for October 2017
\n\u2013 April 2018
\nDestination: Finance and Planning Committee
\n209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nTo be
\nreceived
\nFifteen press releases have been issued since the General Assembly in Chicago.
\n2017
\nOct 13: President\u2018s inaugural speech
\nOct 13: WMA Expresses Solidarity with Polish Doctors
\nOct 14: Revised Physicians\u2018 Pledge Published
\nOct 14: WMA Opposes Recreational Cannabis
\nOct 15: WMA to Postpone Assembly in Istanbul
\nOct 17: Chicago Assembly decisions
\nOct 18: Quality Assurance guidance
\nOct 19: Climate change funding called for
\nOct 26: WMA opposes euthanasia bill
\nNov 10: WMA calls for release of Iranian doctor
\n2018
\nJan 29: Indian Government criticised over dismantling medical council
\nJan 30: WMA condemns arrests of Turkish Medical Association leaders
\nFeb 1: Joint letter to Erdogan calls for release of TMA leaders
\nFeb 26: International community criticised over Syrian hospital bombing
\nApr 5: WHO and WMA sign memorandum of understanding
\nGeneral Publicity
\nThere was a good response to the publication of the revised Declaration of Geneva following the
\nChicago Assembly. The Pledge was exclusively published by JAMA (the Journal of the American
\nMedical Association) and in the weeks following publication media reports appeared all over the
\nworld. This prompted some constructive debate and was generally very well received. A number of
\nnational medical associations posted the revised Declaration on their website and there were many
\nreports of the Pledge being adopted by various NMAs and being recited at the start of physician
\nmeetings. In the days immediately following the Assembly, there were literally hundreds of tweets
\nposted from around the world.
\nApril 2018 FPL 209\/PR Report\/Apr2018
\n2
\nOther policy statements from the Assembly that received good publicity included the statements on
\nmedical cannabis, bullying and harassment and climate change. A selection of media coverage can
\nbe found on the WMA website.
\nSeveral other topics have received considerable media publicity in the last six months. These
\ninclude the issue of physician assisted suicide and in particular the end of life conference held in
\nRome, which was marked by a message from the Pope. This received extensive publicity around the
\nworld.
\nThe other event that provoked considerable media attention was the arrest of leaders of the Turkish
\nMedical Association. Following the arrests, the WMA led a mass campaign on twitter that drew
\nworldwide attention to the issue. This demonstrated yet again that social media has become a
\npowerful medium for instant, short term reaction to events.
\nTwitter
\nThe number of followers on the WMA twitter account continues to grow and reached 9,000 in
\nMarch. The total is increasing by around 2,000 a year. The average number of WMA tweets being
\nposted over recent months has been more than 70 a month. Estimated statistics show that the largest
\ngroup of followers come from the US, the UK, Canada and Australia. Not surprisingly, almost half
\nof the followers are in the 25-34 age range, with very few above the age of 55.
\nThe WMA has joined with other organisations to campaign on influenza and fake medicines. Some
\nposts have been boosted as part of the official campaign.
\nMs Magda Mihaila, the WMA Communication and Information manager, has now taken on full
\nresponsibility for twitter (https:\/\/twitter.com\/#!\/medwma) as well as Facebook.
\nFacebook
\nWMA Facebook postings are dealt with by the office in Ferney, led by Ms Mihaila. Items are now
\nbeing posted regularly on the site and the number of Facebook followers has risen to over 10,700.
\nSome posts reach as much as 8.5 k views. In the future, the office intends to increase the number of
\nfollowers among the members of WMA. In the future, WMA intends to create more original
\ncontent for social media.
\n\u00a7\u00a7\u00a7
\n09.04.18
\n1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument
\nno:
\nSMAC 209\/Agenda\/Apr2018\/REV Original:
\nEnglish
\nTitle: Agenda of the Socio-Medical Affairs
\nCommittee
\nDestination: Socio-Medical Affairs Committee
\n209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nFor
\nconsideration
\nNote This revised agenda includes new items 4.3,
\n6.1 and 6.2.
\nThursday 26 April 2018
\nMembership of the Committee
\nDr Miguel Roberto JORGE (Chair)
\nDr David O. BARBE
\nDr Michael Bryant GANNON
\nDr Thomas SZEKERES
\nDr Mark PORTER
\nDr Louis FRANCESCUTTI
\nDr Shuyang ZHANG
\nDr Walter VORHAUER
\nDr Seraf\u00edn ROMERO
\nDr Ramin PARSA-PARSI
\nDr Ajay KUMAR
\nDr Toru KAKUTA
\nDr Kenji MATSUBARA
\nDr MooJin CHOO
\nDr Ren\u00e9 H\u00c9MAN
\nDr Mzukisi GROOTBOOM
\nDr Heidi STENSMYREN
\nDr Julio TROSTCHANSKY
\nEx-officio (with voting rights)
\nDr Ardis Dee Hoven, Chair of Council
\nDr Frank Ulrich Montgomery, Vice-Chair of Council
\nDr Andrew Dearden, Treasurer
\nEx-officio (without voting rights)
\nDr Yoshitake Yokokura, President
\nDr Leonid Eidelman, President-Elect
\nDr Ketan Desai, Immediate Past President
\nDr Otmar Kloiber, Secretary General
\nMs Marie Colegrave-Juge, Legal Advisor
\nMr Adolf H\u00e4llmayr, Financial Advisor
\nMs Joelle Balffe, Facilitor
\nMs Clarisse Delorme, Advocacy Advisor
\nMarch 2018 SMAC 209\/Agenda\/Apr2018\/REV
\n2
\n1. GENERAL BUSINESS
\n1.1 Call to order by the Chair of the SMAC
\n1.2 Report of the previous meeting held in Chicago, United-States, 11-14 October 2017
\nApprove: Report of the Socio-Medical Affairs Committee
\n(SMAC 207\/Report\/Oct2017)
\n1.3 Chair\u2019s Opening Remark
\n1.4 Health and Migration, Dr. Poonam Dhavan, Migration Health Programme Coordinator,
\nInternational Organisation for Migration (IOM)
\n2. MONITORING REPORT (ORAL)
\n3. BUSINESS IN PROGRESS
\n3.1 Health and Environment
\nReceive: Oral Report of the Environment Caucus
\n3.2 Plastic Bags, Ecological Issues & Environmental Degradation
\nConsider: Proposed revision of the WMA Statement on Environmental Degradation
\nand Sound Management of Chemicals
\n(SMAC 209\/Environmental Degradation\/Apr2018)
\n3.3 Medical Tourism
\nConsider: Proposal for a WMA Statement on Medical Tourism
\n(SMAC 209\/Medical Tourism REV5\/Apr2018)
\n3.4 Women in Medicine
\nConsider: Proposed WMA statement on Women in Medicine & Comments
\n(SMAC 209\/Women in Medicine COM REV2\/Apr2018)
\n3.5 Professional Autonomy of Physicians
\nConsider: Proposed revision of the WMA Declaration of Seoul on Professional
\nAutonomy and Clinical Independence & comments
\n(SMAC 209\/Declaration of Seoul COM REV\/Apr2018)
\nConsider: Proposed revision of the WMA Declaration of Madrid on Professionally-led
\nRegulation & comments
\n(SMAC 209\/Declaration of Madrid COM REV\/Apr2018)
\nMarch 2018 SMAC 209\/Agenda\/Apr2018\/REV
\n3
\n3.6 Sustainable Development
\nConsider: Proposed WMA Statement on Sustainable Development & Comments
\n(SMAC 209\/Sustainable Development COM REV\/Apr2018)
\n3.7 Avian & Pandemic Influenza
\nConsider: Proposed WMA Statement on Avian and Pandemic Influenza & Comments
\n(SMAC 209\/Pandemic Influenza COM REV\/Apr2018)
\n4. NEW ITEMS
\n4.1 Nuclear Weapons
\nConsider: Proposed revision of WMA Statement on Nuclear Weapons
\n(SMAC 209\/Nuclear Weapons\/Apr2018)
\n4.2 Development and Promotion of a Maternal and Child Health Handbook
\nConsider: Proposed WMA Statement on the Development and Promotion of a
\nMaternal and Child Health Handbook
\n(SMAC 209\/Maternal and child Handbook\/Apr2018)
\n4.3 Pseudoscience, pseudotherapies, intrusion and sects in the field of health
\nConsider: WMA Declaration on Pseudoscience, pseudotherapies, intrusion and sects in
\nthe field of health (SMAC 209\/ Pseudoscience \/Apr2018)
\n5. CLASSIFICATION OF 2008 POLICIES
\nConsider: Recommendations received on SMAC Documents
\n(SMAC 209\/Policy Review 2008\/Apr2018)
\n6. ANY OTHER BUSINESS
\n6.1 Presentation and preliminary discussion on a proposal for a WMA Network on Disaster
\nMedicine (Japanese Medical Association)
\n6.2 Presentation and preliminary discussion on a white paper on Artificial Intelligence
\n(American Medical Association)
\n7. ADJOURNMENT
\n\u00a7\u00a7\u00a7
\n10.04.2018<\/p>\n

1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument
\nno:
\nSMAC 207\/Report\/Oct2017 Original:
\nEnglish
\nTitle: Report of the Socio-Medical Affairs
\nCommittee
\nDestination: Socio-Medical Affairs Committee
\n209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nFor
\nconsideration
\nWednesday, 11 October 2017
\nMembership of the Committee
\nDr. Miguel Roberto JORGE (Chair)
\nDr. David O. BARBE
\nDr. Michael Bryant GANNON
\nDr Thomas SZEKERES
\nDr. Mark PORTER
\nDr. Louis FRANCESCUTTI
\nDr. Shuyang ZHANG
\nDr. Walter VORHAUER
\nDr. Seraf\u00edn ROMERO
\nDr. Ramin PARSA-PARSI
\nDr. Ajay KUMAR
\nProf. Leonid EIDELMAN
\nDr. Toru KAKUTA
\nDr. Kenji MATSUBARA
\nDr. MooJin CHOO
\nDr. Ren\u00e9 H\u00c9MAN
\nDr. Mzukisi GROOTBOOM
\nDr. Heidi STENSMYREN
\nDr. Julio TROSTCHANSKY
\nEx-officio (with voting rights)
\nDr Ardis Dee Hoven, Chair of Council
\nProf. Dr med. Frank Ulrich Montgomery, Vice-Chair of Council
\nDr Andrew Dearden, Treasurer
\nEx-officio (without voting rights)
\nDr Ketan Desai, President
\nSir Michael Marmot, Immediate Past President
\nDr Yoshitake Yokokura, President-Elect
\nDr Otmar Kloiber, Secretary General
\nMs Marie Colegrave-Juge, Legal Advisor
\nMr Adolf H\u00e4llmayr, Financial Advisor
\nProf Vivienne Nathanson, Facilitator
\nOctober 2017 SMAC 207\/Report\/Oct2017
\n2
\n1. GENERAL BUSINESS
\n1.1 The meeting was called to order by the Chair of Council at 16:05 on 10 October 2017.
\n1.2 Apologies for absence: Dr. T. SZEKERES replaced by Dr H. LINDNER; Dr.J.
\nTROSTCHANSKY replaced by Dr A. RODRIGUEZ.
\n1.3 The Committee approved the report of the previous meeting held in Livingstone,
\nZambia (SMAC 206\/Report\/Apr2017).
\n2. MONITORING REPORT (ORAL)
\nDr. J. TAINIJOKI, WMA Medical Advisor, informed the Committee that a high-level
\nMeeting on Non-Communicable Diseases is scheduled prior to the next United Nations
\nGeneral Assembly in September 2018. The Secretariat is involved in the preparation process,
\nadvocating for a holistic approach on NCDs, which should include Social Determinants of
\nHealth. She invited members interested to contact the secretariat.
\n3. BUSINESS IN PROGRESS
\n3.1 Health and Environment
\nThe Chair of Council, Dr. A. HOVEN, reminded the Committee that Dr. D. SHIN, Co-Chair
\nof the Health and Environment Caucus [Prof. V. NATHANSON is the other co-Chair],
\nresigned from his position a few months ago. Dr. A. HOVEN announced that she would
\nappoint a new Chair to the Caucus and asked for constituent members to volunteer for this
\nposition. Dr. A.HOVEN will appoint a new Chair from among the volunteers after the
\nChicago meetings.
\n3.2 Role of Physicians in Adoption Practices
\nThe Committee considered the proposal for a WMA Statement on the Role of Physicians
\nin Preventing Exploitation in Adoption Practices (SMAC 207\/Trafficking with Minors COM
\nREV3\/Oct2017).
\nRECOMMENDATION
\n3.2.1 That the proposal for a WMA Statement on the Role of Physicians
\nin Preventing Exploitation in Adoption Practices (SMAC 207\/Trafficking with
\nMinors REV3\/Apr2017) be approved by the Council and forwarded to the
\nGeneral Assembly for adoption.
\n3.3 Medical Tourism
\nOctober 2017 SMAC 207\/Report\/Oct2017
\n3
\nThe Committee considered the proposal for a WMA Statement on Medical Tourism and
\ncomments (SMAC 207\/Medical Tourism REV4\/Oct2017) submitted by the Israel Medical
\nAssociation, rapporteur.
\nRECOMMENDATION
\n3.3.1 That the proposal for a WMA Statement on Medical Tourism (SMAC
\n207\/Medical Tourism REV4\/Oct2017) be sent back to the rapporteur for
\nfurther work.
\n3.4 Tuberculosis
\nThe Committee considered the proposed revision of WMA Resolution on Tuberculosis and
\ncomments (SMAC 207\/Tuberculosis COM REV2\/Oct2017).
\nRECOMMENDATION
\n3.4.1 That the proposed revision of WMA Resolution on Tuberculosis (SMAC
\n207\/Tuberculosis REV2\/Oct2017) be approved by the Council and forwarded
\nto the General Assembly for adoption.
\n3.5 Health and Climate Change
\nThe Committee considered the proposed WMA Declaration on Health and Climate Change
\nand comments (SMAC 207\/Climate Change COM REV3\/Oct2017)
\nRECOMMENDATION
\n3.5.1 That the proposed WMA Declaration on Health and Climate Change (SMAC
\n207\/Climate Change REV3\/Oct2017) be approved by the Council and
\nforwarded to the General Assembly for adoption.
\n3.6 Women in Medicine
\nThe Committee considered the proposed WMA statement on Women in Medicine &
\nComments (SMAC 207\/Women in Medicine COM REV\/Oct2017).
\nRECOMMENDATION
\n3.6.1 That the proposed WMA statement on Women in Medicine (SMAC
\n207\/Women in Medicine REV\/Oct2017) be re-circulated to constituent
\nmembers for comments.
\n3.7 Fair Medical Trade
\nThe Committee considered the proposed WMA Statement on Fair Medical Trade &
\nComments (SMAC 207\/Fair Medical Trade COM REV\/Oct2017).
\nRECOMMENDATION
\nOctober 2017 SMAC 207\/Report\/Oct2017
\n4
\n3.7.1 That the proposed WMA Statement on Fair Medical Trade (SMAC 207\/Fair
\nMedical Trade REV2\/Oct2017), as amended, be approved by the Council and
\nforwarded to the General Assembly for adoption.
\n3.8 Plastic Bags & Ecological Issues
\nThe Committee considered the proposed WMA Statement on Curbing Consumption of Plastic
\nBags to Address Growing Ecological Issues & Comments (SMAC 207\/Plastic Bags COM
\nREV\/Oct2017).
\nRECOMMENDATION
\n3.8.1 To appoint a rapporteur to review the WMA Statement on environmental
\ndegradation and sound management of chemicals in order to incorporate the
\nissue of plastic bags pollution. The Swedish Medical Association volunteered
\nto undertake that work.
\n3.9 Professional Autonomy of Physicians
\nThe Committee considered the proposed revision of the WMA Declaration of Seoul on
\nProfessional Autonomy and Clinical Independence (SMAC 207\/Declaration of
\nSeoul\/Oct2017) and the proposed revision of the WMA Declaration on Professionally-led
\nRegulation (SMAC 207\/Declaration of Madrid\/Oct2017).
\nRECOMMENDATION
\n3.9.1 That the proposed revision of the WMA Declaration of Seoul on Professional
\nAutonomy and Clinical Independence (SMAC 207\/Declaration of
\nSeoul\/Oct2017) be circulated to constituent members for comments.
\n3.9.2 That the proposed revision of the WMA Declaration of Madrid on
\nProfessionally-led Regulation (SMAC 207\/Declaration of Madrid\/Oct2017) be
\ncirculated to constituent members for comments.
\n3.10 Sustainable Development
\nThe Committee received the oral report from the working group, chaired by Dr. M.
\nMICHIGANA (Japan Medical Association), and then considered the Proposed WMA
\nStatement on Sustainable Development (SMAC 207\/Sustainable Development\/Oct2017).
\nRECOMMENDATION
\n3.10.1 That the Proposed WMA Statement on Sustainable Development (SMAC
\n207\/Sustainable Development\/Oct2017) be circulated to constituent members
\nfor comments.
\n3.11 Avian & Pandemic Influenza
\nThe Committee received the oral report from the Secretary General and then considered the
\nproposed revision of WMA Statement on Avian and Pandemic Influenza (SMAC
\n207\/Pandemic Influenza\/Oct2017) prepared by Dr. Caline MATTAR, AMR specialist.
\nOctober 2017 SMAC 207\/Report\/Oct2017
\n5
\nRECOMMENDATION
\n3.11.1 That the proposed revision of WMA Statement on Avian and Pandemic
\nInfluenza (SMAC 207\/Pandemic Influenza\/Oct2017) be circulated to
\nconstituent members for comments.
\n3.12 Family Planning and the Right of a Woman to Contraception
\nThe Committee considered the proposed revision of WMA Statement on Family Planning and
\nthe Right of a Woman to Contraception (SMAC 207\/Right to Contraception\/Oct2017), which
\nunderwent a minor revision as part of the annual policy review process.
\nRECOMMENDATION
\n3.12.1 That the proposed revision of WMA Statement on Family Planning and the
\nRight of a Woman to Contraception (SMAC 207\/Right to
\nContraception\/Oct2017) be approved by the Council and forwarded to the
\nGeneral Assembly for information.
\n3.13 Noise Pollution
\nThe Committee considered the proposed revision of the Statement on noise pollution (SMAC
\n207\/Noise Pollution\/Oct2017), which underwent a minor revision as part of the annual policy
\nreview process.
\nRECOMMENDATION
\n3.13.1 That the proposed revision of the Statement on noise pollution (SMAC
\n207\/Noise Pollution\/Oct2017) be approved by the Council and forwarded to
\nthe General Assembly for information.
\n3.14 Support of the Medical Associations in Latin America and the Caribbean
\nThe Committee considered the proposed revision of the Resolution on Support of the Medical
\nAssociations in Latin America and the Caribbean (SMAC 207\/Latin America and
\nCaribbean\/Oct2017) which underwent a minor revision as part of the annual policy review
\nprocess.
\nRECOMMENDATION
\n3.14.1 That the proposed revision of the Resolution on Support of the Medical
\nAssociations in Latin America and the Caribbean (SMAC 207\/Latin America
\nand Caribbean\/Oct2017) be approved by the Council and forwarded to the
\nGeneral Assembly for information.
\n3.15 Economic Embargoes and Health
\nOctober 2017 SMAC 207\/Report\/Oct2017
\n6
\nThe Committee considered the proposed revision of WMA Resolution on Economic
\nEmbargoes and Health (SMAC 207\/Economic Embargoes\/Oct2017) which underwent a
\nminor revision as part of the annual policy review process.
\nRECOMMENDATION
\n3.15.1 That the proposed revision of WMA Resolution on Economic Embargoes and
\nHealth (SMAC 207\/Economic Embargoes\/Oct2017) be approved by the
\nCouncil and forwarded to the General Assembly for information.
\n4. ADJOURNMENT
\nThe meeting was adjourned at 17.10.
\n\u00a7\u00a7\u00a7
\n12.10.2017
\n1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument
\nno:
\nSMAC 209\/Environmental
\nDegradation\/Apr2018\/REV
\nOriginal:
\nEnglish
\nTitle: Proposed revision of the WMA Statement
\non Environmental Degradation and
\nSound Management of Chemicals
\nDestination: Socio-Medical Affairs Committee
\n209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nFor
\nconsideration
\nNote At the meeting in Chicago in October 2017 the Socio-Medical
\nAffairs Committee considered a proposed WMA Resolution
\non Curbing Consumption of Plastic Bags to Address Growing
\nEcological Issues. Rather than adopting the proposed policy,
\nit was decided to review the WMA Statement on
\nEnvironmental Degradation and Sound Management of
\nChemicals in order to incorporate the issue of plastic bags
\npollution. The Swedish Medical Association was appointed
\nrapporteur and submits this proposed revision of the existing
\nWMA statement, with the support of Peter Orris. The
\nproposed revision includes wording regarding plastic
\npollution. Amendments are highlighted in bold, underlined or
\nstrikethrough.
\nThis revised version includes an amendment under the
\nsection \u201cNational and International Actions\u201d which was
\nomitted in the original text.
\nPREAMBLE
\nThis Statement focuses on one important aspect of environmental degradation, which is
\nenvironmental contamination by harmful domestic and industrial substances. It emphasizes the
\nharmful chemical contribution to environmental degradation and physicians\u2019 role in promoting sound
\nmanagement of chemicals as part of sustainable development, especially in the healthcare
\nenvironment.
\nMost chemicals to which humans are exposed come from industrial sources and include, food
\nadditives, household consumer and cosmetic products, agrochemicals, and other substances (drugs;
\ndietary supplements) used for therapeutic purposes. Recently, attention has been concentrated on the
\neffects of human engineered (or synthetic) chemicals on the environment, including specific
\nJanuary 2018 SMAC 209\/Environmental Degradation \/Apr2018\/REV
\n2
\nindustrial or agrochemicals and on new patterns of distribution of natural substances due to human
\nactivity. As the number of such compounds has multiplied, governments and international
\norganizations have begun to develop a more comprehensive approach to their safe regulation. The
\nincreasing amount of plastic waste in our environment is another serious concern, that needs to
\nbe addressed.
\nWhile governments have the primary responsibility for establishing a framework to protect the
\npublic\u2019s health from chemical hazards, the World Medical Association, on behalf of its members,
\nemphasizes the need to highlight the human health risks and make recommendations for further
\naction.
\nBACKGROUND
\nChemicals of Concern
\nDuring the last half-century, the use of chemical pesticides and fertilizers dominated agricultural
\npractice and manufacturing industries rapidly expanded their use of synthetic chemicals in the
\nproduction of consumer and industrial goods.
\nThe greatest concern relates to chemicals, which persist in the environment, have low rates of
\ndegradation, bio-accumulate in human and animal tissue (concentrating as they move up the food
\nchain), and which have significant harmful impacts on human health and the environment
\n(particularly at low concentrations). Some naturally occurring metals including lead, mercury, and
\ncadmium have industrial sources and are also of concern. Advances in environmental health research
\nincluding environmental and human sampling and measuring techniques, and better information
\nabout the potential of low dose human health effects have helped to underscore emerging concerns.
\nHealth effects from chemical emissions can be direct (occurring as an immediate effect of the
\nemission) or indirect. Indirect health effects are caused by the emissions\u2019 effects on water, air and
\nfood quality as well as the alterations in regional and global systems, such as red tide in many
\noceans, and the ozone layer and the climate, to which the emissions may contribute.
\nNational and International Actions
\nThe model of regulation of chemicals varies widely both within and between countries, from
\nvoluntary controls to statutory legislation. It is important that all countries move to a coherent,
\nstandardized national legislated approach to regulatory control. Furthermore, international
\nregulations must be coherent such that developing countries will not be forced by economic
\ncircumstances to accept elevated toxic exposure levels circumvent potentially weak national
\nregulations. An example of a legislative framework can be found at
\nhttp:\/\/ec.europa.eu\/environment\/chemicals\/index.htm.
\nSynthetic chemicals include all substances that are produced by, or result from, human activities
\nincluding industrial and household chemicals, fertilizers, pesticides, chemicals contained in products
\nand in wastes, prescription and over-the-counter drug products and dietary supplements, and
\nunintentionally produced byproducts of industrial processes or incineration, like dioxins.
\nFurthermore, nanomaterials, in some circumstances, can be regulated by synthetic chemicals
\nregulations but in other cases, may need explicit regulation.
\nNotable International Agreements on Chemicals
\nJanuary 2018 SMAC 209\/Environmental Degradation \/Apr2018\/REV
\n3
\nSeveral notable agreements on chemicals exist. These were prompted by the first United Nations
\nConference on the Human Environment declaration in 1972 (Stockholm) on the discharge of toxic
\nsubstances into the environment. These agreements include the 1989 Basel Convention to
\ncontrol\/prevent trans-boundary movements of hazardous wastes, the 1992 Rio Declaration on
\nEnvironment and Development, the 1998 Rotterdam Convention on informed consent and shipment
\nof hazardous substances, and the 2001 Stockholm Convention on Persistent Organic Pollutants. It
\nshould be noted that little information is available on the efficacy of the controls.
\nStrategic approach to international chemicals management
\nWorldwide hazardous environmental contamination persists despite these agreements, making a
\nmore comprehensive approach to chemicals essential. Reasons for ongoing contamination include
\npersistence of companies, absolute lack of controls in some countries, lack of awareness of the
\npotential hazards, inability to apply the precautionary principle, non-adherence to the various
\nconventions and treaties and lack of political will. The Strategic Approach to International
\nChemicals Management (SAICM) was adopted in Dubai, on February 6, 2006 by delegates from
\nover 100 governments and representatives of civil society. This is a voluntary global plan of action
\ndesigned to assure the sound management of chemicals throughout their life cycle so that, by 2020,
\nchemicals are used and produced in ways that minimize significant adverse effects on human health
\nand the environment. The SAICM addresses both agricultural and industrial chemicals, covers all
\nstages of the chemical life cycle of manufacture, use and disposal, and includes chemicals in
\nproducts and in wastes.
\nPlastic waste
\nPlastic has been part of life for more than 100 years and is regularly used in some form by
\nnearly everyone. While some biodegradable varieties are being developed, most plastics break
\ndown very slowly with the decomposition process taking hundreds of years. This means that
\nmost plastics that have ever been manufactured are still on Earth, unless burnt polluting the
\natmosphere with poisonous smoke.
\nConcerns about the use of plastic include accumulation of waste in landfills and in natural
\nhabitats, physical problems for wildlife resulting from ingestion or entanglement in plastic,
\nthe leaching of chemicals from plastic products and the potential for plastics to transfer
\nchemicals to wildlife and humans. Many plastics in use today are halogenated plastics or
\ncontain other additives used in production, that have potentially harmful effects on health
\n(e.g. carcinogenic or promoting endocrine disruption).
\nOur current usage of plastic is not sustainable, accumulating waste and therefore
\ncontributing to environmental degradation and potentially harmful effects on health. Specific
\nregulation is therefore needed to counter the harmful distribution of slowly degradable plastic
\nwaste into the environment and the incineration of such waste which often creates toxic
\nbyproducts.
\nWORLD MEDICAL ASSOCIATION (WMA) RECOMMENDATIONS
\nDespite these national and international initiatives, chemical contamination of the environment due
\nto inadequately controlled chemical production and usage continues to exert harmful effects on
\nglobal public health. Evidence linking some chemicals to some health issues is strong, but far from
\nall chemicals have been tested for their health or environmental impacts. This is especially true
\nfor newer chemicals or nano materials, particularly at low doses over long periods of time. Plastic
\nJanuary 2018 SMAC 209\/Environmental Degradation \/Apr2018\/REV
\n4
\ncontamination of our natural environment, including in the sea where plastic decomposes to
\nminute particles, is an additional area of serious concern. Physicians and the healthcare sector are
\nfrequently required to make decisions concerning individual patients and the public as a whole based
\non existing data. Physicians therefore caution that they, too, have a significant role to play in closing
\nthe gap between policy formation and chemicals management and in reducing risks to human health.
\nThe World Medical Association recommends that:
\nADVOCACY
\n\u2022 National Medical Associations (NMAs) advocate for legislation that reduces chemical
\npollution, reduces human exposure to chemicals, detects and monitors harmful chemicals in
\nboth humans and the environment, and mitigates the health effects of toxic exposures with
\nspecial attention to vulnerability during pregnancy and early childhood.
\n\u2022 NMAs urge their governments to support international efforts to restrict chemical pollution
\nthrough safe management, or phase out and safer substitution when unmanageable (e.g.
\nasbestos), with particular attention to developed countries aiding developing countries to
\nachieve a safe environment and good health for all.
\n\u2022 NMAs facilitate better communication between government ministries\/departments
\nresponsible for the environment and public health.
\n\u2022 Physicians and their medical associations advocate for environmental protection, disclosure
\nof product constituents, sustainable development, and green chemistry within their
\ncommunities, countries and regions.
\n\u2022 Physicians and their medical associations should support the phase out of mercury and
\npersistent bioaccumulative and toxic chemicals in health care devices and products and
\navoid incineration of wastes from these products which may create further toxic
\npollution.
\n\u2022 Physicians and their medical associations should support legislation to require an
\nenvironmental and health impact assessment prior to the introduction of a new chemical or a
\nnew industrial facility.
\n\u2022 Physicians should encourage the publication of evidence of the effects of different chemicals
\nand plastics, and dosages on human health and the environment. These publications should
\nbe accessible internationally and readily available to media, non-governmental organizations
\n(NGOs) and concerned citizens locally.
\n\u2022 Physicians and their medical associations should advocate for the development of effective
\nand safe systems to collect and dispose of pharmaceuticals that are not consumed. They
\nshould also advocate for the introduction worldwide of efficient systems to collect and
\ndispose of plastic waste.
\n\u2022 Physicians and their medical associations should encourage efforts to curb the
\nmanufacture and use of plastic packaging and plastic bags, and to halt the introduction
\nof plastic waste into the environment. These efforts may include specific regulations
\nlimiting the use of plastic packaging and plastic bags.
\n\u2022 Physicians and their medical associations should support efforts to rehabilitate or clean areas
\nof environmental degradation based on a \u201cpolluter pays\u201d and precautionary principles and
\nensure that moving forward, such principles are built into legislation.
\n\u2022 The WMA, NMAs and physicians should urge governments to collaborate within and
\nbetween departments to ensure coherent regulations are developed.
\nLEADERSHIP
\nJanuary 2018 SMAC 209\/Environmental Degradation \/Apr2018\/REV
\n5
\nThe WMA:
\n\u2022 Supports the goals of the Strategic Approach to International Chemicals Management
\n(SAICM), which promotes best practices in the handling of chemicals by utilizing safer
\nsubstitution, waste reduction, sustainable non-toxic building, recycling, as well as safe and
\nsustainable waste handling in the health care sector.
\n\u2022 Cautions that these chemical practices must be coordinated with efforts to reduce greenhouse
\ngas emissions from health care to mitigate its contribution to global warming.
\n\u2022 Urges physicians, medical associations and countries to work collaboratively to develop
\nsystems for event alerts to ensure that health care systems and physicians are aware of high-
\nrisk industrial accidents as they occur, and receive timely accurate information regarding the
\nmanagement of these emergencies.
\n\u2022 Urges local, national and international organizations to focus on sustainable production, safer
\nsubstitution, green safe jobs, and consultation with the health care community to ensure that
\ndamaging health impacts of development are anticipated and minimized.
\n\u2022 Emphasizes the importance of the safe disposal of pharmaceuticals as one aspect of health
\ncare\u2019s responsibility and the need for collaborative work in developing best practice models
\nto reduce this part of the chemical waste problem.
\n\u2022 Encourages environmental classification of pharmaceuticals in order to stimulate prescription
\nof environmentally less harmful pharmaceuticals.
\n\u2022 Encourages local, national and international efforts to reduce the use of plastic
\npackaging and plastic bags.
\n\u2022 Encourages ongoing outcomes research on the impact of regulations and monitoring of
\nchemicals on human health and the environment.
\nThe WMA recommends that Physicians;
\n\u2022 Work to reduce toxic medical waste and exposures within their professional settings as part
\nof the World Health Professional Alliance\u2019s campaign for Positive Practice Environments.
\n\u2022 Work to provide information on the health impacts associated with exposure to toxic
\nchemicals, how to reduce patient exposure to specific agents and encourage behaviors that
\nimprove overall health.
\n\u2022 Inform patients about the importance of safe disposal of pharmaceuticals that are not
\nconsumed.
\n\u2022 Work with others to help address the gaps in research regarding the environment and health
\n(i.e., patterns and burden of disease attributed to environmental degradation; community and
\nhousehold impacts of industrial chemicals; the effects, including on health, of distribution
\nof plastic and of plastic waste into our natural environment; the most vulnerable
\npopulations and protections for such populations).
\nPROFESSIONAL EDUCATION & CAPACITY BUILDING
\nThe WMA recommends that:
\n\u2022 Physicians and their professional associations assist in building professional and public
\nawareness of the importance of the environment and global chemical pollutants on personal
\nhealth.
\n\u2022 National Medical Associations (NMAs) and physician professional associations develop tools
\nfor physicians to help assess their patients\u2019 risk from chemical exposures.
\nJanuary 2018 SMAC 209\/Environmental Degradation \/Apr2018\/REV
\n6
\n\u2022 Physicians and their professional associations develop locally appropriate continuing medical
\neducation on the clinical signs, diagnosis and treatment of diseases that are introduced into
\ncommunities as a result of chemical pollution and exacerbated by climate change.
\n\u2022 Environmental health and occupational medicine should become a core theme in medical
\neducation. Medical schools should encourage in the training of sufficient specialists in
\nenvironmental health and occupational medicine.
\n\u00a7\u00a7\u00a7
\nReferences:
\nWiser G, Center for International Environmental Law, UNEP Forum, Sept. 2005
\nUnited Nations Environment Programme (UNEP)
\nhttp:\/\/chm.pops.int\/Convention\/tabid\/54\/language\/en-US\/Default.aspx
\nThompson RC, Moore CJ, vom Saal FS, Swan SH. Plastics, the environment and human health: current consensus and
\nfuture trends. Philosophical Transactions of the Royal Society B: Biological Sciences. 2009;364(1526):2153-2166.
\ndoi:10.1098\/rstb.2009.0053.
\nBarnes, D. K. A.; Galgani, F.; Thompson, R. C.; Barlaz, M. (14 June 2009). \u00abAccumulation and fragmentation of
\nplastic debris in global environments\u00bb. Philosophical Transactions of the Royal Society B: Biological
\nSciences. 364 (1526): 1985\u20131998. doi:10.1098\/rstb.2008.0205. PMC 2873009\u202f . PMID 19528051.
\n18.04.2018
\n1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument
\nno:
\nSMAC 209\/Medical Tourism
\nREV5\/Apr2018
\nOriginal:
\nEnglish
\nTitle: Proposal for a WMA Statement on
\nMedical Tourism
\nDestination: Socio-Medical Affairs Committee
\n209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nFor
\nConsideration
\nNote: This was proposed by the Israeli Medical Association (IsMA)
\nto the Council in Buenos Aires (April 2016) which decided to
\ncirculate it for comments. At its 205th session in Taipei
\n(October 2016), the Council decided to re-circulate it for
\ncomments.
\nThe Council in Livingstone (April 2017) considered the
\ncomments from constituent members and the compromise
\nversion proposed by IsMA. After discussion, it was decided to
\nsend the proposal back to the rapporteur for further work. Last
\nOctober in Chicago, the Council considered the revised version
\n(REV4) and decided to send it again to the rapporteur for
\nadditional work.
\nThe changes are highlighted in bold and underlined.
\nSuggested
\nKeywords:
\nMedical Tourism, Foreign Patients, Guidelines, Ethics
\nPREAMBLE
\n1. Medical tourism is an expanding phenomenon, although to date it has no agreed upon definition
\nand, as a result, practices and protocols in different countries can vary substantially. For
\npurposes of this statement, medical tourism is defined as a situation where patients travel
\nvoluntarily across international borders to receive medical treatment, most often at their own
\ncost. Treatments span a range of medical services, and commonly include: dental care, cosmetic
\nsurgery, elective surgery, and fertility treatment (OECD, 2011).
\n2. This statement does not cover cases where a national health care system or treating hospital
\nsends a patient abroad to receive treatment at its own cost or where, as in the European Union,
\npatients are allowed to seek care in another EU Member State according to legally defined
\nMarch 2018 SMAC 209\/Medical Tourism REV5\/Apr2018
\n2
\ncriteria, and their home health system bears the costs. Also not covered is a situation in which
\npeople are in a foreign country when they become ill and need medical care.
\n3. If not regulated appropriately, medical tourism may have medico-legal and ethical ramifications
\nand negative implications, including but not limited to: internal brain drain, establishment of a
\ntwo-tiered health system, and the spread of antimicrobial resistance. Therefore, it is imperative
\nthat there are clear rules and regulation to govern this growing phenomenon.
\n4. Medical tourism is an emerging global industry, with health service providers in many
\ncountries competing for foreign patients, whose treatment represents a significant potential
\nsource of income. The awareness of health as a potential economic benefit and the willingness
\nto invest in it rise with the economic welfare of countries, and billions of dollars are invested
\neach year in medical tourism all over the world. The key stakeholders within this industry
\ninclude patients, brokers, governments, health care providers, insurance providers, and travel
\nagencies. The proliferation of medical tourism websites and related content raise concerns
\nabout unregulated and inaccurate on-line health information.
\n5. A medical tourist is in a more fragile and vulnerable situation than that of a patient in his or
\nher home country. Therefore, extra sensitivity on the part of caretakers is needed at every stage
\nof treatment and throughout the patient\u2019s care, including linguistic and cultural accommodation
\nwherever possible. When medical treatment is sought abroad, the normal continuum of care
\nmay be interrupted and additional precautions should therefore be taken.
\n6. Medical tourism bears many ethical implications that should be considered by all
\nstakeholders. Medical tourists receive care in both state-funded and private medical
\ninstitutions and regulations must be in place in both scenarios. These recommendations are
\naddressed primarily to physicians. The WMA encourages others who are involved in medical
\ntourism to adopt these principles.
\nRECOMMENDATIONS
\nGeneral
\n7. The WMA emphasises the importance of developing health care systems in each country in
\norder to prevent excessive medical tourism resulting from limited treatment options in a
\npatient\u00b4s home country. Financial incentives to travel outside a patient\u2019s home country for
\nmedical care should not inappropriately limit diagnostic and therapeutic alternatives in the
\npatient\u2019s home country, or restrict treatment or referral options.
\n8. The WMA calls on governments to carefully consider all the implications of medical
\ntourism to the healthcare system of a country by developing comprehensive, coordinated
\nnational protocols for medical tourism in consultation and cooperation with all relevant
\nstakeholders. These protocols should assess the possibilities of each country to receive medical
\ntourists, to agree on necessary procedures, and to prevent negative impacts to the country\u00b4s
\nhealth care system.
\n9. The WMA calls on governments and service providers to ensure that medical tourism does
\nnot negatively affect the proper use of limited health care resources or the availability of
\nappropriate care for local residents in hosting countries. Special attention should be paid to
\ntreatments with long waiting times or involving scarce medical resources. Medical tourism must
\nnot promote unethical or illegal practices, such as organ trafficking. Authorities, including
\nMarch 2018 SMAC 209\/Medical Tourism REV5\/Apr2018
\n3
\ngovernment, should be able to stop elective medical tourism where it is endangering the ability
\nto treat the local population.
\n10. The acceptance of medical tourists should never be allowed to distort the normal assessment of
\nclinical need and, where appropriate, the development of waiting lists, or priority lists for
\ntreatment. Once accepted to treatment by a health care provider, medical tourists should be
\ntreated in accordance with the urgency of their medical condition. Whenever possible patients
\nshould be referred to institutions that have been approved by national authorities or accredited
\nby appropriately recognised accreditation bodies.
\nPrior to travel
\n11. Patients should be made aware that treatment practices and health care laws may be
\ndifferent than in their home country and that treatment is provided according to the laws and
\npractices of the host country. Patients should be informed by the physician\/service provider of
\ntheir rights and legal recourse prior to travelling outside their home country for medical care,
\nincluding information regarding legal recourse in case of patient injury and possible
\ncompensation mechanisms.
\n12. The physician in the host country should establish a treatment plan, including a cost
\nestimate and payment plan, prior to the medical tourist’s travel to the host country. In addition,
\nthe physician and the medical tourism company (if any) should collaborate in order to ensure
\nthat all arrangements are made in accordance with the patient\u00b4s medical needs. Patients should
\nbe provided with information about the potential risks of combining surgical procedures with
\nlong flights and vacation activities.
\n13. Medical tourists should be informed that privacy laws are not the same in all countries and,
\nin the context of the supplementary services they receive, it is possible that their medical
\ninformation will be exposed to individuals who are not medical professionals (such as
\ninterpreters). If a medical tourist nonetheless decides to avail him or herself of these services, he
\nor she should be provided with documentation specifying the services provided by non-medical
\npractitioners (including interpreters) and an explanation as to who will have access to his or her
\nmedical information, and the medical tourist should be asked to consent to the necessary
\ndisclosure.
\n14. All stakeholders (clinical and administrative) involved in the care of medical tourists must
\nbe made aware of their ethical obligations to protect confidentiality. Where possible,
\ninterpreters, and other administrative staff with access to health information of the medical
\ntourist should sign confidentiality agreements.
\n15. The medical tourist should be informed that a change in his or her clinical condition might
\nresult in a change in the cost estimate and in associated travel plans and visa requirements.
\n16. If the treatment plan is altered because of a medical need that becomes clear after the initial
\nplan has been established, the medical tourist should be notified of the change and why it was
\nnecessary. Consent should be obtained from the patient for any changes to the treatment plan.
\n17. When a patient is suffering from an incurable condition, the physician in the host country
\nshall provide the patient with accurate information about his or her medical treatment options,
\nincluding the limitations of the treatment, the ability of the treatment to alter the course of the
\ndisease in an appreciable manner, to increase life expectancy and to improve the quality of life.
\nMarch 2018 SMAC 209\/Medical Tourism REV5\/Apr2018
\n4
\nIf, after examining all the data, the physician concludes that it is not possible to improve the
\npatient\u2019s medical condition, the physician should advise the patient of this and discourage the
\npatient from travelling.
\nTreatment
\n18. Physicians are obligated to treat every individual accepted for treatment, both local and
\nforeigner, without discrimination. All the obligations detailed in law and international medical
\nethical codes apply equally to the physician in his or her encounter with medical tourists.
\n19. Medical decisions concerning the medical tourist should be made by physicians, in
\ncooperation with the patient, and not by non-medical personnel.
\n20. At the discretion of the treating physicians, and where information is available and of good
\nquality, the patient should not be required to undergo tests previously performed, unless there is
\na clinical need to repeat tests.
\n21. The patient should receive information about his or her treatment in a language he or she
\nunderstands. This includes the right to receive a summary of the treatment progress and
\ntermination by the treating physician and a translation of the documents, as needed.
\n22. Agreement should be reached before treatment begins, on the transfer of test results and X-rays,
\nback to the home country of the patient.
\n23. Where possible, communication between the physicians in the host and home country
\nshould be established in order to ensure appropriate aftercare and clinical follow-up of the
\nmedical problems for which the patient was treated.
\n24. The physician who prepares the treatment plan for the patient should confirm the diagnosis,
\nthe prognosis and the treatments that the medical tourist has received.
\n25. The patient should receive a copy of his or her medical documents for the purpose of
\ncontinuity of care and follow-up in his or her home country. Where necessary, the patient
\nshould be given a detailed list of medical instructions and recommendations for the period
\nfollowing his or her departure. This information should include a description of the expected
\nrecovery time and the time required before travelling back to his or her home is possible.
\nAdvertising
\n26. Advertising for medical tourism services, whether via the internet or in any other manner,
\nshould comply with accepted principles of medical ethics and include detailed information
\nregarding the services provided. Information should address the service provider\u2019s areas of
\nspecialty, the physicians to whom it refers the benefits of its services, and the risks that may
\naccompany medical tourism. Access to licensing\/accreditation status of physicians and
\nfacilities and the facility\u2019s outcomes data should be made readily available. Advertising
\nmaterial should note that all medical treatment carries risks and specific additional risks may
\napply in the context of medical tourism.
\n27. National Medical Associations should do everything in their power to prevent improper
\nadvertising or advertising that is in violation of medical ethical principles, including advertising
\nMarch 2018 SMAC 209\/Medical Tourism REV5\/Apr2018
\n5
\nthat contains incorrect or partial information and\/or any information that is liable to mislead
\npatients, such as overstatement of potential benefits.
\n28. Advertising that notes the positive attributes of a specific medical treatment should also
\npresent the risks inherent in such treatment and should not guarantee treatment results or foster
\nunrealistic expectations of benefits or treatment results.
\nTransparency and the prevention of conflicts of interest
\n29. Possible conflicts of interest may be inevitable for physicians treating medical tourists,
\nincluding at the behest of their employing institution. It is essential that all clinical
\ncircumstances and relationships are managed in an open and transparent manner.
\n30. A physician shall exercise transparency and shall disclose to the medical tourist any
\npersonal, financial, professional or other conflict of interest, whether real or perceived, that may
\nbe connected to his or her treatment.
\n31. A physician should not accept any benefit, other than remuneration for the treatment, in the
\ncontext of the medical treatment, and should not offer the medical tourist nor accept from him
\nor her any business or personal offer, as long as the physician-patient relationship exists. Where
\nthe physician is treating the medical tourist as another fee paying patient, the same rules should
\napply as with his\/her other fee paying patients.
\n32. A physician should ensure that any contract with a medical tourism company or medical
\ntourist does not constitute a conflict of interest with his or her current employment, or with his
\nor her ethical and professional obligations towards other patients.
\nTransparency in payment and in the physician’s fees
\n33. A treatment plan and estimate should include a detailed report of all costs, including a
\nbreakdown of physician’s fees, such as: consultancy and surgery and additional fees the patient
\nmight incur, such as: hospital costs, surgical assistance, prosthesis (if separate), and costs for
\npost-operative care.
\n34. The cost estimate may be changed after the treatment plan has been given only in the event
\nthat the clinical condition of the patient has changed, or where circumstances have changed in a
\nway that it was impossible to anticipate or prevent. If the pricing was thus changed, the patient
\nmust be informed as to the reason for the change in costs in as timely a fashion as possible.
\nMedical Tourism: Treatments, Markets and Health System Implications: A Scoping Review, Paris:
\nOrganisation for Economic Co-operation and Development (2011)
\n\u00a7\u00a7\u00a7
\nMarch 2017<\/p>\n

1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument no: SMAC 209\/Women in Medicine COM REV2\/Apr2018 Original:
\nEnglish
\nTitle: Proposed WMA Statement on Women in Medicine
\nDestination: Socio-Medical Affairs Committee
\n209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nFor
\nConsideration
\nNote: This is a proposal from the Israeli Medical Association (IsMA). The 206th Council session in
\nLivingstone (April 2017) considered and decided to circulate it within WMA membership for
\ncomments. The Council session in Chicago (October 2017) considered the compromised
\nversion and decided to circulate it again within WMA membership for comments.
\nKeywords Women, Gender, Workforce, Male Physician, Female Physician, Pay, Employment
\nOpportunities, Feminization, Work-Life Balance.
\nAbbreviation key:
\nAM Associate Members
\nAMA American Medical Association
\nAMV Associazione Medica del Vaticano (Vatican State)
\nBMA British Medical Association
\nCMA Canadian Medical Association
\nMarch 2018 SMAC 209\/Women in Medicine COM REV2\/Apr2018
\n2
\nCGCM Consejo General de Colegios M\u00e9dicos de Espana (Spain)
\nCNOM French National Medical Council
\nDMA Danish Medical Association
\nFMA Finnish Medical Association
\nGMA German Medical Association
\nJDN Junior Doctors Network
\nNZMA New Zealand Medical Association
\nNMA Norwegian Medical Association
\nSAMA South African Medical Association
\nSwMA Swedish Medical Association
\nGENERAL COMMENTS
\nAM The Associate Members support this document but feel it needs to be stronger emphasizing that the social and cultural changes, especially
\nabout harassment of women, need to be the first and most important part of what needs to happen. We have moved that to the forefront,
\nemphasizing its importance especially in the current social environment. We have moved some paragraphs around to indicate their relative
\nimportance. We think \u201cfamily friendliness\u201d could be more specific. We support this document with or without our suggestions.
\nAMV We appreciate the work done by the Israeli Medical Association and completely agree with this proposal.
\nBMA Overall this statement is very comprehensive and identifies some important areas where greater support and enforcement of rights offer
\nmajor benefit to women doctors. We would like to propose the following changes to ensure the statement has the maximum relevance and
\nimpact for women doctors.
\nCNOM The CNOM (French Medical Council) thanks the IsMA for the quality and importance of this text and supports it apart from paragraphs 25
\nand 28.
\nDMA The Danish Medical Association is still critical towards this draft. We believe that the statement should be adjusted to focus
\nunambiguously on equal rights and opportunities \u2013 rather than on problems and solutions for women in particular.
\nThe authors have already to some extent moved the draft in this direction \u2013 but we believe that more needs to be done. For example, we
\nbelieve that some of the wording about the increase of the number of women in medicine still has a pejorative ring to it – for example the
\nuse of the phrase \u201cthe feminization of medicine\u201d.
\nSimilarly, we believe that a change in title would be helpful. The title should reflect WMA\u2019s goal concerning gender equal rights and
\nopportunities rather than pointing to women in medicine as a separate issue.
\nMarch 2018 SMAC 209\/Women in Medicine COM REV2\/Apr2018
\n3
\nFMA FMA would like to thank the IMA for their work and for a more balanced text. However, we would still like to raise a question, whether
\nthe document could be even further developed and titled as a Statement on Gender Equality in Medicine? Parts of the text already
\ncorrespond to this title.
\nNZMA We welcome the development of this statement and are generally supportive of the fundamental principles. We have proposed a few minor
\nsuggested wording changes as tracked changes in the draft statement (see below).
\nGMA \u2022 The GMA suggests avoiding the term \u201cfeminization\u201d, which, according to female leaders in the medical profession, has a negative
\nconnotation in certain contexts and is sometimes used pejoratively. It has been replaced in most instances, but still appears in the
\npreamble.
\n\u2022 The GMA notes that there is some overlap between the section on Work-Life Balance and the section on Pregnancy and Parenthood
\n(e.g., paragraph 10 could fit in both categories).
\n\u2022 The GMA also suggests moving paragraph 13 to the Pregnancy and Parenthood section and combining it with paragraph 18.
\nParagraphs 19 and 20 are also covered elsewhere in the paper (e.g. in paragraph 18 \u201cParents should have the right to take maternity or
\nparental leave without negative consequences\u2026\u201d)
\n\u2022 The GMA recommends that paragraphs 22 and 23 focused on breastfeeding be combined.
\nNMA Thanks to the Israeli Medical Association for revising this document. The document is improved and it does not only deal with female
\nphysicians, but also with equal rights between the sexes and a family friendly profession. We think the document should be even more
\ndirected towards both sexes and suggest some additions and deletions in the document. We do not agree that certain measures have to be
\ntaken due to the increased number of female physicians in medicine. More female physicians should not be considered as a challenge or a
\nproblem, and the concept feminisation of medicine could be perceived as something negative. Physicians of both sexes have common
\ninterests in developing a working life with equal opportunities for both female and male physicians. The situation is therefore more
\ncomplex, and measures and changes in attitudes are necessary to establish good working environments for both male and female
\nphysicians. It must be acceptable also for male physicians to leave at 4 pm to pick up children in the kindergarten and male physicians
\nshould have equal opportunities to take marital leave without any reprisals from the employer.
\nSAMA SAMA feels that this is an important document, which raises important issues. Further comments have been made in the body of the
\ndocument. The current document seems to have lost its emphasis on the issues that affect women in medicine and is now emphasising a
\ngeneral working environment.
\nSwMA The SMA feels that this policy would benefit from focusing even more on equal opportunities and rights for female and male physicians,
\nrather than on perceived challenges due to a larger proportion of women in the medical workforce. We have suggested some changes of
\nwording throughout the document to try to achieve this.
\nMarch 2018 SMAC 209\/Women in Medicine COM REV2\/Apr2018
\n4
\nNumbering will be deleted (or adjusted) when the revised text is adopted.
\nProposed Text:
\nSMAC 207\/Women in Medicine
\nREV\/Oct2017
\nSpecific Comments
\nAdditions: bold\/underlined
\nDeletions: lined-out
\nComments only: [italic]
\nProposed Revised Text by:
\nIsMA
\nSMAC 209\/ Women in Medicine
\nREV2\/Apr2018
\nTitle WMA Statement on Women in
\nMedicine
\nWMA Statement on Medicine in
\nMedicine
\nPreamble
\nNew The WMA notes the increasing trend around the
\nworld for women to enter medical schools and the
\nmedical profession, and believes that the study and
\nthe practice of medicine must be transformed to a
\ngreater or lesser extent in order to support all
\npeople who study to become or practice as
\nphysicians, of whatever gender. This is an essential
\nprocess of modernization by which inclusiveness is
\npromoted by gender neutrality. This statement
\nproposes mechanisms to identify and address
\nbarriers causing discrimination between genders.
\n[BMA]
\nThe WMA notes the increasing trend
\naround the world for women to enter
\nmedical schools and the medical
\nprofession, and believes that the
\nstudy and the practice of medicine
\nmust be transformed to a greater or
\nlesser extent in order to support all
\npeople who study to become or
\npractice as physicians, of whatever
\ngender. This is an essential process of
\nmodernization by which
\ninclusiveness is promoted by gender
\nneutrality. This statement proposes
\nmechanisms to identify and address
\nbarriers causing discrimination
\nbetween genders.
\n1. The statement highlights the rise in
\nfemale physicians and with this the
\nopportunities and challenges which
\narise. The statement recommends
\nactions in the following areas:
\nincreased presence of women in
\nacademia and management roles,
\nwork-life balance, changes in
\nDelete parag. [NMA] and [SwMA]
\nParag. 1 and 2 to change places [SAMA]
\nThe statement highlights the increase rise in the
\nnumber of female physicians and with this the
\npotential opportunities and challenges which arise
\n[CMA]. The statement recommends actions in the
\nMarch 2018 SMAC 209\/Women in Medicine COM REV2\/Apr2018
\n5
\norganizational culture and long-term
\nimplications of the feminization of
\nmedicine.
\nfollowing areas: increased presence of women in
\nacademia and management roles, work-life balance,
\nchanges in organizational culture and long-term
\nimplications of the feminization increased
\nproportion of women in of medicine. [GMA]
\nThe statement highlights the rise in female physicians
\nand with this the opportunities and challenges which
\narise. The statement recommends actions in the
\nfollowing areas: changes in organizational culture
\nincluding the elimination of harassment in training
\nand the workplace, increased presence of women in
\nacademia and management roles (including
\nleadership and partnership), work-life balance,
\nchanges in organizational culture, and long-term
\nimplications of the feminization of medicine
\nworkforce changes in medicine. [AM: Please define
\nthe use of \u201cthe feminization of medicine\u201d or use
\nanother term]
\nThe statement highlights the rise in female physicians
\nand with this the opportunities and challenges which
\narise. The statement recommends actions in the
\nfollowing areas: increased presence of women in
\nacademia and management roles, work-life balance,
\nchanges in organizational culture and long-term
\nimplications of the feminization increased
\nproportion of women in of medicine. [GMA]
\nThe statement highlights the rise in numbers of
\nfemale physicians and with this the opportunities and
\nchallenges which that arise. [NZMA]
\nThe statement highlights the rise increase in female
\nphysicians and with this the opportunities and
\nMarch 2018 SMAC 209\/Women in Medicine COM REV2\/Apr2018
\n6
\nchallenges which arise. The statement recommends
\nactions in the following areas: increased presence of
\nwomen in academia and management roles, work-life
\nbalance, changes in organizational culture and long-
\nterm implications of workforce planning. the
\nfeminization of medicine. [AMA]
\n\u2026.. The statement recommends actions in the
\nfollowing areas: increased presence of women in
\nacademia and management roles, work-life balance,
\nchanges in organizational culture and long-term
\nimplications of gender neutrality in the feminization
\nof medicine. [BMA]
\n2. In many countries around the world,
\nthe number of women studying and
\npracticing medicine has steadily risen
\nover the past decades, surpassing 50%
\nin many places.
\nParag. 1 and 2 to change places [SAMA]
\nMoved after parag. 3 for better flow of the document
\n[SwMA]
\nIn many countries around the world, the number of
\nwomen studying and practicing medicine has steadily
\nrisen over the past decades, surpassing 50% in many
\nplaces. Both men and women must have the same
\nopportunities to do a career in medicine. [NMA]
\nIn many countries around the world, the
\nnumber of women studying and practicing
\nmedicine has steadily risen over the past
\ndecades, surpassing 50% in many places.
\n3. This issue was previously recognized
\nin the WMA Resolution on Access of
\nWomen and Children to Health Care
\nand the Role of Women in the Medical
\nProfession (1997 Hamburg, 2008
\nSeoul) which, among other things,
\ncalled for increased representation and
\nparticipation in the medical profession,
\nespecially in light of the growing
\nenrolment of women in medical
\nDelete parag. [NMA]
\nParag. 3 and 4 to change places [SAMA]
\nThis The issue of women in medicine [SwMA] was
\npreviously recognized in the WMA Resolution on
\nAccess of Women and Children to Health Care and the
\nRole of Women in the Medical Profession (1997
\nHamburg, 2008 Seoul) [SwMA] which that [NZMA],
\namong other things, called for increased representation
\nMarch 2018 SMAC 209\/Women in Medicine COM REV2\/Apr2018
\n7
\nschools. It also called for a higher
\ngrowth rate of membership of women
\nin the NMA’s through empowerment,
\ncareer development, training and other
\nstrategic initiatives.
\nand participation in the medical profession, especially
\nin light of the growing enrolment of women in medical
\nschools. It also called for a higher growth rate of
\nmembership of women in the NMA’s National
\nMedical Associations (NMAs) through empowerment,
\ncareer development, training and other strategic
\ninitiatives. [SwMA+AM+SAMA+AMA+BMA]
\nIn many countries around the world, the number of
\nwomen studying and practicing medicine has
\nsteadily risen over the past decades, surpassing 50%
\nin many places. [SwMA: Moved from parag. 2 above
\nfor better flow of the document]
\n4. This development is in need of
\nsupportive measures including the
\nfollowing:
\nParag. 3 and 4 to change places [SAMA]
\nThis development is in need of supportive measures
\noffers opportunities for action, including in the
\nfollowing areas: [SwMA]
\nThis development offers opportunities for
\naction, including in the following areas:
\nNew \u2022 Elimination of harassment against women in
\nboth training and the workplace. [AM]
\n\u2022 Greater emphasis on a proper
\nbalance of work and family life,
\nwhile supporting the professional
\ndevelopment of an individual
\nphysician.
\n\u2022 Greater emphasis on a proper balance of work and
\nfamily life, while supporting the professional
\ndevelopment of an individual physicians. [SwMA]
\nGreater emphasis on a proper balance of
\nwork and family life, while supporting
\nthe professional development of
\nindividual physicians.
\n\u2022 Encouragement and actualization
\nof women in both academia,
\nleadership and managerial roles.
\n\u2022 Encouragement and actualization of women in
\nboth [CMA] academia and non-academic
\npractice environments, leadership, partnership,
\nand managerial roles. [AM]
\nEncouragement and actualization of
\nwomen in academia, leadership and
\nmanagerial roles.
\nMarch 2018 SMAC 209\/Women in Medicine COM REV2\/Apr2018
\n8
\n\u2022 Encouragement and actualization of women in
\nboth academia, senior \/ leadership and managerial
\nroles. [BMA]
\n\u2022 Equalization of pay and
\nemployment opportunities for men
\nand women, the elimination of
\ngender pay gaps in medicine, and
\nthe removal of barriers negatively
\naffecting the advancement of
\nfemale physicians.
\nEqualization of pay and employment opportunities for
\nmen and women, the elimination of sex and gender
\npay gaps [AMA] in medicine, and the removal of
\nbarriers negatively affecting the advancement of
\nfemale physicians. [NMA]
\nEqualization of pay and employment
\nopportunities for men and women, the
\nelimination of gender pay gaps in
\nmedicine, and the removal of barriers
\nnegatively affecting the advancement of
\nfemale physicians.
\nThe issue of women in medicine was
\npreviously recognized in the WMA
\nResolution on Access of Women and
\nChildren to Health Care and the Role of
\nWomen in the Medical Profession which,
\namong other things, called for increased
\nrepresentation and participation in the
\nmedical profession, especially in light of
\nthe growing enrolment of women in
\nmedical schools. It also called for a
\nhigher growth rate of membership of
\nwomen in National Medical Associations
\n(NMAs) through empowerment, career
\ndevelopment, training and other strategic
\ninitiatives.
\nRECOMMENDATIONS RECOMMENDATIONS
\nMoved from below, as amended (parag 24-26):
\nChanges in organizational culture
\nThe medical profession and employers should work to
\neliminate not tolerate discrimination and harassment
\nMarch 2018 SMAC 209\/Women in Medicine COM REV2\/Apr2018
\n9
\non the basis of gender and create a supportive
\nenvironment that allows for equal opportunities for
\ntraining, employment and advancement. Physicians
\nand staff should be periodically trained to
\nrecognize, respond, and report signs of
\ndiscrimination and harassment so that action can
\nbe taken to eliminate them from the workplace.
\nEmployers should have confidential, non-
\nretaliatory protected programs for reporting
\ndiscrimination and harassment. There should be a
\nseparate unbiased independent mechanism for
\naddressing these reports on both an individual and
\nsystemic level.
\nHospitals should recognise that female physicians
\nhave been found to face higher levels of mental illness
\nand suicide than their male peers and should
\ninvestigate and address structural issues within the
\nworkforce that may contribute to this, including but
\nnot limited to organisational culture.
\n[AM comments: This statement should be footnoted
\nwith data and source, if possible]
\nFamily friendliness should be part of the
\norganizational culture of hospitals and other places of
\nemployment by providing paid family leave when
\nindicated.
\n[AM]
\nIncreased presence of women in
\nacademia, leadership and
\nmanagement roles.
\nDelete [NMA] Increased presence of women in
\nacademia, leadership and management
\nroles.
\nMarch 2018 SMAC 209\/Women in Medicine COM REV2\/Apr2018
\n10
\n5. National Medical
\nAssociations\/Medical
\nSchools\/Employers should facilitate
\nthe establishment of mentoring
\nprograms, sponsorship, and active
\nrecruitment to provide female medical
\nstudents and physicians, guidance and
\nencouragement necessary to
\nundertake leadership and management
\nroles.
\nDelete parag. [NMA]
\nNational Medical Associations\/Medical
\nSchools\/Employers should are urged to facilitate the
\nestablishment of mentoring programs, sponsorship,
\nand active recruitment to provide female all medical
\nstudents and physicians, guidance and encouragement
\nnecessary to undertake leadership and management
\nroles. [SwMA]
\nNational Medical Associations\/Medical
\nSchools\/Employers should facilitate the establishment
\nof mentoring programs, sponsorship, and active
\nrecruitment to provide both female and male medical
\nstudents and physicians, guidance and encouragement
\nnecessary to undertake leadership and management
\nroles. [NZMA]
\nNational Medical Associations\/Medical
\nSchools\/Employers are urged to facilitate
\nthe establishment of mentoring programs,
\nsponsorship, and active recruitment to
\nprovide medical students and physicians
\nwith the necessary guidance and
\nencouragement necessary to undertake
\nleadership and management roles.
\n6. NMAs should explore opportunities
\nand incentives to encourage both men
\nand women to pursue diverse careers
\nin medicine and apply for fellowships,
\nacademic, senior leadership and
\nmanagement positions.
\nNMAs should explore support opportunities and
\nincentives to encourage both men and women to
\npursue diverse careers in medicine and apply for
\nfellowships, academic, senior leadership and
\nmanagement positions. [SwMA]
\nNMAs should explore opportunities and incentives to
\nencourage both men and more women to pursue
\ndiverse careers in medicine. NMAs should
\nencourage and women to apply for fellowships,
\nacademic, senior leadership and management
\npositions. [AM]
\nNMAs should explore opportunities and
\nincentives to encourage both men and
\nwomen to pursue diverse careers in
\nmedicine and apply for fellowships,
\nacademic, senior leadership and
\nmanagement positions.
\n7. NMAs should lobby for gender equal
\nmedical education and work policies.
\nDeleted paragraph. [SwMA]
\nNMAs should lobby pro-actively [AM] for gender
\nequal medical education, and work and responsibility
\nNMAs should lobby for gender equal
\nmedical education and work policies.
\nMarch 2018 SMAC 209\/Women in Medicine COM REV2\/Apr2018
\n11
\npolicies [CGCM]
\nNMAs should lobby for equal sex and gender equal
\nmedical education and work policies. [AMA]
\n8. Engagement of women in health
\npolicy organizations and professional
\nmedical organizations should be
\nencouraged.
\nEngagement of both women and men in health policy
\norganizations and professional medical organizations
\nshould be encouraged. [SwMA]
\nEqual engagement of women and men in health
\npolicy organizations and professional medical
\norganizations should be encouraged. [NZMA]
\nNMAs should encourage the engagement
\nof both men and women in health policy
\norganizations and professional medical
\norganizations.
\nWork-Life Balance Work-Life Balance
\n9. Physicians should recognize that an
\nappropriate work-life balance is
\nbeneficial to all physicians, however
\nthat women may uniquely face
\nchallenges to work-life balance
\nimposed by societal expectations that
\nmust be addressed to solve the issue.
\nPhysicians should recognize that an appropriate work-
\nlife balance is beneficial to all physicians, however
\nthat women may uniquely face challenges to work-life
\nbalance imposed by societal expectations that must be
\naddressed to solve the issue. [SwMA]
\nPhysicians should recognize that an appropriate work-
\nlife balance is beneficial to all physicians, however
\nand [NZMA] that women may uniquely face unique
\nchallenges to work-life balance imposed by societal
\nexpectations that must be addressed to solve the issue.
\n[GMA]
\nPhysicians should recognize that an appropriate work-
\nlife balance is beneficial to all physicians, however
\nthat women may uniquely face challenges to work-life
\nbalance imposed by societal expectations concerning
\ngender roles that must be addressed to solve the issue.
\n[CGCM]
\nPhysicians should recognize that an
\nappropriate work-life balance is
\nbeneficial to all physicians, but that
\nwomen may face unique challenges to
\nwork-life balance imposed by societal
\nexpectations concerning gender roles that
\nmust be addressed to solve the issue.
\nMarch 2018 SMAC 209\/Women in Medicine COM REV2\/Apr2018
\n12
\n10. Hospitals and other places of
\nemployment should strive to provide
\nand promote access to high quality,
\naffordable, flexible childcare for
\nworking parents, including the
\nprovision of onsite housing and
\nchildcare where appropriate. These
\nshould be available to male and
\nfemale physicians, recognizing the
\nneed for a better work-life balance.
\nThey should provide information on
\navailable services which support the
\ncompatibility of work and family.
\nHospitals and other places of employment should
\nstrive to provide and promote access to high quality,
\naffordable, flexible childcare for working parents,
\nincluding the provision of onsite housing and
\nchildcare where appropriate. These services should be
\navailable to both male and female working
\nphysicians, recognizing the need for a better work-life
\nbalance. They should provide information on available
\nservices which support the compatibility of work and
\nfamily. [SwMA]
\nHospitals and other places of employment should
\nstrive to provide and promote access to high quality,
\naffordable, flexible childcare for working parents,
\nincluding the provision of onsite housing and
\nchildcare where appropriate. These should be
\navailable to male and female all physicians [AM],
\nrecognizing the need for a better work-life balance. As
\nwell as about co-responsibility in personal life.
\nThey should provide male and female physicians
\ninformation [CGCM] on available services which that
\nsupport the compatibility of work and family.
\n[NZMA]
\nHospitals and other places of employment should be
\nreceptive to the possibility of flexible and family-
\nfriendly working hours, including part-time
\nresidencies, posts, and professional appointments,
\nwhere appropriate. particularly in fields in which
\nwomen are underrepresented. [NMA]
\nHospitals and other places of
\nemployment should strive to provide and
\npromote access to high quality,
\naffordable, flexible childcare for working
\nparents, including the provision of onsite
\nhousing and childcare where appropriate.
\nThese services should be available to
\nboth male and female physicians,
\nrecognizing the need for a better work-
\nlife balance. Employers should provide
\ninformation on available services which
\nsupport the compatibility of work and
\nfamily.
\n11. Hospitals and other places of
\nemployment should be receptive to
\nthe possibility of flexible and family-
\nfriendly working hours, including
\nHospitals and other places of employment should be
\nreceptive to the possibility of flexible and family-
\nfriendly working hours where appropriate, including
\npart-time residencies, posts, and professional
\nHospitals and other places of
\nemployment should be receptive to the
\npossibility of flexible and family-friendly
\nworking hours, including part-time
\nMarch 2018 SMAC 209\/Women in Medicine COM REV2\/Apr2018
\n13
\npart-time residencies, posts, and
\nprofessional appointments, where
\nappropriate, particularly in fields in
\nwhich women are underrepresented.
\nappointments, where appropriate [NZMA].
\nparticularly in fields in which women are
\nunderrepresented. [NMA + SwMA]
\nresidencies, posts, and professional
\nappointments, particularly in fields in
\nwhich women are underrepresented.
\n12. There is a need for increased research
\non alternative work schedules and
\ntelecommunication opportunities that
\nwill allow flexibility in balancing
\nwork-life demands.
\nThere is a need for increased research on alternative
\nwork schedules and telecommunication opportunities
\nthat will allow flexibility in balancing work-life
\ndemand of men and women. [CGCM]
\nThere is a need for increased research on
\nalternative work schedules and
\ntelecommunication opportunities that will
\nallow flexibility in balancing work-life
\ndemands.
\n13. NMAs should advocate for the
\nenforcement and, where necessary,
\nthe introduction of policy mandating
\nappropriate paid maternity leave and
\nparental leave in their respective
\ncountries.
\nNMAs should advocate for the enforcement and,
\nwhere necessary, the [SwMA] introduction of policy
\nmandating appropriate paid maternity leave and
\n[CMA + SwMA] parental leave in their respective
\ncountries. The policy should include options for
\nflexible working hours. [SwMA]
\nNMAs should advocate for the enforcement and,
\nwhere necessary, the introduction of policy mandating
\nappropriate paid maternity leave and parental leave
\nand rights in their respective countries. [BMA]
\nMove to parag. 18.[GMA]
\nNMAs should advocate for the
\nenforcement and, where necessary, the
\nintroduction of policy mandating
\nappropriate paid parental leave and rights
\nin their respective countries.
\n14. Medical workplaces and professional
\norganisations should have fair,
\nimpartial and transparent policies and
\npractices to give female doctors and
\nmedical students equal access to
\nemployment, education and training
\nopportunities in medicine.
\nMedical workplaces and professional organisations
\nshould have fair, impartial and transparent policies
\nand practices to give female and male doctors and
\nmedical students equal access to employment,
\neducation and training opportunities in medicine.
\n[SwMA]
\nMedical workplaces and professional organisations
\nshould have fair, impartial and transparent policies
\nand practices to give all [NZMA] female doctors
\nphysicians and medical students equal access to
\nemployment, education and training opportunities in
\nMedical workplaces and professional
\norganisations should have fair, impartial
\nand transparent policies and practices to
\ngive all physicians and medical students
\nequal access to employment, education
\nand training opportunities in medicine.
\nMarch 2018 SMAC 209\/Women in Medicine COM REV2\/Apr2018
\n14
\nmedicine. [AMA]
\nPregnancy and Parenthood Pregnancy and Parenthood
\n15. It should be inadmissible for
\nemployers to ask applicants about
\nfamily planning in relation to work.
\nIt should be illegal inadmissible for employers to ask
\napplicants about pregnancy and\/or family planning
\nin relation to work. [BMA]
\nIt should be inadmissible for employers to ask
\napplicants about family planning in relation to work
\nor when applying medical school or residency.
\n[JDN]
\nIt should be illegal for employers to ask
\napplicants about pregnancy and\/or family
\nplanning in relation to work.
\nNew Physicians should have the freedom to choose when
\nthey wish to have children and should not feel
\npressures against doing so at a time of their
\nchoosing. [JDN]
\n16. A risk assessment should be made by
\nthe employer concerning the risks to
\npregnant physicians working shifts.
\nThe pregnant physician should have
\nthe right to not work night shifts or
\non-call shifts during pregnancy,
\nespecially during the last trimester,
\nwithout negative consequences on
\nsalary or progression in residency.
\nA risk assessment should be made by the employer
\nconcerning the risks to pregnant physicians working
\nshifts. The pregnant physician should have the right
\nnot to not work night shifts or on-call shifts during the
\nlater part of pregnancy, especially during the last
\ntrimester, without any negative employment
\nconsequences on salary or progression in residency.
\n[SwMA]
\nA risk assessment should be made by the employer
\nconcerning the risks to pregnant physicians working
\nshifts. Considerations for radiation exposure,
\nhazardous chemicals, environmental exposures,
\nlifting requirements, access to adequate food and
\nwater, and restroom access should be addressed
\nand accommodations provided. The pregnant
\nphysician, whether in training or practicing, should
\nhave the right to make schedule accommodations in
\nEmployers should assess the risks to
\npregnant physicians and their unborn
\nchildren, when a physician has recently
\ngiven birth and when she is
\nbreastfeeding. Where it is found, or a
\nmedical practitioner considers, that an
\nemployee or her child would be at risk
\nwere she to continue with her normal
\nduties, the employer should provide
\nsuitable alternative work for which the
\nphysician should receive her normal rate
\nof pay. Physician should have the right to
\nnot work night shifts or on-call shifts
\nduring the later part of pregnancy,
\nwithout negative consequences on salary,
\nemployment or progression in residency.
\nMarch 2018 SMAC 209\/Women in Medicine COM REV2\/Apr2018
\n15
\norder to avoid night shifts or on-call shifts (if
\ndesired), and radiologic and infectious exposure
\nduring pregnancy, especially during the last trimester,
\nwithout negative consequences on salary or
\nprogression in residency. Pregnant physicians
\nshould be able to choose which work or training
\naccommodations best fit their personal and family
\nneeds. [AM]
\nA risk assessment of the workplace should be made
\nby the employer concerning the risks to pregnant
\nphysicians and their unborn children, when a
\nphysician has recently given birth and when she is
\nbreastfeeding. where it is found, or a medical
\npractitioner considers, that an employee or her
\nchild would be at risk were she to continue with
\nher normal duties, the employer should provide
\nsuitable alternative work for which the physician
\nshould receive her normal rate of pay working
\nshifts. The pregnant physician should have the right to
\nnot work night shifts or on-call shifts during
\npregnancy, especially during the last trimester,
\nwithout negative consequences on salary or
\nprogression in residency. [BMA: The statement on
\nrisk assessments for pregnant doctors working shifts
\nshould be widened to include the range of workplace
\nactivities that could put pregnant physicians and their
\nunborn children at risk e.g. long periods of standing,
\nlifting heavy items. It should also be broadened to
\ninclude new mothers and those breastfeeding.]
\n17. Pregnant physicians should have
\nequal training opportunities in post-
\ngraduate training.
\nPregnant physicians should have equal
\ntraining opportunities in post-graduate
\ntraining.
\n18. Parents should have the right to take Parents should have the right to take maternity or Parents should have the right to take
\nMarch 2018 SMAC 209\/Women in Medicine COM REV2\/Apr2018
\n16
\nmaternity or parental leave without
\nnegative consequences on their
\nemployment, training or career
\nopportunities.
\nparental leave without negative consequences on their
\nemployment, training or career opportunities [SwMA
\n+ CMA]
\nParents should have the right to take maternity or
\nparental leave without negative consequences on their
\nemployment, training or career opportunities. NMAs
\nshould advocate for the enforcement and, where
\nnecessary, the introduction of policy mandating
\nappropriate paid maternity leave and parental
\nleave in their respective countries. [GMA]
\nadequate parental leave without negative
\nconsequences on their employment,
\ntraining or career opportunities.
\n19. Parents should have adequate parental
\nleave with fair pay and options for
\nflexible working.
\nDelete parag. [GMA + SwMA]
\n20. Parents should have the right to return
\nto the same position after parental
\nleave, without the fear of termination.
\nDelete parag. [GMA + SwMA] Parents should have the right to return to
\nthe same position after parental leave,
\nwithout the fear of termination.
\n21. Employers and training bodies should
\nprovide necessary supports to any
\nphysician returning after a prolonged
\nperiod of absence including inter alia
\nfor parental, maternity and elder-care
\nleave.
\nEmployers and training bodies should provide
\nnecessary supports to any physician returning after a
\nprolonged period of absence, including inter alia for
\nafter parental, or maternity and elder-care leave.
\n(SwMA)
\nEmployers and training bodies should provide
\nnecessary supports to any physician returning after a
\nprolonged period of absence including inter alia for
\nparental and\/or maternity or caring for older or
\ndisabled relatives and elder-care leave. [BMA]
\nEmployers and training bodies should
\nprovide necessary support to any
\nphysician returning after a prolonged
\nperiod of absence including parental,
\nmaternity and elder-care leave.
\nMarch 2018 SMAC 209\/Women in Medicine COM REV2\/Apr2018
\n17
\n22. Mothers should be able to breastfeed
\n(or be given protected time for breast
\npumping) during work hours, within
\nthe current guidelines from the WHO.
\nMothers should be able to breastfeed (or
\nbe given protected time for breast
\npumping) during work hours, within the
\ncurrent guidelines from the WHO.
\n23. Workplaces should provide adequate
\naccommodation for women who are
\nbreastfeeding including designated
\nareas for breastfeeding, breast
\npumping, and milk storage.
\nWorkplaces should provide adequate accommodation
\nareas for women who are breastfeeding, including
\ndesignated areas for breastfeeding, breast pumping,
\nand milk storage. [SwMA]
\nWorkplaces should provide adequate
\naccommodation for women who are
\nbreastfeeding including designated areas
\nfor breastfeeding, breast pumping, and
\nmilk storage.
\nChanges in organizational culture Changes in organisational culture
\n24. The medical profession and
\nemployers should work to eliminate
\ndiscrimination and harassment on the
\nbasis of gender and create a
\nsupportive environment that allows
\nfor equal opportunities for training,
\nemployment and advancement.
\nThe medical profession and employers should work to
\neliminate discrimination and harassment on the basis
\nof sex and gender and create a supportive
\nenvironment that allows for equal opportunities for
\ntraining, employment and advancement. [AMA]
\nThe medical profession and employers
\nshould work to eliminate discrimination
\nand harassment on the basis of gender
\nand create a supportive environment that
\nallows equal opportunities for training,
\nemployment and advancement.
\n25. Hospitals should recognise that
\nfemale physicians have been found to
\nface higher levels of mental illness
\nand suicide than their male peers and
\nshould investigate and address
\nstructural issues within the workforce
\nthat may contribute to this, including
\nbut not limited to organisational
\nculture.
\nDelete parag. [CNOM: Unless we can back up this
\nphenomenon with a reference to the scientific
\nevidence, we would recommend deleting this
\nparagraph]
\nHospitals should recognise that female physicians
\nhave been found to face be subject to higher risks
\nlevels of mental illness and suicide than their male
\npeers and should investigate and address structural
\nissues within the workforce that may contribute to
\nthis, including but not limited to organisational
\nculture. [SwMA: Please add reference to studies
\nshowing this]
\nHospitals and other primary care and work for
\nwomen centers should recognise that female
\nphysicians have been found to face higher levels of
\nMarch 2018 SMAC 209\/Women in Medicine COM REV2\/Apr2018
\n18
\nmental illness and suicide than their male peers and
\nshould investigate and address structural issues about
\nhiring policies within for the workforce that may
\ncontribute to this, including but not limited to
\norganisational culture [CGCM]
\n[SAMA: Please provide a reference for this
\nstatement]
\nReplace parag. by: Employers should recognise that
\nfemale physicians have been found to face
\nsignificant levels of mental illness, from mild to
\nsevere conditions, and suicide [BMA: The statement
\non hospitals addressing the issues associated with the
\nhigher risks of mental illness and suicide experienced
\nby women needs qualification. Whilst there is some
\nevidence that women doctors in some countries are at
\na higher risk of suicide compared to men, the evidence
\non mental health is more complex due to factors
\nincluding underreporting of mental health issues by
\nmen. It is therefore preferable to highlight and
\naddress the specific mental health issues experienced
\nby women doctors which are linked to career
\npathways, combining work with family and workplace
\ndiscrimination. There is a role for all healthcare
\nemployers in tackling these issues, not just hospitals.]
\n26. Family friendliness should be part of
\nthe organizational culture of hospitals
\nand other places of employment.
\nFamily friendliness should be part of the
\norganizational culture of hospitals and
\nother places of employment.
\nWorkforce planning and research Workforce planning and research
\nMove parag. 29 below here [AM]
\n27. Governments should take the
\nincreasing number of women entering
\nNMA\u2019s should encourage Governments should to
\ntake the increasing number of women entering
\nNMAs should encourage governments to
\ntake the increasing number of women
\nMarch 2018 SMAC 209\/Women in Medicine COM REV2\/Apr2018
\n19
\nmedicine into consideration in the
\ncontext of long-term workforce
\nplanning. A diverse workforce is
\nbeneficial to the system and to
\npatients. Organizations delivering
\nhealthcare should focus on ensuring
\nsystems are appropriately resourced to
\nensure all those working within it are
\nable to deliver safe care to patients
\nand are appropriately and equitably
\nrewarded. Governments should also
\nwork to counteract negative attitudes
\nand behaviour, bias, and\/or outdated
\nnorms and values from organizations
\nand individuals.
\nmedicine into consideration in the context of long-
\nterm workforce planning\u2026. [SAMA]
\nGovernments should take the increasing number of
\nwomen entering medicine into consideration in the
\ncontext of long-term workforce planning. A diverse
\nworkforce is beneficial to the system health care and
\nto patients. Governments need to take this into
\naccount in the context of long-term workforce
\nplanning. Organizations delivering healthcare should
\nfocus on ensuring systems are appropriately resourced
\nto ensure that all those working within it them are
\nable to deliver safe care to patients and are
\nappropriately and equitably rewarded. Governments
\nshould also work to counteract negative attitudes and
\nbehaviour, bias, and\/or outdated norms and values
\nfrom organizations and individuals. [SwMA]
\nGovernments and employers should take the
\nincreasing number of women entering medicine into
\nconsideration in the context of long-term workforce
\nplanning. A diverse workforce is beneficial to the
\nhealth care system and to patients\u2026. [AM]
\nentering medicine into consideration in
\nthe context of long-term workforce
\nplanning. A diverse workforce is
\nbeneficial to the health care system and
\nto patients. Organizations delivering
\nhealthcare should focus on ensuring
\nsystems are appropriately resourced to
\nensure that all those working within them
\nare able to deliver safe care to patients
\nand are appropriately and equitably
\nrewarded. Governments should also work
\nto counteract negative attitudes and
\nbehaviour, bias, and\/or outdated norms
\nand values from organizations and
\nindividuals.
\n28. Governments should invest in
\nresearch to evaluate the long-term
\nimplications associated with the
\ndifferent approaches of male and
\nfemale physicians to patient care.
\nThey should work to identify those
\nfactors that drive women to choose
\ncertain career steps and fields of
\nspecialization early on in their
\nmedical education and training and
\nstrive to address barriers in order to
\nNMA\u2019s should encourage Governments should to
\ninvest in research\u2026. [SAMA]
\nGovernments should invest in research to evaluate the
\nlong-term implications associated with the different
\napproaches of male and female physicians to patient
\ncare. They should work to identify those factors that
\ndrive women and men [SwMA] to choose certain
\ncareer steps and fields of specialization early on in
\ntheir medical education and training and strive to
\naddress any identified barriers [CMA] in order to
\nNMAs should encourage governments to
\ninvest in research to identify those factors
\nthat drive women to choose certain fields
\nof specialization early on in their medical
\neducation and training
\nand strive to address any identified
\nbarriers in order to achieve equal
\nrepresentation of men and women in all
\nfields of medicine.
\nMarch 2018 SMAC 209\/Women in Medicine COM REV2\/Apr2018
\n20
\nachieve equal representation of
\nwomen in all fields of medicine.
\nachieve equal representation of women and men in all
\nfields of medicine. [SwMA]
\nReplace parag. by: Research should be
\ncommissioned to identify those factors that drive
\nwomen to choose certain fields of specialization
\nearly on in their medical education and training, so
\nthat women have a broader choice of career and
\nspecialty. [BMA: The statement on research required
\nto evaluate the long-term implications associated with
\nthe different approaches of male and female
\nphysicians to patient care requires clarification. The
\nkey priority in research and policy focus should be the
\nbarriers which still prevent women being able to
\nchoose and continue their careers in certain
\nspecialties of medicine \u2013 e.g. because of a lack of
\nflexibility, inability to work part time, long\/unsocial
\nhours culture].
\nConsidering the data now available to us which
\nwould enable investigation into the question that
\ngender could have an impact on the different
\napproaches of male and female physicians to
\npatient care or different care models, governments
\nshould invest in research to evaluate the long-term
\nimplications associated with the different approaches
\nof male and female physicians to patient care.They
\nshould work to identify those factors that drive women
\nto choose certain career steps and fields of
\nspecialization early on in their medical education and
\ntraining and strive to address barriers in order to
\nachieve equal representation of women in all fields of
\nmedicine. [CNOM]
\n29. Governments and employers should NMA\u2019s should encourage Governments and NMAs should encourage governments
\nMarch 2018 SMAC 209\/Women in Medicine COM REV2\/Apr2018
\n21
\nensure that men and women receive
\nequal compensation for
\ncommensurate work and work to
\neliminate the gender pay gap in
\nmedicine.
\nemployers should to ensure that men and women
\nreceive equal compensation for commensurate work
\nand work to eliminate the gender pay gap in medicine.
\n[SAMA]
\nGovernments and employers should ensure that men
\nand women and men receive equal compensation for
\ncommensurate work and work to eliminate the gender
\npay gap in medicine. [SwMA]
\nGovernments and employers should ensure that men
\nand women receive equal compensation for
\ncommensurate work and work to eliminate the sex
\nand gender pay gap in medicine. [AMA]
\nMove above, before parag. 27 [AM]
\nand employers to ensure that men and
\nwomen receive equal compensation for
\ncommensurate work and strive to
\neliminate the gender pay gap in medicine.
\n*****
\n06.03.2018<\/p>\n

1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument
\nno:
\nSMAC 209\/Declaration of Seoul COM REV\/Apr2018 Original:
\nEnglish
\nTitle: Proposed revision of WMA Declaration of Seoul on Professional Autonomy
\nand Clinical Independence
\nDestination: Socio-Medical Affairs Committee
\n209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nFor
\nConsideration
\nNote: As part of the annual policy review process, the Council in Buenos Aires (April 2016) decided that
\nthe Statement on Professional Responsibility for standards of Medical Care, under the 10-years
\npolicy review, be rescinded and archived, and that the WMA Declarations of Seoul and Madrid be
\nmerged in a single document, completed with the missing sections from that Statement. Prof.
\nVivienne Nathanson, British Medical Association (BMA), volunteered to complete that work.
\nFurther to the proposed revision submitted to the Council in Taipei (Oct. 2016) and then circulated
\nfor comments, the Council in Livingstone (April 2017) reversed its decision and decided that the
\nDeclarations of Seoul and Madrid be kept separate and revised individually to incorporate the
\nrelevant missing sections from the Statement on Professional Responsibility for standards of
\nMedical Care, which will then be rescinded and archived.
\nMarch 2017 SMAC 209\/Declaration of Seoul COM REV\/Apr2018
\n2
\nThe text below presents the proposed revision of the Declaration of Seoul from prof. Nathanson.
\nThe 207th Council session in Chicago (October 2017) considered the proposal and decided to
\ncirculate it within WMA membership for comments.
\nAbbreviation key:
\nAM Associate Members
\nAMA American Medical Association
\nAMV Associazione Medica del Vaticano (Vatican State
\nCMA Canadian Medical Association
\nCNOM French National Medical Council
\nFMA Finnish Medical Association
\nDMA Danish Medical Association
\nNZMA New Zealand Medical Association
\nNMA Norwegian Medical Association
\nRDMA Royal Dutch Medical Association
\nSAMA South African Medical Association
\nSwMA Swedish Medical Association
\nGENERAL COMMENTS
\nAMV The proposed revision of WMA Declaration of Seoul on Professional Autonomy and Clinical Independence is accepted as it is.
\nCMA The CMA supports this Declaration.
\nDMA The DMA supports this important, clear and well-written document.
\nCNOM The CNOM (French Medical Council) supports this text and would like professional autonomy to be defined throughout the text as the
\nability of physicians to organise their professional lives (which can be difficult for physicians working as employees), which helps to
\nguarantee clinical independence. This definition would ensure consensus for all members of the WMA.
\nFMA FMA can accept the amended document except for para 6 which we propose to be reworded.
\nJDN No changes proposed
\nNMA NMA supports this document, but suggests two minor changes.
\nNZMA We are comfortable with this revised declaration and have no specific amendments.
\nNumbering will be deleted (or adjusted) when the revised text is adopted.
\nMarch 2017 SMAC 209\/Declaration of Seoul COM REV\/Apr2018
\n3
\nNo Proposed Text:
\nSMAC 207\/Declaration of
\nSeoul\/Oct2017
\nSpecific Comments
\nAdditions: bold\/underlined
\nDeletions: lined-out
\nComments only: [italic]
\nProposed Revised Text by:
\nRapporteur
\nSMAC 209\/ Declaration of Seoul REV\/Apr2018
\nRapporteur\u2019s comments are in italic
\nTitle Declaration of Seoul on Professional
\nAutonomy and Clinical Independence
\nDeclaration of Seoul on Professional Autonomy
\nand Clinical Independence
\nThe WMA reaffirms the Declaration
\nof Madrid on professionally-led
\nregulation.
\nThe WMA reaffirms the Declaration of Madrid on
\nprofessionally-led regulation
\nThe World Medical Association
\nrecognises the essential nature of
\nprofessional autonomy and physician
\nclinical independence, and states that:
\nThe World Medical Association recognises the
\nessential nature of professional autonomy and
\nphysician clinical independence, and states that:
\n1 Professional autonomy and clinical
\nindependence are essential elements in
\nproviding quality health care to all
\npatients and populations.
\nProfessional autonomy and clinical independence
\nare essential elements in providing quality health
\ncare to all patients and populations. The
\nautonomy and professional independence of the
\nphysician are essential requirements for high
\nquality health care and therefore it is a benefit
\nfor the patients whose rights it protects, and for
\nthe society, reason why they must be preserved.
\n[CGCM]
\n[AMA: Combined first two paragraphs]
\nProfessional autonomy and clinical independence
\nare essential elements in providing quality health
\ncare to all patients and populations. Professional
\nautonomy and independence are essential for
\nthe delivery of high quality health care and
\ntherefore benefit patients and society.
\nQuestion from compiler \u2013 should this be removed
\ngiven the language in the final para?
\n2 Professional autonomy and clinical
\nindependence describes the processes
\nunder which is individual physicians
\nhave the freedom to exercise their
\nprofessional judgment in the care and
\ntreatment of their patients without
\nundue or inappropriate influence by
\noutside parties or individuals.
\nProfessional autonomy and clinical independence
\ndescribes the processes under which is individual
\nphysicians have the freedom to exercise their
\nprofessional judgment in the care and treatment of
\ntheir patients without undue or inappropriate
\ninfluence by outside parties or individuals.
\nMarch 2017 SMAC 209\/Declaration of Seoul COM REV\/Apr2018
\n4
\n3 Medicine is a highly complex art and
\nscience. Through lengthy training and
\nexperience, physicians become
\nmedical experts and healers weighing
\nevidence to formulate advice to
\npatients. Whereas patients have the
\nright to self-determination, deciding
\nwithin certain constraints which
\nmedical interventions they will
\nundergo, they expect their physicians
\nto be free to make clinically
\nappropriate recommendations.
\nMedicine is a highly complex art and science.
\nThrough lengthy training and experience,
\nphysicians become medical experts and healers
\ntherapists (NMA) weighing evidence to
\nformulate advice to patients. Whereas patients
\nhave the right to self-determination, deciding
\nwithin certain constraints which medical
\ninterventions they will undergo, they expect their
\nphysicians to be free to make clinically
\nappropriate recommendations.
\n(NMA comments: In Norway \u00abhealer\u00bb is
\nassociated with persons not officially recognised
\nas health care personnel)
\nMedicine is a highly complex art and science
\n. Through
\nlengthy training and experience, physicians
\nbecome medical experts and healers weighing
\nevidence to formulate advice to patients. Whereas
\npatients have the right to self-determination,
\ndeciding within certain constraints which medical
\ninterventions they will undergo, they expect their
\nphysicians to be free to make clinically
\nappropriate recommendations.[SwMA]
\nMedicine is a highly complex art and science
\n. Through
\nlengthy training and experience, physicians
\nbecome medical experts and healers weighing
\nevidence to formulate advice to patients. Whereas
\npatients have the right to self-determination,
\ndeciding within certain constraints which medical
\ninterventions they will undergo, they expect their
\nphysicians to be free to make clinically
\nappropriate recommendations.
\nNew The professional service of the physician
\ncannot be considered a commercial service
\nbecause it is subject to specific ethical
\nstandards that allow it to provide professional,
\ncompetent, qualified and respectful care with
\nthe professional standards and values that
\nprotect the patient [CGCM: to link to parag.3]
\nWhile there is a \u201chigher calling\u201d to medicine it is
\nalso commercially provided in many countries.
\n4 Physicians recognize that they must
\ntake into account the structure of the
\nPhysicians recognize that they must take into
\naccount the structure of the health system and
\nPhysicians recognize that they must take into
\naccount the structure of the health system and
\nMarch 2017 SMAC 209\/Declaration of Seoul COM REV\/Apr2018
\n5
\nhealth system and available resources.
\nUnreasonable restraints on clinical
\nindependence imposed by
\ngovernments and administrators are
\nnot in the best interests of patients,
\nmay not be evidence based and risk
\nundermining the trust which is an
\nessential component of the patient-
\nphysician relationship.
\navailable resources and prudent use of those
\nresources. Unreasonable restraints on clinical
\nindependence imposed by governments and
\nadministrators are not in the best interests of
\npatients, may not be evidence based and risk
\nundermining the trust which is an essential
\ncomponent of the patient-physician relationship.
\n[SAMA]
\nPhysicians recognize that they must take into
\naccount the structure of the health system and
\navailable resources when making treatment
\ndecisions. Unreasonable restraints on clinical
\nindependence imposed by governments and
\nadministrators are not in the best interests of
\npatients, because they may not be evidence based
\nand risk undermining the trust which is an
\nessential component of the patient-physician
\nrelationship. [AMA]
\navailable resources when making treatment
\ndecisions. Unreasonable restraints on clinical
\nindependence imposed by governments and
\nadministrators are not in the best interests of
\npatients, because they may not be evidence based
\nand risk undermining the trust which is an
\nessential component of the patient-physician
\nrelationship
\nNew Professional autonomy does not imply that the
\nphysician can deviate from the professional
\nguidelines when he considers it necessary and
\nhe must be prepared to explain his
\nperformance and assume his responsibilities.
\n[CGCM: to link to parag. 4]
\nProfessional autonomy is limited by adherence
\nto professional rules, standards and the
\nevidence base.
\nNew Whilst there is need for priority setting and
\nlimitations on health care coverage due to
\nlimited resources, increasingly, governments,
\nhealth care funders (third party payers),
\nadministrators and Managed Care
\norganisations interfere with clinical autonomy
\nPriority setting and limitations on health care
\ncoverage are essential due to limited resources.
\nGovernments, health care funders (third party
\npayers), administrators and Managed Care
\norganisations may interfere with clinical
\nautonomy by seeking to impose rules and
\nMarch 2017 SMAC 209\/Declaration of Seoul COM REV\/Apr2018
\n6
\nby imposing unreasonable rules and disease
\ncover limitations. These rules do not take into
\nconsiderations evidence-based medicine
\nprinciple, cost-effectiveness and best interest of
\npatients. Often, economic evaluation studies are
\nundertaken from funder\u2019s perspective and not
\nfrom users\u2019 perspective which put more
\nemphasis on cost-savings than health outcomes.
\n[SAMA: Subject to editorial language changes]
\nlimitations. These may not reflect evidence-
\nbased medicine principles, cost-effectiveness
\nand the best interest of patients. Economic
\nevaluation studies may be undertaken from a
\nfunder\u2019s not a users\u2019 perspective and
\nemphasise cost-savings rather than health
\noutcomes.
\nNew Furthermore, priority setting, funding decision
\nmaking and resource allocation\/limitations
\nprocesses are not transparent. The lack of
\ntransparency further perpetuates health
\ninequities. [SAMA]
\nPriority setting, funding decision making and
\nresource allocation\/limitations processes are
\nfrequently not transparent. A lack of
\ntransparency further perpetuates health
\ninequities.
\n5 Some hospital administrators and
\nthird-party payers consider physician
\nprofessional autonomy to be
\nincompatible with prudent
\nmanagement of health care costs. The
\nreality is that professional autonomy is
\na major contributing factor to
\nphysicians assisting patients to make
\ninformed choices, and enables
\nphysicians to refuse demands by
\npatients and family members for
\naccess to inappropriate treatments and
\nservices.
\nSome hospital administrators and third-party
\npayers consider physician professional autonomy
\nto be incompatible with prudent management of
\nhealth care costs. The reality is that p (NMA)
\nProfessional autonomy is a major contributing
\nfactor to physicians assisting patients to make
\ninformed choices, and enables physicians to refuse
\ndemands by patients and family members for
\naccess to inappropriate treatments and services.
\n(NMA\u2019s comments: WMA should avoid
\ncharacterising other occupational groups
\nnegatively)
\nSome hospital administrators and third-party
\npayers may [SwMA] consider physician
\nprofessional autonomy to be incompatible with
\nprudent management of health care costs. When
\nnecessary, National Medical Associations
\n(NMAs) should address these concerns [AM].
\nSome hospital administrators and third-party
\npayers consider physician professional autonomy
\nto be incompatible with prudent management of
\nhealth care costs. The reality is that Professional
\nautonomy is a major contributing factor to allows
\nphysicians assisting patients to help patients
\nmake informed choices, and enables supports
\nphysicians to if they refuse demands by patients
\nand family members for access to inappropriate
\ntreatments and services.
\nMarch 2017 SMAC 209\/Declaration of Seoul COM REV\/Apr2018
\n7
\nThe reality, however [SwMA], is that professional
\nautonomy is a major contributing factor to
\nphysicians assisting patients to make informed
\nchoices, and enables physicians to refuse demands
\nby patients and family members for access to
\ninappropriate treatments and services. When
\ndisagreements arise among physicians, patients
\nand families, physicians should listen carefully
\nto the patients\u2019 concerns, and try to arrive at a
\nmutually satisfying solution. [AM]
\nSome hospital administrators and third-party
\npayers consider physician professional autonomy
\nto be incompatible with prudent management of
\nhealth care costs. The reality is that However,
\nprofessional autonomy is a major contributing
\nfactor to allows physicians assisting patients to
\nhelp patients make informed choices, and enables
\nsupports physicians to if they refuse demands by
\npatients and family members for access to
\ninappropriate treatments and services. [AMA]
\n6 Interference with the professional
\nautonomy and clinical independence
\nof physicians by other health care
\nprofessionals can damage optimal
\npatient care as fundamentally as
\ninterference by lay personnel.
\nDelete paragraph and replace by new paragraph
\nbelow [AMA]
\nInterference with the professional autonomy and
\nclinical independence of physicians by other
\nhealth care professionals and others can damage
\noptimal patient care as fundamentally as
\ninterference by lay personnel. The physician
\nmust be guaranteed the freedom to express
\nclinical and ethical opinion without any
\ninappropriate external interference. [CGCM]
\nThe AMA suggestion is taken, see new para below
\nMarch 2017 SMAC 209\/Declaration of Seoul COM REV\/Apr2018
\n8
\nInterference with the professional autonomy and
\nclinical independence of physicians by other
\nhealth care professionals employed by funders,
\nadministrators and managed care
\norganisations can damage optimal patient care as
\nfundamentally as interference by lay personnel.
\n[SAMA]
\nInterference with the professional autonomy and
\nclinical independence of physicians by other
\nhealth care professionals can damage optimal
\npatient care as fundamentally as interference by
\nlay personnel. [SwMA]
\nInterference with the professional autonomy and
\nclinical independence of physicians by other
\nhealth care professionals can damage optimal
\npatient care as fundamentally as interference by
\nlay personnel. may create confusion in clinical
\nsettings and have negative effect on patient
\ncare, and should thus be avoided. This does not
\nrule out the need for team work in patient care.
\n[FMA]
\nNew Care is given by teams of health care
\nprofessionals, led by physicians. No member of
\nthe care team should interfere with the
\nprofessional autonomy and clinical
\nindependence of the physician, who assumes
\nthe ultimate responsibility for the care of the
\npatient. In situations where another team
\nmember has clinical concerns about the
\nproposed course of treatment, a mechanism to
\nCare is given by teams of health care
\nprofessionals, usually led by physicians. No
\nmember of the care team should interfere with
\nthe professional autonomy and clinical
\nindependence of the physician who assumes the
\nultimate responsibility for the care of the
\npatient. In situations where another team
\nmember has clinical concerns about the
\nproposed course of treatment, a mechanism to
\nMarch 2017 SMAC 209\/Declaration of Seoul COM REV\/Apr2018
\n9
\nvoice those concerns without fear of reprisal
\nshould exist. [AMA]
\nvoice those concerns without fear of reprisal
\nshould exist.
\nNew The delivery of health care by physicians is
\ngoverned by ethical rules, professional norms
\nand by applicable law. Physicians contribute to
\nthe development of normative standards,
\nrecognizing that this both regulates their work
\nas professionals and provides assurance to the
\npublic. [AM]
\nThe delivery of health care by physicians is
\ngoverned by ethical rules, professional norms
\nand by applicable law. Physicians contribute to
\nthe development of normative standards,
\nrecognizing that this both regulates their work
\nas professionals and provides assurance to the
\npublic.
\n7 Ethics committees, credentials
\ncommittees and other forms of peer
\nreview have been long established,
\nrecognised and accepted by organised
\nmedicine as ways to scrutinise
\nphysicians\u2019 professional conduct and,
\nwhere appropriate, impose reasonable
\nrestrictions on the absolute
\nprofessional freedom of physicians
\n(from paragraph 3 of the Statement on
\nProfessional Responsibility for
\nstandards of Medical Care).
\nAs a guarantee of the autonomy and
\nprofessional and clinical independence of the
\nphysician and of the patients and of compliance
\nwith their norms are the ethics committees
\n[CGCM]. Ethics committees, credentials
\ncommittees and other forms of peer review that
\n[CGCM] have been long established, recognised
\nand accepted by organised medicine as ways to
\nscrutinise physicians\u2019 professional conduct and,
\nwhere appropriate, impose reasonable restrictions
\non the absolute [SwMA] professional freedom of
\nphysicians.
\nEthics committees, credentials committees and
\nother forms of peer review, including regulating
\nbodies, have been long established \u2026. [SAMA]
\nEthics committees, credentials committees and
\nother forms of peer review have long been been
\nlong established, recognised and accepted by
\norganised medicine as ways to scrutinise
\nphysicians\u2019 professional conduct and, where
\nappropriate, impose reasonable restrictions on the
\nEthics committees, credentials committees and
\nother forms of peer review have long been been
\nlong established, recognised and accepted by
\norganised medicine as ways to scrutinise
\nof scrutinizing physicians\u2019 professional conduct
\nand, where appropriate, may impose reasonable
\nrestrictions on the absolute professional freedom
\nof physicians.
\nMarch 2017 SMAC 209\/Declaration of Seoul COM REV\/Apr2018
\n10
\nabsolute professional freedom of physicians.
\n[AMA]
\n8 The World Medical Association
\nreaffirms the importance of
\nprofessional autonomy and clinical
\nindependence as an essential
\ncomponent of high quality medical
\ncare and a benefit to the patient that
\nmust be preserved. The WMA also
\naffirms that professional autonomy
\nand clinical independence are core
\nelements of medical professionalism.
\nThe World Medical Association WMA [RDMA]
\nreaffirms the importance of professional autonomy
\nand clinical independence as an essential
\ncomponent of high quality medical care and a
\nbenefit to the patient that must be preserved. The
\nWMA also affirms that professional autonomy
\nand clinical independence are core elements of
\nmedical professionalism. The medical profession
\nfor the benefit of its patients and a professional
\nexercise of the highest quality has a permanent
\nobligation to protect, defend and support the
\nautonomy and professional independence of the
\nphysician. [CGCM]
\nThe World Medical Association reaffirms the
\nimportance of that professional autonomy and
\nclinical independence as an are essential
\ncomponents of high quality medical care and a
\nbenefit to the patient the patient-physician
\nrelationship that must be preserved. The WMA
\nalso affirms that professional autonomy and
\nclinical independence are core elements of
\nmedical professionalism. [AMA]
\nThe World Medical Association reaffirms the
\nimportance of that professional autonomy and
\nclinical independence as an are essential
\ncomponents of high quality medical care and a
\nbenefit to the patient the patient-physician
\nrelationship that must be preserved. The WMA
\nalso affirms that professional autonomy and
\nclinical independence are core elements of
\nmedical professionalism.
\nSee query in para before para 2
\n\u00a7\u00a7\u00a7
\n09.03.2018
\n1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument no: SMAC 209\/ Declaration of Madrid COM REV\/Apr2018 Original:
\nEnglish
\nTitle: Proposed revision of WMA Declaration of Madrid on Professionally-
\nled Regulation
\nDestination: Socio-Medical Affairs Committee
\n209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nFor
\nConsideration
\nNote: As part of the annual policy review process, the Council in Buenos Aires (April 2016)
\ndecided that the Statement on Professional Responsibility for standards of Medical Care,
\nunder the 10-years policy review, be rescinded and archived, and that the WMA
\nDeclarations of Seoul and Madrid be merged in a single document, completed with the
\nmissing sections from that Statement. Prof. Vivienne Nathanson, British Medical
\nAssociation (BMA), volunteered to complete that work.
\nFurther to the proposed revision submitted to the Council in Taipei (Oct. 2016) and then
\ncirculated for comments, the Council in Livingstone (April 2017) reversed its decision and
\ndecided that the Declarations of Seoul and Madrid be kept separate and revised individually
\nto incorporate the relevant missing sections from the Statement on Professional
\nResponsibility for standards of Medical Care, which will then be rescinded and archived.
\nThe 207th Council session in Chicago (October 2017) considered the proposed revision of
\nMarch 2017 SMAC 209\/ Declaration of Madrid COM REV\/Apr2018
\n2
\nthe Declaration of Madrid and decided to circulate it within WMA membership for
\ncomments.
\nAbbreviation key:
\nAM Associate Members
\nAMA American Medical Association
\nAMV Associazione Medica del Vaticano (Vatican State
\nBMA British Medical Association
\nCMA Canadian Medical Association
\nCNOM French National Medical Council
\nCGCM Consejo General de Colegios M\u00e9dicos de Espana (Spain)
\nDMA Danish Medical Association
\nFMA Finnish Medical Association
\nJDN Junior Doctors Network
\nNMA Norwegian Medical Association
\nNZMA New Zealand Medical Association
\nRDMA Royal Dutch Medical Association
\nSwMA Swedish Medical Association
\nGENERAL COMMENTS
\nAM The Associate Membership supports this document with or without our suggestions above.
\nBMA While we can agree with the sentiment of the declaration \u2013 the system described does not apply to the UK. The statement, as it is currently
\nwritten, assumes that all national regulatory systems are still \u2018professionally-led\u2019 and describes how this must be maintained\/protected\/
\nencouraged. Given that the UK has moved away from this model, it is very difficult for us to adhere to this.
\nDMA The DMA supports this document. We have a few minor suggestions (see below in the text).
\nFMA FMA supports the proposed amendments to the Declaration. We have a few comments to the text.
\nNZMA We are broadly comfortable with this revised declaration and have no specific amendments. However, we received the following comment
\non clause 11 (last paragraph):
\nMarch 2017 SMAC 209\/ Declaration of Madrid COM REV\/Apr2018
\n3
\nThis looks mostly fine, except that regulation in our part of the world is done by a body which is not directly elected by the profession, and
\ninvolves political patronage, in that the MCNZ is approved by, and responsible to, the Minister of Health. A minority of the members are
\nelected, and they are subject to ministerial approval. Most are appointed by the Minister. Not sure how this lies with the WMA position.
\nThe statement seems a bit na\u00efve. Much of the regulation in NZ and Australia now happens between the colleges and regulatory bodies,
\nwhereas the NZMA contributes on a global level with policies and positions, especially the Code of Ethics, but does not really regulate
\ndespite being influential. Maybe the paper is being pragmatic and avoiding what it cannot directly influence.
\nNMA Acknowledging that this document could be valuable for some of WMAs members, NMA experiences this document to be a little bit out
\nof date. The medical profession must be open to the society and attentive to its surroundings and NMA has no regulatory responsibilities.
\nPara 2 illustrates our concerns. It is too categorical to say that physicians are the best to judge the actions of their peers. The profession
\nshould in the spirit of the Geneva Declaration not close within itself, but be open also to be judged by others and learn from the society and
\nthe patients. We suggest that the document is rewritten to be less categorical and more inclusive.
\nSwMA The SMA feels that the proposed wording is too strongly based on the concept that professionally-led regulation is the only acceptable
\nsolution to achieve high standard health care. We totally agree that the medical profession must be actively involved and have a strong
\nvoice in the development of rules and guidelines for health care. However, we do not believe that it is always absolutely necessary for the
\nmedical profession to have regulatory powers. If used appropriately, we believe that other systems can be accepted. We have suggested
\nsome changes of wording in order for the declaration to be a bit more flexible in this regard. In Sweden, for example, different authorities
\n(The National Board of Health and Welfare, The Health and Social Care Inspectorate and The Medical Responsibility Board) develop rules
\nand guidelines for and supervise health care and health professionals. In our opinion, this system works quite well.
\nAMV We accept the Proposed revision of WMA Declaration of Madrid on Professionally-led Regulation as it is.
\nMarch 2017 SMAC 209\/ Declaration of Madrid COM REV\/Apr2018
\n4
\nNumbering will be deleted (or adjusted) when the revised text is adopted.
\nNo Proposed Text:
\nSMAC 207\/Declaration of
\nMadrid\/Oct2017
\nSpecific Comments
\nAdditions: bold\/underlined
\nDeletions: lined-out
\nComments only: [italic]
\nProposed Revised Text by:
\nRapporteur
\nSMAC 209\/ Declaration of Madrid
\nREV\/Apr2018
\nRapporteur\u2019s comments are in italic
\nTitle Declaration of Madrid on
\nProfessionally-led Regulation
\nThe WMA reaffirms the
\nDeclaration of Seoul on
\nprofessional autonomy and
\nclinical independence of
\nphysicians.
\nThe WMA reaffirms the Declaration of
\nSeoul on professional autonomy and clinical
\nindependence of physicians
\nNew PREAMBLE
\nThe regulation of the medical profession is key to
\nensure social confidence in the profession, to ensure
\nthe qualification and registration of professionals, to
\ncontrol the profession and its responsibilities, to
\nensure the revalidation, maintenance and updating of
\nprofessional competence, transparency and
\naccountability, to respond professionally to the needs
\nof citizens, to defend the professional autonomy of the
\nphysician, to develop medical ethics, deontology and
\ndisciplinary intervention and to promote articulation
\nbetween the State, the profession and the health
\nsystem.
\nThe performance of the profession and the social
\nThis new preamble would appear to be
\nunacceptable to Countries such as Australia,
\nNZ, the UK, Sweden and Norway, from their
\ngeneral comments as it insists on wholly
\nmedical professional led regulation
\nA shorter preamble is therefore suggested
\ntaking in some of these concepts
\nThe regulation of the medical profession
\nplays an essential role in ensuring and
\nmaintaining public confidence in the
\nstandards of care and of behaviour that
\nthey can expect from the medical
\nprofessionals who serve them. That
\nregulation requires very strong
\nMarch 2017 SMAC 209\/ Declaration of Madrid COM REV\/Apr2018
\n5
\nresponsibility of physicians is framed in a system of
\nvalues belonging to the profession. The fundamental
\npurpose of medical regulation is to protect citizens,
\nensuring that the profession is exercised by qualified
\npeople with credentials that certify their professional
\ncompetence and maintenance thereof over time,
\ngenerating social confidence in medicine.
\nThe medical profession must take the initiative in its
\nregulation and lead the necessary changes in order to
\nreach the highest levels of ethical and professional
\ndemands. An effective, committed, independent and
\ntransparent self-regulation is a key element to
\ncontinue deserving the social legitimacy that sustains
\nthe medical profession. (CGCM)
\nindependent professional involvement.
\nThis may be the leading voice or one
\namongst other caring and informed
\npartners providing that regulation
\nassures the highest possible standards
\nwithin the medical profession.
\nPhysicians aspire to the
\ndevelopment or maintenance of
\nsystems of regulation that will
\nbest protect the highest possible
\nstandards of care for all patients.
\nPhysicians believe that
\nprofessionally led models provide
\nthe optimum environment to
\nenhance and assure the individual
\nphysician\u2019s right to treat patients
\nwithout interference, based on his
\nor her best clinical judgment.
\nTherefore, the WMA urges its
\nconstituent members and all
\nphysicians to take actions to
\nensure such systems are in place.
\nThese actions should be informed
\nPhysicians aspire to the development or maintenance of
\nsystems of regulation that will best protect the highest
\npossible standards of care for all patients. Physicians
\nbelieve that Professionally led models provide the
\noptimum environment to enhance and assure the
\nindividual physician\u2019s right to treat patients without
\ninterference, based on his or her best clinical
\njudgment\u2026\u2026 (AM)
\nPhysicians aspire to the development or maintenance of
\nsystems of regulation that will best protect the highest
\npossible standards of care for all patients. Physicians
\nbelieve that professionally led models provide the
\noptimum environment to enhance and assure the
\nindividual physician\u2019s right to treat patients without
\ninterference, based on his or her best clinical judgment.
\nTherefore, the WMA urges its constituent members and
\nPhysicians aspire to the development or
\nmaintenance of systems of regulation that
\nwill best protect the highest possible
\nstandards of care for all patients. Physicians
\nbelieve that professionally led models
\nprovide the optimum environment to
\nenhance and assure the individual
\nphysician\u2019s right to treat patients without
\ninterference, based on his or her best clinical
\njudgment. Therefore, the WMA urges its
\nconstituent members and all physicians to
\ntake actions to ensure effective such systems
\nare in place. These actions should be
\ninformed by the following principles:
\nMarch 2017 SMAC 209\/ Declaration of Madrid COM REV\/Apr2018
\n6
\nby the following principles: all physicians to take actions to ensure such systems are
\nin place. These actions should be informed by the
\nfollowing principles. (SwMA)
\n1 Physicians have been granted by
\nsociety a high degree of
\nprofessional autonomy and
\nclinical independence, whereby
\nthey are able to make
\nrecommendations based on their
\nknowledge and experience,
\nclinical evidence and their holistic
\nunderstanding of the patient
\nincluding his\/her best interests
\nwithout undue or inappropriate
\noutside influence.
\nPhysicians have been granted by society enjoy (AMA) a
\nhigh degree of professional autonomy and clinical
\nindependence that allows them to perform a qualified
\nand responsible profession without undue external
\ninterference. Professional self-regulation shows the
\ntrust that society has placed in physicians, whereby
\nthey are able to make recommendations based on their
\nknowledge and experience, clinical evidence and their
\nholistic understanding of the patient including his\/her best
\ninterests without undue or inappropriate outside
\ninfluence. (CGCM)
\nPhysicians have been granted by society a high degree of
\ncomplete professional autonomy (CNOM) and clinical
\nindependence, whereby they are able to make
\nrecommendations based on their knowledge and
\nexperience, clinical evidence and their holistic
\nunderstanding of the best interest of the patient
\nincluding his\/her best interests [RDMA: Where does this
\n\u2018holistic understanding\u2019 refer to?] without undue or
\ninappropriate outside influence (SwMA).
\nPhysicians have been granted by society a high degree of
\nprofessional autonomy and clinical independence,
\nwhereby they are able to make recommendations based
\non their knowledge and experience, clinical evidence and
\ntheir holistic understanding of the patient including
\nhis\/her best interests best interests of their patients
\nwithout undue or inappropriate outside influence. [FMA:
\nPhysicians have been granted by society
\nenjoy a high degree of professional
\nautonomy and clinical independence,
\nwhereby they are able to make
\nrecommendations based on their knowledge
\nand experience, clinical evidence and their
\nholistic understanding of the patient
\nincluding his\/her best interests without
\nundue or inappropriate outside influence.
\nHolistic would have the usual definition \u2013
\nphysicians understand their patients within
\ntheir family, environment, work etc
\nMarch 2017 SMAC 209\/ Declaration of Madrid COM REV\/Apr2018
\n7
\nWe prefer the current wording]
\n2 The planning and delivery of all
\ntypes of health care is based upon
\nan ethical model by which all
\nphysicians are governed. This is
\nan element of professionalism and
\nprotects patients. Physicians are
\nbest placed to judge the actions of
\ntheir peers against such normative
\nstandards, bearing in mind
\nrelevant local circumstances.
\nThe professional self-regulation of physicians must be
\nbased on an ethical model that applies to everyone
\nequally and develops the principles of professionalism
\nthat protects and benefits patients. The planning and
\ndelivery of all types of health care is based upon an
\nethical model by which all physicians are governed. This
\nis an element of professionalism and protects patients.
\n[CGCM] Physicians are best placed qualified to judge
\nthe actions of their peers against such normative
\nstandards, bearing in mind relevant local circumstances.
\n[AMA]
\nThe planning and delivery of all types of health care is
\nbased upon an ethical model and current evidence-based
\nmedical knowledge by which all physicians are governed
\n[CNOM]. This is an element of professionalism and
\nprotects patients. Physicians are best placed to judge the
\nactions of their peers against such normative standards,
\nbearing in mind relevant local circumstances. (SwMA)
\nThe professional self-regulation of
\nphysicians must be based on a model that
\napplies to everyone equally and that
\nprotects and benefits patients .The
\nplanning and delivery of all types of health
\ncare is based upon an ethical model and
\ncurrent evidence-based medical
\nknowledge by which all physicians are
\ngoverned. This is an element of
\nprofessionalism and protects patients.
\nPhysicians are best placed qualified to judge
\nthe actions of their peers against such
\nnormative standards, bearing in mind
\nrelevant local circumstances.
\n3 The medical profession has a
\ncontinuing responsibility to be
\nself-regulating. Ultimate control
\nand decision-making authority
\nmust rest with physicians, based
\non their specific medical training,
\nknowledge, experience and
\nexpertise.
\nEach country, in a collective, medical action will
\nassume the responsibility of establishing and
\nmaintaining a system of self-regulation through its
\nNational Medical Association that ensures the
\nprofessional autonomy of the physician to make
\ndecisions regarding the medical care of their patients,
\nguaranteeing professional, responsible and
\nappropriate conduct. The medical profession has a
\ncontinuing responsibility to be self-regulating. Ultimate
\ncontrol and decision-making authority must rest with
\nphysicians, based on their specific medical training,
\nThe CGCM amendment would be
\nunacceptable to those countries which
\naccept a mixed model of regulation. The
\nrevised wording seeks to keep the concept of
\nmedical leadership without causing
\nproblems with these members.
\nThe medical profession has a continuing
\nresponsibility to be strongly involved in
\nregulation or self-regulating. Ultimate
\nMarch 2017 SMAC 209\/ Declaration of Madrid COM REV\/Apr2018
\n8
\nknowledge, experience and expertise. [CGCMC]
\nThe medical profession has a continuing responsibility to
\nbe self-regulating. Ultimate control and decision-making
\nauthority must rest with physicians, based on their
\nspecific medical training, knowledge, experience and
\nexpertise. Physicians in each country are urged to
\nestablish, maintain and actively participate in a
\ntransparent system of professionally-led regulation.
\n[SwMA]
\ncontrol and decision-making authority must
\nrest with include physicians, based on their
\nspecific medical training, knowledge,
\nexperience and expertise. In countries
\nwhere self-regulation remains physicians
\nmust ensure that this retains the
\nconfidence of the public. In countries that
\nhave a mixed regulation system
\nphysicians must ensure that it maintains
\nprofessional confidence.
\n4 Physicians in each country are
\nurged to establish, maintain and
\nactively participate in a legitimate
\nrigorous and transparent system of
\nprofessionally-led regulation.
\nPhysicians in each country are urged to establish,
\nmaintain and actively participate in a legitimate fair
\n(CGCM), rigorous (FMA+RDMA) and transparent
\nsystem of professionally-led regulation, though efforts
\nsuch as national clinical guidelines developed by and
\nfor physicians (DMA)
\n(RDMA: The term \u2018rigorous\u2019 seems to strict? Without
\nthis word the sentence is complete as well (legitimate and
\ntransparent system\u2026). \u2018rigorous\u2019 suggests that regulation
\nhas always to be followed, but in the end it is always the
\nphysician who decides to follow a rule or not (comply or
\nexplain).)
\nPhysicians in each country are urged to establish,
\nmaintain and actively participate in a legitimate rigorous
\nand transparent system of professionally-led regulation.
\nSuch systems are intended to balance physicians\u2019
\nrights to exercise medical judgment freely with the
\nobligation to do so wisely and temperately. (AMA)
\nPhysicians in each country are urged to
\nestablish, maintain and actively participate
\nin a fair, legitimate rigorous and transparent
\nsystem of professionally-led regulation.
\nSuch systems are intended to balance
\nphysicians\u2019 rights to exercise medical
\njudgment freely with the obligation to do
\nso wisely and temperately.
\nRigorous has been left in as it requires an
\nevidence base to the system.
\nMarch 2017 SMAC 209\/ Declaration of Madrid COM REV\/Apr2018
\n9
\nMove to the end of paragraph 3 with amendments
\n(SwMA)
\n5 National Medical Associations
\nmust do their utmost to promote
\nand support the concept of
\nprofessionally-led regulation
\namongst their membership and the
\npublic. To ensure that potential
\nconflicts of interest between their
\nrepresentative and regulatory roles
\nare avoided they must ensure
\nseparation of the two processes
\nand rigorous attention to a
\ntransparent and fair system of
\nregulation that will assure the
\npublic of its fairness.
\nNational Medical Associations must do their utmost to
\npromote and support the concept of professionally-led
\nregulation amongst their membership and the public. To
\nensure that potential conflicts of interest between their
\nrepresentative and regulatory roles are avoided they must
\nensure separation of the two processes and pay rigorous
\nattention (BMA) to a transparent and fair system of
\nregulation that will assure the public of its independence
\nand fairness (CMA).
\nNational Medical Associations must do their utmost to
\npromote and support the concept of professionally-led
\nregulation amongst their membership and the public. To
\nensure that potential conflicts of interest between their
\nrepresentative and regulatory roles are avoided they must
\nensure separation of the two processes and rigorous
\nattention to a transparent and fair system of regulation
\nthat will assure the public of its fairness. The regulator
\nmust be transparent and communicate the
\ninformation available regarding ethical and
\nprofessional norms on which their professional
\npractice is based to society and its professionals.
\n(CGCM)
\nNational Medical Associations must do their utmost to
\npromote and support the concept of professionally-led
\nregulation amongst their membership and the public. To
\nensure that avoid potential conflicts of interest between
\ntheir representative and regulatory roles are avoided they
\nNational Medical Associations must do their
\nutmost to promote and support the concept
\nof well-informed and effective
\nprofessionally-led regulation amongst their
\nmembership and the public. To ensure that
\npotential conflicts of interest between their
\nrepresentative and regulatory roles are
\navoided they must ensure separation of the
\ntwo processes and pay rigorous attention to
\na transparent and fair system of regulation
\nthat will assure the public of its
\nindependence and fairness .
\nThe new words near the beginning make it
\nclear that regulation must be effective to be
\nacceptable. The use of well informed allows
\nthose espousing professionally led to justify
\nit by this phrase. For those espousing a
\nmixed regulatory framework it gives
\nstrength to their arguments for considerable
\nprofessional involvement.
\nMarch 2017 SMAC 209\/ Declaration of Madrid COM REV\/Apr2018
\n10
\nNational Medical Associations must ensure appropriate
\ntransparency and a clear separation of the two
\nprocesses and rigorous attention to a transparent and fair
\nsystem of regulation that will assure the public of its
\nfairness. (SwMA)
\n\u2026.. To ensure that potential conflicts of interest between
\ntheir representative and regulatory roles are avoided they
\nmust ensure separation of the two processes and rigorous
\nattention to a transparent and fair system of regulation
\nthat will assure the public of its fairness. (RDMA: RDMA
\nthinks it unnecessary to add this very strict instruction)
\nSwitch parag. 5 and 10: Parag 10 replaces 5:
\n\u201cWhatever judicial or regulatory process a country has
\nestablished, any judgement on a physician\u2019s professional
\nconduct or performance must incorporate evaluation by
\nthe physician\u2019s professional peers who, by their training
\nknowledge and experience, understand the complexity of
\nthe medical issues involved\u201d. (AMA)
\nNew Any system of professionally-led regulation must
\nensure the quality of care provided to patients, the
\ncompetence of the physician providing that care and
\nguarantee the professional conduct of all physicians,
\ngenerating social confidence in medicine and in the
\nphysician. (CGCM)
\nThis is covered in many other paras.
\n6 Any system of professionally-led
\nregulation must ensure:
\nAny system of professionally-led regulation must ensure
\nand enhance (FMA):
\nAny system of professionally-led regulation must ensure:
\nAny system of professionally-led regulation
\nmust enhance and ensure:
\nMarch 2017 SMAC 209\/ Declaration of Madrid COM REV\/Apr2018
\n11
\n(BMA)
\n\u00a7 the quality of the care
\nprovided to patients,
\n\u00a7 ensure the delivery of high quality of the safe
\ncare provided to patients, (BMA)
\n\u00a7 the delivery of high quality of the
\nsafe care provided to patients,
\n\u00a7 the competence of the
\nphysician providing that care
\n\u00a7 ensure the competence of the physician providing
\nthat care (BMA)
\n\u00a7 the competence of the physician
\nproviding that care
\n\u00a7 the professional conduct of all
\nphysicians, and
\n\u00a7 ensure the professional conduct of all physicians,
\nand (BMA)
\n\u00a7 the professional conduct of all physicians, and
\n(AM)
\n\u00a7 the professional conduct of all
\nphysicians, and
\nNew \u00a7 \u00a7 Protection of the society (SAMA) \u00a7 the protection of society
\n\u00a7 Inspire the confidence of
\npatients, their families and the
\npublic.
\n\u00a7 Inspire (AM+FMA) the confidence of patients,
\ntheir families and the public. (SwMA) and (AM)
\n\u00a7 Inspire the confidence support of patients, their
\nfamilies and the public. (AMA: see also para. 11)
\n\u00a7 Inspire the confidence of patients, their families
\nand the public as far as possible in the case of a
\nlife-threatening emergency. (CNOM)
\nReplace last bullet by: As such, the regulation
\nshould pursue the confidence of patients, their
\nfamilies and the public. (RDMA: Grammatically
\nwrong. It is hard to understand how regulation can
\ninspire confidence. RDMA thinks regulation needs to
\npursue confidence.)
\n\u00a7 Promote Inspire the trust and
\nconfidence of patients, their families and
\nthe public.
\nNew \u00a7 Ensure the regulation system itself is subject to the regulation system itself is subject to
\nMarch 2017 SMAC 209\/ Declaration of Madrid COM REV\/Apr2018
\n12
\nquality assurance (BMA) quality assurance
\nNew \u00a7 The honour of the medical profession (AM)
\n7 To ensure that the patient is
\noffered quality continuing care,
\nphysicians must be required to
\nparticipate actively in the process
\nof Continuing Professional
\nDevelopment in order to update
\nand maintain their clinical
\nknowledge, skills and
\ncompetence.
\nTo ensure that the patient is offered quality continuing
\ncare, physicians must be required to should (SwMA)
\nparticipate actively in the process of Continuing
\nProfessional Development, including reflection, (BMA)
\nin order to update and maintain their clinical knowledge,
\nskills and competence. Employers and management
\nhave a responsibility to enable physicians to meet this
\nrequirement (DMA)
\nTo ensure that the patient is offered quality continuing
\ncare, physicians must be required to participate actively in
\nthe process of Continuing Professional Development in
\norder to update and maintain their clinical knowledge,
\nskills and competence. (RDMA: Physicians should not
\nonly be required to do so, they should actually do so.)
\nTo ensure that the patient is offered quality
\ncontinuing care, physicians must be required
\nto must participate actively in the process of
\nContinuing Professional Development,
\nincluding in reflective practice, in order to
\nupdate and maintain their clinical
\nknowledge, skills and competence.
\nEmployers and management have a
\nresponsibility to enable physicians to meet
\nthis requirement.
\n8 The professional conduct of
\nphysicians must always be within
\nthe bounds of the Code of Ethics
\ngoverning physicians in each
\ncountry. National Medical
\nAssociations must promote
\nprofessional and ethical conduct
\namong physicians for the benefit
\nof their patients. Ethical violations
\nmust be promptly recognized,
\nreported and acted upon.
\nPhysicians who have erred must
\nbe appropriately disciplined and
\nThe professional conduct of physicians must always be
\nwithin the bounds of the Code of Ethics governing
\nphysicians in each country. National Medical
\nAssociations must promote professional and ethical
\nconduct among physicians for the benefit of their patients.
\nProfessional Associations should insist upon ethical
\nconsideration to be sure that physicians resist
\nfinancial incentives to offer either too much or too
\nlittle medical care (AM). Ethical violations must should
\nbe promptly recognized, reported and acted upon.
\nPhysicians who have erred must be appropriately
\ndisciplined and where possible rehabilitated. (SwMA)
\nThe professional conduct of physicians must
\nalways be within the bounds of the Code of
\nEthics governing physicians in each country.
\nNational Medical Associations must
\npromote professional and ethical conduct
\namong physicians for the benefit of their
\npatients, and ethical violations must be
\npromptly recognized, reported to the
\nrelevant regulatory authority and acted
\nupon. Physicians who have erred must be
\nappropriately disciplined and where possible
\nrehabilitated. Physicians are obligated to
\nMarch 2017 SMAC 209\/ Declaration of Madrid COM REV\/Apr2018
\n13
\nwhere possible rehabilitated. The professional conduct of physicians must always be
\nwithin the bounds of the Code of Ethics governing
\nphysicians in each country. National Medical
\nAssociations must promote professional and ethical
\nconduct among physicians for the benefit of their patients,
\nand ethical violations must be promptly recognized,
\nreported and acted upon. Physicians who have erred must
\nbe appropriately disciplined and where possible
\nrehabilitated. Physicians are obligated to intervene in a
\ntimely manner to ensure that impaired colleagues
\ncease practicing and receive appropriate assistance
\nfrom a physician health program. (AMA)
\nDelete the last 2 sentences (\u201cethical violations\u201d until end
\nof parag.) (RDMA: The RDMA is not sure if this is
\nnecessary to add. A first question is who should report
\nand act upon it. A second consideration is that these
\n\u2018actions\u2019 suggest a rather harsh regime of possibly
\n\u2018naming and shaming\u2019. RDMA thinks this is not the most
\neffective way to promote professional conduct, since it
\nmay lead to defensive medicine and to attempts to hide
\nmistakes. Both can work out contrarily to what is
\nwanted.)
\nintervene in a timely manner to ensure
\nthat impaired colleagues cease practicing
\nand receive appropriate assistance from a
\nphysician health program.
\nTo ensure clarity that this is not about
\nnaming and shaming the report must be to
\nthe appropriate regulatory authority
\nNew The professionally-led regulatory body should publish
\nthe outcomes of disciplinary hearings that identifies
\noffending physicians who have been found responsible
\nof violations while keeping patients anonymous. These
\ninclude criminal charges, cautions, specified
\ncontinuing education and remediation programs, and
\nany fines paid. This establishes transparency and trust
\nbetween the public and physicians, increases patient
\nWhile publication appears useful this is too
\nbroad, especially given that many cases go
\nto successful appeals.
\nA modified for of words has been included in
\ncase the members want to \u201crequire\u201d some
\nform of publication.
\nMarch 2017 SMAC 209\/ Declaration of Madrid COM REV\/Apr2018
\n14
\nsafety, and promotes just outcomes for offenses. (JDN) The regulatory body should, when the
\njudicial or quasi-judicial processes are
\ncomplete, and assuming the case is found
\nagainst the physician, publish their
\nfindings and include details of the
\nremedial action taken. Lessons learned
\nfrom every case should, as possible, be
\nextracted and used in professional
\neducation processes.
\n9 National Medical Associations are
\nurged to assist each other in
\ncoping with new and developing
\nproblems, including potential
\ninappropriate threats to
\nprofessionally-led regulation. The
\nongoing exchange of information
\nand experiences between National
\nMedical Associations is essential
\nfor the benefit of patients.
\nNational Medical Associations are urged to assist each
\nother in coping with new and developing problems,
\nincluding potential inappropriate threats to professionally-
\nled regulation. The ongoing challenges. Such exchange
\nof information and experiences between National Medical
\nAssociations is essential for the benefit of patients
\n(SwMA)
\nNational Medical Associations are urged to assist each
\nother in coping with new and developing problems,
\nincluding potential inappropriate threats to professionally-
\nled regulation. The ongoing exchange of information and
\nexperiences between National Medical Associations is
\nessential for the benefit of patients. (AMA)
\n(DMA comments: We would suggest adding examples of
\n\u201cinappropriate threats\u201d. Also, perhaps \u201cinappropriate\u201d
\nis redundant here.)
\nNational Medical Associations are urged to
\nassist each other in coping with new and
\ndeveloping problems, including potential
\ninappropriate threats to professionally-led
\nregulation. The ongoing exchange of
\ninformation and experiences between
\nNational Medical Associations is essential
\nfor the benefit of patients.
\n10 Whatever judicial or regulatory
\nprocess a country has established,
\nany judgement on a physician\u2019s
\nprofessional conduct or
\nSwitch parag. 5 and 10: Parag 5 replaces 10, with
\namendments:
\n\u201cNational Medical Associations must do their utmost to
\npromote and support the concept of professionally-led
\nWhatever judicial or regulatory process a
\ncountry has established, any judgment on a
\nphysician\u2019s professional conduct or
\nMarch 2017 SMAC 209\/ Declaration of Madrid COM REV\/Apr2018
\n15
\nperformance must incorporate
\nevaluation by the physician\u2019s
\nprofessional peers who, by their
\ntraining knowledge and
\nexperience, understand the
\ncomplexity of the medical issues
\ninvolved. (from parag. 2 under
\n\u00ab Position \u00bb of the Statement on
\nProfessional Responsibility for
\nstandards of Medical Care)
\nregulation amongst their membership and the public. To
\nensure that potential conflicts of interest between their
\nrepresentative and regulatory roles are avoided, they
\nmust ensure separation of the two processes and rigorous
\nattention adherence to a transparent and fair equitable
\nsystem of regulation that will assure the public of its
\nfairness\u201d. (AMA)
\nperformance must incorporate evaluation by
\nthe physician\u2019s professional peers who, by
\ntheir training knowledge and experience,
\nunderstand the complexity of the medical
\nissues involved. (from parag. 2 under
\n\u00ab Position \u00bb of the Statement on
\nProfessional Responsibility for standards of
\nMedical Care
\nNew The World Medical Association and National Medical
\nAssociations advocate to both patients and the public
\nthat a system of professionally-led regulation is critical
\nto ensure high quality medical care. (AM)
\nSee comments from NZMA, BMA, NMA,
\nSwMA above
\n11 An effective and responsible
\nsystem of professionally-led
\nregulation by the medical
\nprofession in each country must
\nnot be self-serving or internally
\nprotective of the profession, and
\nthe process must be fair,
\nreasonable and sufficiently
\ntransparent to ensure
\nthis. National Medical
\nAssociations should assist their
\nmembers in understanding that
\nself-regulation must not only be
\nprotective of physicians, but must
\nmaintain the safety, support and
\nconfidence of the general public
\nas well as the honour of the
\nAn effective and responsible system of professionally-led
\nregulation by the medical profession in each country must
\nnot be self-serving or internally protective of the
\nprofession, and to ensure this the process must be fair,
\nreasonable and sufficiently transparent and offer
\nguarantees regarding the benefits to patients,
\ngenerating social confidence in the profession. to
\nensure this (CGCM). Consideration should be given to
\nthe addition of health care consumers as part of a non-
\nprofessional minority on professionally-led regulatory
\nbodies(AM). National Medical Associations should
\nassist their members in understanding that self-regulation
\nmust not only be protective of physicians, but must
\nmaintain the safety, support and confidence of the general
\npublic as well as the honour of the profession itself.
\n(RDMA: Why should it be protective of physicians at all?
\nAn effective and responsible system of
\nprofessionally-led regulation by the medical
\nprofession in each country must not be self-
\nserving or internally protective of the
\nprofession., and the process must be fair,
\nreasonable and sufficiently transparent to
\nensure this. National Medical Associations
\nshould assist their members in
\nunderstanding that self-regulation must not
\nonly be protective of physicians, but must
\nmaintain the safety, support and confidence
\nof the general public as well as the honour
\nof the profession itself.
\nMarch 2017 SMAC 209\/ Declaration of Madrid COM REV\/Apr2018
\n16
\nprofession itself. See point above what regulation should aim for instead.
\nMoreover \u2018be protective of physicians\u2019 here seems in
\ncontrast to \u2018not be self-serving or internally protective of
\nthe profession\u2019 as mentioned in the first sentence.)
\nAn effective and responsible system of professionally-led
\nregulation by the medical profession in each country must
\nnot be self-serving or internally protective of the
\nprofession, and the process must be fair, reasonable and
\nsufficiently transparent to ensure this. National Medical
\nAssociations should assist their members in
\nunderstanding that self-regulation must not only be
\nprotective of physicians, but must maintain the safety,
\nsupport and confidence of the general public as well as
\nthe honour of the profession itself. (SwMA)
\nAn effective and responsible system of professionally-led
\nregulation by the medical profession in each country must
\nnot be self-serving or internally protective of the
\nprofession, and the process must be fair, reasonable and
\nsufficiently transparent to ensure this. National Medical
\nAssociations should assist their members in
\nunderstanding that self-regulation must not only be
\nprotective of physicians, but must maintain the safety,
\nsupport and confidence of the general public as well as
\nthe honour of the profession itself. (CMA: Unless \u201conly\u201d
\nis removed, this sentence is in direct opposition to the one
\npreceding it).
\nAn effective and responsible system of professionally-led
\nregulation by the medical profession in each country must
\nnot be self-serving or internally protective of the
\nprofession. and the process must be fair, reasonable and
\nMarch 2017 SMAC 209\/ Declaration of Madrid COM REV\/Apr2018
\n17
\nsufficiently transparent to ensure this. [note: previously
\nstated.]National Medical Associations should assist their
\nmembers in understanding that self-regulation must not
\nonly protect be protective of physicians, but must
\nmaintain the safety, support and confidence of the general
\npublic as well as and the honour of the profession itself.
\n(AMA)
\nNew Acting responsibly, the physician should always
\nconsider the economic dimension of their actions,
\nregardless of who finances them. This consideration
\nshould not serve as a pretext to deny patients the
\nnecessary medical services. (CGCM)
\nWhile physicians must always consider
\nthe economic dimensions of their
\nrecommended care this must not be a
\npretext for denial of necessary medical
\nservices.
\nQuestion \u2013 is this relevant to the topic of this
\ndocument?
\n*****
\nMarch 2018<\/p>\n

1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument no: SMAC 209\/Sustainable Development COM REV\/Apr2018 Original:
\nEnglish
\nTitle: Proposed WMA Statement on Sustainable Development
\nDestination: Socio-Medical Affairs Committee
\n209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nFor
\nConsideration
\nNote: The Council in Tapei (October 2016) decided to set up a working group on sustainable
\ndevelopment with the mandate to develop a proposal for a WMA policy on sustainable
\ndevelopment and to define a proposed strategy for sustainable development at international
\nand national level. The WG is composed of constituent members from the following
\ncountries: Japan (Chair), Portugal, Brazil, the Netherlands, UK and the Junior Doctors
\nNetwork.
\nThe WG appointed as rapporteur Agostinho Sousa (Portugal) and has submitted the below
\nproposal to the Council in Chicago (October 2017). The Council considered the proposal
\nand decided to circulate it within WMA membership for comments.
\nAbbreviation key:
\nAM Associate Members
\nAMA American Medical Association
\nMarch 2017 SMAC 209\/ Sustainable Development COM REV\/Apr2018
\n2
\nAMV Associazione Medica del Vaticano
\nBMA British Medical Association
\nCGCM Consejo General de Colegios M\u00e9dicos de Espana
\nCMA Canadian Medical Association
\nDMA Danish Medical Association
\nFMA Finnish Medical Association
\nNMA Norwegian Medical Association
\nRDMA Royal Dutch Medical Association
\nSAMA The South African Medical Association
\nSwMA Swedish Medical Association
\nGENERAL COMMENTS
\nAM The Associate Membership supports this document with or without our suggestions.
\nAMV Accepted as it is.
\nBMA We fully support this paper and are pleased to see that the WG has gone beyond the SGDs by drawing together the various policy instruments that
\nunderpin the goals.
\nCMA The CMA supports this Statement.
\nDMA The DMA believes that this document needs further development with regards to both content and form. As the draft stands, the focus and the key
\nmessages in the document are unclear which leads the reader in doubt about the purpose of the statement.
\nFMA FMA thanks the working group for the draft statement. In our view, the document would benefit from some rewriting, especially as regards paragraphs
\n8-12 [Because of the issue on the paragraph numbering, those paragraphs are now numbered 7-11; see text below]. It could be further clarified how
\nthese policy priorities link to SDGs and whose priorities they are. Furthermore, it could e.g. be explained how the implementation of Health in All
\nPolicies can help in the fulfillment of the SDGs. We also propose to shift paragraph 7 [should be numbered 6 in the next version, see above] to the
\nrecommendations.
\nNMA The Norwegian Medical Association supports this document as it is.
\nNumbering will be deleted (or adjusted) when the revised text is adopted.
\nMarch 2017 SMAC 209\/ Sustainable Development COM REV\/Apr2018
\n3
\nNo Proposed Text:
\nSMAC 207\/Sustainable
\nDevelopment\/Oct2017
\nSpecific Comments
\nAdditions: bold\/underlined
\nDeletions: lined-out
\nComments only: [italic]
\nProposed Revised Text by:
\nRapporteur
\nSMAC 209\/ Sustainable Development
\nREV\/Apr2018
\nTitle WMA Statement on Sustainable
\nDevelopment
\nPreamble
\n1. The WMA believes that health and well-
\nbeing are dependent upon social
\ndeterminants of health (SDH), the
\ncircumstances in which people are born,
\ngrow, live, work and age. These social
\ndeterminants will directly influence the
\nachievement of the United Nations
\nSustainable Development Goals (SDGs).
\nMany of the SDG goals, targets and the
\nindicators that have been developed to
\nmeasure progress towards them, will also
\nbe useful measures of the impact action is
\nhaving on reducing the SDH and, in
\nparticular, health inequities.
\n\u2026 Many of the SDG goals, targets and the indicators that
\nhave been developed to measure progress towards them,
\nwill also be useful measures of the impact of action is
\nhaving on reducing the SDH and, in particular, on reducing
\nhealth inequities. [BMA]
\nThe WMA believes that health and well-being are
\ndependent upon social determinants of health (SDH), the
\ncircumstancesconditions in which people are born, grow,
\nlive, work and age; and the social influences on these
\nconditions \u2026 Many of the SDG goals, targets and the
\nindicators that have been developed to measure progress
\ntowards them, will also be useful measures of the impact
\naction is having on reducingimproving the SDH and, in
\nparticular, health inequities. [AM]
\nThe WMA believes that health and well-being are
\ndependent upon social determinants of health (SDHs), the
\ncircumstances in which people are born, grow, live, work
\nand age \u2026 Many of the SDG goals, targets and the
\nindicators that have been developed to measure progress
\ntowards them, will also be useful measures of the impact
\naction is having on reducing the SDHs and, in particular,
\nhealth inequities. [SAMA]
\nThe WMA believes that health and well-being
\nare dependent upon social determinants of
\nhealth (SDHs), the conditions circumstance in
\nwhich people are born, grow, live, work and
\nage. These social determinants will directly
\ninfluence the achievement of the United
\nNations Sustainable Development Goals
\n(SDGs). Many of the SDG goals, targets and
\nthe indicators that have been developed to
\nmeasure progress towards them, will also be
\nuseful measures of the impact of action is
\nhaving on reducing improving the SDH and,
\nin particular, on reducing health inequities.
\nMarch 2017 SMAC 209\/ Sustainable Development COM REV\/Apr2018
\n4
\n2. This statement builds upon WMA policy
\non SDH as set out in the Declaration of
\nOslo, and upon the basic principles of
\nmedical ethics set out in the Declaration
\nof Geneva. (1)
\nThis statement builds upon WMA policy on SDH as set out
\nin the Declaration of Oslo on Social Determinants of
\nHealth, and upon the basic principles of medical ethics set
\nout in the Declaration of Geneva. (1) [SwMA]
\nThis statement builds upon WMA policy on
\nSocial Determinants of Health DH as set out
\nin the Declaration of Oslo, and upon the basic
\nprinciples of medical ethics set out in the
\nDeclaration of Geneva. (1)
\n3. The WMA recognizes the important
\nefforts undertaken by the United Nations
\nwith the adoption on 25 September 2015
\nof the resolution \u201cTransforming our
\nworld: the 2030 Agenda for Sustainable
\nDevelopment\u201d (2). The Sustainable
\nDevelopment Agenda is based upon five
\nkey themes: people, planet, prosperity,
\npeace and partnership and the principle of
\nleaving no one behind. The WMA
\nsupports the importance of global efforts
\non sustainable development and the
\nimpact that it could bring to humanity.
\n\u2026 The WMA affirmssupports the importance of global
\nefforts on sustainable development and the impact that they
\ncanit could bring to humanity. [BMA]
\nThe WMA recognizes the important efforts
\nundertaken by the United Nations with the
\nadoption on 25 September 2015 of the
\nresolution \u201cTransforming our world: the 2030
\nAgenda for Sustainable Development\u201d (2).
\nThe Sustainable Development Agenda is based
\nupon five key themes: people, planet,
\nprosperity, peace and partnership and the
\nprinciple of leaving no one behind. The WMA
\nsupports affirms the importance of global
\nefforts on sustainable development and the
\nimpact that they can it could bring to
\nhumanity.
\n4. SDGs are built on the lessons learned
\nfrom successes and failures in achieving
\nthe Millennium Development Goals
\n(MDGs), including inequity in many areas
\nof life. While there is no overarching
\nconcept unifying the SDGs, the WMA
\nbelieves that inequity in health and
\nwellbeing encapsulates much of the
\nagenda. The WMA notes that while only
\n[Comment: WE NEED TO SAY EXACTLY WHAT
\nGOAL #3 IS, AND POSSIBLY FOOTNOTE OR
\nDESCRIBE ALL THE GOALS.] [AM]
\n\u2026 The WMA notes that while only goal 3 is overtly about
\nhealth, many of the goals have major health components.
\n[SAMA]
\nSDGs are built on the lessons learned from
\nsuccesses and failures in achieving the
\nMillennium Development Goals (MDGs),
\nincluding inequity in many areas of life. While
\nthere is no overarching concept unifying the
\nSDGs, the WMA believes that inequity in
\nhealth and wellbeing encapsulates much of the
\n2030 Agenda. The WMA notes that while only
\nSDG 31
\ngoal 3 is overtly about health, many of
\nthe goals have major health components.
\n1
\nSustainable Development Goal 3. Ensure healthy lives and promote well-being for all at all ages by 2030
\nMarch 2017 SMAC 209\/ Sustainable Development COM REV\/Apr2018
\n5
\ngoal 3 is overtly about health many of the
\ngoals have major health components.
\n5. The WMA recognizes governments must
\ncommit and invest to fully implement the
\ngoals by 2030, in alignment with the
\nAddis Ababa Action Agenda (3) (4). The
\nWMA also recognizes the risk that the
\nSDGs might be considered unaffordable
\ndue to their estimated potential cost of
\nbetween US$ 3.3 and US$ 4.5 trillion a
\nyear. (5)
\nThe WMA recognizes that governments must commit and
\ninvest to fully implement the goals by 2030, in alignment
\nwith the Addis Ababa Action Agenda (3) (4) \u2026 [SwMA]
\nThe WMA recognizes all governments must
\ncommit and invest to fully implement the goals
\nby 2030, in alignment with the Addis Ababa
\nAction Agenda (3) (4). The WMA also
\nrecognizes the risk that the SDGs might be
\nconsidered unaffordable due to their estimated
\npotential cost of between US$ 3.3 and US$ 4.5
\ntrillion a year. (5)
\n6. The WMA emphasises the need for cross
\nand intersectoral work to achieve the
\ngoals and believes that health must be
\naddressed in all SDGs and not only under
\nhealth specific goal number 3. (2) (6)
\nThe WMA emphasises the need for cross and
\nintersectoral work to achieve the goals and
\nbelieves that health must be addressed in all
\nSDGs and not only under health specific SDG
\n3 goal number 3. (2) (6)
\nPolicy priorities: Policy priorities:
\n7. Recognition of Health in All Policies and
\nthe Social Determinants of Health.
\nRecognition of the Social Determinants of Health and the
\nHealth in All Policies \/ Multisectoral \/ Whole of
\nGovernment \/ Whole of Society approach
\n[rearranged sentence and made additions] [SAMA]
\nRecognition of Health in All Policies and the
\nSocial Determinants of Health \/ Whole of
\nSociety approach
\n8. Other areas are essential to achieving the
\nSDG3s. They include:
\nPolicyOther areas that are essential to achieving the
\nSDG3s. They include: [BMA]
\n[Comment: what is meant by SDG3s ?] [RDMA]
\nOther Policy areas that are essential to
\nachieving the SDG 3 s. They include:
\nMarch 2017 SMAC 209\/ Sustainable Development COM REV\/Apr2018
\n6
\nOther areasconsiderations are also essential to achieving
\nthe SDG3s targets. They include: [SwMA]
\nAttention to Oother areas that are essential to achieving
\nthe SDG3s, they that include: [SAMA]
\n\u2022 Patient Empowerment and Patient
\nSafety
\n\u2022 Continuous Quality Improvement in
\nHealth Care
\n\u2022 Overcoming the Impact of Aging on
\nHealth Care
\n\u2022 Addressing Antimicrobial Resistance
\n\u2022 The safety and welfare of Health care
\nstaff
\n\u2022 Patient Empowerment and Patient Safety
\n\u2022 Continuous Quality Improvement in
\nHealth Care
\n\u2022 Overcoming the Impact of Aging on
\nHealth Care
\n\u2022 Addressing Antimicrobial Resistance
\n\u2022 The safety and welfare of Health care staff
\n[Added paragraph:] The AMM and NMAs should
\npromote the principle of equity in health is an objective
\nshared by society. It must also be ensured that the
\nhealth sector does not increase inequalities in health and
\npromote equitable provision of health services in all
\ngroups of society and in all stages of health care.
\n[CGCM]
\n9. Ensure policy alignment between all the
\nUN Agencies and the work of regional
\ngovernmental organizations such as EU,
\nAfrican Union, Arab League, ASEAN,
\nand Organization of American States. (7)
\nEnsureEnsuring policy alignment \u2026 [SAMA]
\nEnsure policy alignment betweenamong all the UN
\nAgencies and the work of regional governmental
\norganizations such as EU, African Union, Arab League,
\nASEAN, and Organization of American States. (7) [AMA]
\nEnsuringe policy alignment between among
\nall the UN Agencies and the work of regional
\ngovernmental organizations such as EU,
\nAfrican Union, Arab League, ASEAN, and
\nOrganization of American States. (7)
\n10. The WMA commits to working
\ncollaboratively with other stakeholders on
\nthe other global agreements that will
\nThe WMA commits to working collaboratively with a wide
\nrange ofother stakeholders on the variousother global
\nThe WMA commits to working collaboratively
\nwith other stakeholders on the other global
\nMarch 2017 SMAC 209\/ Sustainable Development COM REV\/Apr2018
\n7
\nunderpin the SDG process and
\nprogramme.
\nagreements that will underpin the SDG process and
\nprogramme. [BMA]
\n[Delete paragraph:] [SwMA]
\n[Comment: THIS FITS BETTER UNDER THE
\nRECOMMENDATIONS SECTION. WE HAVE
\nSUGGESTED ADDITIONAL WORDING IN THE FIRST
\nPARAGRAPH OF THAT SECTION.] [SwMA]
\nThe WMA\u2019s commitscommitment to working
\ncollaboratively with other stakeholders on the other global
\nagreements that will underpin the SDG process and
\nprogramme. [SAMA]
\nagreements that will underpin the SDG process
\nand programme.
\n11. The implementation of the other three
\nglobal agreements regarding the
\nsustainable development process:
\nThe WMA commits to support implementation of the
\nother three global agreements regarding the sustainable
\ndevelopment process: [BMA]
\nThe implementation of the other three global agreements
\nregarding the sustainable development process: [AM]
\nThe WMA supports tThe implementation of the other
\nthree additional global agreements regarding the
\nsustainable development process: [AMA]
\nThe WMA commits to support
\nimplementation of the other three global
\nagreements regarding the sustainable
\ndevelopment process:
\n\u2022 The Addis Ababa Action Agenda as
\nthe mechanism that will provide the
\nfinancial support for the 2030 Agenda
\n\u2022 The Addis Ababa Action Agenda ais the mechanism
\nthat will provide the financial support for the 2030
\nAgenda [AM]
\n\u2022 The Addis Ababa Action Agenda as the mechanism that
\nwill provide the financial support for the 2030 Agenda.
\n[SAMA]
\nThe Addis Ababa Action Agenda as the
\nmechanism that will provide the financial
\nsupport for the 2030 Agenda.
\nMarch 2017 SMAC 209\/ Sustainable Development COM REV\/Apr2018
\n8
\n\u2022 The Paris Agreement as the only
\nbinding mechanism of the sustainable
\ndevelopment process that sets out a
\nglobal action plan to put the world on
\ntrack to avoid dangerous climate
\nchange by limiting global warming to
\nwell below 2\u00b0C above pre-industrial
\nlevels. (8) (9)
\n\u2022 The Paris Agreement ais the only binding mechanism of
\nthe sustainable development process that sets out a
\nglobal action plan to put the world on track to avoid
\ndangerous climate change by limiting global warming to
\nwell below 2\u00b0C above pre-industrial levels. (8) (9)
\n[AM]
\nThe Paris Agreement is the only binding
\nmechanism of the sustainable development
\nprocess that sets out a global action plan to put
\nthe world on track to avoid dangerous climate
\nchange by limiting global warming to well
\nbelow 2\u00b0C above pre-industrial levels. (8) (9)
\n\u2022 The Sendai Framework for Disaster
\nRisk Reduction as the agreement
\nwhich recognizes that the State has
\nthe primary role to reduce disaster
\nrisk but that responsibility should be
\nshared with other stakeholders
\nincluding local government, the
\nprivate sector and other stakeholders.
\n(10)
\n\u2022 The Sendai Framework for Disaster Risk Reduction as
\nthe agreement which recognizes that the State has the
\nprimary role to reduce disaster risk but that
\nresponsibility should be shared with other stakeholders
\nincluding local government, and the private sector and
\nother stakeholders. (10) [BMA]
\n\u2022 The Sendai Framework for Disaster Risk Reduction ais
\nthe agreement which recognizes that the State has the
\nprimary role to reduce disaster risk but that
\nresponsibility should be shared with other stakeholders
\nincluding local government, the private sector and other
\nstakeholders. (10) [AM]
\nThe Sendai Framework for Disaster Risk
\nReduction as the agreement which recognizes
\nthat the State has the primary role to reduce
\ndisaster risk but that responsibility should be
\nshared with other stakeholders including local
\ngovernment, the private sector and other
\nstakeholders. (10)
\n[Added paragraph:] Establish strategies for
\nstrengthening specific public health programs and
\nnational health systems to address the social
\ndeterminants of health, redirecting health services,
\ninterventions and programs with the aim of reducing
\ninequities and ensuring universal coverage and
\nachieving that establishments, goods and services related
\nto health are available to all, are acceptable, accessible,
\nappropriate and of good quality. [CGCM]
\nMarch 2017 SMAC 209\/ Sustainable Development COM REV\/Apr2018
\n9
\nRecommendations and Commitments
\n12. The WMA commits to work with other
\nintergovernmental organizations,
\nincluding the UN and WHO, for the
\nimplementation and follow-up of this
\nagenda and related international
\nagreements. (11) (12) (13).
\nThe WMA commits to work with other intergovernmental
\norganizations, including the UN and the WHO, and other
\nstakeholders for the implementation and follow-up of this
\nagenda and related international agreements. (11) (12) (13).
\n[SwMA]
\n\u2026 The WMA commits to working with other
\nintergovernmental organizations, including the UN and
\nWHO, for the implementation and follow-up of this agenda
\nand related international agreements. (11) (12) (13). [Added
\nsentence:] This should include putting pressure on
\nStates that have not committed to some of the binding
\ninternational agreements, including the Paris
\nAgreement. [SAMA]
\nThe WMA commits to work with other non-governmental
\nand intergovernmental organizations, including the UN and
\nWHO, for the implementation and follow-up of this agenda,
\nand related international agreements, and for policy and
\nadvocacy alignment. (11) (12) (13) [AMA]
\nThe WMA commits to work with other
\nintergovernmental organizations, including the
\nUN, and the WHO, healthcare
\nprofessionals\u2019 organizations and other
\nstakeholders, for the implementation and
\nfollow-up of this Agenda and related
\ninternational agreements, and for policy and
\nadvocacy alignment. (11) (12) (13).
\n13. The WMA commits to collaborate with its
\nconstituent member Associations to
\nsupport their work at national level and
\nwith governments on the 2030 Agenda
\nimplementation.
\nThe WMA commits to collaborateing with its constituent
\nmember Associations to support their work at national and
\nregional levels, and with governments on the 2030 Agenda
\nimplementation. [SAMA]
\nThe WMA commits to collaborate with its
\nconstituent member Associations to support
\ntheir work at regional and national levels, and
\nwith their governments on the 2030 Agenda
\nimplementation.
\n14. The WMA recommends that NMAs
\ncreate a strategy regarding data collection,
\nimplementation, capacity building and
\nadvocacy, to enhance policy coherence
\nThe WMA recommends that NMAs create a strategyies
\nregarding data collection, implementation, capacity building
\nand advocacy, to enhance policy coherence and to
\nThe WMA recommends that NMAs create a
\nstrategiesy regarding data collection,
\nimplementation, capacity building and
\nadvocacy, to enhance policy coherence and to
\nMarch 2017 SMAC 209\/ Sustainable Development COM REV\/Apr2018
\n10
\nand to maximise the impact of doctors at
\nnational and global levels.
\nmaximise the impact of doctorsAgenda implementation at
\nnational and global levels. [SwMA]
\nmaximise the impact of doctors 2030 Agenda
\nimplementation at national and global levels.
\n15. The WMA commits to work with other
\nnon-governmental organizations,
\nincluding other healthcare professionals\u2019
\norganizations, to align policy and
\nadvocacy. (14)
\nThe WMA commits to working with other non-
\ngovernmental organizations, a range of partners besides
\ngovernments, including business, other healthcare
\nprofessionals\u2019 organizations, conservation agencies,
\ndonors, and community organisations, to align policy and
\nadvocacy. (14) [SAMA]
\n[Delete paragraph; incorporated in #12] [AMA]
\nThe WMA commits to work with other non-
\ngovernmental organizations, including other
\nhealthcare professionals\u2019 organizations, to
\nalign policy and advocacy. (14)
\n16. The WMA also recommends that NMAs
\nwork with development banks, NGOs,
\nintergovernmental organisations and other
\nstakeholders that are also working for
\nimplementing of the 2030 Agenda,
\nespecially in their own countries (15) (16)
\n(17) (18)
\nThe WMA also recommends that NMAs work with
\ndevelopment banks, NGOs, intergovernmental
\norganisations and other stakeholders that are also working
\nforto implementing of the 2030 aAgenda, especially in their
\nown countries (15) (16) (17) (18) [BMA]
\nThe WMA also recommends that NMAs workcollaborate
\nwith development banks, NGOs, intergovernmental
\norganisations and other stakeholders that are also working
\nforto implementing of the 2030 Agenda, especially in their
\nown countries (15) (16) (17) (18) [SwMA]
\nThe WMA also recommends that NMAs work cooperate
\nwith development banks, NGOs, intergovernmental
\norganisations and other stakeholders that are also working
\nfor implementing of to implement the 2030 Agenda,
\nespecially in their own countries (15) (16) (17) (18) [AMA]
\nThe WMA also recommends that NMAs work
\ncollaborate with development banks, NGOs,
\nintergovernmental organisations and other
\nstakeholders who that are also working for to
\nimplementing of the 2030 Agenda, especially
\nin their own countries (15) (16) (17) (18)
\n17. WMA asks the UN and WHO to develop
\nguidelines on how financing for health
\nwill be implemented to reach the targets
\nestablished by the 2030 agenda and
\nWMA asks the UN and WHO to develop guidelines on how
\nfinancing for health will be implemented to reach the
\ntargets established by the 2030 aAgenda, and the economic
\nimplications of NCDs, aging and antimicrobial resistance.
\n(5) [BMA]
\nThe WMA encourages asks the UN and the
\nWHO to develop guidelines on how financing
\nfor health will be implemented to reach the
\ntargets established by the 2030 Aagenda and
\nMarch 2017 SMAC 209\/ Sustainable Development COM REV\/Apr2018
\n11
\neconomic implications of NCDs, aging
\nand antimicrobial resistance. (5)
\nWMA asksencourages the UN and the WHO to develop
\nguidelines on how financing for health will be implemented
\nto reach the targets established by the 2030 agenda and
\neconomic implications of NCDs, aging and antimicrobial
\nresistance. (5) [SwMA]
\nThe WMA asks the UN and WHO to develop guidelines \u2026
\n[SAMA]
\nthe economic implications of NCDs, aging and
\nantimicrobial resistance. (5)
\n[Added paragraph:] Physicians and their NMAs must
\nassume the SDGs of sustainable development as their
\nown and strive to achieve the specific objectives of the
\nhealth field, promoting healthy lifestyles and the quality
\nof life of individuals and communities, ensuring the
\nsustainability of the systems that sustain life. [CGCM]
\nReferences:
\n1. The World Medical Association. WMA Declaration of Geneva. [Online] May 2006. [Cited: 13 February 2017.]
\nhttp:\/\/www.wma.net\/en\/30publications\/10policies\/g1\/index.html.
\n2. UN General Assembly. Transforming our world: the 2030 Agenda for Sustainable Development. [Online] 21 October 2015. [Cited: 13 February 2017.]
\nhttp:\/\/www.un.org\/ga\/search\/view_doc.asp?symbol=A\/RES\/70\/1&Lang=E.
\n3. United Nations. Addis Ababa Action Agenda of the Third International Conference on Financing for Development. [Online] 2015. [Cited: 13 February 2017.]
\nhttp:\/\/www.un.org\/esa\/ffd\/wp-content\/uploads\/2015\/08\/AAAA_Outcome.pdf.
\n4. UN DESA. A DESA Briefing Note On The Addis Ababa Action Agenda. [Online] 2015. [Cited: 13 February 2017.] http:\/\/www.un.org\/esa\/ffd\/ffd3\/wp-
\ncontent\/uploads\/sites\/2\/2015\/07\/DESA-Briefing-Note-Addis-Action-Agenda.pdf.
\n5. World Health Organization. Health in 2015: from MDGs to SDGs- Chapter 9. The SDGs: Reflections on the Implications and Challenges for Health.
\n[Online] WHO, December 2015. [Cited: 13 February 2017.] http:\/\/www.who.int\/gho\/publications\/mdgs-sdgs\/MDGs-SDGs2015_chapter9.pdf?ua=1.
\n6. Adams, Barbara and Judd, Karen. Silos or system? The 2030 Agenda requires an integrated approach to sustainable development. [Online] 2016. [Cited: 13
\nFebruary 2017.] https:\/\/www.globalpolicywatch.org\/wp-content\/uploads\/2016\/09\/GPW12_2016_09_23.pdf.
\nMarch 2017 SMAC 209\/ Sustainable Development COM REV\/Apr2018
\n12
\n7. UN Economic and Social Commission for Western Asia. Implementation of the 2030 Agenda for Sustainable Development in the Arab States.
\nImplementation challenges at the national level. New York, USA : UN ECOSOC, 2016.
\n8. UNFCCC. Paris Agreement. [Online] 2015. [Cited: 13 February 2017.]
\nhttp:\/\/unfccc.int\/files\/essential_background\/convention\/application\/pdf\/english_paris_agreement.pdf.
\n9. European Comission. Paris Agreement. [Online] February 2017. [Cited: 13 February 2017.]
\nhttp:\/\/ec.europa.eu\/clima\/policies\/international\/negotiations\/paris_en.
\n10. United Nations. Sendai Framework for Disaster Risk Reduction 2015 – 2030. [Online] 2015. [Cited: 13 February 2017.]
\nhttp:\/\/www.unisdr.org\/files\/43291_sendaiframeworkfordrren.pdf.
\n11. World Health Organization. Universal Health Coverage Data Portal. [Online] World Health Organization, 2016. [Cited: February 13, 2017.]
\nhttp:\/\/apps.who.int\/gho\/cabinet\/uhc.jsp.
\n12. Organisation for Economic Co-operation and Development. Better Policies for 2030: AN OECD Action Plan on the Sustainable Development Goals.
\n[Online] OECD, 2016. [Cited: 13 February 2017.] http:\/\/www.oecd.org\/dac\/OECD-action-plan-on-the-sustainable-development-goals-2016.pdf.
\n13. WHO. Progress in the implementation of the 2030 Agenda for Sustainable Development. [Online] 12 December 2016. [Cited: 13 February 2017.]
\nhttp:\/\/apps.who.int\/gb\/ebwha\/pdf_files\/EB140\/B140_32-en.pdf.
\n14. United Nations. Parterships for SDGs. [Online] United Nations, 2016. [Cited: 13 February 2017.] https:\/\/sustainabledevelopment.un.org\/partnerships\/.
\n15. The World Bank. Press Release. Global Community Makes Record $75 Billion Commitment to End Extreme Poverty. [Online] 15 December 2016. [Cited:
\n13 February 2017.] http:\/\/www.worldbank.org\/en\/news\/press-release\/2016\/12\/15\/global-community-commitment-end-poverty-ida18.
\n16. Asian Development Bank. Key Indicators for Asia and the Pacific 2016. [Online] 2016. [Cited: 13 February 2017.]
\nhttps:\/\/www.adb.org\/sites\/default\/files\/publication\/204091\/ki2016.pdf.
\n17. United States Council for International Business. Business for 2030. [Online] USCIB, 2015. [Cited: 13 February 2017.] http:\/\/www.businessfor2030.org\/.
\n18. World Bank Group; UNDP. Transitioning from the MDGs to the SDGs. [Online] 9 November 2016. [Cited: 13 February 2017.]
\nhttp:\/\/www.undp.org\/content\/dam\/undp\/library\/SDGs\/English\/Transitioning%20from%20the%20MDGs%20to%20the%20SDGs.pdf?download.
\n*****
\nFebruary 2018
\n1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument
\nno:
\nSMAC 209\/Pandemic Influenza COM REV\/Apr2018 Original:
\nEnglish
\nTitle: Proposed revision of WMA Statement on Avian and Pandemic Influenza
\nDestination: Socio-Medical Affairs Committee
\n209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nFor
\nConsideration
\nNote: As part of the annual policy review 2016, the Council in Buenos Aires (April 2016) decided that the
\nWMA Statement on Avian and Pandemic influenza should undergo a minor revision. During its
\nsession in Taipei (October 2016) \u2013 on the request of Secretary General Dr Otmar Kloiber – the
\nCouncil agreed to postpone the revision process given some concerns about the scientific content of
\nthe paper.
\nAt the Council in Livingstone (April 2017), Dr Kloiber informed the Council that a revised version
\nof the Statement will be submitted in October in Chicago. The proposed revision was prepared by
\nDr Caline Mattar, AMR specialist. The 207th Council session in Chicago (October 2017)
\nconsidered the proposal and decided to circulate it within WMA membership for comments.
\nAbbreviation key:
\nAM Associate Members
\nAMA American Medical Association
\nMarch 2017 SMAC 209\/Pandemic Influenza COM REV\/Apr2018
\n2
\nAMV Associazione Medica del Vaticano
\nBMA British Medical Association
\nCGCM Consejo General de Colegios M\u00e9dicos de Espana
\nCNOM Conseil National de l\u2019Ordre des M\u00e9decins (France)
\nCMA Canadian Medical Association
\nDMA Danish Medical Association
\nFMA Finnish Medical Association
\nNMA Norwegian Medical Association
\nRDMA Royal Dutch Medical Association
\nSAMA The South African Medical Association
\nSwMA Swedish Medical Association
\nGENERAL COMMENTS
\nAM Excellent document. We support it with or without our edits. We further suggest removing the word, \u201cetc\u201d from paragraphs 7c and 8c. If
\nother items should be listed, we prefer listing the specifics. [Note: this has been added in the table below]
\nAMA The discussion of mutation risks or co-existence with other viruses included in the 2006 version (paragraph 5) has been omitted. We
\nbelieve this discussion is crucial to an understanding the genesis of pandemic strains of viruses and should be reinstated.
\nAMV We think that the point 7.b [\u201cIdentify legal and ethical frameworks as well as governance in relation to the pandemic\u201d] is a bit generic. It
\nshould be possible to find a more specific recommendation.
\nBMA We overall support this paper and feel that it has been produced to a high technical standard. However, we have some concern that the
\nlanguage may be too technical throughout the piece and that the overall tone may not be widely accessible to an international audience.
\nDMA The DMA has no comments to this document.
\nCNOM There seems to be a crossover in the text between aviary influenza and seasonal influenza.
\nFMA FMA can accept the revised document. However, we would like to point out that WMA now has a general statement on epidemics and
\npandemics, and we propose to refer to that in the preamble of this document.
\nNMA The Norwegian Medical Association supports this document with some minor changes.
\nMarch 2017 SMAC 209\/Pandemic Influenza COM REV\/Apr2018
\n3
\nNumbering will be deleted (or adjusted) when the revised text is adopted.
\nNo Proposed Text:
\nSMAC 207\/Pandemic
\nInfluenza\/Oct2017
\nSpecific Comments
\nAdditions: bold\/underlined
\nDeletions: lined-out
\nComments only: [italic]
\nProposed Revised Text by:
\nRapporteur
\nSMAC 209\/ Pandemic Influenza
\nREV\/Apr2018
\nTitle WMA Statement on Avian and
\nPandemic Influenza
\nWMA Statement on Avian and
\nPandemic Influenza
\nPreamble Preamble
\n1. Pandemic influenza occurs
\napproximately three or four times
\nevery century. It usually occurs when a
\nnovel influenza A virus emerges that
\ncan easily be transmitted from person-
\nto-person, to which humans have little
\nor no immunity. Infection control and
\nsocial distancing practices can help
\nslow down the spread of the virus.
\nVaccine development can be
\nchallenging as the pandemic strain
\nmay not be accurately predicted.
\nAdequate supplies of antivirals are key
\nfor treatment of specific at risk
\npopulation and possibly control further
\nspread in certain settings.
\n[Last sentence deleted] [CGCM]
\n\u2026 Adequate supplies of antivirals are key for
\ntreatment of specific at risk populations and possibly
\ncontrol further spread in certain settings. [SAMA]
\n\u2026 Adequate supplies of antivirals are key for
\ntreatment of specific at risk population and possibly
\ncontrol in controlling further spread of the outbreak.
\nin certain settings. [AMA]
\nPandemic influenza occurs approximately
\nthree or four times every century. It usually
\noccurs when a novel influenza A virus
\nemerges that can easily be transmitted
\nfrom person-to-person, to which humans
\nhave little or no immunity. Infection
\ncontrol and social distancing practices can
\nhelp slow down the spread of the virus.
\nVaccine development can be challenging
\nas the pandemic strain may not be
\naccurately predicted. Adequate supplies of
\nantivirals are key for treatment of specific
\nat risk population and controlling further
\nspread of the outbreak.
\n2. Avian influenza is a zoonotic infection
\nof birds and poultry, and can cause
\nsporadic human infections. Birds act as
\nreservoir and shed the virus in their
\nfeces, mucous and saliva. Humans are
\ninfected if they are exposed through
\nthe mouth, eyes, or inhalation of virus
\nparticles. There may have been
\nevidence of a non-sustained human to
\n\u2026 There may also have been evidence of a non-
\nsustainedlimited human to human limitedtransmission
\nreported as well. [BMA]
\n\u2026 There may have been evidence of a nNon-sustained
\nhuman to human limited transmission has been
\nreported as well. [SwMA]
\nAvian influenza is a zoonotic infection of
\nbirds and poultry, and can cause sporadic
\nhuman infections. Birds act as reservoir
\nand shed the virus in their feces, mucous
\nand saliva. Humans are infected if they are
\nexposed through the mouth, eyes, or from
\nthe inhalation of virus particles. Limited
\nevidence of human to human transmission
\nMarch 2017 SMAC 209\/Pandemic Influenza COM REV\/Apr2018
\n4
\nhuman limited transmission reported
\nas well.
\n\u2026 Humans are infected if they are exposed through the
\nmouth, eyes, or from the inhalation of virus particles.
\nThere may have has been evidence of a non-sustained
\nhuman to human limited transmission reported as well.
\n[CMA]
\n\u2026 Birds act as a reservoir and shed the virus in their
\nfeces, mucous and saliva. Humans aremay be infected
\nif they are exposed through the mouth, eyes, or
\ninhalation of virus particles. There may have been
\nevidence of a non-sustained Limited evidence of
\nhuman to human limited transmission has been
\nreported as well. [AMA]
\nhas been reported as well
\n3. This statement provides guidance to
\nNational Medical Associations and
\nphysicians on how they should be
\ninvolved in their respective country’s
\npandemic influenza planning process
\nin addition to responding to Avian
\nInfluenza or pandemic influenza
\nshould it occur. It also delineates the
\nrequirements for government
\npreparedness and response. Finally, it
\nprovides recommendations about
\nactivities that physicians should
\nconsider in preparing themselves for
\npandemic influenza.
\nThis statement alongside with WMA Statement on
\nEpidemics and Pandemics provides guidance to
\nNational Medical Associations and physicians on how
\nthey should be involved in their respective country’s
\npandemic influenza planning process in addition to
\nresponding to Avian Influenza or pandemic influenza
\nshould it occur\u2026 [FMA]
\nThis statement provides guidance to National Medical
\nAssociations and physicians on how they should be
\ninvolved in their respective country’s pandemic
\ninfluenza planning and how to respond process in
\naddition to responding to Avian Influenza or pandemic
\ninfluenza should it occur. \u2026 [AMA]
\nThis statement alongside with WMA
\nStatement on Epidemics and Pandemics
\nprovides guidance to National Medical
\nAssociations and physicians on how they
\nshould be involved in their respective
\ncountry’s pandemic influenza planning and
\nhow to respond to Avian Influenza or
\npandemic influenza
\nRecommendations Recommendations
\nAvian Influenza Avian Influenza
\n4. In the event that an Avian Influenza
\nstrain transmission to humans
\nincreases, the following measures
\nshould be taken:
\nIn the event of an avian influenza outbreak, that an
\nAvian Influenza strain transmission to humans
\nincreases, the following measures should be taken:
\n[AMA]
\nIn the event of an avian influenza
\noutbreak, the following measures should
\nbe taken
\nMarch 2017 SMAC 209\/Pandemic Influenza COM REV\/Apr2018
\n5
\na Sources of exposure should be avoided
\nwhen possible as this is the most
\neffective prevention measure
\nSources of exposure should be avoided when possible
\nas this is the most effective prevention measure.
\n[CMA, SAMA]
\nSources of exposure should be avoided
\nwhen possible as this is the most effective
\nprevention measure.
\nb Personal protective equipment should
\nbe used and hand hygiene practices
\nemphasized for personnel handling
\npoultry as well as the healthcare team
\nPersonal protective equipment should be used and
\nhand hygiene practices emphasized for personnel
\nhandling poultry as well as the for healthcare teams
\n[SwMA]
\nPersonal protective equipment should be used and
\nhand hygiene practices emphasized for personnel
\nhandling poultry as well as members of the healthcare
\nteam. [CMA]
\n\u2026 as well as the healthcare team. [SAMA]
\nPersonal protective equipment should be
\nused and hand hygiene practices
\nemphasized for personnel handling poultry
\nas well as members of the healthcare
\nteam.
\nc All infected\/exposed birds should be
\ndestroyed with proper disposal of
\ncarcasses, and rigorous disinfection of
\nfarms
\nAll infected\/exposed birds should be destroyed with
\nproper disposal of carcasses, and rigorous disinfection
\nof farms. [CMA, SAMA]
\nAll infected\/exposed birds, and other potentially
\ninfected animals should be destroyed with proper
\ndisposal of carcasses, and rigorous disinfection of
\nfarms and markets [AM]
\nAll infected\/exposed birds should be destroyed with
\nproper disposal of carcasses, and rigorous disinfection
\nor quarantine of farms [AMA]
\nAll infected\/exposed birds should be
\ndestroyed with proper disposal of
\ncarcasses, and rigorous disinfection or
\nquarantine of farms.
\nd Stockpiles of vaccines should be
\nmaintained for use during an outbreak
\nStockpiles of vaccines should be maintained for use
\nduring an outbreak. [CMA, SAMA]
\nStockpiles of vaccines and antivirals should be
\nmaintained for use during an outbreak [AMA]
\nStockpiles of vaccines and antivirals
\nshould be maintained for use during an
\noutbreak.
\ne Antiviral medications such as
\nneuraminidase inhibitors can be used
\nAntiviral medications such as neuraminidase inhibitors
\ncan be used for treatment. [CMA, SAMA]
\nAntiviral medications such as
\nneuraminidase inhibitors maycan be used
\nMarch 2017 SMAC 209\/Pandemic Influenza COM REV\/Apr2018
\n6
\nfor treatment
\nAntiviral medications such as neuraminidase
\ninhibitors maycan be used for treatment [AMA]
\nfor treatment.
\n[Added paragraph:] f. Surveillance should be
\nincreased [AM]
\nPandemic Influenza Preparedness Pandemic Influenza Preparedness
\n5. WHO and National Public Health
\nOfficials:
\nWHO and National Public Health
\nOfficials:
\nThe coordination of the international
\nresponse to an influenza pandemic is
\nthe responsibility of the World Health
\nOrganization (WHO). The WHO
\ncurrently uses an all-hazards risk based
\napproach, to allow for a coordinated
\nresponse based on varying degrees of
\nseverity of the pandemic.
\nThe coordination of the international
\nresponse to an influenza pandemic is the
\nresponsibility of the World Health
\nOrganization (WHO). The WHO currently
\nuses an all-hazards risk based approach, to
\nallow for a coordinated response based on
\nvarying degrees of severity of the
\npandemic.
\n6. The WHO must: The WHO must: [BMA]
\nThe WHO mustshould: [SwMA, CMA]
\nThe WHO should:
\na Offer technical and laboratory
\nassistance to affected countries if the
\nneed arises and monitor activity levels
\nof potential pandemic influenza strains
\ncontinuously, ensuring the designation
\nof \u201cPublic Health Emergency of
\nInternational Concern\u201d is done in a
\ntimely manner if needed.
\nThe WHO must Ooffer technical and laboratory
\nassistance to affected countries if the need arises and
\nmonitor activity levels of potential pandemic influenza
\nstrains continuously, ensuring the designation of
\n\u201cPublic Health Emergency of International Concern\u201d is
\ndone in a timely manner if needed. [BMA]
\nOffer technical and laboratory assistance to affected
\ncountries if the need arises and continuously monitor
\nactivity levels of potential pandemic influenza strains
\ncontinuously, ensuring the designation of \u201cPublic
\nHealth Emergency of International Concern\u201d is done in
\na. Offer technical and laboratory
\nassistance to affected countries if
\nneeded the need arises and
\ncontinuously monitor activity
\nlevels of potential pandemic
\ninfluenza strains continuously,
\nensuring that the designation of
\n\u201cPublic Health Emergency of
\nInternational Concern\u201d is done in a
\ntimely manner if needed
\nMarch 2017 SMAC 209\/Pandemic Influenza COM REV\/Apr2018
\n7
\na timely manner if needed. [SwMA]
\nOffer technical and laboratory assistance to affected
\ncountries if needed the need arises and monitor
\nactivity levels of potential pandemic influenza strains
\ncontinuously, ensuring that the designation of \u201cPublic
\nHealth Emergency of International Concern\u201d is done
\nin a timely manner if needed. [AMA]
\n[Added paragraph, from text of 7.e. modified and
\nmoved here:] The WHO should monitor and
\ncoordinate processes by which Ggovernments are
\nalso urged to share biological materials
\nnamelyincluding virus strains and others, to facilitate
\nthe production of and ensure access to vaccines
\nglobally, this process should be monitored and
\ncoordinated by the WHO. [AMA]
\nb. Monitor and coordinate
\nprocesses by which governments
\nshare biological materials
\nincluding virus strains, to facilitate
\nthe production of and ensure access
\nto vaccines globally
\nb The WHO should communicate
\navailable information on influenza
\nactivity of concern as early as possible
\nto allow for a timely response.
\nThe WHO should cCommunicate available
\ninformation on influenza activity of concern as early as
\npossible to allow for a timely response. [SwMA,
\nCMA]
\nThe WHO should Communicate available critical
\ninformation on influenza activity of concern as early
\nas possible to allow for a timely response. [AMA]
\nc. Communicate available
\ninformation on influenza activity of
\nconcern as early as possible to
\nallow for a timely response
\n7. National governments are urged to
\ndevelop National Action plans to
\naddress the following points:
\nNational governments are urged to develop National
\nAction plans tothat address the following points:
\n[SwMA]
\nNational governments are urged to develop National
\nAction plans in coordination with physicians and.\/or
\nmedical organizations. As planning proceeds,
\ntimely and clear information and the rationale
\nNational governments are urged to develop
\nNational Action plans to address the
\nfollowing points:
\nMarch 2017 SMAC 209\/Pandemic Influenza COM REV\/Apr2018
\n8
\nbehind decisions, should be available to public
\nhealth authorities, the medical establishment and
\nthe public. Plans should be shared with the WHO
\nand to address the following points: [AM]
\nNational governments or designated government
\nagencies are urged to develop National Action plans to
\naddress the following points: [SAMA]
\nNational governments are urged to develop National
\npandemicAction plans to address the following points:
\n[AMA]
\na Ensure that there is local capacity for
\ndiagnostics and surveillance to allow
\ncontinuous surveying of influenza
\nactivity around the country;
\nEnsure that there is local capacity for diagnostics and
\nsurveillance to allow continuous surveying of
\ninfluenza activity around the country;. [CMA, SAMA]
\nEnsure that there is adequate local capacity for
\ndiagnosistics and surveillance to allow continuous
\nmonitoringsurveying of influenza activity around the
\ncountry [AMA]
\nEnsure that there is adequate local
\ncapacity for diagnosis and surveillance to
\nallow continuous monitoring of influenza
\nactivity around the country
\n[Added paragraph] Consider the surge capacity of
\nhospitals, laboratories, and public health
\ninfrastructure and improve them if necessary.
\n[AMA]
\nConsider the surge capacity of hospitals,
\nlaboratories, and public health
\ninfrastructure and improve them if
\nnecessary.
\nb Identify legal and ethical frameworks as
\nwell as governance in relation to the
\npandemic;
\nIdentify legal and ethical frameworks as well as
\ngovernance structures in relation to the pandemic
\nplanning;. [CMA]
\nDevelop and iIdentify legal and ethical frameworks as
\nwell as governance in relation to the pandemic. [AM]
\nIdentify legal and ethical frameworks as
\nwell as governance structures in relation
\nto the pandemic planning.
\nMarch 2017 SMAC 209\/Pandemic Influenza COM REV\/Apr2018
\n9
\nc Identify the mechanisms and the
\nrelevant authorities to escalate
\ninterventions to slow the spread of the
\nvirus in the community such as school
\nclosures, quarantine, border closures
\netc;
\nIdentify the appropriate mechanisms, such as school
\nclosures, quarantine, border closures etc, and the
\nrelevant authorities to escalate interventions in order
\nto slow the spread of the virus in the community such
\nas school closures, quarantine, border closures etc
\n[SwMA]
\nIdentify the mechanisms and the relevant authorities to
\nescalate interventions to slow the spread of the virus in
\nthe community such as school closures, quarantine,
\nborder closures etc;. [CMA, SAMA]
\nDevelop and iIdentify the mechanisms \u2026 such as
\nschool closures, quarantine, border closures. etc; [If
\nother items should be listed, we prefer listing the
\nspecifics.] [AM]
\nIdentify the mechanisms and the relevant authorities to
\ninitiate and escalate interventions to slow the spread
\nof the virus in the community such as school closures,
\nquarantine, border closures etc [AMA]
\nIdentify the mechanisms and the relevant
\nauthorities to initiate and escalate
\ninterventions to slow the spread of the
\nvirus in the community such as school
\nclosures, quarantine, border closures etc.
\nd Prepare risk communication and crisis
\ncommunication strategies and messages
\nin anticipation of public and media fear
\nand anxiety;
\nPrepare risk communicationand crisis communication
\nstrategies and messages in anticipation of public and
\nmedia fear and anxiety [SwMA]
\nPrepare risk communication and crisis communication
\nstrategies and messages in anticipation of public and
\nmedia fear and anxiety;. [CMA]
\nPrepare risk communication and crisis
\ncommunication strategies and messages in
\nanticipation of public and media fear and
\nanxiety.
\ne Governments are also urged to share
\nbiological materials namely virus
\nstrains and others, to facilitate the
\nGovernments are also urged to sShare biological
\nmaterials namely virus strains and others, to facilitate
\nthe production and ensure access to vaccines globally,
\nGovernments are also urged to share
\nbiological materials namely virus strains
\nand others, to facilitate the production and
\nMarch 2017 SMAC 209\/Pandemic Influenza COM REV\/Apr2018
\n10
\nproduction and ensure access to
\nvaccines globally, this process should
\nbe monitored and coordinated by the
\nWHO;
\nthis process should be monitored and coordinated by
\nthe WHO. [BMA]
\nGovernments are also urged to sShare biological
\nmaterials namely virus strains and others, to facilitate
\nthe production and ensure access to vaccines globally,;
\nthis process should be monitored and coordinated by
\nthe WHO. [CMA]
\nGovernments are also urged to share Processes that
\nensure appropriate sharing of biological materials
\nnamely virus strains and others, to facilitate the
\nproduction of and ensure access to vaccines globally,
\nthis. These processes should be monitored and
\ncoordinated by the WHO;. [SwMA]
\nGovernments are also urged to share biological
\nmaterials namely virus strains and others, to facilitate
\nthe production and ensure access to vaccines globally,.
\nTthis process should be monitored and coordinated by
\nthe WHO. [SAMA]
\nGovernments are also urged to share biological
\nmaterials namely virus strains and others, to facilitate
\nthe production and ensure access to vaccines globally.,
\nthis process should be monitored and coordinated by
\nthe WHO. [This text has been modified and moved to
\nan added paragraph after 6.a] [AMA]
\nensure access to vaccines globally.,
\nf Ensure that diagnostics and surveillance
\nefforts are continued and that enough
\nvaccine stockpiles are established;
\nEnsure that diagnostics and surveillance efforts are
\ncontinued and that adequate enough vaccine and
\nantiviral stockpiles are established. [AMA]
\nEnsure that diagnostics and surveillance
\nefforts are continued and that adequate
\nenough vaccine and antiviral stockpiles
\nare established.
\nMarch 2017 SMAC 209\/Pandemic Influenza COM REV\/Apr2018
\n11
\ng Protocols should be in place to manage
\npatients in the community, triage in
\nhealthcare facilities, ventilation
\nmanagement, as well as handling of
\ninfectious waste;
\nProtocols should be in place to manage patients in the
\ncommunity, triage in healthcare facilities, and for
\nventilation management, as well as handling of
\ninfectious waste [BMA]
\nProtocols should be in place to manage patients in the
\ncommunity, triage in healthcare facilities, ventilation
\nmanagement, as well as handling of infectious waste
\n[SwMA]
\n\u2026 as well as handling of infectious waste;. [CMA,
\nSAMA]
\nEstablish pProtocols should be in place to manage
\npatients in the community, carry out triage in
\nhealthcare facilities, provide ventilation management,
\nas well as and handleing of infectious waste [AMA]
\nEstablish pProtocols should be in place to
\nmanage patients in the community, carry
\nout triage in healthcare facilities, provide
\nventilation management, as well as and
\nhandleing of infectious waste.
\nh The allocation of vaccine doses,
\nantivirals and hospital beds should be
\ncoordinated with experts;
\nThe aAllocation of vaccine doses, antivirals and
\nhospital beds should be coordinated with experts.
\n[SwMA]
\naAllocation of vaccine doses, antivirals
\nand hospital beds should be coordinated
\nwith experts.
\ni Priority for vaccination should be given
\nto the highest risk groups including
\nthose required to maintain essential
\nservices;
\nPriority for vaccination should be given to the highest
\nrisk groups including those required to maintain
\nessential services;, including health care services.
\n[CMA]
\nPriority for vaccination should be given to
\nthe highest risk groups including those
\nrequired to maintain essential services;,
\nincluding health care services.
\nj Provide guidance and timely
\ninformation to regional health
\ndepartments, health care organizations,
\nand physicians;
\nProvide gGuidance and timely information to regional
\nhealth departments, health care organizations, and
\nphysicians. [SwMA]
\ngGuidance and timely information to
\nregional health departments, health care
\norganizations, and physicians
\nk Prepare for an increase in demand for
\nhealthcare services especially if
\nclinical severity of the illness is high.
\nIn this case prioritization and
\nPreparePreparation for an increase in demand for
\nhealthcare services especially if clinical severity of the
\nillness is high. In thissuch cases prioritization and
\nPreparePreparation for an increase in
\ndemand for healthcare services and
\nabsences of health care providers
\nMarch 2017 SMAC 209\/Pandemic Influenza COM REV\/Apr2018
\n12
\ncoordination of available resources is
\nessential;
\ncoordination of available resources is essential.
\n[SwMA]
\n\u2026 In this case prioritization and coordination of
\navailable resources is essential. This may include
\ntapping into private sector capacity where state
\nresources are insufficient. [SAMA]
\nPrepare for an increase in demand for healthcare
\nservices and absences of health care providers.
\nespecially if clinical severity of the illness is high. In
\nthis case prioritization and coordination of available
\nresources is essential. [AMA]
\nespecially if clinical severity of the illness
\nis high. In thissuch cases prioritization and
\ncoordination of available resources is
\nessential. This may include tapping into
\nprivate sector capacity where state
\nresources are insufficient.
\nl Ensure adequate funding is allocated for
\npreparedness and response;
\nEnsure aAdequate funding is allocated for
\npreparedness and response [SwMA]
\nEnsure adequate funding is allocated for preparedness
\nand response;. [CMA, SAMA]
\nEnsure adequate funding is allocated for preparedness
\nand response of pandemics and their health and
\nsocial consequences. [CGCM]
\nEnsure adequate funding is allocated for pandemic
\npreparedness and response [AMA]
\nEnsure adequate funding is allocated for
\npandemic preparedness and response as
\nwell as its health and social
\nconsequences.
\nm Make sure that mechanisms are in place
\nto ensure the safety of healthcare
\nfacilities, personnel and protection for
\nsupply chains for vaccines and
\nantivirals if needed.
\nMake sure that mMechanisms are in place to ensure
\nthe safety of healthcare facilities, and personnel and
\nprotection for vaccines and antivirals supply chains
\nfor vaccines and antivirals if needed. [SwMA]
\nMake sure that mechanisms are in place to ensure the
\nsafety of healthcare facilities, personnel and protection
\nMake sure that mechanisms are in place to
\nensure the safety of healthcare facilities,
\npersonnel and protection for the supply
\nchains for vaccines and antivirals
\nMarch 2017 SMAC 209\/Pandemic Influenza COM REV\/Apr2018
\n13
\nfor the supply chains for vaccines and antivirals if
\nneeded. [AMA]
\n[Added paragraph:] n. Promote and finance
\nresearch to develop vaccines and effective
\ntreatments with lasting effects against the viruses
\nthat produce these pandemics. [CGCM]
\nn. Promote and fund research to develop
\nvaccines and effective treatments with
\nlasting effects against influenza.
\n[Added paragraph:] o. Encourage collaboration
\nbetween human and veterinary medicine in the
\nprevention, approach and research of bird flu to
\nachieve control of this and any other pandemic.
\n[CGCM]
\no. Encourage collaboration between
\nhuman and veterinary medicine in the
\nprevention, research and control of
\navian influenza
\n8. National Medical Associations are
\nurged to:
\nNational governments or, if necessary, National
\nMedical Associations are urged to: [RDMA]
\n[In some countries, including the Netherlands, the
\nactions mentioned below are performed by
\ngovernmental organisations and not the NMA.
\nTherefore RDMA would like to change the title as
\nabove] [RDMA]
\nNational Medical Associations should have their own
\norganization-specific business contingency plan in
\nplace to ensure continued support of their
\nmembers, and are urged to: [AM]
\nNational Medical Associations are urged
\nto:
\na Delineate their involvement in the
\nnational pandemic influenza
\npreparedness plan which can include
\nincreasing capacity building amongst
\nthe physician communities,
\nparticipating in guideline development
\nand communication with healthcare
\nDelineate their involvement in the national pandemic
\ninfluenza preparedness plan which can include
\nincreasing capacity building amongst the physician
\ncommunities, participating in guideline development
\nand communication with healthcare professionals.
\n[BMA]
\nDelineate their involvement in the national
\npandemic influenza preparedness plan,
\nwhich can may include increasing capacity
\nbuilding amongst physicians, participating
\nin guideline development and
\ncommunication with healthcare
\nprofessionals.
\nMarch 2017 SMAC 209\/Pandemic Influenza COM REV\/Apr2018
\n14
\nprofessionals. Delineate their involvement in the national pandemic
\ninfluenza preparedness plan, which can may include
\nincreasing capacity building amongst the physician
\ncommunity, participating in guideline development
\nand communication with healthcare professionals.
\n[SwMA]
\nDelineate their involvement in the national pandemic
\ninfluenza preparedness plan which canmay include
\nincreasing capacity building amongst the physician
\ncommunities, \u2026 [AMA]
\nb Help educate the public through the
\nmedia and official channels of
\ncommunication.
\nHelp educate the public about avian and pandemic
\ninfluenza through the media and official channels of
\ncommunication [SwMA]
\nHelp educate the public about avian and
\npandemic influenza
\nc Promote infection control practices
\namongst the public to slow the spread
\nof influenza, including home
\nconfinement of infected patients, hand
\nhygiene, cough etiquette etc;
\n\u2026 hand hygiene, cough etiquette etc;. [CMA]
\n\u2026 of infected patients, hand hygiene, cough etiquette.
\netc; [If other items should be listed, we prefer listing
\nthe specifics.] [AM]
\n\u2026 of infected patients, hand hygiene, cough etiquette
\netc. [SAMA]
\nd When feasible, NMAs should
\ncoordinate with other healthcare
\nprofessionals\u2019 organizations as well as
\nother NMAs to identify common issues
\nand congruent policies regarding to
\npandemic influenza preparedness and
\nresponse;
\nWhen feasible, NMAs should coordinate with other
\nhealthcare professionals\u2019 organizations as well as other
\nNMAs to identify common issues and congruent
\npolicies regarding to pandemic influenza preparedness
\nand response [BMA]
\nWhen feasible, NMAs should coordinate with other
\nNMAs as well as other healthcare professionals\u2019
\norganizations as well as other NMAs to identify
\ncommon issues and promote congruent policies
\nWhen feasible, NMAs should coordinate
\nwith other healthcare professionals\u2019
\norganizations as well as other NMAs to
\nidentify common issues and congruent
\npolicies regardingrelated to pandemic
\ninfluenza preparedness and response;.
\nMarch 2017 SMAC 209\/Pandemic Influenza COM REV\/Apr2018
\n15
\nregarding to pandemic influenza preparedness and
\nresponse [SwMA]
\nWhen feasible, NMAs should coordinate with other
\nhealthcare professionals\u2019 organizations as well as other
\nNMAs to identify common issues and congruent
\npolicies regardingrelated to pandemic influenza
\npreparedness and response;. [CMA]
\nWhen feasible, NMAs should coordinate with other
\nhealthcare professionals\u2019 organizations as well as other
\nNMAs to identify common issues and congruent
\npolicies regarding to pandemic influenza preparedness
\nand response [NMA]
\n\u2026 regarding to pandemic influenza preparedness and
\nresponse;. [RDMA, SAMA]
\nWhen feasible, NMAs should Coordinate with other
\nhealthcare professionals\u2019 organizations \u2026 [AMA]
\ne When available, NMAs should consider
\nthe implementation of support strategies
\nfor members involved in the response
\nincluding mental health services,
\nfacilitation of health emergency
\nresponse teams, and locum relief among
\nothers;
\nWhen available, NMAs should Consider the
\nimplementation of support strategies for members
\ninvolved in the pandemic influenza response,
\nincluding mental health services, facilitation of health
\nemergency response teams, and locum local relief
\namong others. [SwMA]
\nWhen available, NMAs should consider the
\nimplementation of support strategies for members
\ninvolved in the response including mental health
\nservices, facilitation of health emergency response
\nteams, and locum relief among others;. [CMA]
\nWhen available, NMAs should consider the
\nshould Consider implementing the
\nimplementation of support strategies for
\nmembers involved in the response
\nincluding mental health services,
\nfacilitation of health emergency response
\nteams, and locum relief.
\nMarch 2017 SMAC 209\/Pandemic Influenza COM REV\/Apr2018
\n16
\nimplementation of support strategies for members
\ninvolved in the response including mental health
\nservices, facilitation of health emergency response
\nteams, and locum relief among others. [NMA]
\nWhen available, NMAs should Consider
\nimplementing the implementation of support
\nstrategies for members involved in the response
\nincluding mental health services, facilitation of health
\nemergency response teams, and locum relief among
\nothers. [AMA]
\nf NMAs should be prepared to advocate
\non behalf of members who, during a
\npandemic, will have rapidly emerging
\nprofessional needs that must be met and
\non behalf of patients and the public who
\nwill be affected by the unfolding events.
\nNMAs should be prepared to Advocate, on behalf of
\nmembers who, before and during a pandemic, for
\nallocation of adequate resources to meet foreseeable
\nand emerging needs of healthcare, patients and the
\ngeneral public. will have rapidly emerging
\nprofessional needs that must be met and on behalf of
\npatients and the public who will be affected by the
\nunfolding events [SwMA]
\nNMAs should be prepared to aAdvocate on behalf of
\nmembers who, during a pandemic, will have rapidly
\nemerging professional needs that must be met and on
\nbehalf of patients and the public who will be affected
\nby the unfolding events. [CMA]
\nNMAs should be prepared to advocate on behalf of
\nmembers who, during a pandemic, will have rapidly
\nemerging professional needs that must be met and on
\nbehalf of patients and the public who will be affected
\nby the unfolding events [NMA]
\nNMAs should be prepared to advocate on behalf of
\nmembers who, during a pandemic, will have rapidly
\nAdvocate, on behalf of members who,
\nbefore and during a pandemic, for
\nallocation of adequate resources to meet
\nforeseeable and emerging needs of
\nhealthcare, patients and the general
\npublic.
\n(Response from the rapporteur to the
\nquestion by the RDMA: During pandemics
\nand outbreaks, and given the significant
\nstress placed on healthcare professionals
\nand facilities, needs will arise that are
\nusually not accounted for by authorities,
\nsuch as staff shortages, education and
\ntraining, personal protective equipment,
\nMarch 2017 SMAC 209\/Pandemic Influenza COM REV\/Apr2018
\n17
\nemerging professional needs that must be met and on
\nbehalf of patients and the public who will be affected
\nby the unfolding events. [RDMA]
\n[RDMA does not understand what is meant by this
\nsentence. Please clarify.]
\nNMAs should be prepared to advocate on behalf of
\nmembers who, during a pandemic, will have rapidly
\nemerging professional needs – education, supplies,
\nand manpower – that must be met and on behalf of
\npatients and the public who will be affected by the
\nunfolding events. [AM]
\n\u2026 on behalf of patients and the public who will be
\naffected by the unfolding events. [SAMA]
\nNMAs should be prepared to Advocate on behalf of
\nmembers who, during a pandemic, will have rapidly
\nemerging professional needs that must be met and on
\nbehalf of patients and the public who will also be
\naffected by the unfolding events [AMA]
\nvaccine doses, antiviral supplies, burnout
\netc. NMAs should be prepared to advocate
\non behalf of their members to ensure that
\nthe essential needs are met, but also on
\nbehalf of patients and the public which are
\nalso affected by shortages, inadequate
\nsupplies, specific care needs, etc. )
\n[Added paragraph:] g. Encourage health personnel
\nto protect themselves by vaccination [NMA]
\n[It should not be necessary to repeat NMAs in the sub
\nitems, confer the headline. Not only physicians should
\nbe vaccinated (item 9b), but all health care personnel.]
\n[NMA]
\ng. Encourage health personnel to protect
\nthemselves by vaccination
\n[Added paragraph:] g. Develop their own
\norganization-specific business contingency plans to
\nensure continued support of their members. [AMA]
\nh. Develop their own organization-
\nspecific business contingency plans to
\nensure continued support of their
\nmembers.
\n9. Physicians: Physicians:
\nMarch 2017 SMAC 209\/Pandemic Influenza COM REV\/Apr2018
\n18
\na Physicians must be sufficiently
\nknowledgeable about pandemic
\ninfluenza and transmission risks,
\nincluding local and international
\nepidemiology;
\nPhysicians must receive sufficient education so as to
\nbe sufficiently knowledgeable about pandemic
\ninfluenza and transmission risks, including local and
\ninternational epidemiology. [SwMA]
\nPhysicians must be sufficiently knowledgeable about
\npandemic influenza and transmission risks, including
\nlocal, national and international epidemiology. [CMA]
\na. Physicians must be sufficiently
\nknowledgeable about pandemic
\ninfluenza and transmission risks,
\nincluding local, national and
\ninternational epidemiology
\nb Physicians should implement infection
\ncontrol practices and vaccination if
\navailable, to protect themselves as well
\nas other staff members during both
\nseasonal and pandemic influenza;
\nPhysicians should implement infection control
\npractices and vaccination if available, to protect
\nthemselves as well as other staff members during both
\nseasonal and pandemic influenza. [SwMA]
\nPhysicians should implement infection control
\npractices and vaccination if available, to protect
\nthemselves as well as other staff members during both
\nseasonal and pandemic influenza. [AM]
\nPhysicians should implement infection control
\npractices and vaccination if available be vaccinated in
\norder to protect themselves as well as other staff
\nmembers during outbreaks of both seasonal and
\npandemic influenza. [AMA]
\nb. Physicians should implement
\ninfection control practices and
\nvaccination if available, to protect
\nthemselves as well as other staff
\nmembers during seasonal and
\npandemic influenza outbreaks.
\nc Physicians must participate in
\nlocal\/regional pandemic influenza
\npreparedness planning.
\nPhysicians must should, to the extent possible,
\nparticipate in local\/regional pandemic influenza
\npreparedness planning [SwMA]
\nPhysicians must participate in local\/regional pandemic
\ninfluenza preparedness planning and training. [AM]
\nPhysicians must participate and remain involved in
\nlocal\/regional pandemic influenza preparedness
\nplanning [AMA]
\nc. Physicians must participate in
\nlocal\/regional pandemic influenza
\npreparedness planning and
\ntraining.
\nMarch 2017 SMAC 209\/Pandemic Influenza COM REV\/Apr2018
\n19
\n[Added paragraph:] d. In case of epidemic,
\nphysicians for ethical and professional reasons, will
\nnot abandon any patient who needs their care,
\nunless forced to do so by the competent authority or
\nthere is an imminent and unavoidable vital risk to
\ntheir persons. [CGCM]
\n(Response from the rapporteur to the
\naddition by CGCM: I would leave the
\ndecision to NMAs whether to include this
\nin the policy, however from the scientific
\nperspective, there are categories of
\nphysicians and healthcare professionals
\nwho may have certain health conditions
\nthat would put them at a very high risk
\nshould they become infected with influenza
\nsuch as pregnant women, transplant or
\nHIV infected healthcare workers, so
\ncareful consideration should be placed
\nwith a generalized statement. )
\n[Added paragraph:] d. Develop contingency plans to
\ndeal with possible disruptions in essential services
\nand personnel shortages. [AMA]
\nd. Develop contingency plans to deal
\nwith possible disruptions in essential
\nservices and personnel shortages.
\n*****
\n21.03.2018<\/p>\n

1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument
\nno:
\nSMAC 209\/Nuclear Weapons\/Apr2018 Original:
\nEnglish
\nTitle: Proposed revision of the WMA Statement
\non Nuclear Weapons
\nDestination: Socio-Medical Affairs Committee
\n209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nFor
\nconsideration
\nNote The WMA Statement on nuclear weapons was adopted in
\n1998 and amended in 2008 and 2015. The proposed revision
\nfrom the Japan Medical Association has been prepared in
\nconsultation with the International Physicians for the
\nProhibition of Nuclear Weapons (IPPNW) in the context of
\nthe recent adoption of the UN Treaty on the prohibition of
\nnuclear weapons. Amendments are highlighted in bold,
\nunderlined or strikethrough.
\nPREAMBLE
\nThe WMA Declarations of Geneva, of Helsinki and of Tokyo make clear the duties and
\nresponsibilities of the medical profession to preserve and safeguard the health of the patient and to
\nconsecrate itself to the service of humanity. Therefore, and in light of the catastrophic
\nhumanitarian consequences that any use of nuclear weapons would have, and the
\nimpossibility of a meaningful health and humanitarian response, the WMA considers that it has
\na duty to work for the elimination of nuclear weapons.
\nRECOMMENDATIONS
\nTherefore, the WMA:
\n1. Condemns the development, testing, production, stockpiling, transfer, deployment, threat and
\nuse of nuclear weapons;
\n2. Requests all governments to refrain from the development, testing, production, stockpiling,
\ntransfer, deployment, threat and use of nuclear weapons and to work in good faith towards the
\nelimination of nuclear weapons;
\n3. Advises all governments that even a limited nuclear war would bring about immense human
\nsuffering and substantial death toll together with catastrophic effects on the earth\u2019s ecosystem,
\nwhich could subsequently decrease the worlds food supply and would put a significant portion
\nof the world\u2019s population at risk of famine;
\nFebruary 2018 SMAC 209\/Nuclear Weapons\/Apr2018
\n2
\n4. Is deeply concerned by plans to retain indefinitely and modernize nuclear arsenals; the
\nabsence of progress in nuclear disarmament by nuclear-armed states; and the growing
\ndangers of nuclear war, whether by intent, including cyberattack, inadvertence or
\naccident;
\n5. Welcomes the Treaty on the Prohibition of Nuclear Weapons, and joins with others in the
\ninternational community, including the Red Cross and Red Crescent movement,
\nInternational Physicians for the Prevention of Nuclear War, the International Campaign
\nto Abolish Nuclear Weapons, and a large majority of UN member states, in calling, as a
\nmission of physicians, on all states to promptly sign, ratify or accede to, and faithfully
\nimplement the Treaty on the Prohibition of Nuclear Weapons; and
\n6. Requests that all National Medical Associations join the WMA in supporting this Declaration,
\nuse available educational resources to educate the general public and to urge their respective
\ngovernments to work towards the elimination of nuclear weapons.
\n7. Requests all National Medical Associations to join the WMA in supporting this Declaration and
\nto urge their respective governments to work urgently to prohibit and eliminate nuclear
\nweapons, by joining and implementing the UN Treaty on the Prohibition of Nuclear
\nWeapons.
\n\u00a7\u00a7\u00a7
\n12.03.2018
\n1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument
\nno:
\nSMAC 209\/Maternal and Child Health
\nHandbook \/Apr2018
\nOriginal:
\nEnglish
\nTitle: Proposed WMA Statement on the
\nDevelopment and Promotion of a
\nMaternal and Child Health Handbook
\nDestination: Socio-Medical Affairs Committee
\n209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nFor
\nconsideration
\nNote This is a proposal from the Japan Medical Association.
\nRelated
\nWMA
\npolicies
\n\u00a7 WMA Declaration of Ottawa on Child Health
\n\u00a7 WMA Statement on Supporting Health Support to
\nStreet Children
\n\u00a7 WMA Statement on Obesity in Children
\nKeywords: Maternal and Child Health, Handbook, Mother, Child,
\nContinuum of Care
\nPREAMBLE
\n1. The WMA believes that both a continuum of care and family empowerment is necessary to
\nimprove the health and wellbeing of the mother and child. The reduction of maternal mortality
\nrate and infant deaths has been an important objective of the MDGs. The reductions of the
\nmaternal mortality ratio, neonatal mortality rate and the under-five mortality rate have been
\nalso important targets to be achieved under the Sustainable Development Goals (SDGs).
\n2. In 1948, Japan became the first country in the world to create and distribute the maternal and
\nchild health (MCH) handbook, in order to protect the health of the mother and child. This MCH
\nhandbook included information on pregnancy, the child\u2019s neonatal and pediatric periods,
\nrecords of personal growth and vaccination as well as health education, all in one book, to be
\nkept at home.
\n3. There are now approximately 40-country versions of the MCH handbook, all adapted to the
\nlocal culture and socio-economic context. The use of MCH handbooks, in particular in low-
\nand medium-income countries, has helped improve the knowledge of mothers on maternal and
\nchild health issues, and has contributed in changing behaviors during pregnancy or delivery.
\nMarch 2018 SMAC 209\/Maternal and Child Health Handbook\/Apr2018
\n2
\n4. The MCH handbook can promote the health of pregnant women, neonates and children by
\nusing it as a tool for strengthening continuum of care. Physicians can make better care
\ndecisions, by referring to the patient\u2019s history and health-check data recorded in the MCH
\nhandbook. Such benefit of the handbook should be shared in more number of countries.
\n5. In Japan, a digital handbook is spreading progressively. It is also expected to utilize the digital
\nhandbook in consideration of confidentiality of health information of the individual patient.
\nRECOMMENDATIONS
\n1. The WMA recommends that the constituent member associations encourage their health
\nauthorities and health institutions to recognize that the MCH handbook is an important tool
\nto help health promotion of mothers, neonates and children.
\n2. The WMA recommends that the constituent member associations and medical professionals
\nto promote the utilization of MCH handbook for realizing leaving no one behind in SDGs,
\nsuch as non-literate people, migrant families, refugees, minorities, mothers, neonates and
\nchildren in remote areas.
\n3. In using a MCH handbook, digital or in print form, the confidentiality of health information
\nof the individual and privacy of mothers and children should be strictly protected.
\n****
\n20.03.2018
\n1
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument
\nno:
\nSMAC 209\/Pseudoscience\/Apr2018 Original:
\nEnglish
\nTitle: Proposed WMA Declaration on
\nPseudoscience, Pseudotherapies,
\nintrusion and sects in the field of health
\nDestination: Socio-Medical Affairs Committee
\n209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nFor
\nconsideration
\nNote This is a proposal from the Spanish Medical Association
\nsubmitted within the deadline required for new item
\nsubmission. The Review Committee considered the
\nproposal and asked to the Spanish Medical Association to
\nwork further on the document (inclusion \/ clarification of
\nterms).
\nKeywords: Pseudoscience, Pseudotherapies, Intrusion
\nSummary Thanks to scientific advances, the developed\/developing societies in which
\nwe live have made significant progress in treating and relieving numerous
\nillnesses affecting human health.
\nHealth systems and social healthcare systems are based on conventional
\nscience. Within the healthcare field, it is very important to preserve our
\ndifferent legislation and national systems, since these are among our most
\nprized assets. There is no doubt about as to the affinity felt by the public
\ntoward its systems and traditions.
\nGiven the scarcity of medicines in certain developing countries, the use of
\nmedicinal plants can be justified when there is supporting evidence of their
\nefficacy and harmlessness. Of course, so too can its use in traditional and
\nindigenous medicine in communities and countries that lack other resources
\nor healthcare systems. In this sense, so-called traditional\/complimentary
\nmedicine should also be based on scientific proof, in order to be considered
\nas an integral part of healthcare services (WHO Traditional Medicine
\nStrategy 2014-2023- World Health Organization).
\nThe concept of pseudoscience (false science) covers beliefs and practices
\nthat are falsely presented as science, as they do not follow a valid and
\nrecognised scientific method. The main characteristic of pseudoscientific
\npractices or beliefs is that they cannot be asserted as true, as what they claim
\nMarch 2018 SMAC 209\/Pseudoscience\/Apr2018
\n2
\nor imply cannot be demonstrated using reliable and valid scientific methods.
\nPseudoscience is a collection of knowledge, methods, beliefs or practices
\nmistakenly regarded as being based on scientific method, and which cannot
\nbe corroborated by the scientific community. (Definition based on the Oxford
\nAmerican Dictionary).
\nAccording to Karl Popper, Austrian philosopher and the father of critical
\nrationalism, the boundary between science and non-science lies in the fact
\nthat scientific theories make verifiable, and therefore falsifiable, claims and
\npredictions, which can therefore be discarded or refuted when they do not
\nstand up to scrutiny. Characterisation as pseudoscience is not determined
\nby the subject itself, but rather by the claims on which its study is built.
\nPseudotherapies are broadly defined as approaches to curing illnesses,
\nrelieving symptoms or improving health that use procedures, techniques,
\nproducts or substances based on criteria not backed up by available scientific
\nevidence demonstrating their effectiveness (simulated treatments with
\nsupposed medicines, techniques based on fantasy, absurd logic, falsification,
\nmind or emotional manipulation techniques, the use of banned or toxic
\nproducts, etc.)
\nPseudotherapies, provided by healthcare professionals or others, constitute
\ntherapeutic offerings that lack the necessary scientific basis to evaluate either
\ntheir validity or effectiveness. Fortunately, their actual impact on society is
\nsmall. Nonetheless, this should be understood and analysed to prevent its
\nspread. No healthcare professional should offer pseudotherapies in their
\nclinical practice.
\nProfessional inclusion is defined as the performance of medical procedures
\nby unskilled and unqualified persons.
\nIn relation to the medical profession, note that, strictly speaking, a medical
\nprocedure consists of the prevention, diagnosis or treatment of diseases using
\nscientific-experimental methods of the official medical art taught in Faculties
\nof Medicine.
\nThere is a worrying increase in the entry of unqualified people into the
\nmedical profession, which is based on the use of new technologies and
\nbolstered by insufficient regulation and restriction of these practices.
\nThe entry of unqualified people into the medical profession has special
\nimplications, as it poses a public health risk which directly affects citizens. It
\nis the responsibility of the health authorities and of regulated and collegiate
\nprofessional organisations to protect the health of citizens, and therefore to
\ncombat the intrusion of unqualified people into the medical profession.
\nMarch 2018 SMAC 209\/Pseudoscience\/Apr2018
\n3
\nIntroduction
\n1. In general, pseudoscience and pseudotherapies are either not recognised by the health
\nauthorities of the majority of countries or are given lower status and frequently surrounded by
\nstigma and major controversy regarding the scientific rationale on which they are based.
\n2. Most countries have no regulatory framework, which has allowed
\npseudotherapies\/pseudoscience to proliferate. We used to regard pseudotherapies as
\ninoffensive due to their lack of side effects, but there is growing evidence to suggest that
\nthey should not be seen as such and are in fact problematic. New legislation is required to
\nput a stop to the proliferation of pseudotherapies.
\n3. Pseudotherapies use a variety of mechanisms to appear effective: the natural evolution of the
\ncondition, regression towards the mean, the inducement of mechanisms pertaining to the
\nplacebo effect, among others. They cause some patients to perceive a cause-and-effect
\nrelationship between pseudotherapies and the perception of improvement.
\n4. These pseudotherapies are based on \u201cfalse science\u201d and represent a significant danger for
\nvarious reasons:
\n4.1 The risk that patients abandon effective medical treatments in favour of practices that
\nhave not demonstrated or lack therapeutic value, which can lead to serious health
\nproblems and even death.
\n4.2 The common likelihood of dangerous delays and \u201closs of opportunity\u201d in the application
\nof medicines, procedures and techniques that are recognised and endorsed by the
\nscientific community.
\n4.3 Apart from causing medical treatment to be abandoned, some pseudotherapies have
\nnegative effects on health.
\n4.4 They cause patients to suffer financial and moral damages.
\n4.5 The rising costs of procedures, which are given on multiple occasions.
\n4.6 Intrusion into in the medical profession, worryingly on the rise due to internet use, can
\nonly be curtailed using legal measures. Government policy must not tolerate these
\npractices, and a serious commitment is required on the part of the authorities.
\n4.7 Cults are frequently involved in the practice of pseudoscience and pseudotherapies.
\n5. A current, broader definition of \u201cSafety\u201d in patient care includes: increasing the patient\u2019s
\nopportunities to receive appropriate, evidence-based care. Impeding access to this type of
\ncare in any way can be considered to be a loss of opportunity and, as such, a possible failure
\nof the healthcare system, which must be addressed and resolved. It is the responsibility of
\nnational governments, but also of professional organisations, scientific societies and
\npatients\u2019 associations to fulfil this commitment.
\nRecommendations
\n6. Considering that the WMA, NMAs and the medical profession in general need to be aware
\nof the problem and of its medical and social repercussions, given its proliferation and
\nconsequences.
\n7. Considering the commitment of the WMA, NMAs and the medical profession, and their
\nresponsibility to health and to the protection of individual and collective health, the
\nfollowing recommendations apply:
\nMarch 2018 SMAC 209\/Pseudoscience\/Apr2018
\n4
\n8. Doctors must continue to practice medicine as a service based on the application of critical
\nscientific knowledge, skills within their specialist field and ethical attitudes and behaviour.
\nAs individuals, they must maintain and keep this up to date, and all organisations and
\nauthorities involved in the governance and regulation of the medical profession must commit
\nto it as well.
\n9. The risk of assuming that pseudoscience and pseudotherapies have a role to play in
\nappropriately treating human suffering goes hand in hand with the ethical debate on the role
\nof the placebo in treatment. Ethical reasoning must play a part in scientific reasoning, since
\nthe first cannot be formed without the second.
\n10. WMA and the NMAs must recommend that national authorities not finance this type of
\nsupposed treatment, since healthcare systems should not reimburse the costs derived from
\nthese pseudotherapies, except where they are shown to be efficient, effective, supported by
\nevidence through rigorous testing, and safe.
\n11. In line with the CPME position paper on complementary and alternative treatments
\n(CPME\/AD\/Board\/26052015\/130_Final\/EN), the safety and efficacy of all existing
\ntreatments should be constantly reassessed. All new diagnostic and therapeutic methods
\nshould be tested in accordance with scientific methods and ethical principles (as
\nrecommended in the WMA Declaration of Helsinki: Ethical principles for medical research
\nin humans\u201464th WMA General Assembly, Fortaleza, Brazil, October 2013). An exhaustive
\nstudy is required into the safety, efficacy, efficiency, scope of application and the supposedly
\nalternative and\/or complementary character of all of these non-conventional therapies and
\ntechniques.
\n12. Traditional and indigenous medicine in communities that lack other means or healthcare
\nsystems must also be based on scientific tests if they are to be considered an integral part of
\nhealthcare services. That is why support is needed for research and development in this field,
\nas set out in the \u201cWHO Strategy on Traditional Medicine 2014-2023\u201d.
\n13. A doctor\u2019s duty is to provide humane and scientific medical care to all patients and similarly,
\nthey should offer the best possible treatment based on scientific evidence. In this regard, the
\nWMA Declaration of Geneva and the International Code of Medical Ethics should be
\nreferences in high quality and ethical medical care, and for the safety of patients.
\n14. For the patient\u2019s safety and quality of care, the doctor must have the freedom to prescribe,
\nwhile respecting scientific evidence and the authorised instructions. In every process, the
\npatient must be kept duly informed and be able to participate in the best therapeutic decision-
\nmaking.
\n15. The medical profession needs to delve into aspects such as the doctor-patient relationship,
\npersonal and social communication, mutual trust, and humanising person-centred healthcare
\nin terms of the patient\u2019s decisions and autonomy in order to steer them away from
\npseudoscience and pseudotherapies by explaining the risks and hazards they pose to their
\nhealth and their lives.
\n16. Physicians need to know that some patient groups, such as patients with cancer, psychiatric
\nillnesses or serious chronic diseases, as well as children, are particularly vulnerable to the
\nMarch 2018 SMAC 209\/Pseudoscience\/Apr2018
\n5
\nrisks associated with alternative and\/or complementary practices that have not been assessed
\nusing evidence-based methods based on conventional science.
\n17. The doctor\u2019s preference must be to perform procedures and prescribe medicines that have
\nbeen scientifically proven to be effective. It is unethical for practices to be inspired by
\nquackery, to lack scientific basis, to promise cures to sick people, to present illusory or
\ninsufficiently tested procedures as being effective, to simulate medical treatments or surgical
\nprocedures or to use products of unknown composition.
\n18. It is the physician\u2019s duty to tell patients that traditional non-conventional, alternative and\/or
\ncomplementary practices are not regarded as scientific medical specialities, which means that
\ntraining certifications in these fields do not constitute specialist qualifications that are
\nrecognised by the scientific community, and they are not legally recognised in most
\ncountries; nor are they part, in the strict sense, of the contents of the Medical Act.
\n19. In relation to so-called \u201cPseudoscience\/Pseudotherapies\u201d, it is important to remember that:
\na. All medical acts are subject to Lex Artis ad hoc.
\nb. All medical acts require the doctor to be \u201cadequately trained\u201d.
\nc. A medical act requires a relationship of trust and good practice between the doctor and
\nhis\/her patients.
\nd. Doctors who perform and apply techniques and therapies that are not endorsed by the
\nscientific community must appropriately inform their patients and assume all the legal,
\nprofessional and ethical obligations implied by medical activity under lex artis ad hoc.
\ne. To raise the need to establish a clearer definition of these types of
\npseudotherapies\/pseudosciences and to tighten up lax, permissive or non-existent
\nlegislation.
\nf. Intrusion into in the medical profession, worryingly on the rise due to internet use, can
\nonly be curtailed using legal measures. Government policy must not tolerate these
\npractices, and a serious commitment is required on the part of the authorities.
\n20. A current and broader definition of \u201cSafety in patient care\u201d includes increasing the patient\u2019s
\nchances of receiving adequate and evidence-based care. Any obstacle to their access to this
\ntype of care (such as pseudotherapies and pseudoscience without scientific evidence) may be
\nconsidered a loss of opportunity and, as such, as a possible failure of the healthcare system,
\nwhich must be addressed and corrected. Fulfilling this commitment is the responsibility of
\nnational governments, but also of professional organisations, scientific societies and patients\u2019
\nassociations. We recommend:
\na. To report all acts of professional intrusion and all pseudoscience and pseudotherapy
\nactivities that put public health at risk, as well as bad practice, misleading advertising and
\nunaccredited websites that offer services and\/or products that put the health of patients at
\nrisk and\/or could be considered fraudulent.
\nb. NMAs and the ANM must address pseudotherapies and emotional\/mental manipulation
\ntechniques with a significant cult element (Germanic New Medicine \u2013 GNM \u2013 Hamer
\nMethod and its variants of BioNeuroEmotion and Biodecoding, emotional theory of
\ndisease), as well as those that may contain misleading advertising on curing cancer
\nthrough the use of unauthorised products (MMS, Miracle Mineral Solution \u201328% sodium
\nchlorite). All of these must be expressly excluded from all healthcare systems and
\nconsidered to be an assault on public health and the safety of patients.
\nMarch 2018 SMAC 209\/Pseudoscience\/Apr2018
\n6
\n21. Governments should establish stricter provisions protecting patients treated with traditional
\nnon-conventional, complementary and\/or alternative medicines. When such a practice is
\nfound to be harmful, there should be a system in place to either stop or substantially restrict
\nany given treatment classified as complementary and\/or alternative in order to protect public
\nhealth.
\n****
\n09.04.2018
\nTHE WORLD MEDICAL ASSOCIATION, INC.
\nDocument
\nno:
\nSMAC 209\/Policy Review 2008\/Apr2018 Original:
\nEnglish
\nTitle: Annual Policy Review 2008:
\nRecommendations received on SMAC
\ndocuments
\nDestination: Socio-Medical Affairs Committee
\n209th
\nCouncil Session
\nRadisson Blu Latvija Hotel
\nRiga, Latvia
\n26-28 April 2018
\nAction(s)
\nrequired:
\nFor
\nConsideration
\nThe ongoing policy review process adopted by the WMA requires a review of every policy for which
\nit had been ten years since adoption or last revision.
\nThe first step in the review process is to survey Constituent Members for their advice on whether a
\npolicy requires (a) reaffirmation, (b) minor or editorial changes before reaffirmation (c) a major
\nrevision, or (d) rescinding and archiving. On 6 February 2018, a memo was sent to Constituent
\nMembers asking them to recommend the classifications of the 2008 policies. The result of this
\nconsultation is as follows:
\n1) List of Respondents (26):
\nAustralian Medical Association (AuMA) Norway Medical Association (NMA)
\nBangladesh Medical Association (BaMA) Netherlands medical Association(RDMA)
\nCanadian Medical Association (CMA) Consejo General de Colegios Medicos de Espa\u00f1a
\n(CGCM)
\nConseil National de l\u00b4Ordre des M\u00e9decins
\nFrance (CNOM)
\nSwedish Medical Association (SwMA)
\nDanish Medical Association (DMA) Taiwan Medical Association (TMA)
\nIsraeli Medical Association (IsMA) Medical Association of Thailand (MAT)
\nJapan Medical Association (JMA) Turkish Medical Association (TuMA)
\nKorean Medical Association (KMA) British Medical Association (BMA)
\nKuwait Medical Association (KuMA) Vatican Medical Association (AMV)
\nGerman Medical Associaiton (GMA) Pakistan Medical Association (PkMA)
\nAustrian Medical Chamber (AMC) Finnish Medical Associaiton (FMA)
\nRwanda Medical Association (RMA) American Medical Associaiton (AMA)
\nColegio Medico de Mexico (CMM) The South African Medical Association (SAMA)
\n2) Policies\u2019 abbreviations :
\nAccess of Women : Resolution on Access of Women and Children to Health Care and the Role of
\nWomen in the Medical Profession
\nVeterinary: Resolution on Collaboration Between Human and Veterinary Medicine
\nMarch 2018 SMAC 209\/Policy Review 2008\/Apr2018
\nPoppies: Resolution on Poppies for Medicine Project for Afghanistan
\nEconomic crisis: Resolution on the Economic Crisis: Implications for Health
\nMines: Resolution Supporting the Ottawa Convention on the Prohibition of the Use,
\nStockpiling, Production, and Transfer of Anti-Personnel Mines and on Their
\nDestruction
\nSodium: Statement on Reducing Dietary Sodium Intake
\nMercury: Statement on Reducing the Global Burden of Mercury
\nAM Drugs: Statement on Resistance to Antimicrobial Drugs
\nViolence: Statement on Violence and Health
\n3) Specific comments from NMAs:
\nAccess of Women
\n(JMA) JMA believes that \u00abResolutions\u00bb should not undergo a major revision because they are
\nsupposed to have been adopted reflecting the times when they were adopted. This resolution should
\nbe also reaffirmed without changes, then we can focus on the discussion of the newly proposed
\nStatement on Women in Medicine
\n(KMA) Due to religious and cultural background, women and children in many countries still face
\ndiscrimination. However, access to employment, education and health care services are basic
\nhuman rights that apply to all people, which is why it
\nis desirable that the WMA makes concerted efforts to promote women\u2019s and children\u2019s
\nhuman rights
\n(KuMA) The resolution doesn\u2019t contradict the proposed statement by IsMA and the Resolution
\nlooks fine as it is as women participation and leadership in medicine should be mentioned in both
\ndocuments.
\n(BMA) Need to contextualize the statement and make it relevant for the issues and challenges that
\ndoctors, in particularly women doctors face. The barriers lie more around women\u2019s progression to
\nsenior posts, the effect of taking time out to care for children\/relatives, impact of part time working
\ndue to caring responsibilities. In terms of women\u2019s access to healthcare services, although there are
\nspecific examples of lack of access -eg abortion services in Northern Ireland, it is not correct to say
\nthis is ‘all’ healthcare. The wording on discrimination also needs updating and clarity around
\ndiscrimination against doctors and patients\/public
\n(RDMA) We agree with the staff that the subjects of access to health care for children and women
\non the one hand, and women working in medicine on the other hand should be handled separately.
\nTherefore, we agree to reaffirm with major revision the resolution on access to health care.
\nVeterinary
\n(AuMA) No view expressed.
\n(DMA) The DMA recommends major revision instead of minor revision. The description of
\nthe One-Health initiative should be updated and we suggest that the recommendations include a
\nstatement on the importance of resistance to antimicrobial drugs.
\n(JMA) Same (as comments above) applies to this Resolution.
\nMarch 2018 SMAC 209\/Policy Review 2008\/Apr2018
\n(KMA) The collaboration between human and veterinary medicine should take place in the medical
\n(veterinary medicine) education, clinical research, public health and research and development. In
\ncase of the occurrence of an infectious disease, countermeasures need to be developed to take action
\nthrough a close cooperation among human and veterinary medicine specialty organisations.
\n(RDMA) We agree with minor revision, although we do not quite understand what the staff
\nproposes exactly with regard to the preamble and infectious disease. We notice that the resolution
\nalready states: \u00abThe majority of the emerging infectious diseases, including the bioterrorist agents,
\nare zoonoses.\u00bb
\nEconomic crisis
\n(CMA) Agree with new comprehensive policy on this issue.
\n(BMA) Out of date. Important sentiment.
\nSodium
\n(JMA) As the WMA Secretariat says, the data quickly get outdated, so we should avoid including
\nspecific data in the Statement. However, it is meaningless to remove the data because they were
\nuseful at least when the statement was adopted. To update the issue of sodium intake, it would be
\nbetter to draft a new statement.
\n(CNOM) The CNOM suggests Dr Elena to be rapporteur for the revision of this policy.
\nLe CNOM propose deux rapporteurs les Drs Ahr et Ellena sur les dossiers respectivement la
\nr\u00e9sistance aux antibiotiques et sur la consommation alimentaire de sel ;
\n(KuMA)To update background information and recommendations based on up to date literature.
\n(SwMA) We agree with the Secretariat that information that will get outdated quickly should be
\nremoved from the policy.
\n(RDMA) We think it is very important to substantiate the additions with proper scientific evidence.
\nIf this cannot be found, to leave out that particular addition.
\nMercury
\n(JMA) Japan already implements the UN Minamata Convention on Mercury (2013), and JMA
\nagrees to refer to this convention in the Statement. However, it is unnecessary to refer to the WMA
\nStatement on Environmental Degradation and Sound Management of Chemicals.
\n(KMA) In Korea, we advise not to use mercury containing devices and products, including blood
\npressure meter, thermometer, battery and experimental equipment. It is necessary for the WMA to
\nmaintain its policy on prohibiting the use of mercury containing devices and products to women in
\ntheir childbearing years and child patients
\nAM Drugs
\n(BMA) Needs to be updated with latest progress made at international level
\nMarch 2018 SMAC 209\/Policy Review 2008\/Apr2018
\n(JMA) It is fine to refer to the WHO Report on Surveillance (2014). The Statement should also
\nmention \u00abone health\u00bb concept. In Japan, national intersectoral plan to address the issue of microbial
\nresistance is already implemented.
\n(CNOM) The CNOM suggests Dr Ahr to be rapporteur for the revision of this policy.
\n(KuMA)To update background information and recommendations based on up to date literature.
\n(RDMA) We only think that the mentioning of the package size of this medicine would be too much
\na detail for a WMA-Statement. Furthermore, this seems to be up to the prescribing physician.
\nViolence
\n(JMA) This Statement deals with the issue of violence and health in general while the other
\nviolence-related documents deal with the particulars. JMA reiterates its belief that listing the related
\ndocuments in the Preamble will lead to an endless, unnecessary work. The data in the Preamble will
\nchange quickly and should be deleted. Each document can exist independently and there is no need
\nto compile them.
\n(RDMA) We propose to not specifically include the violence against health care workers, since this
\ncannot be said to be worse to other kinds of violence. Furthermore, we hesitate if emphasis on the
\neconomic consequences is appropriate, since this is not the most serious result of violence. We think
\nit is important that the WMA stresses that violence why whoever against whoever is intrinsically
\nwrong and harmful to all people.
\n4) Constituent Members\u2019 classification
\nName of
\nPolicy
\nConstituent
\nMembers
\nAccess
\nof
\nWomen
\nVeteri-
\nnary
\nPoppies Econo-mic
\ncrisis
\nMines Sodium Mercury AM
\nDrugs
\nViolence
\nAMA C B D D A C B C C
\nAMC C B D D A C B
\nAuMA C D D A C B C C
\nBaMA A A A A A A A A A
\nBMA C B D D A B B C C
\nCGCM C B D D A C B C
\nCMA C B D D A C B C C
\nCMM C B D D A B A A
\nCNOM C A D D A C B C C
\nDMA C C D D A C B C C
\nGMA C B D D A C B C C
\nFMA C B D D A C B C C
\nIsMA B D D A C B C C
\nJMA A A D D A A B C C
\nKMA C B D D A C B C C
\nKuMA A B D D A C A C C
\nNMA C B D D A A
\nMarch 2018 SMAC 209\/Policy Review 2008\/Apr2018
\nPkMA C B D D A C B C C
\nRDMA C B D D A C B C C
\nRMA C B D D A C B C C
\nSAMA C B B+D D A C C
\nSwMA C B D D A C B C C
\nTMA C B D C+D A C B C C
\nMAT A A A A A A A A A
\nTuMA C B D A B B C B
\nVMA C B D D A C B C C
\nTOTAL 25 25 26 25 26 24 24 24 23
\n5) Summary of classification
\nName of Policy
\nClassification
\nAccess
\nof
\nWomen
\nVeterinary Poppies Economic
\ncrisis
\nMines Sodium Mercury AM
\nDrugs
\nViolence
\nReaffirm (a) 4 4 2 2 26 4 3 3 3
\nReaffirm with
\nminor revision (b)
\n20 1 2 21 1
\nMajor revision (c) 21 1 1 18 22 19
\nRescind and
\narchive (d)
\n24 23
\nProposed
\nclassification
\nbased on
\nmembers\u2019
\nrecommendations
\nC B D D A C B C C
\nIn the light of these responses, the Committee is asked to recommend to Council a classification for
\nthese policies in SMAC.
\nThe Secretariat can take care of a policy requiring minor revision, which will be circulated to the
\nmember associations for comment and considered at the October 2018 Committee and Council
\nmeetings. Constituent Members are invited to volunteer, either individually or in workgroups, to
\nundertake any major policy revision. Recommendations for rescinding and archiving will go to the
\nAssembly in October 2018 for final decision.
\n\u00a7\u00a7\u00a7
\n09.04.2018<\/p>\n"},"caption":{"rendered":"

12\/03\/2018 WMA 209th Council Session, Riga 2018 – Provisional Schedule | Online Registration by Cvent http:\/\/www.cvent.com\/events\/wma-209th-council-session-riga-2018\/agenda-879abdce4c6f40d2ad07b3b4b810676d.aspx 1\/2 AGENDA Tuesday,\u00a0April\u00a024,\u00a02018 \u00a0 9:00\u00a0AM\u00a0\u00a0\u00ad\u00a0\u00a06:00\u00a0PM Potential\u00a0workgroup\u00a0meetings \u00a0\u00a0\u00a0\u00a0 Wednesday,\u00a0April\u00a025,\u00a02018 \u00a0 9:00\u00a0AM\u00a0\u00a0\u00ad\u00a0\u00a06:00\u00a0PM Potential\u00a0workgroup\u00a0meetings \u00a0\u00a0\u00a0\u00a0 11:30\u00a0AM\u00a0\u00a0\u00ad\u00a0\u00a012:30\u00a0PM Finance\u00a0Group \u00a0\u00a0\u00a0\u00a0 12:30\u00a0PM\u00a0\u00a0\u00ad\u00a0\u00a02:30\u00a0PM Executive\u00a0Committee \u00a0\u00a0\u00a0\u00a0 7:00\u00a0PM\u00a0\u00a0\u00ad\u00a0\u00a010:00\u00a0PM Meet\u00a0the\u00a0Associate\u00a0Members\u00a0of\u00a0the\u00a0World\u00a0Medical\u00a0Association Informal\u00a0Dinner\u00a0sponsored\u00a0by\u00a0the\u00a0Latvian\u00a0Medical\u00a0Association \u00a0\u00a0 Thursday,\u00a0April\u00a026,\u00a02018 \u00a0 7:30\u00a0AM\u00a0\u00a0\u00ad\u00a0\u00a04:00\u00a0PM Registration\u00a0\u00ad\u00a0Radisson\u00a0Blu\u00a0Latvija\u00a0Conference\u00a0&\u00a0SPA\u00a0Hotel 9:00\u00a0AM\u00a0\u00a0\u00ad\u00a0\u00a010:30\u00a0AM Opening\u00a0Plenary\u00a0Session\u00a0of\u00a0the\u00a0Council 10:30\u00a0AM\u00a0\u00a0\u00ad\u00a0\u00a010:45\u00a0AM Coffee\u00a0Break 10:45\u00a0AM\u00a0\u00a0\u00ad\u00a0\u00a012:30\u00a0PM Finance\u00a0and\u00a0Planning\u00a0Committee 12:30\u00a0PM\u00a0\u00a0\u00ad\u00a0\u00a02:00\u00a0PM Lunch\u00a0break \u00a0\u00a0\u00a0\u00a0 2:00\u00a0PM\u00a0\u00a0\u00ad\u00a0\u00a03:30\u00a0PM Finance\u00a0and\u00a0Planning\u00a0Committee\u00a0(continuation) 3:30\u00a0PM\u00a0\u00a0\u00ad\u00a0\u00a03:45\u00a0PM Coffee\u00a0Break […]<\/p>\n"},"alt_text":"","media_type":"file","mime_type":"application\/pdf","media_details":{"sizes":{"thumbnail":{"file":"201804_CS_English-pdf-106x150.jpg","width":106,"height":150,"mime_type":"image\/jpeg","source_url":"https:\/\/www.wma.net\/wp-content\/uploads\/2018\/04\/201804_CS_English-pdf-106x150.jpg"},"medium":{"file":"201804_CS_English-pdf-212x300.jpg","width":212,"height":300,"mime_type":"image\/jpeg","source_url":"https:\/\/www.wma.net\/wp-content\/uploads\/2018\/04\/201804_CS_English-pdf-212x300.jpg"},"large":{"file":"201804_CS_English-pdf-724x1024.jpg","width":724,"height":1024,"mime_type":"image\/jpeg","source_url":"https:\/\/www.wma.net\/wp-content\/uploads\/2018\/04\/201804_CS_English-pdf-724x1024.jpg"},"full":{"file":"201804_CS_English-pdf.jpg","width":1058,"height":1497,"mime_type":"application\/pdf","source_url":"https:\/\/www.wma.net\/wp-content\/uploads\/2018\/04\/201804_CS_English-pdf.jpg"}}},"post":7901,"source_url":"https:\/\/www.wma.net\/wp-content\/uploads\/2018\/04\/201804_CS_English.pdf","_links":{"self":[{"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/media\/10747"}],"collection":[{"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/media"}],"about":[{"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/types\/attachment"}],"author":[{"embeddable":true,"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/comments?post=10747"}]}}