{"id":7355,"date":"2017-03-03T11:52:43","date_gmt":"2017-03-03T11:52:43","guid":{"rendered":"https:\/\/www.wma.net\/wp-content\/uploads\/2016\/11\/HB-E-2015-1.pdf"},"modified":"2017-03-03T14:05:19","modified_gmt":"2017-03-03T14:05:19","slug":"hb-e-2015-1-2","status":"inherit","type":"attachment","link":"https:\/\/www.wma.net\/es\/politicas\/hb-e-2015-1-2\/","title":{"rendered":"HB-E-2015-1"},"author":2,"comment_status":"open","ping_status":"closed","template":"","meta":[],"acf":[],"description":{"rendered":"<p class=\"attachment\"><a href='https:\/\/www.wma.net\/wp-content\/uploads\/2016\/11\/HB-E-2015-1.pdf'>HB-E-2015-1<\/a><\/p>\n<p>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nThe<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association,<br \/>\n \u00a0Inc.<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0Version<br \/>\n \u00a0History<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\n\u00a9<br \/>\n \u00a0The<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association,<br \/>\n \u00a0Inc.<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nVersion<br \/>\n \u00a02010,<br \/>\n \u00a0Vancouver;<br \/>\n \u00a0Printed<br \/>\n \u00a0in<br \/>\n \u00a0March<br \/>\n \u00a02011<br \/>\n \u00a0<br \/>\nVersion<br \/>\n \u00a02011,<br \/>\n \u00a0Montevideo;<br \/>\n \u00a0Printed<br \/>\n \u00a0in<br \/>\n \u00a0December<br \/>\n \u00a02011<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n\u2022 Replacements<br \/>\n \u00a0<br \/>\nCode<br \/>\n \u00a0 Short<br \/>\n \u00a0Title<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102000-\u00ad\u201001-\u00ad\u20102010<br \/>\n \u00a0by<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102000-\u00ad\u201001-\u00ad\u20102011<br \/>\n \u00a0<br \/>\nPrison<br \/>\n \u00a0Conditions<br \/>\n \u00a0on<br \/>\n \u00a0TB<br \/>\n \u00a0(amended<br \/>\n \u00a0in<br \/>\n \u00a02011)<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101988-\u00ad\u201001-\u00ad\u20102005<br \/>\n \u00a0by<br \/>\n \u00a0<br \/>\nR-\u00ad\u20101988-\u00ad\u201001-\u00ad\u20102005<br \/>\n \u00a0<br \/>\nCorrection<br \/>\n \u00a0of<br \/>\n \u00a0misclassified<br \/>\n \u00a0document<br \/>\n \u00a0type<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101988-\u00ad\u201005-\u00ad\u20102007<br \/>\n \u00a0by<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101988-\u00ad\u201005-\u00ad\u20102011<br \/>\n \u00a0<br \/>\nTobacco<br \/>\n \u00a0Products<br \/>\n \u00a0Health<br \/>\n \u00a0Hazards<br \/>\n \u00a0(amended<br \/>\n \u00a0in<br \/>\n \u00a02011)<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101996-\u00ad\u201005-\u00ad\u20102006<br \/>\n \u00a0 Replacement<br \/>\n \u00a0due<br \/>\n \u00a0to<br \/>\n \u00a0typo<br \/>\n \u00a0in<br \/>\n \u00a0the<br \/>\n \u00a0footer<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101997-\u00ad\u201001-\u00ad\u20102007<br \/>\n \u00a0 Correction<br \/>\n \u00a0(in<br \/>\n \u00a02007<br \/>\n \u00a0it<br \/>\n \u00a0was<br \/>\n \u00a0reaffirmed,<br \/>\n \u00a0not<br \/>\n \u00a0amended)<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101997-\u00ad\u201002-\u00ad\u20102007<br \/>\n \u00a0 Correction<br \/>\n \u00a0of<br \/>\n \u00a0typo<br \/>\n \u00a0in<br \/>\n \u00a0the<br \/>\n \u00a0header<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n\u2022 Additions<br \/>\n \u00a0of<br \/>\n \u00a0the<br \/>\n \u00a0policies<br \/>\n \u00a0newly<br \/>\n \u00a0adopted<br \/>\n \u00a0by<br \/>\n \u00a0the<br \/>\n \u00a062nd<\/p>\n<p> \u00a0WMA<br \/>\n \u00a0General<br \/>\n \u00a0Assembly,<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0Montevideo,<br \/>\n \u00a0Uruguay,<br \/>\n \u00a0October<br \/>\n \u00a02011<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102011-\u00ad\u201001-\u00ad\u20102011<br \/>\n \u00a0 Disaster<br \/>\n \u00a0Preparedness<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102011-\u00ad\u201002-\u00ad\u20102011<br \/>\n \u00a0 End-\u00ad\u2010of-\u00ad\u2010Life<br \/>\n \u00a0Medical<br \/>\n \u00a0Care<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102011-\u00ad\u201003-\u00ad\u20102011<br \/>\n \u00a0 Leprosy<br \/>\n \u00a0Control<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102011-\u00ad\u201001-\u00ad\u20102011<br \/>\n \u00a0 Chronic<br \/>\n \u00a0Disease<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102011-\u00ad\u201002-\u00ad\u20102011<br \/>\n \u00a0 Monitoring<br \/>\n \u00a0Tokyo<br \/>\n \u00a0Declaration<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102011-\u00ad\u201003-\u00ad\u20102011<br \/>\n \u00a0 Protection<br \/>\n \u00a0and<br \/>\n \u00a0Integrity<br \/>\n \u00a0of<br \/>\n \u00a0Medical<br \/>\n \u00a0Personnel<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102011-\u00ad\u201004-\u00ad\u20102011<br \/>\n \u00a0 Social<br \/>\n \u00a0Determinants<br \/>\n \u00a0of<br \/>\n \u00a0Health<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102011-\u00ad\u201005-\u00ad\u20102011<br \/>\n \u00a0 Social<br \/>\n \u00a0Media<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102011-\u00ad\u201001-\u00ad\u20102011<br \/>\n \u00a0 Adequate<br \/>\n \u00a0Pain<br \/>\n \u00a0Treatment<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102011-\u00ad\u201002-\u00ad\u20102011<br \/>\n \u00a0 Bahrain<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102011-\u00ad\u201003-\u00ad\u20102011<br \/>\n \u00a0 Economic<br \/>\n \u00a0Embargoes<br \/>\n \u00a0and<br \/>\n \u00a0Health<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102011-\u00ad\u201004-\u00ad\u20102011<br \/>\n \u00a0 Independence<br \/>\n \u00a0of<br \/>\n \u00a0Medical<br \/>\n \u00a0Associations<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nVersion<br \/>\n \u00a02012,<br \/>\n \u00a0Bangkok;<br \/>\n \u00a0Printed<br \/>\n \u00a0in<br \/>\n \u00a0October<br \/>\n \u00a02012<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n\u2022 Additions<br \/>\n \u00a0of<br \/>\n \u00a0the<br \/>\n \u00a0resolutions<br \/>\n \u00a0newly<br \/>\n \u00a0adopted<br \/>\n \u00a0by<br \/>\n \u00a0the<br \/>\n \u00a0191st<\/p>\n<p> \u00a0WMA<br \/>\n \u00a0Council<br \/>\n \u00a0Session,<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nPrague,<br \/>\n \u00a0Czech<br \/>\n \u00a0Republic,<br \/>\n \u00a0April<br \/>\n \u00a02012<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nCode<br \/>\n \u00a0 Short<br \/>\n \u00a0Title<br \/>\n \u00a0<br \/>\nCR-\u00ad\u20102012-\u00ad\u201001-\u00ad\u20102012<br \/>\n \u00a0 Danger<br \/>\n \u00a0in<br \/>\n \u00a0Health<br \/>\n \u00a0Care<br \/>\n \u00a0in<br \/>\n \u00a0Syria<br \/>\n \u00a0and<br \/>\n \u00a0Bahrain<br \/>\n \u00a0<br \/>\nCR-\u00ad\u20102012-\u00ad\u201002-\u00ad\u20102012<br \/>\n \u00a0 Professional<br \/>\n \u00a0Autonomy<br \/>\n \u00a0and<br \/>\n \u00a0Self-\u00ad\u2010Regulation<br \/>\n \u00a0in<br \/>\n \u00a0Turkey<br \/>\n \u00a0<br \/>\nCR-\u00ad\u20102012-\u00ad\u201003-\u00ad\u20102012<br \/>\n \u00a0 Autonomy<br \/>\n \u00a0of<br \/>\n \u00a0Professional<br \/>\n \u00a0Orders<br \/>\n \u00a0in<br \/>\n \u00a0West<br \/>\n \u00a0Africa<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n\u2022 Replacements<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102002-\u00ad\u201004-\u00ad\u20102002<br \/>\n \u00a0by<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102002-\u00ad\u201004-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nAdvanced<br \/>\n \u00a0Technology<br \/>\n \u00a0(amended<br \/>\n \u00a0in<br \/>\n \u00a02012)<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101956-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0by<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101956-\u00ad\u201001-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nArmed<br \/>\n \u00a0Conflict<br \/>\n \u00a0(amended<br \/>\n \u00a0in<br \/>\n \u00a02012)<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102002-\u00ad\u201005-\u00ad\u20102002<br \/>\n \u00a0by<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102002-\u00ad\u201005-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nAbuse<br \/>\n \u00a0of<br \/>\n \u00a0Psychiatry<br \/>\n \u00a0(amended<br \/>\n \u00a0in<br \/>\n \u00a02012)<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n\u2022 Removals<br \/>\n \u00a0of<br \/>\n \u00a0the<br \/>\n \u00a0policies<br \/>\n \u00a0rescinded<br \/>\n \u00a0and<br \/>\n \u00a0archived<br \/>\n \u00a0by<br \/>\n \u00a0the<br \/>\n \u00a063rd<\/p>\n<p> \u00a0WMA<br \/>\n \u00a0General<br \/>\n \u00a0Assembly,<br \/>\n \u00a0<br \/>\nBangkok,<br \/>\n \u00a0Thailand,<br \/>\n \u00a0October<br \/>\n \u00a02012<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102002-\u00ad\u201003-\u00ad\u20102002<br \/>\n \u00a0 Health<br \/>\n \u00a0Care<br \/>\n \u00a0Services<br \/>\n \u00a0in<br \/>\n \u00a0Afghanistan<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102002-\u00ad\u201004-\u00ad\u20102002<br \/>\n \u00a0 Pan<br \/>\n \u00a0American<br \/>\n \u00a0Health<br \/>\n \u00a0Organization<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n\u2022 Additions<br \/>\n \u00a0of<br \/>\n \u00a0the<br \/>\n \u00a0policies<br \/>\n \u00a0newly<br \/>\n \u00a0adopted<br \/>\n \u00a0by<br \/>\n \u00a0the<br \/>\n \u00a063rd<\/p>\n<p> \u00a0WMA<br \/>\n \u00a0General<br \/>\n \u00a0Assembly,<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nBangkok,<br \/>\n \u00a0Thailand,<br \/>\n \u00a0October<br \/>\n \u00a02012<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102012-\u00ad\u201001-\u00ad\u20102012<br \/>\n \u00a0 Electronic<br \/>\n \u00a0Cigarettes<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102012-\u00ad\u201002-\u00ad\u20102012<br \/>\n \u00a0 Collective<br \/>\n \u00a0Action<br \/>\n \u00a0by<br \/>\n \u00a0Physicians<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102012-\u00ad\u201003-\u00ad\u20102012<br \/>\n \u00a0 Forced<br \/>\n \u00a0and<br \/>\n \u00a0Coerced<br \/>\n \u00a0Sterilisation<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102012-\u00ad\u201004-\u00ad\u20102012<br \/>\n \u00a0 Organ<br \/>\n \u00a0and<br \/>\n \u00a0Tissue<br \/>\n \u00a0Donation<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102012-\u00ad\u201005-\u00ad\u20102012<br \/>\n \u00a0 Prioritisation<br \/>\n \u00a0of<br \/>\n \u00a0Immunisation<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102012-\u00ad\u201006-\u00ad\u20102012<br \/>\n \u00a0 Violence<br \/>\n \u00a0in<br \/>\n \u00a0the<br \/>\n \u00a0Health<br \/>\n \u00a0Sector<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102012-\u00ad\u201001-\u00ad\u20102012<br \/>\n \u00a0 Minimum<br \/>\n \u00a0Price<br \/>\n \u00a0for<br \/>\n \u00a0Alcohol<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102012-\u00ad\u201002-\u00ad\u20102012<br \/>\n \u00a0 Plain<br \/>\n \u00a0Packaging<br \/>\n \u00a0of<br \/>\n \u00a0Cigarettes<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102012-\u00ad\u201003-\u00ad\u20102012<br \/>\n \u00a0 Capital<br \/>\n \u00a0Punishment<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102012-\u00ad\u201004-\u00ad\u20102012<br \/>\n \u00a0 Professor<br \/>\n \u00a0Cyril<br \/>\n \u00a0Karabus<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nVersion<br \/>\n \u00a02013-\u00ad\u20101,<br \/>\n \u00a0Bali;<br \/>\n \u00a0Printed<br \/>\n \u00a0in<br \/>\n \u00a0April<br \/>\n \u00a02013<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n\u2022 Additions<br \/>\n \u00a0of<br \/>\n \u00a0the<br \/>\n \u00a0resolutions<br \/>\n \u00a0newly<br \/>\n \u00a0adopted<br \/>\n \u00a0by<br \/>\n \u00a0the<br \/>\n \u00a0194th<\/p>\n<p> \u00a0WMA<br \/>\n \u00a0Council<br \/>\n \u00a0Session,<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nBali,<br \/>\n \u00a0Indonesia,<br \/>\n \u00a0April<br \/>\n \u00a02013<br \/>\n \u00a0<br \/>\nCode<br \/>\n \u00a0 Short<br \/>\n \u00a0Title<br \/>\n \u00a0<br \/>\nCR-\u00ad\u20102013-\u00ad\u201001-\u00ad\u20102013<br \/>\n \u00a0 Professor<br \/>\n \u00a0Cyril<br \/>\n \u00a0Karabus<br \/>\n \u00a0<br \/>\nCR-\u00ad\u20102013-\u00ad\u201002-\u00ad\u20102013<br \/>\n \u00a0 Criminalisation<br \/>\n \u00a0of<br \/>\n \u00a0Medical<br \/>\n \u00a0Practice<br \/>\n \u00a0<br \/>\nCR-\u00ad\u20102013-\u00ad\u201003-\u00ad\u20102013<br \/>\n \u00a0 Standardisation<br \/>\n \u00a0in<br \/>\n \u00a0Medical<br \/>\n \u00a0Practice<br \/>\n \u00a0and<br \/>\n \u00a0Patient<br \/>\n \u00a0Safety<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n\u2022 Replacements<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101981-\u00ad\u201002-\u00ad\u20101999<br \/>\n \u00a0by<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101981-\u00ad\u201002-\u00ad\u20102010<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nCorrection<br \/>\n \u00a0(in<br \/>\n \u00a02010<br \/>\n \u00a0it<br \/>\n \u00a0was<br \/>\n \u00a0reaffirmed,<br \/>\n \u00a0not<br \/>\n \u00a0amended)<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102003-\u00ad\u201002-\u00ad\u20102003<br \/>\n \u00a0by<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102003-\u00ad\u201002-\u00ad\u20102013<br \/>\n \u00a0<br \/>\nLiving<br \/>\n \u00a0Wills<br \/>\n \u00a0(reaffirmed<br \/>\n \u00a0in<br \/>\n \u00a02013)<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102002-\u00ad\u201001-\u00ad\u20102002<br \/>\n \u00a0by<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102002-\u00ad\u201001-\u00ad\u20102013<br \/>\n \u00a0<br \/>\nEuthanasia<br \/>\n \u00a0(reaffirmed<br \/>\n \u00a0in<br \/>\n \u00a02013)<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102003-\u00ad\u201001-\u00ad\u20102003<br \/>\n \u00a0by<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102003-\u00ad\u201001-\u00ad\u20102013<br \/>\n \u00a0<br \/>\nAnnual<br \/>\n \u00a0Medical<br \/>\n \u00a0Ethics<br \/>\n \u00a0Day<br \/>\n \u00a0(reaffirmed<br \/>\n \u00a0in<br \/>\n \u00a02013)<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nVersion<br \/>\n \u00a02013-\u00ad\u20102,<br \/>\n \u00a0Fortaleza;<br \/>\n \u00a0Printed<br \/>\n \u00a0in<br \/>\n \u00a0February<br \/>\n \u00a02014<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n\u2022 Replacements<br \/>\n \u00a0<br \/>\nCode<br \/>\n \u00a0 Short<br \/>\n \u00a0Title<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102003-\u00ad\u201001-\u00ad\u20102003<br \/>\n \u00a0by<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102003-\u00ad\u201001-\u00ad\u20102013<br \/>\n \u00a0<br \/>\nForensic<br \/>\n \u00a0Investigations<br \/>\n \u00a0of<br \/>\n \u00a0the<br \/>\n \u00a0Missing<br \/>\n \u00a0<br \/>\n(amended<br \/>\n \u00a0in<br \/>\n \u00a02013)<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102002-\u00ad\u201006-\u00ad\u20102002<br \/>\n \u00a0by<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102002-\u00ad\u201006-\u00ad\u20102013<br \/>\n \u00a0<br \/>\nWomen\u2019s<br \/>\n \u00a0Right<br \/>\n \u00a0to<br \/>\n \u00a0Health<br \/>\n \u00a0Care<br \/>\n \u00a0<br \/>\n(amended<br \/>\n \u00a0in<br \/>\n \u00a02013)<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n\u2022 Removals<br \/>\n \u00a0of<br \/>\n \u00a0the<br \/>\n \u00a0policies<br \/>\n \u00a0rescinded<br \/>\n \u00a0and<br \/>\n \u00a0archived<br \/>\n \u00a0by<br \/>\n \u00a0the<br \/>\n \u00a064th<\/p>\n<p> \u00a0WMA<br \/>\n \u00a0General<br \/>\n \u00a0Assembly,<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nFortaleza,<br \/>\n \u00a0Brazil,<br \/>\n \u00a0October<br \/>\n \u00a02013<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102003-\u00ad\u201004-\u00ad\u20102003<br \/>\n \u00a0 SARS<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n\u2022 Additions<br \/>\n \u00a0of<br \/>\n \u00a0the<br \/>\n \u00a0policies<br \/>\n \u00a0newly<br \/>\n \u00a0adopted<br \/>\n \u00a0by<br \/>\n \u00a0the<br \/>\n \u00a064th<\/p>\n<p> \u00a0WMA<br \/>\n \u00a0General<br \/>\n \u00a0Assembly,<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nFortaleza,<br \/>\n \u00a0Brazil,<br \/>\n \u00a0October<br \/>\n \u00a02013<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102013-\u00ad\u201001-\u00ad\u20102013<br \/>\n \u00a0 Fungal<br \/>\n \u00a0Disease<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102013-\u00ad\u201002-\u00ad\u20102013<br \/>\n \u00a0 Human<br \/>\n \u00a0Papillomavirus<br \/>\n \u00a0Vaccination<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102013-\u00ad\u201003-\u00ad\u20102013<br \/>\n \u00a0 Natural<br \/>\n \u00a0Variations<br \/>\n \u00a0of<br \/>\n \u00a0Human<br \/>\n \u00a0Sexuality<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102013-\u00ad\u201004-\u00ad\u20102013<br \/>\n \u00a0 Victims<br \/>\n \u00a0of<br \/>\n \u00a0Torture<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102013-\u00ad\u201005-\u00ad\u20102013<br \/>\n \u00a0 Death<br \/>\n \u00a0Penalty<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102013-\u00ad\u201001-\u00ad\u20102013<br \/>\n \u00a0 Criminalisation<br \/>\n \u00a0of<br \/>\n \u00a0Medical<br \/>\n \u00a0Practice<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102013-\u00ad\u201002-\u00ad\u20102013<br \/>\n \u00a0 Healthcare<br \/>\n \u00a0Situation<br \/>\n \u00a0in<br \/>\n \u00a0Syria<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102013-\u00ad\u201003-\u00ad\u20102013<br \/>\n \u00a0 Prohibition<br \/>\n \u00a0of<br \/>\n \u00a0Chemical<br \/>\n \u00a0Weapons<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102013-\u00ad\u201004-\u00ad\u20102013<br \/>\n \u00a0 Standardisation<br \/>\n \u00a0in<br \/>\n \u00a0Medical<br \/>\n \u00a0Practice<br \/>\n \u00a0and<br \/>\n \u00a0Patient<br \/>\n \u00a0Safety<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102013-\u00ad\u201005-\u00ad\u20102013<br \/>\n \u00a0 Support<br \/>\n \u00a0of<br \/>\n \u00a0the<br \/>\n \u00a0AMB<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nVersion<br \/>\n \u00a02014-\u00ad\u20101,<br \/>\n \u00a0Tokyo;<br \/>\n \u00a0Printed<br \/>\n \u00a0in<br \/>\n \u00a0June<br \/>\n \u00a02014<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n\u2022 Replacements<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nCode<br \/>\n \u00a0 Short<br \/>\n \u00a0Title<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102004-\u00ad\u201001-\u00ad\u20102004<br \/>\n \u00a0by<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102004-\u00ad\u201001-\u00ad\u20102014<br \/>\n \u00a0<br \/>\nWFME<br \/>\n \u00a0(reaffirmed<br \/>\n \u00a0in<br \/>\n \u00a02014)<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nVersion<br \/>\n \u00a02014-\u00ad\u20102,<br \/>\n \u00a0Durban;<br \/>\n \u00a0Printed<br \/>\n \u00a0in<br \/>\n \u00a0January<br \/>\n \u00a02015<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n\u2022 Replacements<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102002-\u00ad\u201001-\u00ad\u20102003<br \/>\n \u00a0by<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102002-\u00ad\u201001-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nBiological<br \/>\n \u00a0Weapons<br \/>\n \u00a0(reaffirmed<br \/>\n \u00a0in<br \/>\n \u00a02012)<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102002-\u00ad\u201003-\u00ad\u20102002<br \/>\n \u00a0by<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102002-\u00ad\u201003-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nPatient<br \/>\n \u00a0Safety<br \/>\n \u00a0(reaffirmed<br \/>\n \u00a0in<br \/>\n \u00a02012)<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102002-\u00ad\u201001-\u00ad\u20102002<br \/>\n \u00a0by<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102002-\u00ad\u201001-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nSafe<br \/>\n \u00a0Injections<br \/>\n \u00a0in<br \/>\n \u00a0Health<br \/>\n \u00a0Care<br \/>\n \u00a0(amended<br \/>\n \u00a0in<br \/>\n \u00a02012)<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102002-\u00ad\u201002-\u00ad\u20102002<br \/>\n \u00a0by<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102002-\u00ad\u201002-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nSelf-\u00ad\u2010Medication<br \/>\n \u00a0(reaffirmed<br \/>\n \u00a0in<br \/>\n \u00a02012)<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102003-\u00ad\u201003-\u00ad\u20102003<br \/>\n \u00a0by<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102003-\u00ad\u201003-\u00ad\u20102014<br \/>\n \u00a0<br \/>\nInternational<br \/>\n \u00a0Migration<br \/>\n \u00a0of<br \/>\n \u00a0Health<br \/>\n \u00a0Workers<br \/>\n \u00a0<br \/>\n(amended<br \/>\n \u00a0in<br \/>\n \u00a02014)<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102004-\u00ad\u201003-\u00ad\u20102004<br \/>\n \u00a0by<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102004-\u00ad\u201003-\u00ad\u20102014<br \/>\n \u00a0<br \/>\nWater<br \/>\n \u00a0and<br \/>\n \u00a0Health<br \/>\n \u00a0(amended<br \/>\n \u00a0in<br \/>\n \u00a02014)<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102002-\u00ad\u201002-\u00ad\u20102002<br \/>\n \u00a0by<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102002-\u00ad\u201002-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nFemale<br \/>\n \u00a0Foeticide<br \/>\n \u00a0(reaffirmed<br \/>\n \u00a0in<br \/>\n \u00a02012)<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102003-\u00ad\u201003-\u00ad\u20102003<br \/>\n \u00a0by<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102003-\u00ad\u201003-\u00ad\u20102014<br \/>\n \u00a0<br \/>\nNon-\u00ad\u2010Commercialization<br \/>\n \u00a0of<br \/>\n \u00a0Human<br \/>\n \u00a0Reproductive<br \/>\n \u00a0<br \/>\nMaterial<br \/>\n \u00a0(amended<br \/>\n \u00a0in<br \/>\n \u00a02014)<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n\u2022 Removals<br \/>\n \u00a0of<br \/>\n \u00a0the<br \/>\n \u00a0policies<br \/>\n \u00a0rescinded<br \/>\n \u00a0and<br \/>\n \u00a0archived<br \/>\n \u00a0by<br \/>\n \u00a0the<br \/>\n \u00a066th<\/p>\n<p> \u00a0WMA<br \/>\n \u00a0General<br \/>\n \u00a0Assembly,<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDurban,<br \/>\n \u00a0South<br \/>\n \u00a0Africa,<br \/>\n \u00a0October<br \/>\n \u00a02014<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102004-\u00ad\u201001-\u00ad\u20102004<br \/>\n \u00a0 Health<br \/>\n \u00a0Emergencies<br \/>\n \u00a0Communication<br \/>\n \u00a0&#038;<br \/>\n \u00a0Coordination<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n\u2022 Additions<br \/>\n \u00a0of<br \/>\n \u00a0the<br \/>\n \u00a0policies<br \/>\n \u00a0newly<br \/>\n \u00a0adopted<br \/>\n \u00a0by<br \/>\n \u00a0the<br \/>\n \u00a065th<\/p>\n<p> \u00a0WMA<br \/>\n \u00a0General<br \/>\n \u00a0Assembly,<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDurban,<br \/>\n \u00a0South<br \/>\n \u00a0Africa,<br \/>\n \u00a0October<br \/>\n \u00a02014<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102014-\u00ad\u201001-\u00ad\u20102014<br \/>\n \u00a0 Protection<br \/>\n \u00a0of<br \/>\n \u00a0Healthcare<br \/>\n \u00a0Workers<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102014-\u00ad\u201001-\u00ad\u20102014<br \/>\n \u00a0 Aesthetic<br \/>\n \u00a0Treatment<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102014-\u00ad\u201002-\u00ad\u20102014<br \/>\n \u00a0 Air<br \/>\n \u00a0Pollution<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102014-\u00ad\u201003-\u00ad\u20102014<br \/>\n \u00a0 Solitary<br \/>\n \u00a0Confinement<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102014-\u00ad\u201001-\u00ad\u20102014<br \/>\n \u00a0 Ebola<br \/>\n \u00a0Viral<br \/>\n \u00a0Disease<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102014-\u00ad\u201002-\u00ad\u20102014<br \/>\n \u00a0 Migrant<br \/>\n \u00a0Workers&#8217;<br \/>\n \u00a0Health<br \/>\n \u00a0and<br \/>\n \u00a0Safety<br \/>\n \u00a0in<br \/>\n \u00a0Qatar<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102014-\u00ad\u201003-\u00ad\u20102014<br \/>\n \u00a0 Ebola<br \/>\n \u00a0Virus<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n\u2022 Additions<br \/>\n \u00a0(Missed<br \/>\n \u00a0in<br \/>\n \u00a0the<br \/>\n \u00a0previous<br \/>\n \u00a0versions)<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nCR-\u00ad\u20102003-\u00ad\u201001-\u00ad\u20102003<br \/>\n \u00a0 Law<br \/>\n \u00a0and<br \/>\n \u00a0Ethics<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nVersion<br \/>\n \u00a02015-\u00ad\u20101,<br \/>\n \u00a0Oslo;<br \/>\n \u00a0Printed<br \/>\n \u00a0in<br \/>\n \u00a0June<br \/>\n \u00a02015<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n\u2022 Addition<br \/>\n \u00a0of<br \/>\n \u00a0the<br \/>\n \u00a0resolution<br \/>\n \u00a0newly<br \/>\n \u00a0adopted<br \/>\n \u00a0by<br \/>\n \u00a0the<br \/>\n \u00a0200th<\/p>\n<p> \u00a0WMA<br \/>\n \u00a0Council<br \/>\n \u00a0Session,<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nOslo,<br \/>\n \u00a0Norway,<br \/>\n \u00a0April<br \/>\n \u00a02015<br \/>\n \u00a0<br \/>\nCode<br \/>\n \u00a0 Short<br \/>\n \u00a0Title<br \/>\n \u00a0<br \/>\nCR-\u00ad\u20102015-\u00ad\u201001-\u00ad\u20102015<br \/>\n \u00a0 Trade<br \/>\n \u00a0Agreements<br \/>\n \u00a0and<br \/>\n \u00a0Public<br \/>\n \u00a0Health<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n\u2022 Replacements<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nCode<br \/>\n \u00a0 Short<br \/>\n \u00a0Title<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101981-\u00ad\u201001-\u00ad\u20102005<br \/>\n \u00a0by<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101981-\u00ad\u201001-\u00ad\u20102015<br \/>\n \u00a0<br \/>\nLisbon<br \/>\n \u00a0(Patient\u2019s<br \/>\n \u00a0Rights)<br \/>\n \u00a0<br \/>\n \u00a0(reaffirmed<br \/>\n \u00a0in<br \/>\n \u00a02015)<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101987-\u00ad\u201001-\u00ad\u20102005<br \/>\n \u00a0by<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101987-\u00ad\u201001-\u00ad\u20102015<br \/>\n \u00a0<br \/>\nEuthanasia<br \/>\n \u00a0(reaffirmed<br \/>\n \u00a0in<br \/>\n \u00a02015)<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101989-\u00ad\u201001-\u00ad\u20102005<br \/>\n \u00a0by<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101989-\u00ad\u201001-\u00ad\u20102015<br \/>\n \u00a0<br \/>\nHong<br \/>\n \u00a0Kong<br \/>\n \u00a0(Elderly<br \/>\n \u00a0Abuse)<br \/>\n \u00a0(reaffirmed<br \/>\n \u00a0in<br \/>\n \u00a02015)<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102005-\u00ad\u201002-\u00ad\u20102005<br \/>\n \u00a0by<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102005-\u00ad\u201002-\u00ad\u20102015<br \/>\n \u00a0<br \/>\nDrug<br \/>\n \u00a0Substitution<br \/>\n \u00a0(reaffirmed<br \/>\n \u00a0in<br \/>\n \u00a02015)<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102005-\u00ad\u201004-\u00ad\u20102005<br \/>\n \u00a0by<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102005-\u00ad\u201004-\u00ad\u20102015<br \/>\n \u00a0<br \/>\nMedical<br \/>\n \u00a0Liability<br \/>\n \u00a0Reform<br \/>\n \u00a0(reaffirmed<br \/>\n \u00a0in<br \/>\n \u00a02015)<br \/>\n \u00a0<br \/>\nR-\u00ad\u20101988-\u00ad\u201001-\u00ad\u20102005<br \/>\n \u00a0by<br \/>\n \u00a0<br \/>\nR-\u00ad\u20101988-\u00ad\u201001-\u00ad\u20102015<br \/>\n \u00a0<br \/>\nAcademic<br \/>\n \u00a0Sanctions<br \/>\n \u00a0or<br \/>\n \u00a0Boycotts<br \/>\n \u00a0(reaffirmed<br \/>\n \u00a0in<br \/>\n \u00a02015)<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nPREFACE<br \/>\n \u00a0<br \/>\nBefore World War II came to an end, a number of medical associations gathered in Lon-<br \/>\ndon to reinvent the approach to international collaboration among the world\u2019s physicians.<br \/>\nThe old model, represented by the pre-war \u201cAssociation Professionnelle Internationale des<br \/>\nM\u00e9decins\u201d (APIM), would no longer meet the needs of the post-war medical profession.<br \/>\nIt was time to create something new.<br \/>\nAfter only two years of preparation, 27 national medical associations met in Paris on Sep-<br \/>\ntember 18th, 1947 for the inauguration of a new global physicians\u2019 association, the World<br \/>\nMedical Association (WMA). The lead-up to this first Assembly was paralleled by the<br \/>\nNuremberg trial against Nazi doctors, which was a key driver of the mission focus of the<br \/>\nnew WMA. This terrible episode in the history of medicine dictated that the organization<br \/>\nmust seek to become the authoritative voice on global standards for medical ethics and<br \/>\nprofessional conduct, rather than focus solely on protecting the interests of the profession.<br \/>\nEffectively coordinating an international organization was anything but easy in the late<br \/>\n1940s. There was no internet, e-mail, mobile phones, personal computers, fax, or even<br \/>\nphotocopiers. For many physicians, attending the Assembly required a cross-continental,<br \/>\nmulti-day journey across a deeply scarred planet, by train and ship and only in exceptional<br \/>\ncircumstances by plane. Yet the commitment of these founding WMA members to their<br \/>\nvision was even greater than the challenges they faced in achieving it. That vision, and the<br \/>\naccompanying goals, ideals, and unity of purpose, are as relevant today as they were during<br \/>\nthose early days. They are now ours to carry on.<br \/>\nThe WMA Handbook of Policies is evidence that the engagement of the world medical<br \/>\nprofession does, in fact, persist. The WMA now is bigger, stronger and more active then<br \/>\never before, and our Handbook is the product of physicians coming together for more than<br \/>\nhalf a century to provide ethical guidance, moral support and practical advice to help their<br \/>\ncolleagues serve their patients to the best of their ability. From the Declaration of Geneva,<br \/>\noften referred to as the \u201cModern Hippocratic Oath\u201d to the Declaration of Helsinki advising<br \/>\nphysicians doing medical research on human subjects, to the Declaration of Tokyo prohi-<br \/>\nbiting physicians from participating in torture and degrading treatment \u2212 to mention just a<br \/>\nfew of WMA\u2019s landmark policies \u2212 the guidance provided by the WMA is as necessary<br \/>\nnow as it has ever been.<br \/>\nThere are many other policies in this world dealing with physician conduct, many of<br \/>\nwhich try to be \u201cmodern\u201d, \u201ceasily readable\u201d and \u201cpolitically correct\u201d. The WMA has never<br \/>\ncapitulated against the \u201cZeitgeist\u201d, but has stood firm with its values, the most important<br \/>\nof which are caring, ethics and science.<br \/>\nSir William Osler said: \u201cThe most important thing is caring, so do it first, for the caring<br \/>\nphysicians best inspires hope and trust.\u201d Hope and trust are the basis for any treatment. A<br \/>\nphysician who cannot generate trust will face more challenges than the one who receives<br \/>\nthe trust of the patients. A patient with hope is far better off than one without.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nBut caring must go hand-in-hand with medical ethics and proper conduct. Physicians are<br \/>\noften confronted with questions of life and death, resource allocations, and dual loyalties<br \/>\nwhen serving a single patient and at the same time respecting the needs of a community or<br \/>\npopulation. The questions are often too difficult and the problems too burdensome for one<br \/>\nperson alone. We are far away from having answers for all such questions, but for many,<br \/>\nthe WMA can provide the ethical guidance that protects patients, supports physicians, and<br \/>\nduly considers the interests of the communities and populations they both belong to.<br \/>\nFinally, science is what distinguishes medicine from well-intended kindness. In medicine,<br \/>\nquality care and ethical conduct cannot be separated from sound science. Still, despite our<br \/>\nsincere and continual quest for increased scientific knowledge, understanding and solu-<br \/>\ntions, we will never be protected from all mistakes. Therefore, practicing the science of<br \/>\nmedicine with faithful adherence to clear ethical guidance is the best we can do.<br \/>\nThis new handbook*<br \/>\nprovides a good part of this guidance. It is proof of our continued<br \/>\nengagement with our colleagues in the different parts of this world and our commitment to<br \/>\nour patients, wherever and whoever they may be. It is a living document and the WMA<br \/>\nwill continue to improve and expand it, in service to the profession and the health of those<br \/>\nwe serve as physicians.<br \/>\nJ. Edward Hill Otmar Kloiber<br \/>\nChairman of Council Secretary General<br \/>\nWonchat Subchaturas<br \/>\nPresident 2010-2011<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\n*<br \/>\nThe World Medical Association is most grateful to the Korean Medical Association for<br \/>\nseconding Ms. Seongmi LEE to the WMA Office at Ferney-Voltaire, providing valuable<br \/>\nhelp in putting this collection of policies together.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nChronological<br \/>\n \u00a0Order<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101948-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101949-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nD-\u00ad\u20101964-\u00ad\u201001-\u00ad\u20102013<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nD-\u00ad\u20101968-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101970-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nD-\u00ad\u20101975-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101981-\u00ad\u201001-\u00ad\u20102015<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101981-\u00ad\u201002-\u00ad\u20102010<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101983-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101987-\u00ad\u201001-\u00ad\u20102015<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101989-\u00ad\u201001-\u00ad\u20102015<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101991-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nD-\u00ad\u20101997-\u00ad\u201001-\u00ad\u20102009<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nD-\u00ad\u20101997-\u00ad\u201002-\u00ad\u20102007<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101998-\u00ad\u201001-\u00ad\u20102009<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nD-\u00ad\u20102000-\u00ad\u201001-\u00ad\u20102011<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102002-\u00ad\u201001-\u00ad\u20102013<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102002-\u00ad\u201002-\u00ad\u20102002<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102002-\u00ad\u201003-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102002-\u00ad\u201004-\u00ad\u20102012<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nD-\u00ad\u20102008-\u00ad\u201001-\u00ad\u20102008<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102009-\u00ad\u201001-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nTABLE<br \/>\n \u00a0OF<br \/>\n \u00a0CONTENTS<br \/>\n \u00a0<br \/>\n-\u00ad\u2010<br \/>\n \u00a0<br \/>\n \u00a0Chronological<br \/>\n \u00a0Order<br \/>\n \u00a0-\u00ad\u2010<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nDECLARATIONS<br \/>\n \u00a0<br \/>\nDeclaration<br \/>\n \u00a0of<br \/>\n \u00a0Geneva<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nInternational<br \/>\n \u00a0Code<br \/>\n \u00a0of<br \/>\n \u00a0Medical<br \/>\n \u00a0Ethics<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDeclaration<br \/>\n \u00a0of<br \/>\n \u00a0Helsinki<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n-\u00ad\u2010<br \/>\n \u00a0Ethical<br \/>\n \u00a0Principles<br \/>\n \u00a0for<br \/>\n \u00a0Medical<br \/>\n \u00a0Research<br \/>\n \u00a0involving<br \/>\n \u00a0Human<br \/>\n \u00a0Subjects<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDeclaration<br \/>\n \u00a0of<br \/>\n \u00a0Sydney<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\non<br \/>\n \u00a0the<br \/>\n \u00a0Determination<br \/>\n \u00a0of<br \/>\n \u00a0Death<br \/>\n \u00a0and<br \/>\n \u00a0the<br \/>\n \u00a0Recovery<br \/>\n \u00a0of<br \/>\n \u00a0Organs<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDeclaration<br \/>\n \u00a0of<br \/>\n \u00a0Oslo<br \/>\n \u00a0on<br \/>\n \u00a0Therapeutic<br \/>\n \u00a0Abortion<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDeclaration<br \/>\n \u00a0of<br \/>\n \u00a0Tokyo<br \/>\n \u00a0with<br \/>\n \u00a0guidelines<br \/>\n \u00a0for<br \/>\n \u00a0Medical<br \/>\n \u00a0Doctors<br \/>\n \u00a0concerning<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nTorture<br \/>\n \u00a0and<br \/>\n \u00a0Other<br \/>\n \u00a0Cruel,<br \/>\n \u00a0Inhuman<br \/>\n \u00a0or<br \/>\n \u00a0Degrading<br \/>\n \u00a0Treatment<br \/>\n \u00a0or<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nPunishment<br \/>\n \u00a0in<br \/>\n \u00a0relation<br \/>\n \u00a0to<br \/>\n \u00a0Detention<br \/>\n \u00a0and<br \/>\n \u00a0Imprisonment<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDeclaration<br \/>\n \u00a0of<br \/>\n \u00a0Lisbon<br \/>\n \u00a0on<br \/>\n \u00a0the<br \/>\n \u00a0Rights<br \/>\n \u00a0of<br \/>\n \u00a0the<br \/>\n \u00a0Patient<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDeclaration<br \/>\n \u00a0on<br \/>\n \u00a0Principles<br \/>\n \u00a0of<br \/>\n \u00a0Health<br \/>\n \u00a0Care<br \/>\n \u00a0for<br \/>\n \u00a0Sports<br \/>\n \u00a0Medicine<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDeclaration<br \/>\n \u00a0of<br \/>\n \u00a0Venice<br \/>\n \u00a0on<br \/>\n \u00a0Terminal<br \/>\n \u00a0Illness<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDeclaration<br \/>\n \u00a0on<br \/>\n \u00a0Euthanasia<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDeclaration<br \/>\n \u00a0of<br \/>\n \u00a0Hong<br \/>\n \u00a0Kong<br \/>\n \u00a0on<br \/>\n \u00a0the<br \/>\n \u00a0Abuse<br \/>\n \u00a0of<br \/>\n \u00a0the<br \/>\n \u00a0Elderly<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDeclaration<br \/>\n \u00a0of<br \/>\n \u00a0Malta<br \/>\n \u00a0on<br \/>\n \u00a0Hunger<br \/>\n \u00a0Strikers<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDeclaration<br \/>\n \u00a0on<br \/>\n \u00a0Guidelines<br \/>\n \u00a0for<br \/>\n \u00a0<br \/>\nContinuous<br \/>\n \u00a0Quality<br \/>\n \u00a0Improvement<br \/>\n \u00a0in<br \/>\n \u00a0Health<br \/>\n \u00a0Care<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDeclaration<br \/>\n \u00a0of<br \/>\n \u00a0Hamburg<br \/>\n \u00a0concerning<br \/>\n \u00a0Support<br \/>\n \u00a0for<br \/>\n \u00a0Medical<br \/>\n \u00a0Doctors<br \/>\n \u00a0Refusing<br \/>\n \u00a0to<br \/>\n \u00a0<br \/>\nParticipate<br \/>\n \u00a0in,<br \/>\n \u00a0or<br \/>\n \u00a0to<br \/>\n \u00a0Condone,<br \/>\n \u00a0the<br \/>\n \u00a0Use<br \/>\n \u00a0of<br \/>\n \u00a0Torture<br \/>\n \u00a0or<br \/>\n \u00a0Other<br \/>\n \u00a0Forms<br \/>\n \u00a0of<br \/>\n \u00a0Cruel,<br \/>\n \u00a0<br \/>\nInhuman,<br \/>\n \u00a0or<br \/>\n \u00a0Degrading<br \/>\n \u00a0Treatment<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDeclaration<br \/>\n \u00a0of<br \/>\n \u00a0Ottawa<br \/>\n \u00a0on<br \/>\n \u00a0Child<br \/>\n \u00a0Health<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDeclaration<br \/>\n \u00a0of<br \/>\n \u00a0Edinburgh<br \/>\n \u00a0on<br \/>\n \u00a0Prison<br \/>\n \u00a0Conditions<br \/>\n \u00a0and<br \/>\n \u00a0the<br \/>\n \u00a0Spread<br \/>\n \u00a0of<br \/>\n \u00a0Tuberculosis<br \/>\n \u00a0<br \/>\nand<br \/>\n \u00a0Other<br \/>\n \u00a0Communicable<br \/>\n \u00a0Diseases<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDeclaration<br \/>\n \u00a0of<br \/>\n \u00a0Washington<br \/>\n \u00a0on<br \/>\n \u00a0Biological<br \/>\n \u00a0Weapons<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDeclaration<br \/>\n \u00a0on<br \/>\n \u00a0Ethical<br \/>\n \u00a0Considerations<br \/>\n \u00a0regarding<br \/>\n \u00a0Health<br \/>\n \u00a0Databases<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDeclaration<br \/>\n \u00a0on<br \/>\n \u00a0Patient<br \/>\n \u00a0Safety<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDeclaration<br \/>\n \u00a0on<br \/>\n \u00a0Medical<br \/>\n \u00a0Ethics<br \/>\n \u00a0and<br \/>\n \u00a0Advanced<br \/>\n \u00a0Technology<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDeclaration<br \/>\n \u00a0of<br \/>\n \u00a0Seoul<br \/>\n \u00a0on<br \/>\n \u00a0Professional<br \/>\n \u00a0Autonomy<br \/>\n \u00a0and<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nClinical<br \/>\n \u00a0Independence<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDeclaration<br \/>\n \u00a0of<br \/>\n \u00a0Delhi<br \/>\n \u00a0on<br \/>\n \u00a0Health<br \/>\n \u00a0and<br \/>\n \u00a0Climate<br \/>\n \u00a0Change<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0Table<br \/>\n \u00a0of<br \/>\n \u00a0Contents<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102009-\u00ad\u201002-\u00ad\u20102009<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nD-\u00ad\u20102011-\u00ad\u201001-\u00ad\u20102011<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102011-\u00ad\u201002-\u00ad\u20102011<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nD-\u00ad\u20102011-\u00ad\u201003-\u00ad\u20102011<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nD-\u00ad\u20102014-\u00ad\u201001-\u00ad\u20102014<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nS-\u00ad\u20101956-\u00ad\u201001-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101983-\u00ad\u201001-\u00ad\u20102005<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101984-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101984-\u00ad\u201002-\u00ad\u20101984<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nS-\u00ad\u20101985-\u00ad\u201001-\u00ad\u20102005<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101988-\u00ad\u201002-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101988-\u00ad\u201004-\u00ad\u20102006<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nS-\u00ad\u20101988-\u00ad\u201005-\u00ad\u20102011<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101989-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101990-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101990-\u00ad\u201004-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101991-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101992-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101992-\u00ad\u201005-\u00ad\u20102007<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101992-\u00ad\u201006-\u00ad\u20102015<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101993-\u00ad\u201001-\u00ad\u20102005<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101993-\u00ad\u201002-\u00ad\u20102005<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101993-\u00ad\u201003-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101994-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101995-\u00ad\u201002-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101995-\u00ad\u201004-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101996-\u00ad\u201001-\u00ad\u20102008<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101996-\u00ad\u201002-\u00ad\u20102010<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101996-\u00ad\u201003-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nDeclaration<br \/>\n \u00a0of<br \/>\n \u00a0Madrid<br \/>\n \u00a0on<br \/>\n \u00a0Professionally-\u00ad\u2010led<br \/>\n \u00a0Regulation<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDeclaration<br \/>\n \u00a0of<br \/>\n \u00a0Montevideo<br \/>\n \u00a0on<br \/>\n \u00a0Disaster<br \/>\n \u00a0Preparedness<br \/>\n \u00a0and<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nMedical<br \/>\n \u00a0Response<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDeclaration<br \/>\n \u00a0on<br \/>\n \u00a0End-\u00ad\u2010of-\u00ad\u2010Life<br \/>\n \u00a0Medical<br \/>\n \u00a0Care<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDeclaration<br \/>\n \u00a0on<br \/>\n \u00a0Leprosy<br \/>\n \u00a0Control<br \/>\n \u00a0around<br \/>\n \u00a0the<br \/>\n \u00a0World<br \/>\n \u00a0and<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nElimination<br \/>\n \u00a0of<br \/>\n \u00a0Discrimination<br \/>\n \u00a0against<br \/>\n \u00a0persons<br \/>\n \u00a0affected<br \/>\n \u00a0by<br \/>\n \u00a0Leprosy<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDeclaration<br \/>\n \u00a0on<br \/>\n \u00a0the<br \/>\n \u00a0Protection<br \/>\n \u00a0of<br \/>\n \u00a0Health<br \/>\n \u00a0Care<br \/>\n \u00a0Workers<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nin<br \/>\n \u00a0Situations<br \/>\n \u00a0of<br \/>\n \u00a0Violence<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nSTATEMENTS<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nRegulations<br \/>\n \u00a0in<br \/>\n \u00a0Time<br \/>\n \u00a0of<br \/>\n \u00a0Armed<br \/>\n \u00a0Conflict<br \/>\n \u00a0and<br \/>\n \u00a0Other<br \/>\n \u00a0Situations<br \/>\n \u00a0of<br \/>\n \u00a0Violence<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Boxing<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Child<br \/>\n \u00a0Abuse<br \/>\n \u00a0and<br \/>\n \u00a0Neglect<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Freedom<br \/>\n \u00a0to<br \/>\n \u00a0Attend<br \/>\n \u00a0Medical<br \/>\n \u00a0Meetings<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Non-\u00ad\u2010Discrimination<br \/>\n \u00a0in<br \/>\n \u00a0Professional<br \/>\n \u00a0Membership<br \/>\n \u00a0and<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nActivities<br \/>\n \u00a0of<br \/>\n \u00a0Physicians<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Access<br \/>\n \u00a0to<br \/>\n \u00a0Health<br \/>\n \u00a0Care<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0the<br \/>\n \u00a0Role<br \/>\n \u00a0of<br \/>\n \u00a0Physicians<br \/>\n \u00a0in<br \/>\n \u00a0Environmental<br \/>\n \u00a0Issues<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Health<br \/>\n \u00a0Hazards<br \/>\n \u00a0of<br \/>\n \u00a0Tobacco<br \/>\n \u00a0Products<br \/>\n \u00a0and<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nTobacco-\u00ad\u2010Derived<br \/>\n \u00a0Products<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Animal<br \/>\n \u00a0Use<br \/>\n \u00a0in<br \/>\n \u00a0Biomedical<br \/>\n \u00a0Research<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Injury<br \/>\n \u00a0Control<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Traffic<br \/>\n \u00a0Injury<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Adolescent<br \/>\n \u00a0Suicide<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Alcohol<br \/>\n \u00a0and<br \/>\n \u00a0Road<br \/>\n \u00a0Safety<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Noise<br \/>\n \u00a0Pollution<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Physician-\u00ad\u2010Assisted<br \/>\n \u00a0Suicide<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Body<br \/>\n \u00a0Searches<br \/>\n \u00a0of<br \/>\n \u00a0Prisoners<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Professional<br \/>\n \u00a0Responsibility<br \/>\n \u00a0for<br \/>\n \u00a0Standards<br \/>\n \u00a0of<br \/>\n \u00a0Medical<br \/>\n \u00a0Care<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Female<br \/>\n \u00a0Genital<br \/>\n \u00a0Mutilation<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Patient<br \/>\n \u00a0Advocacy<br \/>\n \u00a0and<br \/>\n \u00a0Confidentiality<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Medical<br \/>\n \u00a0Ethics<br \/>\n \u00a0in<br \/>\n \u00a0the<br \/>\n \u00a0Event<br \/>\n \u00a0of<br \/>\n \u00a0Disasters<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Ethical<br \/>\n \u00a0Issues<br \/>\n \u00a0concerning<br \/>\n \u00a0Patients<br \/>\n \u00a0with<br \/>\n \u00a0Mental<br \/>\n \u00a0Illness<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Physicians<br \/>\n \u00a0and<br \/>\n \u00a0Public<br \/>\n \u00a0Health<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Resistance<br \/>\n \u00a0to<br \/>\n \u00a0Antimicrobial<br \/>\n \u00a0Drugs<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Family<br \/>\n \u00a0Violence<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nChronological<br \/>\n \u00a0Order<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101996-\u00ad\u201004-\u00ad\u20102007<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101996-\u00ad\u201005-\u00ad\u20102006<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nS-\u00ad\u20101997-\u00ad\u201002-\u00ad\u20102007<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nS-\u00ad\u20101997-\u00ad\u201001-\u00ad\u20101997<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101998-\u00ad\u201001-\u00ad\u20102008<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nS-\u00ad\u20101998-\u00ad\u201002-\u00ad\u20102010<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101999-\u00ad\u201001-\u00ad\u20102009<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nS-\u00ad\u20101999-\u00ad\u201002-\u00ad\u20102010<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102000-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102002-\u00ad\u201001-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102002-\u00ad\u201002-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102003-\u00ad\u201001-\u00ad\u20102013<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102003-\u00ad\u201002-\u00ad\u20102013<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nS-\u00ad\u20102003-\u00ad\u201003-\u00ad\u20102014<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102003-\u00ad\u201004-\u00ad\u20102008<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nS-\u00ad\u20102004-\u00ad\u201002-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102004-\u00ad\u201003-\u00ad\u20102014<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102005-\u00ad\u201001-\u00ad\u20102005<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102005-\u00ad\u201002-\u00ad\u20102015<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102005-\u00ad\u201003-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102005-\u00ad\u201004-\u00ad\u20102015<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102006-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102006-\u00ad\u201002-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102006-\u00ad\u201003-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102006-\u00ad\u201004-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102006-\u00ad\u201005-\u00ad\u20102006<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nS-\u00ad\u20102006-\u00ad\u201006-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Family<br \/>\n \u00a0Planning<br \/>\n \u00a0and<br \/>\n \u00a0the<br \/>\n \u00a0Right<br \/>\n \u00a0of<br \/>\n \u00a0a<br \/>\n \u00a0Woman<br \/>\n \u00a0to<br \/>\n \u00a0Contraception<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Weapons<br \/>\n \u00a0of<br \/>\n \u00a0Warfare<br \/>\n \u00a0and<br \/>\n \u00a0Their<br \/>\n \u00a0Relation<br \/>\n \u00a0to<br \/>\n \u00a0Life<br \/>\n \u00a0and<br \/>\n \u00a0Health<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0the<br \/>\n \u00a0Licensing<br \/>\n \u00a0of<br \/>\n \u00a0Physicians<br \/>\n \u00a0Fleeing<br \/>\n \u00a0Prosecution<br \/>\n \u00a0for<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nSerious<br \/>\n \u00a0Criminal<br \/>\n \u00a0Offences<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nProposal<br \/>\n \u00a0for<br \/>\n \u00a0a<br \/>\n \u00a0United<br \/>\n \u00a0Nations<br \/>\n \u00a0Rapporteur<br \/>\n \u00a0on<br \/>\n \u00a0the<br \/>\n \u00a0Independence<br \/>\n \u00a0and<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nIntegrity<br \/>\n \u00a0of<br \/>\n \u00a0Health<br \/>\n \u00a0Professionals<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Nuclear<br \/>\n \u00a0Weapons<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Medical<br \/>\n \u00a0Care<br \/>\n \u00a0for<br \/>\n \u00a0Refugees,<br \/>\n \u00a0including<br \/>\n \u00a0Asylum<br \/>\n \u00a0Seekers,<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nRefused<br \/>\n \u00a0Asylum<br \/>\n \u00a0Seekers<br \/>\n \u00a0and<br \/>\n \u00a0Undocumented<br \/>\n \u00a0Migrants,<br \/>\n \u00a0and<br \/>\n \u00a0<br \/>\nInternally<br \/>\n \u00a0Displaced<br \/>\n \u00a0Persons<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Patenting<br \/>\n \u00a0Medical<br \/>\n \u00a0Procedures<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0the<br \/>\n \u00a0Relationship<br \/>\n \u00a0between<br \/>\n \u00a0Physicians<br \/>\n \u00a0and<br \/>\n \u00a0Pharmacists<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nin<br \/>\n \u00a0Medical<br \/>\n \u00a0Therapy<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Human<br \/>\n \u00a0Organ<br \/>\n \u00a0Donation<br \/>\n \u00a0and<br \/>\n \u00a0Transplantation<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Safe<br \/>\n \u00a0Injections<br \/>\n \u00a0in<br \/>\n \u00a0Health<br \/>\n \u00a0Care<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Self-\u00ad\u2010Medication<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Forensic<br \/>\n \u00a0Investigations<br \/>\n \u00a0of<br \/>\n \u00a0the<br \/>\n \u00a0Missing<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Advance<br \/>\n \u00a0Directives<br \/>\n \u00a0(\u201cLiving<br \/>\n \u00a0Wills\u201d)<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0the<br \/>\n \u00a0Ethical<br \/>\n \u00a0Guidelines<br \/>\n \u00a0for<br \/>\n \u00a0the<br \/>\n \u00a0International<br \/>\n \u00a0Migration<br \/>\n \u00a0of<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nHealth<br \/>\n \u00a0Workers<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Violence<br \/>\n \u00a0and<br \/>\n \u00a0Health<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0concerning<br \/>\n \u00a0the<br \/>\n \u00a0Relationship<br \/>\n \u00a0<br \/>\nbetween<br \/>\n \u00a0Physicians<br \/>\n \u00a0and<br \/>\n \u00a0Commercial<br \/>\n \u00a0Enterprises<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Water<br \/>\n \u00a0and<br \/>\n \u00a0Health<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Reducing<br \/>\n \u00a0the<br \/>\n \u00a0Global<br \/>\n \u00a0Impact<br \/>\n \u00a0of<br \/>\n \u00a0Alcohol<br \/>\n \u00a0on<br \/>\n \u00a0Health<br \/>\n \u00a0and<br \/>\n \u00a0Society<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Drug<br \/>\n \u00a0Substitution<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Genetics<br \/>\n \u00a0and<br \/>\n \u00a0Medicine<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Medical<br \/>\n \u00a0Liability<br \/>\n \u00a0Reform<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Assisted<br \/>\n \u00a0Reproductive<br \/>\n \u00a0Technologies<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Avian<br \/>\n \u00a0and<br \/>\n \u00a0Pandemic<br \/>\n \u00a0Influenza<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0HIV\/AIDS<br \/>\n \u00a0and<br \/>\n \u00a0the<br \/>\n \u00a0Medical<br \/>\n \u00a0Profession<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Medical<br \/>\n \u00a0Education<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0The<br \/>\n \u00a0Physician\u2019s<br \/>\n \u00a0Role<br \/>\n \u00a0in<br \/>\n \u00a0Obesity<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0the<br \/>\n \u00a0Responsibilities<br \/>\n \u00a0of<br \/>\n \u00a0Physicians<br \/>\n \u00a0in<br \/>\n \u00a0Preventing<br \/>\n \u00a0and<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nTreating<br \/>\n \u00a0Opiate<br \/>\n \u00a0and<br \/>\n \u00a0Psychotropic<br \/>\n \u00a0Drug<br \/>\n \u00a0Abuse<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0Table<br \/>\n \u00a0of<br \/>\n \u00a0Contents<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102007-\u00ad\u201001-\u00ad\u20102007<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102007-\u00ad\u201002-\u00ad\u20102007<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102008-\u00ad\u201001-\u00ad\u20102008<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102008-\u00ad\u201002-\u00ad\u20102008<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102009-\u00ad\u201001-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102009-\u00ad\u201002-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102009-\u00ad\u201003-\u00ad\u20102009<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nS-\u00ad\u20102009-\u00ad\u201004-\u00ad\u20102009<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nS-\u00ad\u20102010-\u00ad\u201001-\u00ad\u20102010<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102011-\u00ad\u201001-\u00ad\u20102011<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nS-\u00ad\u20102011-\u00ad\u201002-\u00ad\u20102011<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nS-\u00ad\u20102011-\u00ad\u201003-\u00ad\u20102011<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102011-\u00ad\u201004-\u00ad\u20102011<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102011-\u00ad\u201005-\u00ad\u20102011<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nS-\u00ad\u20102012-\u00ad\u201001-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102012-\u00ad\u201002-\u00ad\u20102012<br \/>\n \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20102012-\u00ad\u201003-\u00ad\u20102012<br \/>\n \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20102012-\u00ad\u201004-\u00ad\u20102012<br \/>\n \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20102012-\u00ad\u201005-\u00ad\u20102012<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20102012-\u00ad\u201006-\u00ad\u20102012<br \/>\n \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20102013-\u00ad\u201001-\u00ad\u20102013<br \/>\n \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20102013-\u00ad\u201002-\u00ad\u20102013<br \/>\n \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20102013-\u00ad\u201003-\u00ad\u20102013<br \/>\n \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20102013-\u00ad\u201004-\u00ad\u20102013<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20102013-\u00ad\u201005-\u00ad\u20102013<br \/>\n \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20102014-\u00ad\u201001-\u00ad\u20102014<br \/>\n \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20102014-\u00ad\u201002-\u00ad\u20102014<br \/>\n \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20102014-\u00ad\u201003-\u00ad\u20102014<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Human<br \/>\n \u00a0Tissue<br \/>\n \u00a0for<br \/>\n \u00a0Transplantation<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0the<br \/>\n \u00a0Ethics<br \/>\n \u00a0of<br \/>\n \u00a0Telemedicine<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Reducing<br \/>\n \u00a0Dietary<br \/>\n \u00a0Sodium<br \/>\n \u00a0Intake<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Reducing<br \/>\n \u00a0the<br \/>\n \u00a0Global<br \/>\n \u00a0Burden<br \/>\n \u00a0of<br \/>\n \u00a0Mercury<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Conflict<br \/>\n \u00a0of<br \/>\n \u00a0Interest<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Embryonic<br \/>\n \u00a0Stem<br \/>\n \u00a0Cell<br \/>\n \u00a0Research<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Inequalities<br \/>\n \u00a0in<br \/>\n \u00a0Health<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Guiding<br \/>\n \u00a0Principles<br \/>\n \u00a0for<br \/>\n \u00a0the<br \/>\n \u00a0Use<br \/>\n \u00a0of<br \/>\n \u00a0Telehealth<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nfor<br \/>\n \u00a0the<br \/>\n \u00a0Provision<br \/>\n \u00a0of<br \/>\n \u00a0Health<br \/>\n \u00a0Care<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Environmental<br \/>\n \u00a0Degradation<br \/>\n \u00a0and<br \/>\n \u00a0<br \/>\nSound<br \/>\n \u00a0Management<br \/>\n \u00a0of<br \/>\n \u00a0Chemicals<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0the<br \/>\n \u00a0Global<br \/>\n \u00a0Burden<br \/>\n \u00a0of<br \/>\n \u00a0Chronic<br \/>\n \u00a0Disease<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nRecommendation<br \/>\n \u00a0on<br \/>\n \u00a0the<br \/>\n \u00a0Development<br \/>\n \u00a0of<br \/>\n \u00a0a<br \/>\n \u00a0Monitoring<br \/>\n \u00a0and<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nReporting<br \/>\n \u00a0Mechanism<br \/>\n \u00a0to<br \/>\n \u00a0permit<br \/>\n \u00a0Audit<br \/>\n \u00a0of<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nAdherence<br \/>\n \u00a0of<br \/>\n \u00a0States<br \/>\n \u00a0to<br \/>\n \u00a0the<br \/>\n \u00a0Declaration<br \/>\n \u00a0of<br \/>\n \u00a0Tokyo<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0the<br \/>\n \u00a0Protection<br \/>\n \u00a0and<br \/>\n \u00a0Integrity<br \/>\n \u00a0of<br \/>\n \u00a0Medical<br \/>\n \u00a0Personnel<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nin<br \/>\n \u00a0Armed<br \/>\n \u00a0Conflicts<br \/>\n \u00a0and<br \/>\n \u00a0Other<br \/>\n \u00a0Situations<br \/>\n \u00a0of<br \/>\n \u00a0Violence<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Social<br \/>\n \u00a0Determinants<br \/>\n \u00a0of<br \/>\n \u00a0Health<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0the<br \/>\n \u00a0Professional<br \/>\n \u00a0and<br \/>\n \u00a0Ethical<br \/>\n \u00a0Usage<br \/>\n \u00a0of<br \/>\n \u00a0Social<br \/>\n \u00a0Media<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Electronic<br \/>\n \u00a0Cigarettes<br \/>\n \u00a0and<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nOther<br \/>\n \u00a0Electronic<br \/>\n \u00a0Nicotine<br \/>\n \u00a0Delivery<br \/>\n \u00a0Systems<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0the<br \/>\n \u00a0Ethical<br \/>\n \u00a0Implications<br \/>\n \u00a0of<br \/>\n \u00a0Collective<br \/>\n \u00a0Action<br \/>\n \u00a0by<br \/>\n \u00a0Physicians<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Forced<br \/>\n \u00a0and<br \/>\n \u00a0Coerced<br \/>\n \u00a0Sterilisation<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Organ<br \/>\n \u00a0and<br \/>\n \u00a0Tissue<br \/>\n \u00a0Donation<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0the<br \/>\n \u00a0Prioritisation<br \/>\n \u00a0of<br \/>\n \u00a0Immunisation<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Violence<br \/>\n \u00a0in<br \/>\n \u00a0the<br \/>\n \u00a0Health<br \/>\n \u00a0Sector<br \/>\n \u00a0by<br \/>\n \u00a0Patients<br \/>\n \u00a0and<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nThose<br \/>\n \u00a0Close<br \/>\n \u00a0to<br \/>\n \u00a0Them<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Fungal<br \/>\n \u00a0Disease<br \/>\n \u00a0Diagnosis<br \/>\n \u00a0and<br \/>\n \u00a0Management<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Human<br \/>\n \u00a0Papillomavirus<br \/>\n \u00a0Vaccination<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Natural<br \/>\n \u00a0Variations<br \/>\n \u00a0of<br \/>\n \u00a0Human<br \/>\n \u00a0Sexuality<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0the<br \/>\n \u00a0Right<br \/>\n \u00a0to<br \/>\n \u00a0Rehabilitation<br \/>\n \u00a0of<br \/>\n \u00a0Victims<br \/>\n \u00a0of<br \/>\n \u00a0Torture<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0the<br \/>\n \u00a0United<br \/>\n \u00a0Nations<br \/>\n \u00a0Resolution<br \/>\n \u00a0for<br \/>\n \u00a0a<br \/>\n \u00a0Moratorium<br \/>\n \u00a0on<br \/>\n \u00a0the<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nUse<br \/>\n \u00a0of<br \/>\n \u00a0the<br \/>\n \u00a0Death<br \/>\n \u00a0Penalty<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Aesthetic<br \/>\n \u00a0Treatment<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0the<br \/>\n \u00a0Prevention<br \/>\n \u00a0of<br \/>\n \u00a0Air<br \/>\n \u00a0Pollution<br \/>\n \u00a0and<br \/>\n \u00a0Vehicle<br \/>\n \u00a0Emissions<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStatement<br \/>\n \u00a0on<br \/>\n \u00a0Solitary<br \/>\n \u00a0Confinement<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nChronological<br \/>\n \u00a0Order<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nR-\u00ad\u20101981-\u00ad\u201001-\u00ad\u20102008<br \/>\n \u00a0<br \/>\nR-\u00ad\u20101988-\u00ad\u201001-\u00ad\u20102015<br \/>\n \u00a0<br \/>\nR-\u00ad\u20101997-\u00ad\u201002-\u00ad\u20102007<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nR-\u00ad\u20101997-\u00ad\u201003-\u00ad\u20102008<br \/>\n \u00a0<br \/>\nR-\u00ad\u20101998-\u00ad\u201003-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nR-\u00ad\u20101998-\u00ad\u201004-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nR-\u00ad\u20101998-\u00ad\u201005-\u00ad\u20102008<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nR-\u00ad\u20101999-\u00ad\u201001-\u00ad\u20101999<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102002-\u00ad\u201001-\u00ad\u20102013<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102002-\u00ad\u201002-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102002-\u00ad\u201005-\u00ad\u20102012<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nR-\u00ad\u20102002-\u00ad\u201006-\u00ad\u20102013<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102003-\u00ad\u201001-\u00ad\u20102013<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nR-\u00ad\u20102003-\u00ad\u201002-\u00ad\u20102007<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nR-\u00ad\u20102003-\u00ad\u201003-\u00ad\u20102014<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102003-\u00ad\u201004-\u00ad\u20102003<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nR-\u00ad\u20102004-\u00ad\u201001-\u00ad\u20102014<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102006-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102006-\u00ad\u201002-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102006-\u00ad\u201003-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102006-\u00ad\u201004-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102006-\u00ad\u201005-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102007-\u00ad\u201001-\u00ad\u20102007<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nR-\u00ad\u20102007-\u00ad\u201002-\u00ad\u20102007<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102008-\u00ad\u201001-\u00ad\u20102008<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102008-\u00ad\u201002-\u00ad\u20102008<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102008-\u00ad\u201003-\u00ad\u20102008<br \/>\n \u00a0<br \/>\nRESOLUTIONS<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0Physician<br \/>\n \u00a0Participation<br \/>\n \u00a0in<br \/>\n \u00a0Capital<br \/>\n \u00a0Punishment<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0Academic<br \/>\n \u00a0Sanctions<br \/>\n \u00a0or<br \/>\n \u00a0Boycotts<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0Economic<br \/>\n \u00a0Embargoes<br \/>\n \u00a0and<br \/>\n \u00a0Health<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0Access<br \/>\n \u00a0of<br \/>\n \u00a0Women<br \/>\n \u00a0and<br \/>\n \u00a0Children<br \/>\n \u00a0to<br \/>\n \u00a0Health<br \/>\n \u00a0Care<br \/>\n \u00a0and<br \/>\n \u00a0<br \/>\nthe<br \/>\n \u00a0Role<br \/>\n \u00a0of<br \/>\n \u00a0Women<br \/>\n \u00a0in<br \/>\n \u00a0the<br \/>\n \u00a0Medical<br \/>\n \u00a0Profession<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0Improved<br \/>\n \u00a0Investment<br \/>\n \u00a0in<br \/>\n \u00a0Public<br \/>\n \u00a0Health<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0the<br \/>\n \u00a0Medical<br \/>\n \u00a0Workforce<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0supporting<br \/>\n \u00a0the<br \/>\n \u00a0Ottawa<br \/>\n \u00a0Convention<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0the<br \/>\n \u00a0Inclusion<br \/>\n \u00a0of<br \/>\n \u00a0Medical<br \/>\n \u00a0Ethics<br \/>\n \u00a0and<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nHuman<br \/>\n \u00a0Rights<br \/>\n \u00a0in<br \/>\n \u00a0the<br \/>\n \u00a0Curriculum<br \/>\n \u00a0of<br \/>\n \u00a0Medical<br \/>\n \u00a0Schools<br \/>\n \u00a0World-\u00ad\u2010wide<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0Euthanasia<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0Female<br \/>\n \u00a0Foeticide<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0Political<br \/>\n \u00a0Abuse<br \/>\n \u00a0of<br \/>\n \u00a0Psychiatry<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0the<br \/>\n \u00a0Women&#8217;s<br \/>\n \u00a0Right<br \/>\n \u00a0to<br \/>\n \u00a0Health<br \/>\n \u00a0Care<br \/>\n \u00a0and<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nHow<br \/>\n \u00a0that<br \/>\n \u00a0Relates<br \/>\n \u00a0to<br \/>\n \u00a0the<br \/>\n \u00a0Prevention<br \/>\n \u00a0of<br \/>\n \u00a0Mother-\u00ad\u2010to-\u00ad\u2010Child<br \/>\n \u00a0HIV<br \/>\n \u00a0Infection<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0the<br \/>\n \u00a0Designation<br \/>\n \u00a0of<br \/>\n \u00a0an<br \/>\n \u00a0Annual<br \/>\n \u00a0Medical<br \/>\n \u00a0Ethics<br \/>\n \u00a0Day<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0the<br \/>\n \u00a0Responsibility<br \/>\n \u00a0of<br \/>\n \u00a0Physicians<br \/>\n \u00a0in<br \/>\n \u00a0the<br \/>\n \u00a0Denunciation<br \/>\n \u00a0of<br \/>\n \u00a0<br \/>\nActs<br \/>\n \u00a0of<br \/>\n \u00a0Torture<br \/>\n \u00a0or<br \/>\n \u00a0Cruel,<br \/>\n \u00a0Inhuman<br \/>\n \u00a0or<br \/>\n \u00a0Degrading<br \/>\n \u00a0Treatment<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0the<br \/>\n \u00a0Non-\u00ad\u2010Commercialization<br \/>\n \u00a0of<br \/>\n \u00a0<br \/>\nHuman<br \/>\n \u00a0Reproductive<br \/>\n \u00a0Material<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0SARS<br \/>\n \u00a0(Severe<br \/>\n \u00a0Acute<br \/>\n \u00a0Respiratory<br \/>\n \u00a0Syndrome)<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0WFME<br \/>\n \u00a0Global<br \/>\n \u00a0Standards<br \/>\n \u00a0for<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nQuality<br \/>\n \u00a0Improvement<br \/>\n \u00a0of<br \/>\n \u00a0Medical<br \/>\n \u00a0Education<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0Medical<br \/>\n \u00a0Assistance<br \/>\n \u00a0in<br \/>\n \u00a0Air<br \/>\n \u00a0Travel<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0Child<br \/>\n \u00a0Safety<br \/>\n \u00a0in<br \/>\n \u00a0Airline<br \/>\n \u00a0Travel<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0Combating<br \/>\n \u00a0HIV\/AIDS<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0North<br \/>\n \u00a0Korean<br \/>\n \u00a0Nuclear<br \/>\n \u00a0Testing<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0Tuberculosis<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0Health<br \/>\n \u00a0and<br \/>\n \u00a0Human<br \/>\n \u00a0Rights<br \/>\n \u00a0Abuses<br \/>\n \u00a0in<br \/>\n \u00a0Zimbabwe<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0in<br \/>\n \u00a0Support<br \/>\n \u00a0of<br \/>\n \u00a0the<br \/>\n \u00a0Medical<br \/>\n \u00a0Associations<br \/>\n \u00a0<br \/>\nin<br \/>\n \u00a0Latin<br \/>\n \u00a0America<br \/>\n \u00a0and<br \/>\n \u00a0the<br \/>\n \u00a0Caribbean<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0The<br \/>\n \u00a0Economic<br \/>\n \u00a0Crisis:<br \/>\n \u00a0Implications<br \/>\n \u00a0for<br \/>\n \u00a0Health<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0Poppies<br \/>\n \u00a0for<br \/>\n \u00a0Medicine<br \/>\n \u00a0Project<br \/>\n \u00a0for<br \/>\n \u00a0Afghanistan<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0Collaboration<br \/>\n \u00a0Between<br \/>\n \u00a0Human<br \/>\n \u00a0and<br \/>\n \u00a0Veterinary<br \/>\n \u00a0Medicine<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0Table<br \/>\n \u00a0of<br \/>\n \u00a0Contents<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102009-\u00ad\u201001-\u00ad\u20102009<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nR-\u00ad\u20102009-\u00ad\u201002-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102009-\u00ad\u201003-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102010-\u00ad\u201001-\u00ad\u20102010<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102010-\u00ad\u201002-\u00ad\u20102010<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102011-\u00ad\u201001-\u00ad\u20102011<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102011-\u00ad\u201002-\u00ad\u20102011<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nR-\u00ad\u20102011-\u00ad\u201003-\u00ad\u20102011<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102011-\u00ad\u201004-\u00ad\u20102011<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102012-\u00ad\u201001-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102012-\u00ad\u201002-\u00ad\u20102012<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nR-\u00ad\u20102012-\u00ad\u201003-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102012-\u00ad\u201004-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102013-\u00ad\u201001-\u00ad\u20102013<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102013-\u00ad\u201002-\u00ad\u20102013<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102013-\u00ad\u201003-\u00ad\u20102013<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102013-\u00ad\u201004-\u00ad\u20102013<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102013-\u00ad\u201005-\u00ad\u20102013<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102014-\u00ad\u201001-\u00ad\u20102014<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102014-\u00ad\u201002-\u00ad\u20102014<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102014-\u00ad\u201003-\u00ad\u20102014<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nCR-\u00ad\u20102003-\u00ad\u201001-\u00ad\u20102003<br \/>\n \u00a0<br \/>\nCR-\u00ad\u20102005-\u00ad\u201001-\u00ad\u20102005<br \/>\n \u00a0<br \/>\nCR-\u00ad\u20102005-\u00ad\u201002-\u00ad\u20102005<br \/>\n \u00a0<br \/>\nCR-\u00ad\u20102005-\u00ad\u201003-\u00ad\u20102005<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nCR-\u00ad\u20102005-\u00ad\u201004-\u00ad\u20102005<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nCR-\u00ad\u20102005-\u00ad\u201005-\u00ad\u20102005<br \/>\n \u00a0<br \/>\nEmergency<br \/>\n \u00a0Resolution<br \/>\n \u00a0on<br \/>\n \u00a0Legislation<br \/>\n \u00a0against<br \/>\n \u00a0Abortion<br \/>\n \u00a0in<br \/>\n \u00a0Nicaragua<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0supporting<br \/>\n \u00a0the<br \/>\n \u00a0Rights<br \/>\n \u00a0of<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nPatients<br \/>\n \u00a0and<br \/>\n \u00a0Physicians<br \/>\n \u00a0in<br \/>\n \u00a0the<br \/>\n \u00a0Islamic<br \/>\n \u00a0Republic<br \/>\n \u00a0of<br \/>\n \u00a0Iran<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0Task<br \/>\n \u00a0Shifting<br \/>\n \u00a0from<br \/>\n \u00a0the<br \/>\n \u00a0Medical<br \/>\n \u00a0Profession<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0Drug<br \/>\n \u00a0Prescription<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0Violence<br \/>\n \u00a0against<br \/>\n \u00a0Women<br \/>\n \u00a0and<br \/>\n \u00a0Girls<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0the<br \/>\n \u00a0Access<br \/>\n \u00a0to<br \/>\n \u00a0Adequate<br \/>\n \u00a0Pain<br \/>\n \u00a0Treatment<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0Bahrain<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0reaffirming<br \/>\n \u00a0the<br \/>\n \u00a0WMA<br \/>\n \u00a0Resolution<br \/>\n \u00a0on<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nEconomic<br \/>\n \u00a0Embargoes<br \/>\n \u00a0and<br \/>\n \u00a0Health<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0Independence<br \/>\n \u00a0of<br \/>\n \u00a0Medical<br \/>\n \u00a0Associations<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0a<br \/>\n \u00a0Minimum<br \/>\n \u00a0Price<br \/>\n \u00a0for<br \/>\n \u00a0Alcohol<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0Plain<br \/>\n \u00a0Packaging<br \/>\n \u00a0of<br \/>\n \u00a0Cigarettes<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0to<br \/>\n \u00a0reaffirm<br \/>\n \u00a0the<br \/>\n \u00a0WMA\u2019s<br \/>\n \u00a0Prohibition<br \/>\n \u00a0of<br \/>\n \u00a0Physician<br \/>\n \u00a0Participation<br \/>\n \u00a0in<br \/>\n \u00a0<br \/>\nCapital<br \/>\n \u00a0Punishment<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0in<br \/>\n \u00a0Support<br \/>\n \u00a0of<br \/>\n \u00a0Professor<br \/>\n \u00a0Cyril<br \/>\n \u00a0Karabus<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0Criminalisation<br \/>\n \u00a0of<br \/>\n \u00a0Medical<br \/>\n \u00a0Practice<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0the<br \/>\n \u00a0Healthcare<br \/>\n \u00a0Situation<br \/>\n \u00a0in<br \/>\n \u00a0Syria<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0the<br \/>\n \u00a0Prohibition<br \/>\n \u00a0of<br \/>\n \u00a0Chemical<br \/>\n \u00a0Weapons<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0Patient<br \/>\n \u00a0Safety<br \/>\n \u00a0and<br \/>\n \u00a0Standardisation<br \/>\n \u00a0in<br \/>\n \u00a0Medical<br \/>\n \u00a0Practice<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0in<br \/>\n \u00a0Support<br \/>\n \u00a0of<br \/>\n \u00a0the<br \/>\n \u00a0Brazilian<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0Ebola<br \/>\n \u00a0Viral<br \/>\n \u00a0Disease<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0Migrant<br \/>\n \u00a0Workers&#8217;<br \/>\n \u00a0Health<br \/>\n \u00a0and<br \/>\n \u00a0Safety<br \/>\n \u00a0in<br \/>\n \u00a0Qatar<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nResolution<br \/>\n \u00a0on<br \/>\n \u00a0Unproven<br \/>\n \u00a0Therapy<br \/>\n \u00a0and<br \/>\n \u00a0the<br \/>\n \u00a0Ebola<br \/>\n \u00a0Virus<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nCOUNCIL<br \/>\n \u00a0RESOLUTIONS<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nCouncil<br \/>\n \u00a0Resolution<br \/>\n \u00a0on<br \/>\n \u00a0the<br \/>\n \u00a0Relation<br \/>\n \u00a0of<br \/>\n \u00a0Law<br \/>\n \u00a0and<br \/>\n \u00a0Ethics<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nCouncil<br \/>\n \u00a0Resolution<br \/>\n \u00a0on<br \/>\n \u00a0Chronic<br \/>\n \u00a0Non-\u00ad\u2010Communicable<br \/>\n \u00a0Diseases<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nCouncil<br \/>\n \u00a0Resolution<br \/>\n \u00a0on<br \/>\n \u00a0the<br \/>\n \u00a0Healthcare<br \/>\n \u00a0Skills<br \/>\n \u00a0Drain<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nCouncil<br \/>\n \u00a0Resolution<br \/>\n \u00a0on<br \/>\n \u00a0Genocide<br \/>\n \u00a0in<br \/>\n \u00a0Darfur<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nCouncil<br \/>\n \u00a0Resolution<br \/>\n \u00a0on<br \/>\n \u00a0Observer<br \/>\n \u00a0Status<br \/>\n \u00a0for<br \/>\n \u00a0Taiwan<br \/>\n \u00a0to<br \/>\n \u00a0the<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Health<br \/>\n \u00a0Organization<br \/>\n \u00a0and<br \/>\n \u00a0Inclusion<br \/>\n \u00a0as<br \/>\n \u00a0Participating<br \/>\n \u00a0Party<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nto<br \/>\n \u00a0the<br \/>\n \u00a0International<br \/>\n \u00a0Health<br \/>\n \u00a0Regulations<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nCouncil<br \/>\n \u00a0Resolution<br \/>\n \u00a0on<br \/>\n \u00a0Implementation<br \/>\n \u00a0of<br \/>\n \u00a0the<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWHO<br \/>\n \u00a0Framework<br \/>\n \u00a0Convention<br \/>\n \u00a0on<br \/>\n \u00a0Tobacco<br \/>\n \u00a0Control<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nChronological<br \/>\n \u00a0Order<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n*<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0Code<br \/>\n \u00a0explanation<br \/>\n \u00a0(sorting<br \/>\n \u00a0criteria):<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101948-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0 Year<br \/>\n \u00a0of<br \/>\n \u00a0last<br \/>\n \u00a0action<br \/>\n \u00a0<br \/>\nSerial<br \/>\n \u00a0number<br \/>\n \u00a0<br \/>\nYear<br \/>\n \u00a0of<br \/>\n \u00a0adoption<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0Document<br \/>\n \u00a0type<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0 D:<br \/>\n \u00a0<br \/>\n \u00a0Declarations<br \/>\n \u00a0\/<br \/>\n \u00a0S:<br \/>\n \u00a0Statements<br \/>\n \u00a0\/<br \/>\n \u00a0R:<br \/>\n \u00a0Resolutions<br \/>\n \u00a0\/<br \/>\n \u00a0CR:<br \/>\n \u00a0Council<br \/>\n \u00a0Resolutions<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nCouncil<br \/>\n \u00a0Resolution<br \/>\n \u00a0in<br \/>\n \u00a0Support<br \/>\n \u00a0of<br \/>\n \u00a0the<br \/>\n \u00a0Bolivian<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nCouncil<br \/>\n \u00a0Resolution<br \/>\n \u00a0on<br \/>\n \u00a0Organ<br \/>\n \u00a0Donation<br \/>\n \u00a0in<br \/>\n \u00a0China<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nCouncil<br \/>\n \u00a0Resolution<br \/>\n \u00a0supporting<br \/>\n \u00a0the<br \/>\n \u00a0Preservation<br \/>\n \u00a0of<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nInternational<br \/>\n \u00a0Standards<br \/>\n \u00a0of<br \/>\n \u00a0Medical<br \/>\n \u00a0Neutrality<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nCouncil<br \/>\n \u00a0Resolution<br \/>\n \u00a0on<br \/>\n \u00a0Prohibition<br \/>\n \u00a0of<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nPhysician<br \/>\n \u00a0Participation<br \/>\n \u00a0in<br \/>\n \u00a0Torture<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nCouncil<br \/>\n \u00a0Resolution<br \/>\n \u00a0on<br \/>\n \u00a0Danger<br \/>\n \u00a0in<br \/>\n \u00a0Health<br \/>\n \u00a0Care<br \/>\n \u00a0in<br \/>\n \u00a0Syria<br \/>\n \u00a0and<br \/>\n \u00a0Bahrain<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nCouncil<br \/>\n \u00a0Resolution<br \/>\n \u00a0on<br \/>\n \u00a0Threats<br \/>\n \u00a0to<br \/>\n \u00a0Professional<br \/>\n \u00a0Autonomy<br \/>\n \u00a0and<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nSelf-\u00ad\u2010Regulation<br \/>\n \u00a0in<br \/>\n \u00a0Turkey<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nCouncil<br \/>\n \u00a0Resolution<br \/>\n \u00a0on<br \/>\n \u00a0the<br \/>\n \u00a0Autonomy<br \/>\n \u00a0of<br \/>\n \u00a0Professional<br \/>\n \u00a0Orders<br \/>\n \u00a0in<br \/>\n \u00a0West<br \/>\n \u00a0Africa<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nCouncil<br \/>\n \u00a0Resolution<br \/>\n \u00a0on<br \/>\n \u00a0Professor<br \/>\n \u00a0Cyril<br \/>\n \u00a0Karabus<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nCouncil<br \/>\n \u00a0Resolution<br \/>\n \u00a0on<br \/>\n \u00a0Criminalisation<br \/>\n \u00a0of<br \/>\n \u00a0Medical<br \/>\n \u00a0Practice<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nCouncil<br \/>\n \u00a0Resolution<br \/>\n \u00a0on<br \/>\n \u00a0Standardisation<br \/>\n \u00a0in<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nMedical<br \/>\n \u00a0Practice<br \/>\n \u00a0and<br \/>\n \u00a0Patient<br \/>\n \u00a0Safety<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nCouncil<br \/>\n \u00a0Resolution<br \/>\n \u00a0on<br \/>\n \u00a0Trade<br \/>\n \u00a0Agreements<br \/>\n \u00a0and<br \/>\n \u00a0Public<br \/>\n \u00a0Health<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nCR-\u00ad\u20102006-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nCR-\u00ad\u20102006-\u00ad\u201002-\u00ad\u20102006<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nCR-\u00ad\u20102009-\u00ad\u201001-\u00ad\u20102009<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nCR-\u00ad\u20102009-\u00ad\u201002-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nCR-\u00ad\u20102012-\u00ad\u201001-\u00ad\u20102012<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nCR-\u00ad\u20102012-\u00ad\u201002-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nCR-\u00ad\u20102012-\u00ad\u201003-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nCR-\u00ad\u20102013-\u00ad\u201001-\u00ad\u20102013<br \/>\n \u00a0<br \/>\nCR-\u00ad\u20102013-\u00ad\u201002-\u00ad\u20102013<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nCR-\u00ad\u20102013-\u00ad\u201003-\u00ad\u20102013<br \/>\n \u00a0<br \/>\nCR-\u00ad\u20102015-\u00ad\u201001-\u00ad\u20102015<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nOrder<br \/>\n \u00a0by<br \/>\n \u00a0Short<br \/>\n \u00a0Title<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nR-\u00ad\u20102002-\u00ad\u201005-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nR-\u00ad\u20101988-\u00ad\u201001-\u00ad\u20102015<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101988-\u00ad\u201002-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102011-\u00ad\u201001-\u00ad\u20102011<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101991-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102002-\u00ad\u201004-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102014-\u00ad\u201001-\u00ad\u20102014<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102014-\u00ad\u201002-\u00ad\u20102014<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102006-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101992-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102005-\u00ad\u201001-\u00ad\u20102005<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101989-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102003-\u00ad\u201001-\u00ad\u20102013<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101996-\u00ad\u201001-\u00ad\u20102008<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101956-\u00ad\u201001-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102006-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nCR-\u00ad\u20102012-\u00ad\u201003-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102006-\u00ad\u201002-\u00ad\u20102006<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nR-\u00ad\u20102011-\u00ad\u201002-\u00ad\u20102011<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102002-\u00ad\u201001-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101993-\u00ad\u201001-\u00ad\u20102005<br \/>\n \u00a0<br \/>\nCR-\u00ad\u20102006-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101983-\u00ad\u201001-\u00ad\u20102005<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nR-\u00ad\u20101981-\u00ad\u201001-\u00ad\u20102008<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102012-\u00ad\u201003-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101984-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101998-\u00ad\u201001-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102006-\u00ad\u201002-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102011-\u00ad\u201001-\u00ad\u20102011<br \/>\n \u00a0<br \/>\nTABLE<br \/>\n \u00a0OF<br \/>\n \u00a0CONTENTS<br \/>\n \u00a0<br \/>\n-\u00ad\u2010<br \/>\n \u00a0<br \/>\n \u00a0Order<br \/>\n \u00a0by<br \/>\n \u00a0Short<br \/>\n \u00a0Title<br \/>\n \u00a0<br \/>\n \u00a0-\u00ad\u2010<br \/>\n \u00a0<br \/>\n[A]<br \/>\n \u00a0<br \/>\nAbuse<br \/>\n \u00a0of<br \/>\n \u00a0Psychiatry<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nAcademic<br \/>\n \u00a0Sanctions<br \/>\n \u00a0or<br \/>\n \u00a0Boycotts<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nAccess<br \/>\n \u00a0to<br \/>\n \u00a0Health<br \/>\n \u00a0Care<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nAdequate<br \/>\n \u00a0Pain<br \/>\n \u00a0Treatment<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nAdolescent<br \/>\n \u00a0Suicide<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nAdvanced<br \/>\n \u00a0Technology<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nAesthetic<br \/>\n \u00a0Treatment<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nAir<br \/>\n \u00a0Pollution<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nAir<br \/>\n \u00a0Travel<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nAlcohol<br \/>\n \u00a0and<br \/>\n \u00a0Road<br \/>\n \u00a0Safety<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nAlcohol<br \/>\n \u00a0on<br \/>\n \u00a0Health<br \/>\n \u00a0and<br \/>\n \u00a0Society<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nAnimal<br \/>\n \u00a0Use<br \/>\n \u00a0in<br \/>\n \u00a0Biomedical<br \/>\n \u00a0Research<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nAnnual<br \/>\n \u00a0Medical<br \/>\n \u00a0Ethics<br \/>\n \u00a0Day<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nAntimicrobial<br \/>\n \u00a0Resistance<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nArmed<br \/>\n \u00a0Conflict<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nAssisted<br \/>\n \u00a0Reproductive<br \/>\n \u00a0Technologies<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nAutonomy<br \/>\n \u00a0of<br \/>\n \u00a0Professional<br \/>\n \u00a0Orders<br \/>\n \u00a0in<br \/>\n \u00a0West<br \/>\n \u00a0Africa<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nAvian<br \/>\n \u00a0and<br \/>\n \u00a0Pandemic<br \/>\n \u00a0Influenza<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n[B]<br \/>\n \u00a0<br \/>\nBahrain<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nBiological<br \/>\n \u00a0Weapons<br \/>\n \u00a0(Washington)<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nBody<br \/>\n \u00a0Searches<br \/>\n \u00a0of<br \/>\n \u00a0Prisoners<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nBolivian<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nBoxing<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n[C]<br \/>\n \u00a0<br \/>\nCapital<br \/>\n \u00a0Punishment<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nCapital<br \/>\n \u00a0Punishment<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nChild<br \/>\n \u00a0Abuse<br \/>\n \u00a0and<br \/>\n \u00a0Neglect<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nChild<br \/>\n \u00a0Health<br \/>\n \u00a0(Ottawa)<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nChild<br \/>\n \u00a0Safety<br \/>\n \u00a0in<br \/>\n \u00a0Airline<br \/>\n \u00a0Travel<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nChronic<br \/>\n \u00a0Disease<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nOrder<br \/>\n \u00a0by<br \/>\n \u00a0Short<br \/>\n \u00a0Title<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nCR-\u00ad\u20102005-\u00ad\u201001-\u00ad\u20102005<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102009-\u00ad\u201001-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102012-\u00ad\u201002-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102009-\u00ad\u201001-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101997-\u00ad\u201002-\u00ad\u20102007<br \/>\n \u00a0<br \/>\nCR-\u00ad\u20102013-\u00ad\u201002-\u00ad\u20102013<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102013-\u00ad\u201001-\u00ad\u20102013<br \/>\n \u00a0<br \/>\nR-\u00ad\u20101999-\u00ad\u201001-\u00ad\u20101999<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nCR-\u00ad\u20102012-\u00ad\u201001-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102013-\u00ad\u201005-\u00ad\u20102013<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102009-\u00ad\u201001-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102003-\u00ad\u201002-\u00ad\u20102007<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101975-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101968-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102008-\u00ad\u201001-\u00ad\u20102008<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102011-\u00ad\u201001-\u00ad\u20102011<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101994-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nCR-\u00ad\u20102005-\u00ad\u201002-\u00ad\u20102005<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102010-\u00ad\u201001-\u00ad\u20102010<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102005-\u00ad\u201002-\u00ad\u20102015<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nR-\u00ad\u20102014-\u00ad\u201001-\u00ad\u20102014<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102014-\u00ad\u201003-\u00ad\u20102014<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102008-\u00ad\u201001-\u00ad\u20102008<br \/>\n \u00a0<br \/>\nR-\u00ad\u20101997-\u00ad\u201002-\u00ad\u20102007<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102011-\u00ad\u201003-\u00ad\u20102011<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102000-\u00ad\u201001-\u00ad\u20102011<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101989-\u00ad\u201001-\u00ad\u20102015<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102012-\u00ad\u201001-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102009-\u00ad\u201002-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102011-\u00ad\u201002-\u00ad\u20102011<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102010-\u00ad\u201001-\u00ad\u20102010<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101988-\u00ad\u201004-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101987-\u00ad\u201001-\u00ad\u20102015<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102002-\u00ad\u201001-\u00ad\u20102013<br \/>\n \u00a0<br \/>\nChronic<br \/>\n \u00a0Non-\u00ad\u2010Communicable<br \/>\n \u00a0Diseases<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nClimate<br \/>\n \u00a0Change<br \/>\n \u00a0(Delhi)<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nCollective<br \/>\n \u00a0Action<br \/>\n \u00a0by<br \/>\n \u00a0Physicians<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nConflict<br \/>\n \u00a0of<br \/>\n \u00a0Interest<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nCriminal<br \/>\n \u00a0Offences<br \/>\n \u00a0and<br \/>\n \u00a0Licensing<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nCriminalisation<br \/>\n \u00a0of<br \/>\n \u00a0Medical<br \/>\n \u00a0Practice<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nCriminalisation<br \/>\n \u00a0of<br \/>\n \u00a0Medical<br \/>\n \u00a0Practice<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nCurriculum<br \/>\n \u00a0of<br \/>\n \u00a0Medical<br \/>\n \u00a0Schools<br \/>\n \u00a0World-\u00ad\u2010wide<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n[D]<br \/>\n \u00a0<br \/>\nDanger<br \/>\n \u00a0in<br \/>\n \u00a0Health<br \/>\n \u00a0Care<br \/>\n \u00a0in<br \/>\n \u00a0Syria<br \/>\n \u00a0and<br \/>\n \u00a0Bahrain<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDeath<br \/>\n \u00a0Penalty<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDelhi<br \/>\n \u00a0(Climate<br \/>\n \u00a0Change)<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDenunciation<br \/>\n \u00a0of<br \/>\n \u00a0Acts<br \/>\n \u00a0of<br \/>\n \u00a0Torture<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDetention<br \/>\n \u00a0and<br \/>\n \u00a0Imprisonment<br \/>\n \u00a0(Tokyo)<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDetermination<br \/>\n \u00a0of<br \/>\n \u00a0Death<br \/>\n \u00a0(Sydney)<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDietary<br \/>\n \u00a0Sodium<br \/>\n \u00a0Intake<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDisaster<br \/>\n \u00a0Preparedness<br \/>\n \u00a0(Montevideo)<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDisasters<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDrain<br \/>\n \u00a0of<br \/>\n \u00a0Healthcare<br \/>\n \u00a0Skills<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDrug<br \/>\n \u00a0Prescription<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDrug<br \/>\n \u00a0Substitution<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n[E]<br \/>\n \u00a0<br \/>\nEbola<br \/>\n \u00a0Viral<br \/>\n \u00a0Disease<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nEbola<br \/>\n \u00a0Virus<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nEconomic<br \/>\n \u00a0Crisis<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0-\u00ad\u201001-\u00ad\u20102008<br \/>\n \u00a0<br \/>\nEconomic<br \/>\n \u00a0Embargoes<br \/>\n \u00a0and<br \/>\n \u00a0Health<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0-\u00ad\u201002-\u00ad\u20102007<br \/>\n \u00a0<br \/>\nEconomic<br \/>\n \u00a0Embargoes<br \/>\n \u00a0and<br \/>\n \u00a0Health<br \/>\n \u00a0[Revised]<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nEdinburgh<br \/>\n \u00a0(Prison<br \/>\n \u00a0Conditions<br \/>\n \u00a0on<br \/>\n \u00a0TB)<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nElderly<br \/>\n \u00a0Abuse<br \/>\n \u00a0(Hong<br \/>\n \u00a0Kong)<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a001-\u00ad\u20102005<br \/>\n \u00a0<br \/>\nElectronic<br \/>\n \u00a0Cigarettes<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nEmbryonic<br \/>\n \u00a0Stem<br \/>\n \u00a0Cell<br \/>\n \u00a0Research<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0-\u00ad\u201002-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nEnd-\u00ad\u2010of-\u00ad\u2010Life<br \/>\n \u00a0Medical<br \/>\n \u00a0Care<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nEnvironmental<br \/>\n \u00a0Degradation<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0-\u00ad\u201001-\u00ad\u20102010<br \/>\n \u00a0<br \/>\nEnvironmental<br \/>\n \u00a0Issues<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0-\u00ad\u201004-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nEuthanasia<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a001-\u00ad\u20102005<br \/>\n \u00a0<br \/>\nEuthanasia<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0-\u00ad\u201001-\u00ad\u20102002<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0Table<br \/>\n \u00a0of<br \/>\n \u00a0Contents<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nS-\u00ad\u20101996-\u00ad\u201002-\u00ad\u20102010<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102002-\u00ad\u201002-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101993-\u00ad\u201002-\u00ad\u20102005<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102012-\u00ad\u201003-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102003-\u00ad\u201001-\u00ad\u20102013<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101984-\u00ad\u201002-\u00ad\u20101984<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102013-\u00ad\u201001-\u00ad\u20102013<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nS-\u00ad\u20102005-\u00ad\u201003-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101948-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nCR-\u00ad\u20102005-\u00ad\u201003-\u00ad\u20102005<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nD-\u00ad\u20101997-\u00ad\u201002-\u00ad\u20102007<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102013-\u00ad\u201002-\u00ad\u20102013<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102002-\u00ad\u201002-\u00ad\u20102002<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101964-\u00ad\u201001-\u00ad\u20102008<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102006-\u00ad\u201003-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102006-\u00ad\u201003-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101989-\u00ad\u201001-\u00ad\u20102015<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102013-\u00ad\u201002-\u00ad\u20102013<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102007-\u00ad\u201001-\u00ad\u20102007<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102007-\u00ad\u201001-\u00ad\u20102007<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101991-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nR-\u00ad\u20102011-\u00ad\u201004-\u00ad\u20102011<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102009-\u00ad\u201003-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101990-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102003-\u00ad\u201003-\u00ad\u20102014<br \/>\n \u00a0<br \/>\nR-\u00ad\u20101998-\u00ad\u201003-\u00ad\u20102009<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nR-\u00ad\u20102007-\u00ad\u201002-\u00ad\u20102007<br \/>\n \u00a0<br \/>\nCR-\u00ad\u20102003-\u00ad\u201001-\u00ad\u20102003<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102009-\u00ad\u201001-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102011-\u00ad\u201003-\u00ad\u20102011<br \/>\n \u00a0<br \/>\n[F]<br \/>\n \u00a0<br \/>\nFamily<br \/>\n \u00a0Violence<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0-\u00ad\u201002-\u00ad\u20102010<br \/>\n \u00a0<br \/>\nFemale<br \/>\n \u00a0Foeticide<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0-\u00ad\u201002-\u00ad\u20102002<br \/>\n \u00a0<br \/>\nFemale<br \/>\n \u00a0Genital<br \/>\n \u00a0Mutilation<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0S-\u00ad\u201002-\u00ad\u20102005<br \/>\n \u00a0<br \/>\nForced<br \/>\n \u00a0and<br \/>\n \u00a0Coerced<br \/>\n \u00a0Sterilisation<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nForensic<br \/>\n \u00a0Investigations<br \/>\n \u00a0of<br \/>\n \u00a0the<br \/>\n \u00a0Missing<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0-\u00ad\u201001-\u00ad\u20102003<br \/>\n \u00a0<br \/>\nFreedom<br \/>\n \u00a0to<br \/>\n \u00a0Attend<br \/>\n \u00a0Medical<br \/>\n \u00a0Meetings<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a084-\u00ad\u201002-\u00ad\u20101984<br \/>\n \u00a0<br \/>\nFungal<br \/>\n \u00a0Disease<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n[G]<br \/>\n \u00a0<br \/>\nGenetics<br \/>\n \u00a0and<br \/>\n \u00a0Medicine<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a003-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nGeneva<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nGenocide<br \/>\n \u00a0in<br \/>\n \u00a0Darfur<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0-\u00ad\u201003-\u00ad\u20102005<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n[H]<br \/>\n \u00a0<br \/>\nHamburg<br \/>\n \u00a0(Refusing<br \/>\n \u00a0Torture)<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nHealthcare<br \/>\n \u00a0Situation<br \/>\n \u00a0in<br \/>\n \u00a0Syria<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nHealth<br \/>\n \u00a0Databases<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a002-\u00ad\u20102002<br \/>\n \u00a0<br \/>\nHelsinki<br \/>\n \u00a0(Medical<br \/>\n \u00a0Research<br \/>\n \u00a0involving<br \/>\n \u00a0Human<br \/>\n \u00a0Subjects)<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nHIV\/AIDS<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a003-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nHIV\/AIDS<br \/>\n \u00a0and<br \/>\n \u00a0the<br \/>\n \u00a0Medical<br \/>\n \u00a0Profession<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0-\u00ad\u201003-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nHong<br \/>\n \u00a0Kong<br \/>\n \u00a0(Elderly<br \/>\n \u00a0Abuse)<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nHuman<br \/>\n \u00a0Papillomavirus<br \/>\n \u00a0Vaccination<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nHuman<br \/>\n \u00a0Rights<br \/>\n \u00a0Abuses<br \/>\n \u00a0in<br \/>\n \u00a0Zimbabwe<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0-\u00ad\u201001-\u00ad\u20102007<br \/>\n \u00a0<br \/>\nHuman<br \/>\n \u00a0Tissue<br \/>\n \u00a0for<br \/>\n \u00a0Transplantation<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0-\u00ad\u201001-\u00ad\u20102007<br \/>\n \u00a0<br \/>\nHunger<br \/>\n \u00a0Strikers<br \/>\n \u00a0(Malta)<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0D-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n[<br \/>\n \u00a0I<br \/>\n \u00a0]<br \/>\n \u00a0<br \/>\nIndependence<br \/>\n \u00a0of<br \/>\n \u00a0Medical<br \/>\n \u00a0Associations<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nInequalities<br \/>\n \u00a0in<br \/>\n \u00a0Health<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0S03-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nInjury<br \/>\n \u00a0Control<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0S-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nInternational<br \/>\n \u00a0Migration<br \/>\n \u00a0of<br \/>\n \u00a0Health<br \/>\n \u00a0Workers<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nInvestment<br \/>\n \u00a0in<br \/>\n \u00a0Public<br \/>\n \u00a0Health<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0-\u00ad\u201003-\u00ad\u20102009<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n[<br \/>\n \u00a0L<br \/>\n \u00a0]<br \/>\n \u00a0<br \/>\nLatin<br \/>\n \u00a0American<br \/>\n \u00a0and<br \/>\n \u00a0the<br \/>\n \u00a0Caribbean<br \/>\n \u00a0Medical<br \/>\n \u00a0Associations<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0-\u00ad\u201002-\u00ad\u20102007<br \/>\n \u00a0<br \/>\nLaw<br \/>\n \u00a0and<br \/>\n \u00a0Ethics<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nLegislation<br \/>\n \u00a0against<br \/>\n \u00a0Abortion<br \/>\n \u00a0in<br \/>\n \u00a0Nicaragua<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0-\u00ad\u201001-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nLeprosy<br \/>\n \u00a0Control<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nOrder<br \/>\n \u00a0by<br \/>\n \u00a0Short<br \/>\n \u00a0Title<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101981-\u00ad\u201001-\u00ad\u20102015<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102003-\u00ad\u201002-\u00ad\u20102013<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nD-\u00ad\u20102009-\u00ad\u201002-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101991-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102006-\u00ad\u201004-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101949-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102005-\u00ad\u201004-\u00ad\u20102015<br \/>\n \u00a0<br \/>\nCR-\u00ad\u20102009-\u00ad\u201001-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101964-\u00ad\u201001-\u00ad\u20102013<br \/>\n \u00a0<br \/>\nR-\u00ad\u20101998-\u00ad\u201004-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102008-\u00ad\u201002-\u00ad\u20102008<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102014-\u00ad\u201002-\u00ad\u20102014<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102012-\u00ad\u201001-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102011-\u00ad\u201002-\u00ad\u20102011<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102011-\u00ad\u201001-\u00ad\u20102011<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nS-\u00ad\u20102013-\u00ad\u201003-\u00ad\u20102013<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101992-\u00ad\u201005-\u00ad\u20102007<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102003-\u00ad\u201003-\u00ad\u20102014<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101985-\u00ad\u201001-\u00ad\u20102015<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102006-\u00ad\u201004-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101998-\u00ad\u201001-\u00ad\u20102008<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nS-\u00ad\u20102006-\u00ad\u201005-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102006-\u00ad\u201006-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102012-\u00ad\u201004-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102000-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nCR-\u00ad\u20102006-\u00ad\u201002-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101998-\u00ad\u201001-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nR-\u00ad\u20101998-\u00ad\u201005-\u00ad\u20102008<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nS-\u00ad\u20101999-\u00ad\u201001-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101993-\u00ad\u201003-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102002-\u00ad\u201003-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nLisbon<br \/>\n \u00a0(Patient&#8217;s<br \/>\n \u00a0Rights)<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nLiving<br \/>\n \u00a0Wills<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0-\u00ad\u201002-\u00ad\u20102003<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n[M]<br \/>\n \u00a0<br \/>\nMadrid<br \/>\n \u00a0(Professionally-\u00ad\u2010led<br \/>\n \u00a0Regulation)<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nMalta<br \/>\n \u00a0(Hunger<br \/>\n \u00a0Strikers)<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nMedical<br \/>\n \u00a0Education<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nMedical<br \/>\n \u00a0Ethics<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nMedical<br \/>\n \u00a0Liability<br \/>\n \u00a0Reform<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0-\u00ad\u201004-\u00ad\u20102005<br \/>\n \u00a0<br \/>\nMedical<br \/>\n \u00a0Neutrality<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a001-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nMedical<br \/>\n \u00a0Research<br \/>\n \u00a0involving<br \/>\n \u00a0Human<br \/>\n \u00a0Subjects<br \/>\n \u00a0(Helsinki)<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0-\u00ad\u201001-\u00ad\u20102008<br \/>\n \u00a0<br \/>\nMedical<br \/>\n \u00a0Workforce<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0-\u00ad\u201004-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nMercury<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0-\u00ad\u201002-\u00ad\u20102008<br \/>\n \u00a0<br \/>\nMigrant<br \/>\n \u00a0Workers&#8217;<br \/>\n \u00a0Health<br \/>\n \u00a0and<br \/>\n \u00a0Safety<br \/>\n \u00a0in<br \/>\n \u00a0Qatar<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nMinimum<br \/>\n \u00a0Price<br \/>\n \u00a0for<br \/>\n \u00a0Alcohol<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nMonitoring<br \/>\n \u00a0Tokyo<br \/>\n \u00a0Declaration<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nMontevideo<br \/>\n \u00a0(Disaster<br \/>\n \u00a0Preparedness)<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n[N]<br \/>\n \u00a0<br \/>\nNatural<br \/>\n \u00a0Variations<br \/>\n \u00a0of<br \/>\n \u00a0Human<br \/>\n \u00a0Sexuality<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nNoise<br \/>\n \u00a0Pollution<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0-\u00ad\u201005-\u00ad\u20102007<br \/>\n \u00a0<br \/>\nNon-\u00ad\u2010Commercialization<br \/>\n \u00a0of<br \/>\n \u00a0Human<br \/>\n \u00a0Reproductive<br \/>\n \u00a0Material<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0-\u00ad\u201003-\u00ad\u20102003<br \/>\n \u00a0<br \/>\nNon-\u00ad\u2010Discrimination<br \/>\n \u00a0in<br \/>\n \u00a0Professional<br \/>\n \u00a0Membership<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a001-\u00ad\u20102005<br \/>\n \u00a0<br \/>\nNuclear<br \/>\n \u00a0Testing<br \/>\n \u00a0in<br \/>\n \u00a0North<br \/>\n \u00a0Korea<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0-\u00ad\u201004-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nNuclear<br \/>\n \u00a0Weapons<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0-\u00ad\u20102008<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n[O]<br \/>\n \u00a0<br \/>\nObesity<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0S-\u00ad\u201003-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nOpiate<br \/>\n \u00a0and<br \/>\n \u00a0Psychotropic<br \/>\n \u00a0Drug<br \/>\n \u00a0Abuse<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0-\u00ad\u201004-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nOrgan<br \/>\n \u00a0and<br \/>\n \u00a0Tissue<br \/>\n \u00a0Donation<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nOrgan<br \/>\n \u00a0Donation<br \/>\n \u00a0and<br \/>\n \u00a0Transplantation<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0S-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nOrgan<br \/>\n \u00a0Donation<br \/>\n \u00a0in<br \/>\n \u00a0China<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0-\u00ad\u201002-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nOttawa<br \/>\n \u00a0(Child<br \/>\n \u00a0Health)<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nOttawa<br \/>\n \u00a0Convention<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0-\u00ad\u201005-\u00ad\u20102008<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n[P]<br \/>\n \u00a0<br \/>\nPatenting<br \/>\n \u00a0Medical<br \/>\n \u00a0Procedures<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0-\u00ad\u201001-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nPatient<br \/>\n \u00a0Advocacy<br \/>\n \u00a0and<br \/>\n \u00a0Confidentiality<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0S-\u00ad\u201003-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nPatient<br \/>\n \u00a0Safety<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0-\u00ad\u201003-\u00ad\u20102002<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0Table<br \/>\n \u00a0of<br \/>\n \u00a0Contents<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101981-\u00ad\u201001-\u00ad\u20102015<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101995-\u00ad\u201002-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102004-\u00ad\u201002-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101999-\u00ad\u201002-\u00ad\u20102010<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102012-\u00ad\u201002-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102008-\u00ad\u201002-\u00ad\u20102008<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102012-\u00ad\u201005-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102000-\u00ad\u201001-\u00ad\u20102011<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102008-\u00ad\u201001-\u00ad\u20102008<br \/>\n \u00a0<br \/>\nCR-\u00ad\u20102012-\u00ad\u201002-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101996-\u00ad\u201003-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102009-\u00ad\u201002-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102012-\u00ad\u201004-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nCR-\u00ad\u20102013-\u00ad\u201001-\u00ad\u20102013<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102013-\u00ad\u201003-\u00ad\u20102013<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102011-\u00ad\u201003-\u00ad\u20102011<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101995-\u00ad\u201004-\u00ad\u20102006<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nD-\u00ad\u20101997-\u00ad\u201001-\u00ad\u20102009<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nS-\u00ad\u20101998-\u00ad\u201002-\u00ad\u20102010<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101997-\u00ad\u201002-\u00ad\u20102007<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101996-\u00ad\u201004-\u00ad\u20102007<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102009-\u00ad\u201002-\u00ad\u20102009<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nS-\u00ad\u20102002-\u00ad\u201001-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102003-\u00ad\u201004-\u00ad\u20102003<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102002-\u00ad\u201002-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102008-\u00ad\u201001-\u00ad\u20102008<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102011-\u00ad\u201004-\u00ad\u20102011<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102011-\u00ad\u201005-\u00ad\u20102011<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102014-\u00ad\u201003-\u00ad\u20102014<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101981-\u00ad\u201002-\u00ad\u20102010<br \/>\n \u00a0<br \/>\nCR-\u00ad\u20102013-\u00ad\u201003-\u00ad\u20102013<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102013-\u00ad\u201004-\u00ad\u20102013<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101992-\u00ad\u201006-\u00ad\u20102015<br \/>\n \u00a0<br \/>\nPatient&#8217;s<br \/>\n \u00a0Rights<br \/>\n \u00a0(Lisbon)<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0D-\u00ad\u201001-\u00ad\u20102005<br \/>\n \u00a0<br \/>\nPatients<br \/>\n \u00a0with<br \/>\n \u00a0Mental<br \/>\n \u00a0Illness<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0-\u00ad\u201002-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nPhysicians<br \/>\n \u00a0and<br \/>\n \u00a0Commercial<br \/>\n \u00a0Enterprises<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0S-\u00ad\u201002-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nPhysicians<br \/>\n \u00a0and<br \/>\n \u00a0Pharmacists<br \/>\n \u00a0in<br \/>\n \u00a0Medical<br \/>\n \u00a0Therapy<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0S-\u00ad\u201002-\u00ad\u20102010<br \/>\n \u00a0<br \/>\nPlain<br \/>\n \u00a0Packaging<br \/>\n \u00a0of<br \/>\n \u00a0Cigarettes<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nPoppies<br \/>\n \u00a0for<br \/>\n \u00a0Medicine<br \/>\n \u00a0Project<br \/>\n \u00a0for<br \/>\n \u00a0Afghanistan<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0R-\u00ad\u201002-\u00ad\u20102008<br \/>\n \u00a0<br \/>\nPrioritisation<br \/>\n \u00a0of<br \/>\n \u00a0Immunisation<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nPrison<br \/>\n \u00a0Conditions<br \/>\n \u00a0on<br \/>\n \u00a0TB<br \/>\n \u00a0(Edinburgh)<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0-\u00ad\u201001-\u00ad\u20102000<br \/>\n \u00a0<br \/>\nProfessional<br \/>\n \u00a0Autonomy<br \/>\n \u00a0and<br \/>\n \u00a0Clinical<br \/>\n \u00a0Independence<br \/>\n \u00a0(Seoul)<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a001-\u00ad\u20102008<br \/>\n \u00a0<br \/>\nProfessional<br \/>\n \u00a0Autonomy<br \/>\n \u00a0and<br \/>\n \u00a0Self-\u00ad\u2010regulation<br \/>\n \u00a0in<br \/>\n \u00a0Turkey<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nProfessional<br \/>\n \u00a0Responsibility<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0S-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nProfessionally-\u00ad\u2010led<br \/>\n \u00a0Regulation<br \/>\n \u00a0(Madrid)<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nProfessor<br \/>\n \u00a0Cyril<br \/>\n \u00a0Karabus<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nProfessor<br \/>\n \u00a0Cyril<br \/>\n \u00a0Karabus<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nProhibition<br \/>\n \u00a0of<br \/>\n \u00a0Chemical<br \/>\n \u00a0Weapons<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nProtection<br \/>\n \u00a0and<br \/>\n \u00a0integrity<br \/>\n \u00a0of<br \/>\n \u00a0Medical<br \/>\n \u00a0Personnel<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nPublic<br \/>\n \u00a0Health<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0-\u00ad\u201004-\u00ad\u20102006<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n[Q]<br \/>\n \u00a0<br \/>\nQuality<br \/>\n \u00a0Improvement<br \/>\n \u00a0in<br \/>\n \u00a0Health<br \/>\n \u00a0Care<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0D-\u00ad\u201001-\u00ad\u20102009<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n[R]<br \/>\n \u00a0<br \/>\nRefugees&#8217;<br \/>\n \u00a0Medical<br \/>\n \u00a0Care<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0-\u00ad\u201002-\u00ad\u20102010<br \/>\n \u00a0<br \/>\nRefusing<br \/>\n \u00a0Torture<br \/>\n \u00a0(Hamburg)<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0-\u00ad\u201002-\u00ad\u20102007<br \/>\n \u00a0<br \/>\nRight<br \/>\n \u00a0of<br \/>\n \u00a0Woman<br \/>\n \u00a0on<br \/>\n \u00a0Family<br \/>\n \u00a0Planning<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0S-\u00ad\u201004-\u00ad\u20102007<br \/>\n \u00a0<br \/>\nRights<br \/>\n \u00a0of<br \/>\n \u00a0Patients<br \/>\n \u00a0and<br \/>\n \u00a0Physicians<br \/>\n \u00a0in<br \/>\n \u00a0Iran<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0-\u00ad\u201002-\u00ad\u20102009<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n[S]<br \/>\n \u00a0<br \/>\nSafe<br \/>\n \u00a0Injections<br \/>\n \u00a0in<br \/>\n \u00a0Health<br \/>\n \u00a0Care<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0S-\u00ad\u201001-\u00ad\u20102002<br \/>\n \u00a0<br \/>\nSARS<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a003-\u00ad\u201004-\u00ad\u20102003<br \/>\n \u00a0<br \/>\nSelf-\u00ad\u2010Medication<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0-\u00ad\u201002-\u00ad\u20102002<br \/>\n \u00a0<br \/>\nSeoul<br \/>\n \u00a0(Professional<br \/>\n \u00a0Autonomy<br \/>\n \u00a0and<br \/>\n \u00a0Clinical<br \/>\n \u00a0Independence)<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nSocial<br \/>\n \u00a0Determinants<br \/>\n \u00a0of<br \/>\n \u00a0Health<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nSocial<br \/>\n \u00a0Media<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nSolitary<br \/>\n \u00a0Confinemnet<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nSports<br \/>\n \u00a0Medicine<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0-\u00ad\u201002-\u00ad\u20101999<br \/>\n \u00a0<br \/>\nStandardisation<br \/>\n \u00a0in<br \/>\n \u00a0Medical<br \/>\n \u00a0Practice<br \/>\n \u00a0and<br \/>\n \u00a0Patient<br \/>\n \u00a0Safety<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nStandardisation<br \/>\n \u00a0in<br \/>\n \u00a0Medical<br \/>\n \u00a0Practice<br \/>\n \u00a0and<br \/>\n \u00a0Patient<br \/>\n \u00a0Safety<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nSuicide<br \/>\n \u00a0Physician-\u00ad\u2010Assisted<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a092-\u00ad\u201006-\u00ad\u20102005<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nOrder<br \/>\n \u00a0by<br \/>\n \u00a0Short<br \/>\n \u00a0Title<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nSupport<br \/>\n \u00a0of<br \/>\n \u00a0the<br \/>\n \u00a0AMB<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nSydney<br \/>\n \u00a0(Determination<br \/>\n \u00a0of<br \/>\n \u00a0Death)<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n[T]<br \/>\n \u00a0<br \/>\nTaiwan&#8217;s<br \/>\n \u00a0Observer<br \/>\n \u00a0Status<br \/>\n \u00a0to<br \/>\n \u00a0the<br \/>\n \u00a0WHO<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0-\u00ad\u201004-\u00ad\u20102005<br \/>\n \u00a0<br \/>\nTask<br \/>\n \u00a0Shifting<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0-\u00ad\u201003-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nTelehealth<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0S-\u00ad\u201004-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nTelemedicine<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0-\u00ad\u201002-\u00ad\u20102007<br \/>\n \u00a0<br \/>\nTerminal<br \/>\n \u00a0Illness<br \/>\n \u00a0(Venice)<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nTherapeutic<br \/>\n \u00a0Abortion<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nTobacco<br \/>\n \u00a0Products<br \/>\n \u00a0Health<br \/>\n \u00a0Hazards<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0-\u00ad\u201005-\u00ad\u20102007<br \/>\n \u00a0<br \/>\nTobacco-\u00ad\u2010WHO<br \/>\n \u00a0FCTC<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0-\u00ad\u201005-\u00ad\u20102005<br \/>\n \u00a0<br \/>\nTokyo<br \/>\n \u00a0(Detention<br \/>\n \u00a0and<br \/>\n \u00a0Imprisonment)<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nTorture<br \/>\n \u00a0-\u00ad\u2010<br \/>\n \u00a0Prohibition<br \/>\n \u00a0of<br \/>\n \u00a0Physician<br \/>\n \u00a0Participation<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a09-\u00ad\u201002-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nTrade<br \/>\n \u00a0Agreements<br \/>\n \u00a0and<br \/>\n \u00a0Public<br \/>\n \u00a0Health<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nTraffic<br \/>\n \u00a0Injury<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0-\u00ad\u201004-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nTuberculosis<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a005-\u00ad\u20102006<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n[U]<br \/>\n \u00a0<br \/>\nUN<br \/>\n \u00a0Rapporteur<br \/>\n \u00a0on<br \/>\n \u00a0the<br \/>\n \u00a0Independence<br \/>\n \u00a0and<br \/>\n \u00a0Integrity<br \/>\n \u00a0of<br \/>\n \u00a0Health<br \/>\n \u00a0Professionals<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0-\u00ad\u20102007<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n[V]<br \/>\n \u00a0<br \/>\nVenice<br \/>\n \u00a0(Terminal<br \/>\n \u00a0Illness)<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nVeterinary<br \/>\n \u00a0Medicine<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a003-\u00ad\u20102008<br \/>\n \u00a0<br \/>\nVictims<br \/>\n \u00a0of<br \/>\n \u00a0Torture<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nViolence<br \/>\n \u00a0against<br \/>\n \u00a0Women<br \/>\n \u00a0and<br \/>\n \u00a0Girls<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0-\u00ad\u20102010<br \/>\n \u00a0<br \/>\nViolence<br \/>\n \u00a0and<br \/>\n \u00a0Health<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0-\u00ad\u201004-\u00ad\u20102003<br \/>\n \u00a0<br \/>\nViolence<br \/>\n \u00a0and<br \/>\n \u00a0Health<br \/>\n \u00a0Sector<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n[W]<br \/>\n \u00a0<br \/>\nWashington<br \/>\n \u00a0(Biological<br \/>\n \u00a0Weapons)<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWater<br \/>\n \u00a0and<br \/>\n \u00a0Health<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0S03-\u00ad\u20102004<br \/>\n \u00a0<br \/>\nWeapons<br \/>\n \u00a0of<br \/>\n \u00a0Warfare<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0S-\u00ad\u201005-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nWFME<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;<br \/>\n \u00a0R-\u00ad\u201001-\u00ad\u20102004<br \/>\n \u00a0<br \/>\nWomen<br \/>\n \u00a0and<br \/>\n \u00a0Children<br \/>\n \u00a0to<br \/>\n \u00a0Health<br \/>\n \u00a0Care<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..<br \/>\n \u00a0-\u00ad\u20102008<br \/>\n \u00a0<br \/>\nWomen&#8217;s<br \/>\n \u00a0Right<br \/>\n \u00a0to<br \/>\n \u00a0Health<br \/>\n \u00a0Care<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102013-\u00ad\u201005-\u00ad\u20102013<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101968-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nCR-\u00ad\u20102005-\u00ad\u201004-\u00ad\u20102005<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102009-\u00ad\u201003-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102009-\u00ad\u201004-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102007-\u00ad\u201002-\u00ad\u20102007<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101983-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101970-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101988-\u00ad\u201005-\u00ad\u20102011<br \/>\n \u00a0<br \/>\nCR-\u00ad\u20102005-\u00ad\u201005-\u00ad\u20102005<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101975-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nCR-\u00ad\u20102009-\u00ad\u201002-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nCR-\u00ad\u20102015-\u00ad\u201001-\u00ad\u20102015<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101990-\u00ad\u201004-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102006-\u00ad\u201005-\u00ad\u20102006<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nS-\u00ad\u20101997-\u00ad\u201001-\u00ad\u20101997<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nD-\u00ad\u20101983-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102008-\u00ad\u201003-\u00ad\u20102008<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102013-\u00ad\u201004-\u00ad\u20102013<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102010-\u00ad\u201002-\u00ad\u20102010<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102003-\u00ad\u201004-\u00ad\u20102008<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102012-\u00ad\u201006-\u00ad\u20102012<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0D-\u00ad\u20102002-\u00ad\u201001-\u00ad\u20102003<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n \u00a0S-\u00ad\u20102004-\u00ad\u201003-\u00ad\u20102014<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101996-\u00ad\u201005-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102004-\u00ad\u201001-\u00ad\u20102014<br \/>\n \u00a0<br \/>\nR-\u00ad\u20101997-\u00ad\u201003-\u00ad\u20102008<br \/>\n \u00a0<br \/>\nR-\u00ad\u20102002-\u00ad\u201006-\u00ad\u20102013<br \/>\n \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101948-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0DECLARATION<br \/>\n \u00a0OF<br \/>\n \u00a0GENEVA<br \/>\n \u00a0<br \/>\nAdopted by the 2nd<br \/>\nGeneral Assembly of the World Medical Association,<br \/>\nGeneva, Switzerland, September 1948<br \/>\nand amended by the 22nd<br \/>\nWorld Medical Assembly, Sydney, Australia, August 1968<br \/>\nand the 35th<br \/>\nWorld Medical Assembly, Venice, Italy, October 1983<br \/>\nand the 46th<br \/>\nWMA General Assembly, Stockholm, Sweden, September 1994<br \/>\nand editorially revised by the 170th<br \/>\nWMA Council Session,<br \/>\nDivonne-les-Bains, France, May 2005<br \/>\nand the 173rd<br \/>\nWMA Council Session, Divonne-les-Bains, France, May 2006<br \/>\nAT THE TIME OF BEING ADMITTED AS A MEMBER OF THE MEDICAL PROFESSION:<br \/>\nI SOLEMNLY PLEDGE to consecrate my life to the service of humanity;<br \/>\nI WILL GIVE to my teachers the respect and gratitude that is their due;<br \/>\nI WILL PRACTISE my profession with conscience and dignity;<br \/>\nTHE HEALTH OF MY PATIENT will be my first consideration;<br \/>\nI WILL RESPECT the secrets that are confided in me, even after the patient has died;<br \/>\nI WILL MAINTAIN by all the means in my power, the honour and the noble traditions of<br \/>\nthe medical profession;<br \/>\nMY COLLEAGUES will be my sisters and brothers;<br \/>\nI WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin,<br \/>\ngender, nationality, political affiliation, race, sexual orientation, social standing or any<br \/>\nother factor to intervene between my duty and my patient;<br \/>\nI WILL MAINTAIN the utmost respect for human life;<br \/>\nI WILL NOT USE my medical knowledge to violate human rights and civil liberties, even<br \/>\nunder threat;<br \/>\nI MAKE THESE PROMISES solemnly, freely and upon my honour.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0D-\u00ad\u20101949-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0INTERNATIONAL<br \/>\n \u00a0CODE<br \/>\n \u00a0OF<br \/>\n \u00a0MEDICAL<br \/>\n \u00a0ETHICS<br \/>\n \u00a0<br \/>\nAdopted by the 3rd<br \/>\nGeneral Assembly of the World Medical Association,<br \/>\nLondon, England, October 1949<br \/>\nand amended by the 22nd<br \/>\nWorld Medical Assembly, Sydney, Australia, August 1968<br \/>\nand the 35th<br \/>\nWorld Medical Assembly, Venice, Italy, October 1983<br \/>\nand the 57th<br \/>\nWMA General Assembly, Pilanesberg, South Africa, October 2006<br \/>\nDUTIES<br \/>\n \u00a0OF<br \/>\n \u00a0PHYSICIANS<br \/>\n \u00a0IN<br \/>\n \u00a0GENERAL<br \/>\n \u00a0<br \/>\nA PHYSICIAN SHALL always exercise his\/her independent professional judgment and<br \/>\nmaintain the highest standards of professional conduct.<br \/>\nA PHYSICIAN SHALL respect a competent patient&#8217;s right to accept or refuse treatment.<br \/>\nA PHYSICIAN SHALL not allow his\/her judgment to be influenced by personal profit or<br \/>\nunfair discrimination.<br \/>\nA PHYSICIAN SHALL be dedicated to providing competent medical service in full pro-<br \/>\nfessional and moral independence, with compassion and respect for human dignity.<br \/>\nA PHYSICIAN SHALL deal honestly with patients and colleagues, and report to the<br \/>\nappropriate authorities those physicians who practice unethically or incompetently or who<br \/>\nengage in fraud or deception.<br \/>\nA PHYSICIAN SHALL not receive any financial benefits or other incentives solely for<br \/>\nreferring patients or prescribing specific products.<br \/>\nA PHYSICIAN SHALL respect the rights and preferences of patients, colleagues, and<br \/>\nother health professionals.<br \/>\nA PHYSICIAN SHALL recognize his\/her important role in educating the public but<br \/>\nshould use due caution in divulging discoveries or new techniques or treatment through<br \/>\nnon-professional channels.<br \/>\nA PHYSICIAN SHALL certify only that which he\/she has personally verified.<br \/>\nA PHYSICIAN SHALL strive to use health care resources in the best way to benefit<br \/>\npatients and their community.<br \/>\nA PHYSICIAN SHALL seek appropriate care and attention if he\/she suffers from mental<br \/>\nor physical illness.<br \/>\nA PHYSICIAN SHALL respect the local and national codes of ethics.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0D-\u00ad\u20101949-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Pilanesberg<br \/>\n \u00a0<br \/>\nMedical<br \/>\n \u00a0Ethics<br \/>\n \u00a0<br \/>\nDUTIES<br \/>\n \u00a0OF<br \/>\n \u00a0PHYSICIANS<br \/>\n \u00a0TO<br \/>\n \u00a0PATIENTS<br \/>\n \u00a0<br \/>\nA PHYSICIAN SHALL always bear in mind the obligation to respect human life.<br \/>\nA PHYSICIAN SHALL act in the patient&#8217;s best interest when providing medical care.<br \/>\nA PHYSICIAN SHALL owe his\/her patients complete loyalty and all the scientific re-<br \/>\nsources available to him\/her. Whenever an examination or treatment is beyond the physi-<br \/>\ncian&#8217;s capacity, he\/she should consult with or refer to another physician who has the neces-<br \/>\nsary ability.<br \/>\nA PHYSICIAN SHALL respect a patient&#8217;s right to confidentiality. It is ethical to disclose<br \/>\nconfidential information when the patient consents to it or when there is a real and im-<br \/>\nminent threat of harm to the patient or to others and this threat can be only removed by a<br \/>\nbreach of confidentiality.<br \/>\nA PHYSICIAN SHALL give emergency care as a humanitarian duty unless he\/she is<br \/>\nassured that others are willing and able to give such care.<br \/>\nA PHYSICIAN SHALL in situations when he\/she is acting for a third party, ensure that<br \/>\nthe patient has full knowledge of that situation.<br \/>\nA PHYSICIAN SHALL not enter into a sexual relationship with his\/her current patient or<br \/>\ninto any other abusive or exploitative relationship.<br \/>\nDUTIES<br \/>\n \u00a0OF<br \/>\n \u00a0PHYSICIANS<br \/>\n \u00a0TO<br \/>\n \u00a0COLLEAGUES<br \/>\n \u00a0<br \/>\nA PHYSICIAN SHALL behave towards colleagues as he\/she would have them behave<br \/>\ntowards him\/her.<br \/>\nA PHYSICIAN SHALL NOT undermine the patient-physician relationship of colleagues<br \/>\nin order to attract patients.<br \/>\nA PHYSICIAN SHALL when medically necessary, communicate with colleagues who are<br \/>\ninvolved in the care of the same patient. This communication should respect patient confi-<br \/>\ndentiality and be confined to necessary information.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0D-\u00ad\u20101964-\u00ad\u201001-\u00ad\u20102013<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0DECLARATION<br \/>\n \u00a0OF<br \/>\n \u00a0HELSINKI<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n-\u00ad\u2010<br \/>\n \u00a0ETHICAL<br \/>\n \u00a0PRINCIPLES<br \/>\n \u00a0FOR<br \/>\n \u00a0MEDICAL<br \/>\n \u00a0RESEARCH<br \/>\n \u00a0INVOLVING<br \/>\n \u00a0HUMAN<br \/>\n \u00a0SUBJECTS<br \/>\n \u00a0-\u00ad\u2010<br \/>\n \u00a0<br \/>\nAdopted by the 18th<br \/>\nWMA General Assembly, Helsinki, Finland, June 1964<br \/>\nand amended by the:<br \/>\n29th<br \/>\nWMA General Assembly, Tokyo, Japan, October 1975<br \/>\n35th<br \/>\nWMA General Assembly, Venice, Italy, October 1983<br \/>\n41st<br \/>\nWMA General Assembly, Hong Kong, September 1989<br \/>\n48th<br \/>\nWMA General Assembly, Somerset West, Republic of South Africa, October 1996<br \/>\n52nd<br \/>\nWMA General Assembly, Edinburgh, Scotland, October 2000<br \/>\n53rd<br \/>\nWMA General Assembly, Washington DC, USA, October 2002<br \/>\n(Note of Clarification added)<br \/>\n55th<br \/>\nWMA General Assembly, Tokyo, Japan, October 2004<br \/>\n(Note of Clarification added)<br \/>\n59th<br \/>\nWMA General Assembly, Seoul, Republic of Korea, October 2008<br \/>\n64th<br \/>\nWMA General Assembly, Fortaleza, Brazil, October 2013<br \/>\nPREAMBLE<br \/>\n \u00a0<br \/>\n1. The World Medical Association (WMA) has developed the Declaration of Helsinki as<br \/>\na statement of ethical principles for medical research involving human subjects,<br \/>\nincluding research on identifiable human material and data.<br \/>\nThe Declaration is intended to be read as a whole and each of its constituent para-<br \/>\ngraphs should be applied with consideration of all other relevant paragraphs.<br \/>\n2. Consistent with the mandate of the WMA, the Declaration is addressed primarily to<br \/>\nphysicians. The WMA encourages others who are involved in medical research in-<br \/>\nvolving human subjects to adopt these principles.<br \/>\nGENERAL<br \/>\n \u00a0PRINCIPLES<br \/>\n \u00a0<br \/>\n3. The Declaration of Geneva of the WMA binds the physician with the words, \u201cThe<br \/>\nhealth of my patient will be my first consideration,\u201d and the International Code of<br \/>\nMedical Ethics declares that, \u201cA physician shall act in the patient&#8217;s best interest when<br \/>\nproviding medical care.\u201d<br \/>\n4. It is the duty of the physician to promote and safeguard the health, well-being and<br \/>\nrights of patients, including those who are involved in medical research. The physi-<br \/>\ncian&#8217;s knowledge and conscience are dedicated to the fulfilment of this duty.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0D-\u00ad\u20101964-\u00ad\u201001-\u00ad\u20102013<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Fortaleza<br \/>\n \u00a0<br \/>\nMedical<br \/>\n \u00a0Rsearch<br \/>\n \u00a0involving<br \/>\n \u00a0Human<br \/>\n \u00a0Subjects<br \/>\n \u00a0(Helsinki)<br \/>\n \u00a0<br \/>\n5. Medical progress is based on research that ultimately must include studies involving<br \/>\nhuman subjects.<br \/>\n6. The primary purpose of medical research involving human subjects is to understand<br \/>\nthe causes, development and effects of diseases and improve preventive, diagnostic<br \/>\nand therapeutic interventions (methods, procedures and treatments). Even the best<br \/>\nproven interventions must be evaluated continually through research for their safety,<br \/>\neffectiveness, efficiency, accessibility and quality.<br \/>\n7. Medical research is subject to ethical standards that promote and ensure respect for all<br \/>\nhuman subjects and protect their health and rights.<br \/>\n8. While the primary purpose of medical research is to generate new knowledge, this<br \/>\ngoal can never take precedence over the rights and interests of individual research<br \/>\nsubjects.<br \/>\n9. It is the duty of physicians who are involved in medical research to protect the life,<br \/>\nhealth, dignity, integrity, right to self-determination, privacy, and confidentiality of<br \/>\npersonal information of research subjects. The responsibility for the protection of<br \/>\nresearch subjects must always rest with the physician or other health care pro-<br \/>\nfessionals and never with the research subjects, even though they have given consent.<br \/>\n10. Physicians must consider the ethical, legal and regulatory norms and standards for<br \/>\nresearch involving human subjects in their own countries as well as applicable<br \/>\ninternational norms and standards. No national or international ethical, legal or<br \/>\nregulatory requirement should reduce or eliminate any of the protections for research<br \/>\nsubjects set forth in this Declaration.<br \/>\n11. Medical research should be conducted in a manner that minimises possible harm to<br \/>\nthe environment.<br \/>\n12. Medical research involving human subjects must be conducted only by individuals<br \/>\nwith the appropriate ethics and scientific education, training and qualifications. Re-<br \/>\nsearch on patients or healthy volunteers requires the supervision of a competent and<br \/>\nappropriately qualified physician or other health care professional.<br \/>\n13. Groups that are underrepresented in medical research should be provided appropriate<br \/>\naccess to participation in research.<br \/>\n14. Physicians who combine medical research with medical care should involve their<br \/>\npatients in research only to the extent that this is justified by its potential preventive,<br \/>\ndiagnostic or therapeutic value and if the physician has good reason to believe that<br \/>\nparticipation in the research study will not adversely affect the health of the patients<br \/>\nwho serve as research subjects.<br \/>\n15. Appropriate compensation and treatment for subjects who are harmed as a result of<br \/>\nparticipating in research must be ensured.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0D-\u00ad\u20101964-\u00ad\u201001-\u00ad\u20102013<br \/>\n \u00a0<br \/>\nRISKS,<br \/>\n \u00a0BURDENS<br \/>\n \u00a0AND<br \/>\n \u00a0BENEFITS<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n \u00a0<br \/>\n16. In medical practice and in medical research, most interventions involve risks and<br \/>\nburdens.<br \/>\nMedical research involving human subjects may only be conducted if the importance<br \/>\nof the objective outweighs the risks and burdens to the research subjects.<br \/>\n17. All medical research involving human subjects must be preceded by careful assess-<br \/>\nment of predictable risks and burdens to the individuals and groups involved in the<br \/>\nresearch in comparison with foreseeable benefits to them and to other individuals or<br \/>\ngroups affected by the condition under investigation.<br \/>\nMeasures to minimise the risks must be implemented. The risks must be continuously<br \/>\nmonitored, assessed and documented by the researcher.<br \/>\n18. Physicians may not be involved in a research study involving human subjects unless<br \/>\nthey are confident that the risks have been adequately assessed and can be satis-<br \/>\nfactorily managed.<br \/>\nWhen the risks are found to outweigh the potential benefits or when there is con-<br \/>\nclusive proof of definitive outcomes, physicians must assess whether to continue,<br \/>\nmodify or immediately stop the study.<br \/>\nVULNERABLE<br \/>\n \u00a0GROUPS<br \/>\n \u00a0AND<br \/>\n \u00a0INDIVIDUALS<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n19. Some groups and individuals are particularly vulnerable and may have an increased<br \/>\nlikelihood of being wronged or of incurring additional harm.<br \/>\nAll vulnerable groups and individuals should receive specifically considered protec-<br \/>\ntion.<br \/>\n20. Medical research with a vulnerable group is only justified if the research is responsive<br \/>\nto the health needs or priorities of this group and the research cannot be carried out in<br \/>\na non-vulnerable group. In addition, this group should stand to benefit from the<br \/>\nknowledge, practices or interventions that result from the research.<br \/>\nSCIENTIFIC<br \/>\n \u00a0REQUIREMENTS<br \/>\n \u00a0AND<br \/>\n \u00a0RESEARCH<br \/>\n \u00a0PROTOCOLS<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n21. Medical research involving human subjects must conform to generally accepted<br \/>\nscientific principles, be based on a thorough knowledge of the scientific literature,<br \/>\nother relevant sources of information, and adequate laboratory and, as appropriate,<br \/>\nanimal experimentation. The welfare of animals used for research must be respected.<br \/>\n22. The design and performance of each research study involving human subjects must be<br \/>\nclearly described and justified in a research protocol.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0D-\u00ad\u20101964-\u00ad\u201001-\u00ad\u20102013<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Fortaleza<br \/>\n \u00a0<br \/>\nMedical<br \/>\n \u00a0Rsearch<br \/>\n \u00a0involving<br \/>\n \u00a0Human<br \/>\n \u00a0Subjects<br \/>\n \u00a0(Helsinki)<br \/>\n \u00a0<br \/>\nThe protocol should contain a statement of the ethical considerations involved and<br \/>\nshould indicate how the principles in this Declaration have been addressed. The pro-<br \/>\ntocol should include information regarding funding, sponsors, institutional affilia-<br \/>\ntions, potential conflicts of interest, incentives for subjects and information regarding<br \/>\nprovisions for treating and\/or compensating subjects who are harmed as a conse-<br \/>\nquence of participation in the research study.<br \/>\nIn clinical trials, the protocol must also describe appropriate arrangements for post-<br \/>\ntrial provisions.<br \/>\nRESEARCH<br \/>\n \u00a0ETHICS<br \/>\n \u00a0COMMITTEES<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n23. The research protocol must be submitted for consideration, comment, guidance and<br \/>\napproval to the concerned research ethics committee before the study begins. This<br \/>\ncommittee must be transparent in its functioning, must be independent of the<br \/>\nresearcher, the sponsor and any other undue influence and must be duly qualified. It<br \/>\nmust take into consideration the laws and regulations of the country or countries in<br \/>\nwhich the research is to be performed as well as applicable international norms and<br \/>\nstandards but these must not be allowed to reduce or eliminate any of the protections<br \/>\nfor research subjects set forth in this Declaration.<br \/>\nThe committee must have the right to monitor ongoing studies. The researcher must<br \/>\nprovide monitoring information to the committee, especially information about any<br \/>\nserious adverse events. No amendment to the protocol may be made without con-<br \/>\nsideration and approval by the committee. After the end of the study, the researchers<br \/>\nmust submit a final report to the committee containing a summary of the study\u2019s find-<br \/>\nings and conclusions.<br \/>\nPRIVACY<br \/>\n \u00a0AND<br \/>\n \u00a0CONFIDENTIALITY<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n24. Every precaution must be taken to protect the privacy of research subjects and the<br \/>\nconfidentiality of their personal information.<br \/>\nINFORMED<br \/>\n \u00a0CONSENT<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n25. Participation by individuals capable of giving informed consent as subjects in medical<br \/>\nresearch must be voluntary. Although it may be appropriate to consult family mem-<br \/>\nbers or community leaders, no individual capable of giving informed consent may be<br \/>\nenrolled in a research study unless he or she freely agrees.<br \/>\n26. In medical research involving human subjects capable of giving informed consent,<br \/>\neach potential subject must be adequately informed of the aims, methods, sources of<br \/>\nfunding, any possible conflicts of interest, institutional affiliations of the researcher,<br \/>\nthe anticipated benefits and potential risks of the study and the discomfort it may<br \/>\nentail, post-study provisions and any other relevant aspects of the study. The potential<br \/>\nsubject must be informed of the right to refuse to participate in the study or to with-<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0D-\u00ad\u20101964-\u00ad\u201001-\u00ad\u20102013<br \/>\n \u00a0<br \/>\ndraw consent to participate at any time without reprisal. Special attention should be<br \/>\ngiven to the specific information needs of individual potential subjects as well as to<br \/>\nthe methods used to deliver the information.<br \/>\nAfter ensuring that the potential subject has understood the information, the physician<br \/>\nor another appropriately qualified individual must then seek the potential subject\u2019s<br \/>\nfreely-given informed consent, preferably in writing. If the consent cannot be expressed<br \/>\nin writing, the non-written consent must be formally documented and witnessed.<br \/>\nAll medical research subjects should be given the option of being informed about the<br \/>\ngeneral outcome and results of the study.<br \/>\n27. When seeking informed consent for participation in a research study the physician<br \/>\nmust be particularly cautious if the potential subject is in a dependent relationship<br \/>\nwith the physician or may consent under duress. In such situations the informed<br \/>\nconsent must be sought by an appropriately qualified individual who is completely<br \/>\nindependent of this relationship.<br \/>\n28. For a potential research subject who is incapable of giving informed consent, the<br \/>\nphysician must seek informed consent from the legally authorised representative.<br \/>\nThese individuals must not be included in a research study that has no likelihood of<br \/>\nbenefit for them unless it is intended to promote the health of the group represented<br \/>\nby the potential subject, the research cannot instead be performed with persons<br \/>\ncapable of providing informed consent, and the research entails only minimal risk and<br \/>\nminimal burden.<br \/>\n29. When a potential research subject who is deemed incapable of giving informed con-<br \/>\nsent is able to give assent to decisions about participation in research, the physician<br \/>\nmust seek that assent in addition to the consent of the legally authorised representa-<br \/>\ntive. The potential subject\u2019s dissent should be respected.<br \/>\n30. Research involving subjects who are physically or mentally incapable of giving con-<br \/>\nsent, for example, unconscious patients, may be done only if the physical or mental<br \/>\ncondition that prevents giving informed consent is a necessary characteristic of the<br \/>\nresearch group. In such circumstances the physician must seek informed consent<br \/>\nfrom the legally authorised representative. If no such representative is available and if<br \/>\nthe research cannot be delayed, the study may proceed without informed consent<br \/>\nprovided that the specific reasons for involving subjects with a condition that renders<br \/>\nthem unable to give informed consent have been stated in the research protocol and<br \/>\nthe study has been approved by a research ethics committee. Consent to remain in the<br \/>\nresearch must be obtained as soon as possible from the subject or a legally authorised<br \/>\nrepresentative.<br \/>\n31. The physician must fully inform the patient which aspects of their care are related to<br \/>\nthe research. The refusal of a patient to participate in a study or the patient\u2019s decision<br \/>\nto withdraw from the study must never adversely affect the patient-physician<br \/>\nrelationship.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0D-\u00ad\u20101964-\u00ad\u201001-\u00ad\u20102013<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Fortaleza<br \/>\n \u00a0<br \/>\nMedical<br \/>\n \u00a0Rsearch<br \/>\n \u00a0involving<br \/>\n \u00a0Human<br \/>\n \u00a0Subjects<br \/>\n \u00a0(Helsinki)<br \/>\n \u00a0<br \/>\n32. For medical research using identifiable human material or data, such as research on<br \/>\nmaterial or data contained in biobanks or similar repositories, physicians must seek<br \/>\ninformed consent for its collection, storage and\/or reuse. There may be exceptional<br \/>\nsituations where consent would be impossible or impracticable to obtain for such<br \/>\nresearch. In such situations the research may be done only after consideration and<br \/>\napproval of a research ethics committee.<br \/>\nUSE<br \/>\n \u00a0OF<br \/>\n \u00a0PLACEBO<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n33. The benefits, risks, burdens and effectiveness of a new intervention must be tested<br \/>\nagainst those of the best proven intervention(s), except in the following circums-<br \/>\ntances:<br \/>\nWhere no proven intervention exists, the use of placebo, or no intervention, is accept-<br \/>\nable; or<br \/>\nWhere for compelling and scientifically sound methodological reasons the use of any<br \/>\nintervention less effective than the best proven one, the use of placebo, or no inter-<br \/>\nvention is necessary to determine the efficacy or safety of an intervention<br \/>\nand the patients who receive any intervention less effective than the best proven one,<br \/>\nplacebo, or no intervention will not be subject to additional risks of serious or<br \/>\nirreversible harm as a result of not receiving the best proven intervention.<br \/>\nExtreme care must be taken to avoid abuse of this option.<br \/>\nPOST-\u00ad\u2010TRIAL<br \/>\n \u00a0PROVISIONS<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n34. In advance of a clinical trial, sponsors, researchers and host country governments<br \/>\nshould make provisions for post-trial access for all participants who still need an<br \/>\nintervention identified as beneficial in the trial. This information must also be dis-<br \/>\nclosed to participants during the informed consent process.<br \/>\nRESEARCH<br \/>\n \u00a0REGISTRATION<br \/>\n \u00a0AND<br \/>\n \u00a0PUBLICATION<br \/>\n \u00a0AND<br \/>\n \u00a0DISSEMINATION<br \/>\n \u00a0OF<br \/>\n \u00a0RESULTS<br \/>\n \u00a0<br \/>\n35. Every research study involving human subjects must be registered in a publicly<br \/>\naccessible database before recruitment of the first subject.<br \/>\n36. Researchers, authors, sponsors, editors and publishers all have ethical obligations with<br \/>\nregard to the publication and dissemination of the results of research. Researchers<br \/>\nhave a duty to make publicly available the results of their research on human subjects<br \/>\nand are accountable for the completeness and accuracy of their reports. All parties<br \/>\nshould adhere to accepted guidelines for ethical reporting. Negative and inconclusive<br \/>\nas well as positive results must be published or otherwise made publicly available.<br \/>\nSources of funding, institutional affiliations and conflicts of interest must be declared<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0D-\u00ad\u20101964-\u00ad\u201001-\u00ad\u20102013<br \/>\n \u00a0<br \/>\nin the publication. Reports of research not in accordance with the principles of this<br \/>\nDeclaration should not be accepted for publication.<br \/>\nUNPROVEN<br \/>\n \u00a0INTERVENTIONS<br \/>\n \u00a0IN<br \/>\n \u00a0CLINICAL<br \/>\n \u00a0PRACTICE<br \/>\n \u00a0<br \/>\n37. In the treatment of an individual patient, where proven interventions do not exist or<br \/>\nother known interventions have been ineffective, the physician, after seeking expert<br \/>\nadvice, with informed consent from the patient or a legally authorised representative,<br \/>\nmay use an unproven intervention if in the physician&#8217;s judgement it offers hope of<br \/>\nsaving life, re-establishing health or alleviating suffering. This intervention should<br \/>\nsubsequently be made the object of research, designed to evaluate its safety and effi-<br \/>\ncacy. In all cases, new information must be recorded and, where appropriate, made<br \/>\npublicly available.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101968-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0DECLARATION<br \/>\n \u00a0OF<br \/>\n \u00a0SYDNEY<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nTHE<br \/>\n \u00a0DETERMINATION<br \/>\n \u00a0OF<br \/>\n \u00a0DEATH<br \/>\n \u00a0AND<br \/>\n \u00a0THE<br \/>\n \u00a0RECOVERY<br \/>\n \u00a0OF<br \/>\n \u00a0ORGANS<br \/>\n \u00a0<br \/>\nAdopted by the 22nd<br \/>\nWorld Medical Assembly, Sydney, Australia, August 1968<br \/>\nand amended by the 35th<br \/>\nWorld Medical Assembly, Venice, Italy, October 1983<br \/>\nand the 57th<br \/>\nWMA General Assembly, Pilanesberg, South Africa, October 2006<br \/>\nDetermination of death can be made on the basis of the irreversible cessation of all func-<br \/>\ntions of the entire brain, including the brain stem, or the irreversible cessation of circula-<br \/>\ntory and respiratory functions. This determination will be based on clinical judgment ac-<br \/>\ncording to accepted criteria supplemented, if necessary, by standard diagnostic proce-<br \/>\ndures and made by a physician.<br \/>\nEven without intervention, cell, organ and tissue activity in the body may continue tempo-<br \/>\nrarily after a determination of death. Cessation of all life at the cellular level is not a nec-<br \/>\nessary criterion for determination of death.<br \/>\nThe use of deceased donor organs for transplantation has made it important for physicians<br \/>\nto be able to determine when mechanically-supported patients have died.<br \/>\nAfter death has occurred, it may be possible to maintain circulation to the organs and tis-<br \/>\nsues of the body mechanically. This may be done to preserve organs and tissues for trans-<br \/>\nplantation.<br \/>\nPrior to post-mortem transplantation, the determination that death has occurred shall be<br \/>\nmade by a physician who is in no way immediately involved in the transplantation proce-<br \/>\ndure.<br \/>\nFollowing determination of death, all treatment and resuscitation attempts may be ceased<br \/>\nand donor organs may be recovered, provided that prevailing requirements of consent and<br \/>\nother relevant ethical and legal requirements have been fulfilled.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0D-\u00ad\u20101970-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0DECLARATION<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nTHERAPEUTIC<br \/>\n \u00a0ABORTION<br \/>\n \u00a0<br \/>\nAdopted by the 24th<br \/>\nWorld Medical Assembly, Oslo, Norway, August 1970<br \/>\nand amended by the 35th<br \/>\nWorld Medical Assembly, Venice, Italy, October 1983<br \/>\nand the 57th<br \/>\nWMA General Assembly, Pilanesberg, South Africa, October 2006<br \/>\n1. The WMA requires the physician to maintain respect for human life.<br \/>\n2. Circumstances bringing the interests of a mother into conflict with the interests of her<br \/>\nunborn child create a dilemma and raise the question as to whether or not the preg-<br \/>\nnancy should be deliberately terminated.<br \/>\n3. Diversity of responses to such situations is due in part to the diversity of attitudes<br \/>\ntowards the life of the unborn child. This is a matter of individual conviction and con-<br \/>\nscience that must be respected.<br \/>\n4. It is not the role of the medical profession to determine the attitudes and rules of any<br \/>\nparticular state or community in this matter, but it is our duty to attempt both to en-<br \/>\nsure the protection of our patients and to safeguard the rights of the physician within<br \/>\nsociety.<br \/>\n5. Therefore, where the law allows therapeutic abortion to be performed, the procedure<br \/>\nshould be performed by a physician competent to do so in premises approved by the<br \/>\nappropriate authority.<br \/>\n6. If the physician&#8217;s convictions do not allow him or her to advise or perform an abor-<br \/>\ntion, he or she may withdraw while ensuring the continuity of medical care by a quali-<br \/>\nfied colleague.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101975-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0DECLARATION<br \/>\n \u00a0OF<br \/>\n \u00a0TOKYO<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n-\u00ad\u2010<br \/>\n \u00a0GUIDELINES<br \/>\n \u00a0FOR<br \/>\n \u00a0PHYSICIANS<br \/>\n \u00a0CONCERNING<br \/>\n \u00a0TORTURE<br \/>\n \u00a0AND<br \/>\n \u00a0OTHER<br \/>\n \u00a0CRUEL,<br \/>\n \u00a0<br \/>\nINHUMAN<br \/>\n \u00a0OR<br \/>\n \u00a0DEGRADING<br \/>\n \u00a0TREATMENT<br \/>\n \u00a0OR<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nPUNISHMENT<br \/>\n \u00a0IN<br \/>\n \u00a0RELATION<br \/>\n \u00a0TO<br \/>\n \u00a0DETENTION<br \/>\n \u00a0AND<br \/>\n \u00a0IMPRISONMENT<br \/>\n \u00a0-\u00ad\u2010<br \/>\n \u00a0<br \/>\nAdopted by the 29th<br \/>\nWorld Medical Assembly, Tokyo, Japan, October 1975<br \/>\nand editorially revised by the 170th<br \/>\nWMA Council Session, Divonne-les-Bains, France,<br \/>\nMay 2005<br \/>\nand the 173rd<br \/>\nWMA Council Session, Divonne-les-Bains, France, May 2006<br \/>\nPREAMBLE<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nIt is the privilege of the physician to practise medicine in the service of humanity, to<br \/>\npreserve and restore bodily and mental health without distinction as to persons, to comfort<br \/>\nand to ease the suffering of his or her patients. The utmost respect for human life is to be<br \/>\nmaintained even under threat, and no use made of any medical knowledge contrary to the<br \/>\nlaws of humanity.<br \/>\nFor the purpose of this Declaration, torture is defined as the deliberate, systematic or<br \/>\nwanton infliction of physical or mental suffering by one or more persons acting alone or<br \/>\non the orders of any authority, to force another person to yield information, to make a<br \/>\nconfession, or for any other reason.<br \/>\nDECLARATION<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. The physician shall not countenance, condone or participate in the practice of torture<br \/>\nor other forms of cruel, inhuman or degrading procedures, whatever the offense of<br \/>\nwhich the victim of such procedures is suspected, accused or guilty, and whatever the<br \/>\nvictim&#8217;s beliefs or motives, and in all situations, including armed conflict and civil<br \/>\nstrife.<br \/>\n2. The physician shall not provide any premises, instruments, substances or knowledge<br \/>\nto facilitate the practice of torture or other forms of cruel, inhuman or degrading<br \/>\ntreatment or to diminish the ability of the victim to resist such treatment.<br \/>\n3. When providing medical assistance to detainees or prisoners who are, or who could<br \/>\nlater be, under interrogation, physicians should be particularly careful to ensure the<br \/>\nconfidentiality of all personal medical information. A breach of the Geneva Conven-<br \/>\ntions shall in any case be reported by the physician to relevant authorities.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0Divonne-\u00ad\u2010les-\u00ad\u2010Bains<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0D-\u00ad\u20101975-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nDetention<br \/>\n \u00a0and<br \/>\n \u00a0Imprisonment<br \/>\n \u00a0(Tokyo)<br \/>\n \u00a0<br \/>\nThe physician shall not use nor allow to be used, as far as he or she can, medical know-<br \/>\nledge or skills, or health information specific to individuals, to facilitate or otherwise<br \/>\naid any interrogation, legal or illegal, of those individuals.<br \/>\n4. The physician shall not be present during any procedure during which torture or any<br \/>\nother forms of cruel, inhuman or degrading treatment is used or threatened.<br \/>\n5. A physician must have complete clinical independence in deciding upon the care of a<br \/>\nperson for whom he or she is medically responsible. The physician&#8217;s fundamental role<br \/>\nis to alleviate the distress of his or her fellow human beings, and no motive, whether<br \/>\npersonal, collective or political, shall prevail against this higher purpose.<br \/>\n6. Where a prisoner refuses nourishment and is considered by the physician as capable<br \/>\nof forming an unimpaired and rational judgment concerning the consequences of such<br \/>\na voluntary refusal of nourishment, he or she shall not be fed artificially. The decision<br \/>\nas to the capacity of the prisoner to form such a judgment should be confirmed by at<br \/>\nleast one other independent physician. The consequences of the refusal of nourish-<br \/>\nment shall be explained by the physician to the prisoner.<br \/>\n7. The World Medical Association will support, and should encourage the international<br \/>\ncommunity, the National Medical Associations and fellow physicians to support, the<br \/>\nphysician and his or her family in the face of threats or reprisals resulting from a<br \/>\nrefusal to condone the use of torture or other forms of cruel, inhuman or degrading<br \/>\ntreatment.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101981-\u00ad\u201001-\u00ad\u20102015<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0DECLARATION<br \/>\n \u00a0OF<br \/>\n \u00a0LISBON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nTHE<br \/>\n \u00a0RIGHTS<br \/>\n \u00a0OF<br \/>\n \u00a0THE<br \/>\n \u00a0PATIENT<br \/>\n \u00a0<br \/>\nAdopted by the 34th<br \/>\nWorld Medical Assembly, Lisbon, Portugal,<br \/>\nSeptember\/October 1981<br \/>\nand amended by the 47th<br \/>\nWMA General Assembly, Bali, Indonesia, September 1995<br \/>\nand editorially revised by the 171st<br \/>\nWMA Council Session, Santiago, Chile, October 2005<br \/>\nand reaffirmed by the 200th<br \/>\nWMA Council Session, Oslo, Norway, April 2015<br \/>\nPREAMBLE<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nThe relationship between physicians, their patients and broader society has undergone<br \/>\nsignificant changes in recent times. While a physician should always act according to his\/<br \/>\nher conscience, and always in the best interests of the patient, equal effort must be made to<br \/>\nguarantee patient autonomy and justice. The following Declaration represents some of<br \/>\nthe principal rights of the patient that the medical profession endorses and promotes.<br \/>\nPhysicians and other persons or bodies involved in the provision of health care have a joint<br \/>\nresponsibility to recognize and uphold these rights. Whenever legislation, government<br \/>\naction or any other administration or institution denies patients these rights, physicians<br \/>\nshould pursue appropriate means to assure or to restore them.<br \/>\nPRINCIPLES<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. Right to medical care of good quality<br \/>\na. Every person is entitled without discrimination to appropriate medical care.<br \/>\nb. Every patient has the right to be cared for by a physician whom he\/she knows to<br \/>\nbe free to make clinical and ethical judgements without any outside interference.<br \/>\nc. The patient shall always be treated in accordance with his\/her best interests. The<br \/>\ntreatment applied shall be in accordance with generally approved medical princi-<br \/>\nples.<br \/>\nd. Quality assurance should always be a part of health care. Physicians, in parti-<br \/>\ncular, should accept responsibility for being guardians of the quality of medical<br \/>\nservices.<br \/>\ne. In circumstances where a choice must be made between potential patients for a<br \/>\nparticular treatment that is in limited supply, all such patients are entitled to a fair<br \/>\nselection procedure for that treatment. That choice must be based on medical cri-<br \/>\nteria and made without discrimination.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nPatient\u2019s<br \/>\n \u00a0Right<br \/>\n \u00a0(Lisbon)<br \/>\n \u00a0<br \/>\nOslo<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0D-\u00ad\u20101981-\u00ad\u201001-\u00ad\u20102015<br \/>\n \u00a0<br \/>\nf. The patient has the right to continuity of health care. The physician has an obli-<br \/>\ngation to cooperate in the coordination of medically indicated care with other<br \/>\nhealth care providers treating the patient. The physician may not discontinue treat-<br \/>\nment of a patient as long as further treatment is medically indicated, without<br \/>\ngiving the patient reasonable assistance and sufficient opportunity to make alter-<br \/>\nnative arrangements for care.<br \/>\n2. Right to freedom of choice<br \/>\na. The patient has the right to choose freely and change his\/her physician and hospi-<br \/>\ntal or health service institution, regardless of whether they are based in the private<br \/>\nor public sector.<br \/>\nb. The patient has the right to ask for the opinion of another physician at any stage.<br \/>\n3. Right to self-determination<br \/>\na. The patient has the right to self-determination, to make free decisions regarding<br \/>\nhimself\/herself. The physician will inform the patient of the consequences of his\/<br \/>\nher decisions.<br \/>\nb. A mentally competent adult patient has the right to give or withhold consent to<br \/>\nany diagnostic procedure or therapy. The patient has the right to the information<br \/>\nnecessary to make his\/her decisions. The patient should understand clearly what<br \/>\nis the purpose of any test or treatment, what the results would imply, and what<br \/>\nwould be the implications of withholding consent.<br \/>\nc. The patient has the right to refuse to participate in research or the teaching of<br \/>\nmedicine.<br \/>\n4. The unconscious patient<br \/>\na. If the patient is unconscious or otherwise unable to express his\/her will, informed<br \/>\nconsent must be obtained whenever possible, from a legally entitled represen-<br \/>\ntative.<br \/>\nb. If a legally entitled representative is not available, but a medical intervention is<br \/>\nurgently needed, consent of the patient may be presumed, unless it is obvious and<br \/>\nbeyond any doubt on the basis of the patient&#8217;s previous firm expression or con-<br \/>\nviction that he\/she would refuse consent to the intervention in that situation.<br \/>\nc. However, physicians should always try to save the life of a patient unconscious<br \/>\ndue to a suicide attempt.<br \/>\n5. The legally incompetent patient<br \/>\na. If a patient is a minor or otherwise legally incompetent, the consent of a legally<br \/>\nentitled representative is required in some jurisdictions. Nevertheless the patient<br \/>\nmust be involved in the decision-making to the fullest extent allowed by his\/her<br \/>\ncapacity.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101981-\u00ad\u201001-\u00ad\u20102015<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nb. If the legally incompetent patient can make rational decisions, his\/her decisions<br \/>\nmust be respected, and he\/she has the right to forbid the disclosure of information<br \/>\nto his\/her legally entitled representative.<br \/>\nc. If the patient&#8217;s legally entitled representative, or a person authorized by the pa-<br \/>\ntient, forbids treatment which is, in the opinion of the physician, in the patient&#8217;s<br \/>\nbest interest, the physician should challenge this decision in the relevant legal or<br \/>\nother institution. In case of emergency, the physician will act in the patient&#8217;s best<br \/>\ninterest.<br \/>\n6. Procedures against the patient&#8217;s will<br \/>\nDiagnostic procedures or treatment against the patient&#8217;s will can be carried out only in<br \/>\nexceptional cases, if specifically permitted by law and conforming to the principles of<br \/>\nmedical ethics.<br \/>\n7. Right to information<br \/>\na. The patient has the right to receive information about himself\/herself recorded<br \/>\nin any of his\/her medical records, and to be fully informed about his\/her health<br \/>\nstatus including the medical facts about his\/her condition. However, confidential<br \/>\ninformation in the patient&#8217;s records about a third party should not be given to the<br \/>\npatient without the consent of that third party.<br \/>\nb. Exceptionally, information may be withheld from the patient when there is good<br \/>\nreason to believe that this information would create a serious hazard to his\/her<br \/>\nlife or health.<br \/>\nc. Information should be given in a way appropriate to the patient&#8217;s culture and in<br \/>\nsuch a way that the patient can understand.<br \/>\nd. The patient has the right not to be informed on his\/her explicit request, unless<br \/>\nrequired for the protection of another person&#8217;s life.<br \/>\ne. The patient has the right to choose who, if anyone, should be informed on his\/<br \/>\nher behalf.<br \/>\n8. Right to confidentiality<br \/>\na. All identifiable information about a patient&#8217;s health status, medical condition,<br \/>\ndiagnosis, prognosis and treatment and all other information of a personal kind<br \/>\nmust be kept confidential, even after death. Exceptionally, descendants may have<br \/>\na right of access to information that would inform them of their health risks.<br \/>\nb. Confidential information can only be disclosed if the patient gives explicit con-<br \/>\nsent or if expressly provided for in the law. Information can be disclosed to other<br \/>\nhealth care providers only on a strictly \u00abneed to know\u00bb basis unless the patient<br \/>\nhas given explicit consent.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nPatient\u2019s<br \/>\n \u00a0Right<br \/>\n \u00a0(Lisbon)<br \/>\n \u00a0<br \/>\nOslo<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0D-\u00ad\u20101981-\u00ad\u201001-\u00ad\u20102015<br \/>\n \u00a0<br \/>\nc. All identifiable patient data must be protected. The protection of the data must be<br \/>\nappropriate to the manner of its storage. Human substances from which identifi-<br \/>\nable data can be derived must be likewise protected.<br \/>\n9. Right to health education<br \/>\nEvery person has the right to health education that will assist him\/her in making<br \/>\ninformed choices about personal health and about the available health services. The<br \/>\neducation should include information about healthy lifestyles and about methods of<br \/>\nprevention and early detection of illnesses. The personal responsibility of everybody<br \/>\nfor his\/her own health should be stressed. Physicians have an obligation to participate<br \/>\nactively in educational efforts.<br \/>\n10. Right to dignity<br \/>\na. The patient&#8217;s dignity and right to privacy shall be respected at all times in medical<br \/>\ncare and teaching, as shall his\/her culture and values.<br \/>\nb. The patient is entitled to relief of his\/her suffering according to the current state<br \/>\nof knowledge.<br \/>\nc. The patient is entitled to humane terminal care and to be provided with all avail-<br \/>\nable assistance in making dying as dignified and comfortable as possible.<br \/>\n11. Right to religious assistance<br \/>\nThe patient has the right to receive or to decline spiritual and moral comfort including<br \/>\nthe help of a minister of his\/her chosen religion.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101981-\u00ad\u201002-\u00ad\u20102010<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0DECLARATION<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nPRINCIPLES<br \/>\n \u00a0OF<br \/>\n \u00a0HEALTH<br \/>\n \u00a0CARE<br \/>\n \u00a0FOR<br \/>\n \u00a0SPORTS<br \/>\n \u00a0MEDICINE<br \/>\n \u00a0<br \/>\nAdopted by the 34th<br \/>\nWorld Medical Association General Assembly, Lisbon, Portugal,<br \/>\nSeptember\/October 1981<br \/>\nand revised by the 39th<br \/>\nWorld Medical Association General Assembly, Madrid, Spain,<br \/>\nOctober 1987<br \/>\nand the 45th<br \/>\nWorld Medical Association General Assembly, Budapest, Hungary,<br \/>\nOctober 1993<br \/>\nand the 51st<br \/>\nWorld Medical Association General Assembly, Tel Aviv, Israel, October 1999<br \/>\nand reaffirmed by the 185th<br \/>\nWMA Council Session, Evian-les-Bains, France, May 2010<br \/>\nConsidering the involvement of physicians in sports medicine, the WMA recommends the<br \/>\nfollowing ethical guidelines for physicians in order to help meet the needs of athletes, rec-<br \/>\nognizing special circumstances in which their medical care and health guidance is given.<br \/>\nConsequently,<br \/>\n1. The physician who cares for athletes has an ethical responsibility to recognize the<br \/>\nspecial physical and mental demands placed upon them by their performance in sports<br \/>\nactivities.<br \/>\n2. When the sports participant is a child or an adolescent, the physician must give first<br \/>\nconsideration to the participant&#8217;s growth and stage of development.<br \/>\n1. The physician must ensure that the child&#8217;s state of growth and development, as<br \/>\nwell as his or her general condition of health can absorb the rigors of the training<br \/>\nand competition without jeopardizing the normal physical or mental development<br \/>\nof the child or adolescent.<br \/>\n2. The physician must oppose any sports or athletic activity that is not appropriate to<br \/>\nthe child&#8217;s stage of growth and development or general condition of health. The<br \/>\nphysician must act in the best interest of the health of the child or adolescent,<br \/>\nwithout regard to any other interest or pressure from any other source.<br \/>\n3. When the sports participant is a professional athlete and derives livelihood from that<br \/>\nactivity, the physician should pay due regard to the occupational medical aspects<br \/>\ninvolved.<br \/>\n4. The physician should be aware that the use of doping practices1<br \/>\nby a physician is a<br \/>\nviolation of the medical oath and the basic principles of the WMA&#8217;s Declaration of<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nSports<br \/>\n \u00a0Medicine<br \/>\n \u00a0<br \/>\nEvian-\u00ad\u2010les-\u00ad\u2010Bains<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0D-\u00ad\u20101981-\u00ad\u201002-\u00ad\u20102010<br \/>\n \u00a0<br \/>\nGeneva, which states: \u00abMy patient&#8217;s health will always be my first consideration.\u00bb The<br \/>\nWMA considers the problem of doping to be a threat to the health of athletes and<br \/>\nyoung people in general, as well as being in conflict with the principles of medical<br \/>\nethics. The physician must thus oppose and refuse to administer or condone any such<br \/>\nmeans or method which is not in accordance with medical ethics, and\/or which might<br \/>\nbe harmful to the athlete using it, especially:<br \/>\n1. Procedures which artificially modify blood constituents or biochemistry.<br \/>\n2. The use of drugs or other substances whatever their nature and route of adminis-<br \/>\ntration, including central-nervous-system stimulants or depressants and procedures<br \/>\nwhich artificially modify reflexes.<br \/>\n3. Pharmacological interventions that may induce alterations of will or general men-<br \/>\ntal outlook.<br \/>\n4. Procedures to mask pain or other protective symptoms if used to enable the athlete<br \/>\nto take part in events when lesions or signs are present which make his participa-<br \/>\ntion inadvisable.<br \/>\n5. Measures which artificially change features appropriate to age and sex.<br \/>\n6. Training and taking part in events when to do so would not be compatible with<br \/>\npreservation of the individual&#8217;s fitness, health or safety.<br \/>\n7. Measures aimed at an unnatural increase or maintenance of performance during<br \/>\ncompetition. Doping to improve an athlete&#8217;s performance is unethical.<br \/>\n5. The physician should inform the athlete, those responsible for him or her, and other<br \/>\ninterested parties, of the consequences of the procedures the physician is opposing,<br \/>\nguard against their use, enlist the support of other physicians and other organizations<br \/>\nwith the same aim, protect the athlete against any pressures which might induce him<br \/>\nor her to use these methods and help with supervision against these procedures.<br \/>\n6. The sports physician has the duty to give his or her objective opinion on the athlete&#8217;s<br \/>\nfitness or unfitness clearly and precisely, leaving no doubt as to his or her conclu-<br \/>\nsions.<br \/>\n7. In competitive sports or professional sports events, it is the physician&#8217;s duty to decide<br \/>\nwhether the athlete is medically fit to remain on the field or return to the game. This<br \/>\ndecision cannot be delegated to other professionals or to other persons. In the physi-<br \/>\ncian&#8217;s absence these individuals must adhere strictly to the instructions he or she has<br \/>\ngiven them, with priority always being given to the best interests of the athlete&#8217;s<br \/>\nhealth and safety, and not the outcome of the competition.<br \/>\n8. In order to carry out his or her ethical obligations the sports physician must see his or<br \/>\nher authority fully recognized and upheld, particularly wherever it concerns the<br \/>\nhealth, safety and legitimate interests of the athlete, none of which can be prejudiced<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0D-\u00ad\u20101981-\u00ad\u201002-\u00ad\u20102010<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Evian-\u00ad\u2010les-\u00ad\u2010Bains<br \/>\n \u00a0<br \/>\nSports<br \/>\n \u00a0Medicine<br \/>\n \u00a0<br \/>\nto favour the interests of any third party whatsoever. These principles and obligations<br \/>\nshould be supported by an agreement between the sports physician and the athletic<br \/>\norganization involved, recognizing that the physician is obligated to uphold the ethical<br \/>\nprinciples determined in national and international statements to which the medical<br \/>\nprofession has subscribed and by which it is bound.<br \/>\n9. The sports physician should endeavour to keep the patient&#8217;s personal physician fully<br \/>\ninformed of facts relevant to his or her treatment. If necessary the sports physician<br \/>\nshould collaborate to ensure that the athlete does not exert himself or herself in ways<br \/>\ndetrimental to his or her health and does not use potentially harmful techniques to im-<br \/>\nprove performance.<br \/>\n10. In sports medicine, as in all other branches of medicine, professional confidentiality<br \/>\nmust be observed. The right to privacy over medical attention the athlete has received<br \/>\nmust be protected, especially in the case of professional athletes.<br \/>\n11. The sports doctor must not be party to any contract which obliges him or her to re-<br \/>\nserve particular forms of therapy solely and exclusively for any one athlete or group<br \/>\nof athletes.<br \/>\n12. It is desirable that sports physicians from foreign countries, when accompanying a<br \/>\nteam in another country, should enjoy the right to carry out their specific functions.<br \/>\n13. The participation of a sports physician is desirable when sports regulation are being<br \/>\ndrawn up.<br \/>\n1<br \/>\ncf, The Olympic Charter Against Doping in Sport and the Lausanne Declaration on Dopping in<br \/>\nSport adopted by the World Committee on Doping in Sport (February 1999)<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0D-\u00ad\u20101983-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0DECLARATION<br \/>\n \u00a0OF<br \/>\n \u00a0VENICE<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nTERMINAL<br \/>\n \u00a0ILLNESS<br \/>\n \u00a0<br \/>\nAdopted by the 35th<br \/>\nWorld Medical Assembly, Venice, Italy, October 1983<br \/>\nand revised by the 57th<br \/>\nWMA General Assembly, Pilanesberg, South Africa, October 2006<br \/>\nPREFACE<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. When addressing the ethical issues associated with end-of-life care, questions regard-<br \/>\ning euthanasia and physician-assisted suicide inevitably arise. The World Medical<br \/>\nAssociation condemns as unethical both euthanasia and physician-assisted suicide. It<br \/>\nshould be understood that WMA policy on these issues is fully applicable in the con-<br \/>\ntext of this Statement on Terminal Illness.<br \/>\nPREAMBLE<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. When a patient&#8217;s medical diagnosis precludes the hope of health being restored or<br \/>\nmaintained, and the death of the patient is inevitable, the physician and the patient are<br \/>\noften faced with a complex set of decisions regarding medical interventions. Ad-<br \/>\nvances in medical science have improved the ability of physicians to address many<br \/>\nissues associated with end-of-life care. However, it is an area of medicine that histori-<br \/>\ncally has not received the attention it deserves. While the priority of research to cure<br \/>\ndisease should not be compromised, more attention must be paid to developing pallia-<br \/>\ntive treatments and improving the ability of physicians to assess and address the medi-<br \/>\ncal and psychological components of symptoms in terminal illness. The dying phase<br \/>\nmust be recognized and respected as an important part of a person&#8217;s life. As public<br \/>\npressure increases in many countries to consider physician assisted suicide and eutha-<br \/>\nnasia as acceptable options to end suffering in terminal patients, the ethical imperative<br \/>\nto improve palliative treatment in the terminal phase of life comes into sharp focus.<br \/>\n2. The World Medical Association recognizes that attitudes and beliefs toward death and<br \/>\ndying vary widely from culture to culture and among different religions. In addition,<br \/>\nmany palliative and life-sustaining measures require technologies and\/or financial<br \/>\nresources that are simply not available in many places. The approach to medical care<br \/>\nof the terminally ill will be influenced significantly by these factors, and thus at-<br \/>\ntempting to developing detailed guidelines on terminal care that can be universally<br \/>\napplied is neither practical nor wise. Therefore, the World Medical Association arti-<br \/>\nculates the following core principles to assist physicians and National Medical As-<br \/>\nsociations with decision-making related to terminal care.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0D-\u00ad\u20101983-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Pilanesberg<br \/>\n \u00a0<br \/>\nTerminal<br \/>\n \u00a0Illness<br \/>\n \u00a0(Venice)<br \/>\n \u00a0<br \/>\nPRINCIPLES<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. The duty of physicians is to heal, where possible, to relieve suffering and to protect<br \/>\nthe best interests of their patients. There shall be no exception to this principle even in<br \/>\nthe case of incurable disease.<br \/>\n2. In the care of terminal patients, the primary responsibilities of the physician are to<br \/>\nassist the patient in maintaining an optimal quality of life through controlling symp-<br \/>\ntoms and addressing psychosocial needs, and to enable the patient to die with dignity<br \/>\nand in comfort. Physicians should inform patients of the availability, benefits and<br \/>\nother potential effects of palliative care.<br \/>\n3. The patient&#8217;s right to autonomy in decision-making must be respected with regard to<br \/>\ndecisions in the terminal phase of life. This includes the right to refuse treatment and<br \/>\nto request palliative measures to relieve suffering but which may have the additional<br \/>\neffect of accelerating the dying process. However, physicians are ethically prohibited<br \/>\nfrom actively assisting patients in suicide. This includes administering any treatments<br \/>\nwhose palliative benefits, in the opinion of the physician, do not justify the additional<br \/>\neffects.<br \/>\n4. The physician must not employ any means that would provide no benefit for the pa-<br \/>\ntient.<br \/>\n5. Physicians should recognise the right of patients to develop written advance directives<br \/>\nthat describe their wishes regarding care in the event that they are unable to commu-<br \/>\nnicate and that designate a substitute decision-maker to make decisions that are not<br \/>\nexpressed in the advance directive. In particular, physicians should discuss the pa-<br \/>\ntient&#8217;s wishes regarding the approach to life-sustaining interventions as well as pal-<br \/>\nliative measures that might have the additional effect of accelerating death. When-<br \/>\never possible, the patient&#8217;s substitute decision-maker should be included in these con-<br \/>\nversations.<br \/>\n6. Physicians should endeavour to understand and address the psychosocial needs of<br \/>\ntheir patients, especially as they relate to patients&#8217; physical symptoms. Physicians<br \/>\nshould try to ensure that psychological and spiritual resources are available to patients<br \/>\nand their families to help them deal with the anxiety, fear and grief associated with<br \/>\nterminal illness.<br \/>\n7. The clinical management of pain in terminal patients is of paramount importance in<br \/>\nterms of alleviating suffering. Physicians and National Medical Associations should<br \/>\npromote the dissemination and sharing of information regarding pain management to<br \/>\nensure that all physicians involved in terminal care have access to best practice guide-<br \/>\nlines and the most current treatments and methods available. Physicians should be<br \/>\nable to pursue clinically appropriate aggressive pain management without undue fear<br \/>\nof regulatory or legal repercussions.<br \/>\n8. National Medical Associations should encourage governments and research institu-<br \/>\ntions to invest additional resources in developing treatments to improve end-of-life<br \/>\ncare. Medical school curricula should include the teaching of palliative medical care.<br \/>\nWhere it does not exist, the establishment of palliative medicine as a medical special-<br \/>\nty should be considered.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0D-\u00ad\u20101983-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\n9. National Medical Associations should advocate for the development of networks<br \/>\namong institutions and organizations involved in palliative care in order to foster com-<br \/>\nmunication and collaboration.<br \/>\n10. Physicians may, when the patient cannot reverse the final process of cessation of vital<br \/>\nfunctions, apply such artificial means as are necessary to keep organs active for trans-<br \/>\nplantation provided that they act in accordance with the ethical guidelines established<br \/>\nin the World Medical Association Declaration of Sydney on the Determination of Death<br \/>\nand the Recovery of Organs.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nD-\u00ad\u20101987-\u00ad\u201001-\u00ad\u20102015<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0DECLARATION<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nEUTHANASIA<br \/>\n \u00a0<br \/>\nAdopted by the 39th<br \/>\nWorld Medical Assembly, Madrid, Spain, October 1987<br \/>\nand reaffirmed by the 170th<br \/>\nWMA Council Session, Divonne-les-Bains, France, May 2005<br \/>\nand reaffirmed by the 200th<br \/>\nWMA Council Session, Oslo, Norway, April 2015<br \/>\nEuthanasia, that is the act of deliberately ending the life of a patient, even at the patient&#8217;s<br \/>\nown request or at the request of close relatives, is unethical. This does not prevent the phy-<br \/>\nsician from respecting the desire of a patient to allow the natural process of death to follow<br \/>\nits course in the terminal phase of sickness.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0D-\u00ad\u20101989-\u00ad\u201001-\u00ad\u20102015<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0DECLARATION<br \/>\n \u00a0OF<br \/>\n \u00a0HONG<br \/>\n \u00a0KONG<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nTHE<br \/>\n \u00a0ABUSE<br \/>\n \u00a0OF<br \/>\n \u00a0THE<br \/>\n \u00a0ELDERLY<br \/>\n \u00a0<br \/>\nAdopted by the 41st<br \/>\nWorld Medical Assembly, Hong Kong, September 1989<br \/>\nand editorially revised by the 126th<br \/>\nWMA Council Session, Jerusalem, Israel, May 1990<br \/>\nand the 170th<br \/>\nWMA Council Session, Divonne-les-Bains, France, May 2005<br \/>\nand reaffirmed by the 200th<br \/>\nWMA Council Session, Oslo, Norway, April 2015<br \/>\nElderly people may suffer pathological problems such as motor disturbances and psychic<br \/>\nand orientation disorders. As a result of such problems, elderly patients may require assis-<br \/>\ntance with their daily activities that can lead to a state of dependence. This may cause their<br \/>\nfamilies and the community to consider them to be a burden and to subsequently limit or<br \/>\ndeny care and services.<br \/>\nAbuse or neglect of the elderly can be manifested in a variety of ways: physical, psycho-<br \/>\nlogical, financial and\/or material, and medical. Variations in the definition of elder abuse<br \/>\npresent difficulties in comparing findings on the nature and causes of the problem. A num-<br \/>\nber of preliminary hypotheses have been proposed on the etiology of elder abuse includ-<br \/>\ning: dependency on others to provide services; lack of close family ties; family vio-<br \/>\nlence; lack of financial resources; psychopathology of the abuser; lack of community sup-<br \/>\nport, and institutional factors such as low pay and poor working conditions that contribute<br \/>\nto pessimistic attitudes of caretakers.<br \/>\nThe phenomenon of elder abuse is becoming increasingly recognized by both medical<br \/>\nfacilities and social agencies. The first step in preventing elder abuse and neglect is to in-<br \/>\ncrease levels of awareness and knowledge among physicians and other health profes-<br \/>\nsionals. Once high-risk individuals and families have been identified, physicians can parti-<br \/>\ncipate in the primary prevention of maltreatment by making referrals to appropriate com-<br \/>\nmunity and social service centres. Physicians may also participate by providing support<br \/>\nand information on high-risk situations directly to patients and their families. At the same<br \/>\ntime, physicians should employ care and sensitivity to preserve patient trust and confiden-<br \/>\ntiality, particularly in the case of competent patients.<br \/>\nThe World Medical Association therefore adopts the following general principles relating<br \/>\nto abuse of the elderly.<\/p>\n<p> \u00a0<br \/>\nGENERAL<br \/>\n \u00a0PRINCIPLES<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n1. The elderly have the same rights to care, welfare and respect as other human beings.<br \/>\n2. Physicians have a responsibility to help prevent the physical and psychological abuse<br \/>\nof elderly patients.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0D-\u00ad\u20101989-\u00ad\u201001-\u00ad\u20102005<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Divonne-\u00ad\u2010les-\u00ad\u2010Bains<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nElderly<br \/>\n \u00a0Abuse<br \/>\n \u00a0(Hong<br \/>\n \u00a0Kong)<br \/>\n \u00a0<br \/>\n3. Whether consulted by an aged person directly, a nursing home or the family, phy-<br \/>\nsicians should see that the patient receives the best possible care.<br \/>\n4. If physicians verify or suspect ill treatment, as defined in this statement, they should<br \/>\ndiscuss the situation with those in charge, be it the nursing home or the family. If ill<br \/>\ntreatment is confirmed, or if death is considered to be suspicious, they should report<br \/>\nthe findings to the appropriate authorities.<br \/>\n5. To guarantee protection of the elderly in any environment there should be no restric-<br \/>\ntions on their right of free choice of a physician. National Medical Associations should<br \/>\nstrive to make certain that such free choice is preserved within the socio-medical sys-<br \/>\ntem.<br \/>\nThe World Medical Association also makes the following recommendations to physicians<br \/>\ninvolved in treating the elderly, and urges all National Medical Associations to publicize<br \/>\nthis Declaration to their members and the public.<br \/>\nRECOMMENDATIONS<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nPhysicians involved in treating the elderly should:<br \/>\n\u2022 make increased attempts to establish an atmosphere of trust with elderly patients in<br \/>\norder to encourage them to seek medical care when necessary and to feel comfort-<br \/>\nable confiding in the physician;<br \/>\n\u2022 provide medical evaluation and treatment for injuries resulting from abuse and\/or<br \/>\nneglect;<br \/>\n\u2022 attempt to establish or maintain a therapeutic alliance with the family (often the<br \/>\nphysician is the only professional who maintains long-term contact with the patient<br \/>\nand the family), while preserving to the greatest extent possible the confidentiality<br \/>\nof the patient;<br \/>\n\u2022 report all suspected cases of elder abuse and\/or neglect in accordance with local<br \/>\nlegislation;<br \/>\n\u2022 utilize a multidisciplinary team of caretakers from the medical, social service,<br \/>\nmental health, and legal professions, whenever possible; and<br \/>\n\u2022 encourage the development and utilization of supportive community resources that<br \/>\nprovide in-home services, respite care, and stress reduction with high-risk families.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0D-\u00ad\u20101991-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0DECLARATION<br \/>\n \u00a0OF<br \/>\n \u00a0MALTA<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nHUNGER<br \/>\n \u00a0STRIKERS<br \/>\n \u00a0<br \/>\nAdopted by the 43rd<br \/>\nWorld Medical Assembly, St. Julians, Malta, November 1991<br \/>\nand editorially revised by the 44th<br \/>\nWorld Medical Assembly, Marbella, Spain, September 1992<br \/>\nand revised by the 57th<br \/>\nWMA General Assembly, Pilanesberg, South Africa, October 2006<br \/>\nPREAMBLE<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. Hunger strikes occur in various contexts but they mainly give rise to dilemmas in<br \/>\nsettings where people are detained (prisons, jails and immigration detention centres).<br \/>\nThey are often a form of protest by people who lack other ways of making their de-<br \/>\nmands known. In refusing nutrition for a significant period, they usually hope to<br \/>\nobtain certain goals by inflicting negative publicity on the authorities. Short-term or<br \/>\nfeigned food refusals rarely raise ethical problems. Genuine and prolonged fasting<br \/>\nrisks death or permanent damage for hunger strikers and can create a conflict of values<br \/>\nfor physicians. Hunger strikers usually do not wish to die but some may be prepared<br \/>\nto do so to achieve their aims. Physicians need to ascertain the individual&#8217;s true inten-<br \/>\ntion, especially in collective strikes or situations where peer pressure may be a factor.<br \/>\nAn ethical dilemma arises when hunger strikers who have apparently issued clear in-<br \/>\nstructions not to be resuscitated reach a stage of cognitive impairment. The principle<br \/>\nof beneficence urges physicians to resuscitate them but respect for individual auto-<br \/>\nnomy restrains physicians from intervening when a valid and informed refusal has<br \/>\nbeen made. An added difficulty arises in custodial settings because it is not always<br \/>\nclear whether the hunger striker&#8217;s advance instructions were made voluntarily and with<br \/>\nappropriate information about the consequences. These guidelines and the background<br \/>\npaper address such difficult situations.<br \/>\nPRINCIPLES<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. Duty to act ethically. All physicians are bound by medical ethics in their professional<br \/>\ncontact with vulnerable people, even when not providing therapy. Whatever their role,<br \/>\nphysicians must try to prevent coercion or maltreatment of detainees and must protest<br \/>\nif it occurs.<br \/>\n2. Respect for autonomy. Physicians should respect individuals&#8217; autonomy. This can in-<br \/>\nvolve difficult assessments as hunger strikers&#8217; true wishes may not be as clear as they<br \/>\nappear. Any decisions lack moral force if made involuntarily by use of threats, peer<br \/>\npressure or coercion. Hunger strikers should not be forcibly given treatment they re-<br \/>\nfuse. Forced feeding contrary to an informed and voluntary refusal is unjustifiable. Arti-<br \/>\nficial feeding with the hunger striker&#8217;s explicit or implied consent is ethically accept-<br \/>\nable.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0D-\u00ad\u20101991-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Pilanesberg<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nHunger<br \/>\n \u00a0Strikers<br \/>\n \u00a0(Malta)<br \/>\n \u00a0<br \/>\n3. &#8216;Benefit&#8217; and &#8216;harm&#8217;. Physicians must exercise their skills and knowledge to benefit<br \/>\nthose they treat. This is the concept of &#8216;beneficence&#8217;, which is complemented by that<br \/>\nof &#8216;non-maleficence&#8217; or primum non nocere. These two concepts need to be in balance.<br \/>\n&#8216;Benefit&#8217; includes respecting individuals&#8217; wishes as well as promoting their welfare.<br \/>\nAvoiding &#8216;harm&#8217; means not only minimising damage to health but also not forcing<br \/>\ntreatment upon competent people nor coercing them to stop fasting. Beneficence does<br \/>\nnot necessarily involve prolonging life at all costs, irrespective of other values.<br \/>\n4. Balancing dual loyalties. Physicians attending hunger strikers can experience a con-<br \/>\nflict between their loyalty to the employing authority (such as prison management)<br \/>\nand their loyalty to patients. Physicians with dual loyalties are bound by the same<br \/>\nethical principles as other physicians, that is to say that their primary obligation is to<br \/>\nthe individual patient.<br \/>\n5. Clinical independence. Physicians must remain objective in their assessments and not<br \/>\nallow third parties to influence their medical judgement. They must not allow them-<br \/>\nselves to be pressured to breach ethical principles, such as intervening medically for<br \/>\nnon-clinical reasons.<br \/>\n6. Confidentiality. The duty of confidentiality is important in building trust but it is not<br \/>\nabsolute. It can be overridden if non-disclosure seriously harms others. As with other<br \/>\npatients, hunger strikers&#8217; confidentiality should be respected unless they agree to<br \/>\ndisclosure or unless information sharing is necessary to prevent serious harm. If<br \/>\nindividuals agree, their relatives and legal advisers should be kept informed of the<br \/>\nsituation.<br \/>\n7. Gaining trust. Fostering trust between physicians and hunger strikers is often the key<br \/>\nto achieving a resolution that both respects the rights of the hunger strikers and mini-<br \/>\nmises harm to them. Gaining trust can create opportunities to resolve difficult situ-<br \/>\nations. Trust is dependent upon physicians providing accurate advice and being frank<br \/>\nwith hunger strikers about the limitations of what they can and cannot do, including<br \/>\nwhere they cannot guarantee confidentiality.<br \/>\nGUIDELINES<br \/>\n \u00a0FOR<br \/>\n \u00a0THE<br \/>\n \u00a0MANAGEMENT<br \/>\n \u00a0OF<br \/>\n \u00a0HUNGER<br \/>\n \u00a0STRIKERS<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. Physicians must assess individuals&#8217; mental capacity. This involves verifying that an<br \/>\nindividual intending to fast does not have a mental impairment that would seriously<br \/>\nundermine the person&#8217;s ability to make health care decisions. Individuals with<br \/>\nseriously impaired mental capacity cannot be considered to be hunger strikers. They<br \/>\nneed to be given treatment for their mental health problems rather than allowed to fast<br \/>\nin a manner that risks their health.<br \/>\n2. As early as possible, physicians should acquire a detailed and accurate medical<br \/>\nhistory of the person who is intending to fast. The medical implications of any exist-<br \/>\ning conditions should be explained to the individual. Physicians should verify that<br \/>\nhunger strikers understand the potential health consequences of fasting and forewarn<br \/>\nthem in plain language of the disadvantages. Physicians should also explain how da-<br \/>\nmage to health can be minimised or delayed by, for example, increasing fluid intake.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0D-\u00ad\u20101991-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nSince the person&#8217;s decisions regarding a hunger strike can be momentous, ensuring<br \/>\nfull patient understanding of the medical consequences of fasting is critical. Consist-<br \/>\nent with best practices for informed consent in health care, the physician should en-<br \/>\nsure that the patient understands the information conveyed by asking the patient to<br \/>\nrepeat back what they understand.<br \/>\n3. A thorough examination of the hunger striker should be made at the start of the fast.<br \/>\nManagement of future symptoms, including those unconnected to the fast, should be<br \/>\ndiscussed with hunger strikers. Also, the person&#8217;s values and wishes regarding medi-<br \/>\ncal treatment in the event of a prolonged fast should be noted.<br \/>\n4. Sometimes hunger strikers accept an intravenous saline solution transfusion or other<br \/>\nforms of medical treatment. A refusal to accept certain interventions must not preju-<br \/>\ndice any other aspect of the medical care, such as treatment of infections or of pain.<br \/>\n5. Physicians should talk to hunger strikers in privacy and out of earshot of all other<br \/>\npeople, including other detainees. Clear communication is essential and, where neces-<br \/>\nsary, interpreters unconnected to the detaining authorities should be available and they<br \/>\ntoo must respect confidentiality.<br \/>\n6. Physicians need to satisfy themselves that food or treatment refusal is the individual&#8217;s<br \/>\nvoluntary choice. Hunger strikers should be protected from coercion. Physicians can<br \/>\noften help to achieve this and should be aware that coercion may come from the peer<br \/>\ngroup, the authorities or others, such as family members. Physicians or other health<br \/>\ncare personnel may not apply undue pressure of any sort on the hunger striker to sus-<br \/>\npend the strike. Treatment or care of the hunger striker must not be conditional upon<br \/>\nsuspension of the hunger strike.<br \/>\n7. If a physician is unable for reasons of conscience to abide by a hunger striker&#8217;s refusal<br \/>\nof treatment or artificial feeding, the physician should make this clear at the outset<br \/>\nand refer the hunger striker to another physician who is willing to abide by the hunger<br \/>\nstriker&#8217;s refusal.<br \/>\n8. Continuing communication between physician and hunger strikers is critical. Physi-<br \/>\ncians should ascertain on a daily basis whether individuals wish to continue a hunger<br \/>\nstrike and what they want to be done when they are no longer able to communicate<br \/>\nmeaningfully. These findings must be appropriately recorded.<br \/>\n9. When a physician takes over the case, the hunger striker may have already lost mental<br \/>\ncapacity so that there is no opportunity to discuss the individual&#8217;s wishes regarding<br \/>\nmedical intervention to preserve life. Consideration needs to be given to any advance<br \/>\ninstructions made by the hunger striker. Advance refusals of treatment demand res-<br \/>\npect if they reflect the voluntary wish of the individual when competent. In custodial<br \/>\nsettings, the possibility of advance instructions having been made under pressure<br \/>\nneeds to be considered. Where physicians have serious doubts about the individual&#8217;s<br \/>\nintention, any instructions must be treated with great caution. If well informed and<br \/>\nvoluntarily made, however, advance instructions can only generally be overridden if<br \/>\nthey become invalid because the situation in which the decision was made has changed<br \/>\nradically since the individual lost competence.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0D-\u00ad\u20101991-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Pilanesberg<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nHunger<br \/>\n \u00a0Strikers<br \/>\n \u00a0(Malta)<br \/>\n \u00a0<br \/>\n10. If no discussion with the individual is possible and no advance instructions exist,<br \/>\nphysicians have to act in what they judge to be the person&#8217;s best interests. This means<br \/>\nconsidering the hunger strikers&#8217; previously expressed wishes, their personal and cul-<br \/>\ntural values as well as their physical health. In the absence of any evidence of hunger<br \/>\nstrikers&#8217; former wishes, physicians should decide whether or not to provide feeding,<br \/>\nwithout interference from third parties.<br \/>\n11. Physicians may consider it justifiable to go against advance instructions refusing treat-<br \/>\nment because, for example, the refusal is thought to have been made under duress. If,<br \/>\nafter resuscitation and having regained their mental faculties, hunger strikers continue<br \/>\nto reiterate their intention to fast, that decision should be respected. It is ethical to al-<br \/>\nlow a determined hunger striker to die in dignity rather than submit that person to re-<br \/>\npeated interventions against his or her will.<br \/>\n12. Artificial feeding can be ethically appropriate if competent hunger strikers agree to it.<br \/>\nIt can also be acceptable if incompetent individuals have left no unpressured advance<br \/>\ninstructions refusing it.<br \/>\n13. Forcible feeding is never ethically acceptable. Even if intended to benefit, feeding ac-<br \/>\ncompanied by threats, coercion, force or use of physical restraints is a form of inhu-<br \/>\nman and degrading treatment. Equally unacceptable is the forced feeding of some de-<br \/>\ntainees in order to intimidate or coerce other hunger strikers to stop fasting.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0D-\u00ad\u20101997-\u00ad\u201001-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0DECLARATION<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nGUIDELINES<br \/>\n \u00a0FOR<br \/>\n \u00a0CONTINUOUS<br \/>\n \u00a0QUALITY<br \/>\n \u00a0IMPROVEMENT<br \/>\n \u00a0IN<br \/>\n \u00a0<br \/>\nHEALTH<br \/>\n \u00a0CARE<br \/>\n \u00a0<br \/>\nAdopted by the 49th<br \/>\nWorld Medical Assembly, Hamburg, Germany, November 1997<br \/>\nand amended by the 60th<br \/>\nWMA General Assembly, New Delhi, India, October 2009<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nPREAMBLE<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nThe purpose of health care is to prevent, diagnose and treat illness and to maintain and to<br \/>\npromote the health of the population. The goal of quality review in health care is conti-<br \/>\nnuous improvement of the quality of services provided for patients and the population, and<br \/>\nof the ways and means of producing these services. The ultimate goal is to improve both<br \/>\nindividual patient outcomes and population health.<br \/>\nThe obligation to continuously improve one\u2019s professional ability and to rigorously eval-<br \/>\nuate the methods one uses has long been a fundamental tenet of the ethical codes of physi-<br \/>\ncians. According to these codes, a physician must always strive to maintain and increase<br \/>\nhis\/her knowledge and skills. The physician shall recommend only examinations and treat-<br \/>\nments that are believed to be effective and appropriate according to the best available evi-<br \/>\ndence-based medicine.<br \/>\nPhysicians and health care institutions have an ethical and professional obligation to strive<br \/>\nfor continuous quality improvement of services and patient safety. These guidelines are in-<br \/>\ntended to articulate the ethical grounds for these obligations and to strengthen quality re-<br \/>\nview practices.<br \/>\nEthical guidelines for health care quality improvement matter to all physicians, as well as<br \/>\nto institutions providing health care services for patients, those providing continuous<br \/>\nquality improvement services to assist physicians and organizations, health care payers<br \/>\nand regulators, patients, and every other stakeholder in the health care system.<\/p>\n<p> \u00a0<br \/>\nTHE<br \/>\n \u00a0OBLIGATION<br \/>\n \u00a0TO<br \/>\n \u00a0ESTABLISH<br \/>\n \u00a0STANDARDS<br \/>\n \u00a0FOR<br \/>\n \u00a0GOOD<br \/>\n \u00a0QUALITY<br \/>\n \u00a0WORK<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nProfessionals, by definition, are responsible for specifying the standards that constitute<br \/>\ngood quality in their work and the processes needed for the evaluation of that quality.<br \/>\nHealth professionals, therefore, must define high quality health care and determine the<br \/>\nbest methods of measuring the quality of care delivered.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0D-\u00ad\u20101997-\u00ad\u201001-\u00ad\u20102009<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0New<br \/>\n \u00a0Delhi<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nQuality<br \/>\n \u00a0Improvement<br \/>\n \u00a0in<br \/>\n \u00a0Health<br \/>\n \u00a0Care<br \/>\n \u00a0<br \/>\nTHE<br \/>\n \u00a0OBLIGATION<br \/>\n \u00a0TO<br \/>\n \u00a0COLLECT<br \/>\n \u00a0DATA<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nIn order to assess quality of care, it is necessary to obtain reliable data on the patients and<br \/>\npopulations served as well as on care processes and outcomes. Patient records, whether<br \/>\nrecorded on paper, digitally or in any other way, must be created written and preserved<br \/>\nwith care and, with attention to confidentiality requirements. Procedures, decisions and<br \/>\nother matters connected with patients should be recorded in a format that will allow infor-<br \/>\nmation for measuring specific standards to be available on a timely basis when needed.<\/p>\n<p> \u00a0<br \/>\nTHE<br \/>\n \u00a0ROLE<br \/>\n \u00a0OF<br \/>\n \u00a0PROFESSIONAL<br \/>\n \u00a0EDUCATION<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nHealth care professionals should have adequate opportunities to maintain and develop<br \/>\ntheir knowledge and skills by participating in continuing medical education and\/or conti-<br \/>\nnuing professional development. Clinical guidelines based on professional standards for<br \/>\nhigh quality care should be created and made easily available to those requiring<br \/>\nthem. Health care training should include specific instruction in quality improvement<br \/>\ntechniques, including opportunities for hands-on practice in measuring and improving<br \/>\nquality. Health care institutions should create quality improvement systems for their own<br \/>\nuse and to en-sure that instructions concerning such systems are followed.<br \/>\nGood quality work requires resources. Every effort should be made to make sure that ade-<br \/>\nquate time and economic means are available for quality work.<\/p>\n<p> \u00a0<br \/>\nATTENTION<br \/>\n \u00a0TO<br \/>\n \u00a0INAPPROPRIATE<br \/>\n \u00a0USE<br \/>\n \u00a0OF<br \/>\n \u00a0SERVICES<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nInappropriate use of health care services includes overuse, underuse and misuse. Quality<br \/>\nmeasurement in health care should include a balanced set of measures in all three areas.<br \/>\nOveruse of services occurs when health care services are provided under circumstances in<br \/>\nwhich the potential for harm exceeds the possible benefit. Physicians can improve quality<br \/>\nby reducing overuse, thus sparing patients the unnecessary risk that results from inappro-<br \/>\npriate health services.<br \/>\nUnderuse of services is the failure to provide health care services that would be likely to<br \/>\nproduce a favourable outcome for the patient. Physicians should strive to expand the use<br \/>\nof beneficial health care services that are underused.<br \/>\nMisuse of services occurs when an incorrect diagnosis is made or when an appropriate<br \/>\nservice has been selected for a correct diagnosis but the patient does not receive the full<br \/>\npotential benefit of the service because of a preventable adverse event. Misuse of services<br \/>\ncan be greatly reduced by using risk management and error prevention strategies.<br \/>\nMONITORING<br \/>\n \u00a0QUALITY:<br \/>\n \u00a0CLINICAL<br \/>\n \u00a0AUDITS<br \/>\n \u00a0<br \/>\nActive participation in critical self-evaluation, usually through clinical audit programs, is a<br \/>\nuseful mechanism for healthcare professionals, including healthcare administrators and<br \/>\nphysicians, and the institutions in which they work, to improve the quality of their work.<br \/>\nExternal independent examination and accreditation of the institution can also be of use,<br \/>\nwhen carried out appropriately and with due attention to potential unintended effects.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0D-\u00ad\u20101997-\u00ad\u201001-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nINTERNAL<br \/>\n \u00a0AND<br \/>\n \u00a0EXTERNAL<br \/>\n \u00a0QUALITY<br \/>\n \u00a0ASSESSMENT<br \/>\n \u00a0<br \/>\nAt the individual level, a physician should continuously update their knowledge and skills<br \/>\nand subject their level of ability to critical self-appraisal.<br \/>\nIn organizations, the quality of health care can be assessed by both internal and external<br \/>\nmethods.<br \/>\nHealth care institutions should create internal quality improvement systems for their own<br \/>\nuse and ensure that instructions concerning such systems are followed. These systems<br \/>\nshould include continuous conducting of internal clinical peer review, review examination<br \/>\nand treatment methods and their attendant results, tracking of the organization\u2019s ability to<br \/>\nreact to quality data, and monitoring of patient feedback.<br \/>\nExternal quality review initiatives, such as external peer review and audit, should be car-<br \/>\nried out regularly and with a frequency corresponding to the evolution of the field or when<br \/>\nthere is special reason for external assessment. Any review should take into account risk<br \/>\nadjustment of the patient population under consideration.<br \/>\nWhether internal or external, if the results of any quality assessment carry significant op-<br \/>\nportunities for benefit or threats of harms for the organization or individual being assessed,<br \/>\nspecial attention must be paid to potential unintended and dangerous consequences of such<br \/>\nquality assessments. It is especially important to monitor the results of quality improve-<br \/>\nment measurement and intervention strategies over time, with attention to their effects on<br \/>\nespecially vulnerable patient populations.<br \/>\nProtocols to be used for quality review should be replicable and transparent. Appeals me-<br \/>\nchanisms should be built into the protocols.<br \/>\nCONFIDENTIALITY<br \/>\n \u00a0OF<br \/>\n \u00a0PATIENT<br \/>\n \u00a0RECORDS<br \/>\n \u00a0<br \/>\nPatient records are an invaluable source of data for quality improvement. As with other uses<br \/>\nof individually-identifiable patient based information, consent is usually required from the<br \/>\npatient prior to use. If consent cannot reasonably be obtained, then all attempts should be<br \/>\nmade to ensure that medical records are anonymised or pseudonimised for use in quality<br \/>\nimprovement efforts. In every case, patient records used for quality improvement must<br \/>\nonly be accessible to those who need to see them for the purposes of quality improvement.<br \/>\nCONFIDENTIALITY<br \/>\n \u00a0OF<br \/>\n \u00a0PEER<br \/>\n \u00a0REVIEW<br \/>\n \u00a0<br \/>\nFor peer review to be most effective, all parties involved must participate and recognize its<br \/>\nimportance. It is recommended that informed voluntary consent be obtained from those to<br \/>\nbe reviewed. Within a healthcare team, the work of each physician must be able to be eval-<br \/>\nuated. Information regarding an individual physician&#8217;s evaluation should not be pu-blished<br \/>\nwithout the consent of the physician concerned. It is recommended that consent be ob-<br \/>\ntained prior to publishing information regarding an individual physician\u2019s evaluation.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0D-\u00ad\u20101997-\u00ad\u201001-\u00ad\u20102009<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0New<br \/>\n \u00a0Delhi<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nQuality<br \/>\n \u00a0Improvement<br \/>\n \u00a0in<br \/>\n \u00a0Health<br \/>\n \u00a0Care<br \/>\n \u00a0<br \/>\nA provider of services may inform his\/her patients about the results of quality review.<br \/>\nIf reviews are made available to the public, careful monitoring must be undertaken to track<br \/>\nthe effects, intended and unintended, of such public reporting of performance data.<br \/>\nETHICAL<br \/>\n \u00a0REVIEW<br \/>\n \u00a0OF<br \/>\n \u00a0QUALITY<br \/>\n \u00a0IMPROVEMENT<br \/>\n \u00a0ACTIVITIES<br \/>\n \u00a0<br \/>\nNational codes of medical ethics and ethical principles and guidelines that relate to conti-<br \/>\nnuous quality improvement, audit and clinical review must be followed.<br \/>\nQuality improvement should be an ongoing and integral part of the operations of every<br \/>\nhealth care organization. As such, the majority of quality improvement projects will not<br \/>\nrequire specific review by an ethics committee. If there are doubts about specific issues or<br \/>\nif a project poses more than minimal risk compared to the existing processes for care, then<br \/>\nthe project should be referred to an appropriate ethics committee or institutional review<br \/>\nboard. When such formal ethical review is needed, it should be undertaken by a commit-<br \/>\ntee with members who are knowledgeable about quality improvement techniques.<br \/>\nCOMPETENCE<br \/>\n \u00a0AND<br \/>\n \u00a0IMPARTIALITY<br \/>\n \u00a0OF<br \/>\n \u00a0THE<br \/>\n \u00a0REVIEWER<br \/>\n \u00a0<br \/>\nThose who conduct performance reviews must be competent in quality improvement tech-<br \/>\nniques and in clinical audit as well as experienced in the clinical field relating to the re-<br \/>\nview. Where medical care is being reviewed, the reviewer should be a physician whose<br \/>\nknowledge and experience is accepted by those being reviewed.<br \/>\nThe reviewer should be impartial and independent. Whilst he\/she must be aware of the<br \/>\nactivities under review, he\/she must be objective in the report and base conclusions on<br \/>\ncritical evaluation of observation and facts. Commercial or competitive matters should not<br \/>\nbe allowed to influence the content of the reviewer&#8217;s report.<br \/>\nSEPARATION<br \/>\n \u00a0OF<br \/>\n \u00a0QUALITY<br \/>\n \u00a0REVIEWS<br \/>\n \u00a0AND<br \/>\n \u00a0SUPERVISION<br \/>\n \u00a0BY<br \/>\n \u00a0AUTHORITIES<br \/>\n \u00a0<br \/>\nQuality improvement of services and of health care systems is a requirement for every<br \/>\nphysician and health care institution. It is not supervision of professional activities by au-<br \/>\nthorities and it must be kept independent of this. The results of performance reviews or au-<br \/>\ndits of physician activities should be used by supervising authorities only subject to a se-<br \/>\nparate agreement between them and the physicians concerned unless national legislation<br \/>\nmandates an alternative approach. These activities must be fully cognizant of the local le-<br \/>\ngal framework and must not expose participating physicians to litigation.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0D-\u00ad\u20101997-\u00ad\u201002-\u00ad\u20102007<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0DECLARATION<br \/>\n \u00a0OF<br \/>\n \u00a0HAMBURG<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nCONCERNING<br \/>\n \u00a0SUPPORT<br \/>\n \u00a0FOR<br \/>\n \u00a0MEDICAL<br \/>\n \u00a0DOCTORS<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nREFUSING<br \/>\n \u00a0TO<br \/>\n \u00a0PARTICIPATE<br \/>\n \u00a0IN,<br \/>\n \u00a0OR<br \/>\n \u00a0TO<br \/>\n \u00a0CONDONE,<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nTHE<br \/>\n \u00a0USE<br \/>\n \u00a0OF<br \/>\n \u00a0TORTURE<br \/>\n \u00a0OR<br \/>\n \u00a0OTHER<br \/>\n \u00a0FORMS<br \/>\n \u00a0OF<br \/>\n \u00a0CRUEL,<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nINHUMAN<br \/>\n \u00a0OR<br \/>\n \u00a0DEGRADING<br \/>\n \u00a0TREATMENT<br \/>\n \u00a0<br \/>\nAdopted by the 49th<br \/>\nWMA General Assembly, Hamburg, Germany, November 1997<br \/>\nand reaffirmed by the 176th<br \/>\nWMA Council Session, Berlin, Germany, May 2007<br \/>\nPREAMBLE<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. On the basis of a number of international ethical declarations and guidelines subs-<br \/>\ncribed to by the medical profession, medical doctors throughout the world are pro-<br \/>\nhibited from countenancing, condoning or participating in the practice of torture or<br \/>\nother forms of cruel, inhuman or degrading procedures for any reason.<br \/>\n2. Primary among these declarations are the World Medical Association&#8217;s International<br \/>\nCode of Medical Ethics, Declaration of Geneva, Declaration of Tokyo, and Resolu-<br \/>\ntion on Physician Participation in Capital Punishment; the Standing Committee of<br \/>\nEuropean Doctors&#8217; Statement of Madrid; the Nordic Resolution Concerning Physician<br \/>\nInvolvement in Capital Punishment; and, the World Psychiatric Association&#8217;s Decla-<br \/>\nration of Hawaii.<br \/>\n3. However, none of these declarations or statements addresses explicitly the issue of<br \/>\nwhat protection should be extended to medical doctors if they are pressured, called<br \/>\nupon, or ordered to take part in torture or other forms of cruel, inhuman or degrading<br \/>\ntreatment or punishment. Nor do these declarations or statements express explicit sup-<br \/>\nport for, or the obligation to protect, doctors who encounter or become aware of such<br \/>\nprocedures.<br \/>\nRESOLUTION<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. The World Medical Association (WMA) hereby reiterates and reaffirms the responsi-<br \/>\nbility of the organised medical profession:<br \/>\ni. to encourage doctors to honour their commitment as physicians to serve humanity<br \/>\nand to resist any pressure to act contrary to the ethical principles governing their<br \/>\ndedication to this task;<br \/>\nii. to support physicians experiencing difficulties as a result of their resistance to any<br \/>\nsuch pressure or as a result of their attempts to speak out or to act against such in-<br \/>\nhuman procedures; and,<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0D-\u00ad\u20101997-\u00ad\u201002-\u00ad\u20102007<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Berlin<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nRefusing<br \/>\n \u00a0Torture<br \/>\n \u00a0(Hamburg)<br \/>\n \u00a0<br \/>\niii. to extend its support and to encourage other international organisations, as well as<br \/>\nthe national member associations (NMAs) of the World Medical Association, to<br \/>\nsupport physicians encountering difficulties as a result of their attempts to act in<br \/>\naccordance with the highest ethical principles of the profession.<br \/>\n2. Furthermore, in view of the continued employment of such inhumane procedures in<br \/>\nmany countries throughout the world, and the documented incidents of pressure upon<br \/>\nmedical doctors to act in contravention to the ethical principles subscribed to by the<br \/>\nprofession, the WMA finds it necessary:<br \/>\ni. to protest internationally against any involvement of, or any pressure to involve,<br \/>\nmedical doctors in acts of torture or other forms of cruel, inhuman or degrading<br \/>\ntreatment or punishment;<br \/>\nii. to support and protect, and to call upon its NMAs to support and protect, physi-<br \/>\ncians who are resisting involvement in such inhuman procedures or who are<br \/>\nworking to treat and rehabilitate victims thereof, as well as to secure the right to<br \/>\nuphold the highest ethical principles including medical confidentiality;<br \/>\niii. to publicise information about and to support doctors reporting evidence of tor-<br \/>\nture and to make known proven cases of attempts to involve physicians in such<br \/>\nprocedures; and,<br \/>\niv. to encourage national medical associations to ask corresponding academic autho-<br \/>\nrities to teach and investigate in all schools of medicine and hospitals the conse-<br \/>\nquences of torture and its treatment, the rehabilitation of the survivors, the docu-<br \/>\nmentation of torture, and the professional protection described in this Declara-<br \/>\ntion.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0D-\u00ad\u20101998-\u00ad\u201001-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0DECLARATION<br \/>\n \u00a0OF<br \/>\n \u00a0OTTAWA<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nCHILD<br \/>\n \u00a0HEALTH<br \/>\n \u00a0<br \/>\nAdopted by the 50th<br \/>\nWorld Medical Assembly, Ottawa, Canada, October 1998<br \/>\nand amended by the 60th<br \/>\nWMA General Assembly, New Delhi, India, October 2009<br \/>\nPREAMBLE<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nScience has now proven that to reach their potential, children need to grow up in a place<br \/>\nwhere they can thrive &#8211; spiritually, emotionally, mentally, physically and intellectually1<br \/>\n. That<br \/>\nplace must have four fundamental elements:<br \/>\n\u2022 a safe and secure environment;<br \/>\n\u2022 the opportunity for optimal growth and development;<br \/>\n\u2022 health services when needed; and<br \/>\n\u2022 monitoring &#038; research for evidence-based continual improvement into the future2<br \/>\n.<br \/>\nPhysicians know that the future of our world depends on our children: their education,<br \/>\ntheir employability, their productivity, their innovation, and their love and care for one<br \/>\nanother and for this planet. Early childhood experiences strongly influence future develop-<br \/>\nment including basic learning, school success, economic participation, social citizenry,<br \/>\nand health3<br \/>\n. In most situations, parents and caregivers alone cannot provide strong nur-<br \/>\nturing environments without help from local, regional, national and international organi-<br \/>\nzations1<br \/>\n. Physicians therefore join with parents, and with world leaders to advocate for<br \/>\nhealthy children.<br \/>\nThe principles of this Declaration apply to all children in the world from birth to 18 years<br \/>\nof age, regardless of race, age, ethnicity, nationality, political affiliation, creed, language,<br \/>\ngender, disease or disability, physical ability, mental ability, sexual orientation, cultural<br \/>\nhistory, life experience or the social standing of the child or her\/his parents or legal guard-<br \/>\nian. In all countries of the world, regardless of resources, meeting these principles should<br \/>\nbe a priority for parents, communities and governments. The United Nations Con-vention<br \/>\non the Rights of Children (1989) sets out the wider rights of all children and young people,<br \/>\nbut those rights cannot exist without health.<br \/>\nGENERAL<br \/>\n \u00a0PRINCIPLES<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. A place with a safe and secure environment includes:<br \/>\na. Clean water, air and soil;<br \/>\nb. Protection from injury, exploitation, discrimination and from traditional practices<br \/>\nprejudicial to the health of the child, and<br \/>\nc. Healthy families, homes and communities<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0D-\u00ad\u20101998-\u00ad\u201001-\u00ad\u20102009<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0New<br \/>\n \u00a0Delhi<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nChild<br \/>\n \u00a0Health<br \/>\n \u00a0(Ottawa)<br \/>\n \u00a0<br \/>\n2. A place where a child can have good health and development offers:<br \/>\na. Prenatal and maternal care for the best possible health at birth<br \/>\nb. Nutrition for proper growth, development and long-term health<br \/>\nc. Early learning opportunities and high quality care at home and in the community<br \/>\nd. Opportunities and encouragement for physical activity<br \/>\ne. Affordable &#038; accessible high quality primary &#038; secondary education<br \/>\n3. A full range of health resources available to all means:<br \/>\na. The best interests of the child shall be the primary consideration in the provision of<br \/>\nhealth care;<br \/>\nb. Those caring for children shall have the special training and skills necessary to<br \/>\nenable them to respond appropriately to the medical, physical, emotional and de-<br \/>\nvelopmental needs of children &#038; their families<br \/>\nc. Basic health care including health promotion, recommended immunization, drugs<br \/>\n&#038; dental health<br \/>\nd. Mental health care and prompt referral to intervention when problems identified<br \/>\ne. Priority access to drugs for life- or limb-threatening conditions for all mothers and<br \/>\nchildren<br \/>\nf. Hospitalization only if the care and treatment required cannot be provided at home,<br \/>\nin the community or on an outpatient basis<br \/>\ng. Access to specialty diagnostic and treatment services when needed<br \/>\nh. Rehabilitation services and supports within community<br \/>\ni. Pain management and care and prevention (or minimization) of suffering<br \/>\nj. Informed consent is necessary before initiating any diagnostic, therapeutic, re-<br \/>\nhabilitative, or research procedure on a child. In the majority of cases, the consent<br \/>\nshall be obtained from the parent(s) or legal guardian, or in some cases, by ex-<br \/>\ntended family, although the wishes of a competent child should be taken into ac-<br \/>\ncount before consent is given.<br \/>\n4. Research4<br \/>\n&#038; monitoring for continual improvement includes:<br \/>\na. All infants will be officially registered within one month of birth<br \/>\nb. All children will be treated with dignity and respect<br \/>\nc. Quality care is ensured through on-going monitoring of services, including collec-<br \/>\ntion of data, and evaluation of outcomes<br \/>\nd. Children will share in the benefits from scientific research relevant to their needs<br \/>\ne. The privacy of a child patient will be respected<br \/>\n1<br \/>\nIrwin LG, Siddiqi A, Hertzman C. \u201cEarly Child Development: A Powerful Equalizer. Final Re-<br \/>\nport\u201d. World Health Organization Commission on the Social Determinants of Health June 2007<br \/>\n2<br \/>\nWHO Commission on Social Determinants of Health (Closing the Gap in a Generation) 2008<br \/>\n3<br \/>\nCanadian Charter for Child and Youth Health<br \/>\n4<br \/>\nProposed WMA statement on ethical principles for medical research on child subjects<br \/>\n* Please refer the background document for specific principles.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0D-\u00ad\u20102000-\u00ad\u201001-\u00ad\u20102011<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0DECLARATION<br \/>\n \u00a0OF<br \/>\n \u00a0EDINBURGH<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nPRISON<br \/>\n \u00a0CONDITIONS<br \/>\n \u00a0AND<br \/>\n \u00a0THE<br \/>\n \u00a0SPREAD<br \/>\n \u00a0OF<br \/>\n \u00a0TUBERCULOSIS<br \/>\n \u00a0AND<br \/>\n \u00a0<br \/>\nOTHER<br \/>\n \u00a0COMMUNICABLE<br \/>\n \u00a0DISEASES<br \/>\n \u00a0<br \/>\nAdopted by the 52nd<br \/>\nWorld Medical Association General Assembly, Edinburgh, Scotland,<br \/>\nOctober 2000<br \/>\nand revised by the 62nd<br \/>\nWMA General Assembly, Montevideo, Uruguay, October 2011<br \/>\nPREAMBLE<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n \u00a0<br \/>\nPrisoners enjoy the same health care rights as all other people. This includes the right to<br \/>\nhumane treatment and appropriate medical care. The standards for the treatment of pri-<br \/>\nsoners have been set down in a number of Declarations and Guidelines adopted by various<br \/>\nbodies of the United Nations.<br \/>\nThe relationship between physician and prisoner is governed by the same ethical princi-<br \/>\nples as that between the physician and any other patient. There are specific tensions within<br \/>\nthe patient\/physician relationship, which do not exist in other settings, in particular the<br \/>\nrelationship of the physician with his\/her employer, the prison service, and the general<br \/>\nattitude of society to prisoners.<br \/>\nThere are also strong public health reasons for reinforcing the importance of these rules.<br \/>\nThe high incidence of tuberculosis amongst prisoners in a number of countries reinforces<br \/>\nthe need for considering public health as an important element when designing new prison<br \/>\nregimens, and for reforming existing penal and prison systems.<br \/>\nIndividuals facing imprisonment are often from the most marginalised sections of society,<br \/>\nmay have had limited access to health care before imprisonment, may suffer worse health<br \/>\nthat many other citizens and may enter prison with undiagnosed, undetected and untreated<br \/>\nhealth problems.<br \/>\nPrisons can be breeding grounds for infection. Overcrowding, lengthy confinement within<br \/>\ntightly enclosed, poorly lit, badly heated and consequently poorly ventilated and often hu-<br \/>\nmid spaces are all conditions frequently associated with imprisonment and all of which<br \/>\ncontribute to the spread of disease and ill-health. Where these factors are combined with<br \/>\npoor hygiene, inadequate nutrition and limited access to adequate health care, prisons can<br \/>\nrepresent a major public health challenge.<br \/>\nKeeping prisoners in conditions, which expose them to substantial medical risk, poses a<br \/>\nhumanitarian challenge. An infectious prisoner is a risk to other prisoners, prison person-<br \/>\nnel, relatives and other prison visitors and the wider community &#8211; not only when the pri-<br \/>\nsoner is released, but also because prison bars do not keep Tuberculosis bacilli from<br \/>\nspreading into the outside world. The most effective and efficient way of reducing disease<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0D-\u00ad\u20102000-\u00ad\u201001-\u00ad\u20102011<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Montevideo<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nPrison<br \/>\n \u00a0Conditions<br \/>\n \u00a0on<br \/>\n \u00a0TB<br \/>\n \u00a0(Edinburgh)<br \/>\n \u00a0<br \/>\ntransmission is to improve the prison environment, by putting together an efficient medi-<br \/>\ncal service that is capable of detecting and treating the disease, and by targeting prison<br \/>\novercrowding as the most urgent action.<br \/>\nThe increase in active Tuberculosis in prison populations and the development within<br \/>\nsome of these populations of resistant and especially \u00abmulti-drug\u00bb and \u00abextremely-drug\u00bb<br \/>\nresistant forms of TB, as recognised by the World Medical Association in its Statement on<br \/>\nDrug Treatment of Tuberculosis, is reaching very high prevalence and incidence rates in<br \/>\nprisons in some parts of the world.<br \/>\nOther conditions, such as Hepatitis C and HIV Disease, do not have as high a risk of per-<br \/>\nson-to- person communicability as TB but pose transmission risks from blood to blood<br \/>\nborne spread, or sharing and exchange of body fluids. Overcrowded prison conditions also<br \/>\npromote the spread of sexually transmitted diseases. Intravenous drug use will also contri-<br \/>\nbute to the spread of HIV as well as the more contagious Hepatitis B and C. These need<br \/>\nspecific solutions that are not dealt with in this statement. However the principles set out<br \/>\nbelow will also be helpful in reducing the risk from such infective agents.<br \/>\nACTIONS<br \/>\n \u00a0REQUIRED<br \/>\n \u00a0<br \/>\nThe World Medical Association considers it essential both for public health and humani-<br \/>\ntarian reasons that careful attention is paid to:<br \/>\n1. Protecting the rights of prisoners according to the various UN instruments relating<br \/>\nto conditions of imprisonment. Prisoners should enjoy the same rights as other pa-<br \/>\ntients, as outlined in the WMA Declaration of Lisbon;<br \/>\n2. Not allowing the rights of prisoners to be ignored or invalidated because they have<br \/>\nan infectious illness;<br \/>\n3. Ensuring that the conditions in which detainees and prisoners are kept, whether<br \/>\nthey are held during the investigation of a crime, whilst waiting for trial, or as pu-<br \/>\nnishment once sentenced, do not contribute to the development, worsening or trans-<br \/>\nmission of disease.<br \/>\n4. Ensuring that persons being held while going through immigration procedures, are<br \/>\nkept in conditions which do not encourage the spread of disease, although prisons<br \/>\nshould not normally be used to house such persons;<br \/>\n5. Ensuring the coordination of health services within and outside prisons to facilitate<br \/>\ncontinuity of care and epidemiological monitoring of inmate patients when they<br \/>\nare released;<br \/>\n6. Ensuring that prisoners are not isolated, or placed in solitary confinement, as a res-<br \/>\nponse to their infected status without adequate access to health care and the appro-<br \/>\npriate medical treatment of their infected status;<br \/>\n7. Ensuring that, upon admission to or transfer to a different prison, inmates&#8217; health<br \/>\nstatus is reviewed within 24 hours of arrival to assure continuity of care;<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0D-\u00ad\u20102000-\u00ad\u201001-\u00ad\u20102011<br \/>\n \u00a0<br \/>\n8. Ensuring the provision of follow-up treatment for prisoners who, on their release,<br \/>\nare still ill, particularly with TB or any other infectious disease. Because erratic treat-<br \/>\nments or interruptions of treatment may be particularly hazardous epidemiolo-<br \/>\ngically and to the individual, planning for and providing continuing care are essen-<br \/>\ntial elements of prison health care provision;<br \/>\n9. Recognising that the public health mechanisms, which may in the rarest and most<br \/>\nexceptional cases involve the compulsory detention of individuals who pose a se-<br \/>\nrious risk of infection to the wider community must be efficacious, necessary and<br \/>\njustified, and proportional to the risks posed. Such steps should be exceptional and<br \/>\nmust follow careful and critical questioning of the need for such constraints and<br \/>\nthe absence of any effective alternative. In such circumstances detention should be<br \/>\nfor as short a time as possible and be as limited in restrictions as feasible. There<br \/>\nmust also be a system of independent appraisal and periodic review of any such<br \/>\nmeasures, including a mechanism for appeal by the patients themselves. Wherever<br \/>\npossible alternatives to such detention should be used;<br \/>\n10. This model should be used in considering all steps to prevent cross infection and to<br \/>\ntreat existing infected persons within the prison environment.<br \/>\n11. Physicians working in prisons have a duty to report to the health authorities and<br \/>\nprofessional organisations of their country any deficiency in health care provided<br \/>\nto the inmates and any situation involving high epidemiological risk. NMAs are<br \/>\nobliged to attempt to protect those physicians against any possible reprisals.<br \/>\n12. Physicians working in prisons have a duty to follow national public health guide-<br \/>\nlines, where these are ethically appropriate, particularly concerning the mandatory<br \/>\nreporting of infectious and communicable diseases.<br \/>\nANNEX<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nInternational texts relating to medical care in prisons:<br \/>\nUniversal Declaration of Human Rights (Articles 4, 9, 10 and 11). Adopted by the United Nations<br \/>\nGeneral Assembly on 16 December 1948.<br \/>\nStandard Minimum Rules for the Treatment of Prisoners (Rules 22-26). Approved by the United<br \/>\nNations Economic and Social Council on 31 July 1957.<br \/>\nInternational Covenant on Economic, Social and Cultural Rights (Article 12). Adopted by the<br \/>\nUnited Nations General Assembly on 16 December 1966. Entry into force: 3 January 1976.<br \/>\nInternational Covenant on Civil and Political Rights (Articles 6, 7 and 10). Adopted by the United<br \/>\nNations General Assembly on 16 December 1966. Entry into force: 23 March 1976.<br \/>\nPrinciples of Medical Ethics Relevant to the Protection of Prisoners Against Torture (Principle 1).<br \/>\nAdopted by the United Nations General Assembly on 18 December 1982.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0D-\u00ad\u20102000-\u00ad\u201001-\u00ad\u20102011<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Montevideo<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nPrison<br \/>\n \u00a0Conditions<br \/>\n \u00a0on<br \/>\n \u00a0TB<br \/>\n \u00a0(Edinburgh)<br \/>\n \u00a0<br \/>\nBody of Principles for the Protection of All Persons Under Any Forms of Detention or<br \/>\nImprisonment (Principle 24). Adopted by the United Nations General Assembly on 9 December<br \/>\n1988.<br \/>\nBasic Principles for the Treatment of Prisoners (Article 9). Adopted by the United Nations General<br \/>\nAssembly on 14 December 1990.<br \/>\nUnited Nations Rules for the Protection of Juveniles Deprived of Their Liberty (Principles 50-54).<br \/>\nAdopted by the United Nations General Assembly on 14 December 1990.<br \/>\nWHO Guidelines on HIV Infection and AIDS in Prison. Issued in March 1993, Geneva<br \/>\n(Document WHO\/GPA\/DIR\/93.3).<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0D-\u00ad\u20102002-\u00ad\u201001-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0DECLARATION<br \/>\n \u00a0OF<br \/>\n \u00a0WASHINGTON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nBIOLOGICAL<br \/>\n \u00a0WEAPONS<br \/>\n \u00a0<br \/>\nAdopted by the 53rd<br \/>\nWMA General Assembly, Washington, DC, USA, October 2002<br \/>\nand editorialiy revised by the 164th<br \/>\nWMA Council Session, Divonne-les-Bains, France,<br \/>\nMay 2003<br \/>\nand reaffirmed by the 191st<br \/>\nWMA Council Session, Prague, Czech Republic, April 2012<br \/>\nA.<br \/>\n \u00a0<br \/>\n \u00a0INTRODUCTION<br \/>\n \u00a0<br \/>\n1. The World Medical Association recognizes the growing threat that biological wea-<br \/>\npons might be used to cause devastating epidemics that could spread internationally.<br \/>\nAll countries are potentially at risk. The release of organisms causing smallpox,<br \/>\nplague, anthrax or other diseases could prove catastrophic in terms of the resulting<br \/>\nillnesses and deaths compounded by the panic such outbreaks would generate. At<br \/>\nthe same time, there is a growing potential for production of new microbial agents,<br \/>\nas expertise in biotechnology grows and methods for genetic manipulation of<br \/>\norganisms become simpler. These developments are of special concern to medical<br \/>\nand public health professionals because it is they who best know the potential<br \/>\nhuman suffering caused by epidemic disease and it is they who will bear primary<br \/>\nresponsibility for dealing with the victims of biological weapons. Thus, the World<br \/>\nMedical Association believes that medical associations and all who are concerned<br \/>\nwith health care bear a special responsibility to lead in educating the public and<br \/>\npolicy makers about the implications of biological weapons and to mobilize uni-<br \/>\nversal support for condemning research, development, or use of such weapons as<br \/>\nmorally and ethically unacceptable.<br \/>\n2. Unlike the use of nuclear, chemical, and conventional weapons, the consequences<br \/>\nof a biological attack are likely to be insidious. Their impact might continue with<br \/>\nsecondary and tertiary transmission of the agent, weeks or months after the initial<br \/>\nepidemic. The consequences of a successful biological attack, especially if the<br \/>\ninfection were readily communicable, could far exceed those of a chemical or even<br \/>\na nuclear event. Given the ease of travel and increasing globalization, an outbreak<br \/>\nanywhere in the world could be a threat to all nations.<br \/>\n3. A great many severe, acute illnesses occurring over a short span of time would<br \/>\nalmost certainly overwhelm the capacities of most health systems in both the<br \/>\ndeveloping and industrialized world. Health services throughout the world are<br \/>\nstruggling to meet the demands created by HIV\/AIDS and antimicrobial-resistant<br \/>\norganisms, the problems created by civil strife, refugees and crowded, unsanitary<br \/>\nurban environments as well as the increased health needs of aging populations.<br \/>\nCoping over a short period of time with large numbers of desperately ill persons<br \/>\ncould overwhelm entire health systems.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0D-\u00ad\u20102002-\u00ad\u201001-\u00ad\u20102012<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Prague<br \/>\n \u00a0<br \/>\nBiological<br \/>\n \u00a0Weapons<br \/>\n \u00a0(Washington)<br \/>\n \u00a0<br \/>\n4. Actions can be taken to diminish the risk of biological weapons as well as the<br \/>\npotentially harmful consequences of serious epidemics whatever their origin. Inter-<br \/>\nnational collaboration is needed to build a universal consensus that condemns the<br \/>\ndevelopment, production, or use of biological weapons. Programs of surveillance<br \/>\nare needed in all countries for the early detection, identification, and response to<br \/>\nserious epidemic disease; health education and training is needed for professionals,<br \/>\ncivic leaders, and the public alike; and collaborative programs of research are<br \/>\nneeded to improve disease diagnosis, prevention, and treatment.<br \/>\n5. The proliferation of technology and scientific progress in biochemistry, biotech-<br \/>\nnology, and the life sciences provides the opportunity to create novel pathogens<br \/>\nand diseases and simplified production methods for bioweapons. The technology is<br \/>\nrelatively inexpensive and, because production is similar to that used in biological<br \/>\nfacilities such as vaccine manufacturing, it is easy to obtain. Capacity to produce<br \/>\nand effectively disperse biological weapons exists globally, allowing extremists<br \/>\n(acting collectively or individually) to threaten governments and endanger peoples<br \/>\naround the world. Nonproliferation and arms control measures can diminish but<br \/>\ncannot completely eliminate the threat of biological weapons. Thus, there is a need<br \/>\nfor the creation of and adherence to a globally accepted ethos that rejects the<br \/>\ndevelopment and use of biological weapons.<br \/>\nB. STRENGTHENING<br \/>\n \u00a0PUBLIC<br \/>\n \u00a0HEALTH<br \/>\n \u00a0AND<br \/>\n \u00a0DISEASE<br \/>\n \u00a0SURVEILLANCE<br \/>\n \u00a0SYSTEMS<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n2.<br \/>\n1. A critical component in dealing with epidemic disease is a strong public health<br \/>\ninfrastructure. Investment in public health systems will enhance capacity to detect<br \/>\nand to contain expeditiously, rare or unusual disease outbreaks, whether deli-<br \/>\nberately induced or naturally occurring. Core public health functions (disease sur-<br \/>\nveillance and supporting laboratory services) are needed as a foundation for detec-<br \/>\ntion, investigation, and response to all epidemic threats. A more effective global<br \/>\nsurveillance program will improve response to naturally occurring infectious dis-<br \/>\neases and will permit earlier detection and characterization of new or emerging<br \/>\ndiseases.<br \/>\n2. It is especially important that physicians be alert to the occurrence of cases or<br \/>\nclusters of unusual infectious diseases, to seek help from infectious disease<br \/>\nspecialists in diagnosis, and to report cases promptly to public health authorities.<br \/>\nBecause any physician may see only one or a few cases and may not recognize that<br \/>\nan outbreak is occurring, cooperation between primary care physicians and public<br \/>\nhealth authorities is especially important.<br \/>\n3. Public health officials, dealing with an epidemic, will require the cooperation of<br \/>\nemergency management agencies, law enforcement officials, healthcare facilities,<br \/>\nand a variety of community service organizations. For these different groups to work<br \/>\ntogether effectively, advance planning will be important. In addition to developing<br \/>\nsurveillance activities for early detection and reporting, public health efforts should<br \/>\nbe directed toward educating primary caregivers and public health staff about<br \/>\npotential agents that might be used, building laboratory capacity for rapid identifi-<br \/>\ncation of biological agents, providing medical and hospital services as well as<br \/>\nvaccines and drugs to control the epidemic.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0D-\u00ad\u20102002-\u00ad\u201001-\u00ad\u20102012<br \/>\n \u00a0<br \/>\n4. C.<br \/>\n \u00a0<br \/>\n \u00a0ENHANCEMENT<br \/>\n \u00a0OF<br \/>\n \u00a0MEDICAL<br \/>\n \u00a0PREPAREDNESS<br \/>\n \u00a0AND<br \/>\n \u00a0RESPONSE<br \/>\n \u00a0CAPACITY<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\na.<br \/>\n1. The first indication that a biological weapon may have been disseminated is likely<br \/>\nto be the appearance of patients in the offices of practicing physicians, especially<br \/>\nthose in acute care settings. Physicians thus play a critical role in early detection of<br \/>\nan outbreak and must be prepared to recognize and deal with diseases resulting<br \/>\nfrom the use of biological weapons as well as other infectious disease agents and to<br \/>\npromptly report suspicious illnesses and diseases to public health officials.<br \/>\n2. In the course of an epidemic, physicians will be directly involved with mass patient<br \/>\ncare, with mass immunization and antibiotic prophylaxis, with providing informa-<br \/>\ntion to the public, and in a variety of hospital and community efforts to control the<br \/>\nepidemic. Thus, physicians should participate with local and national health<br \/>\nauthorities to develop and implement disaster preparedness and response plans for<br \/>\nintentional and natural infectious disease outbreaks.<br \/>\n5. D.<br \/>\n \u00a0<br \/>\n \u00a0BIOWEAPONS<br \/>\n \u00a0RESEARCH<br \/>\n \u00a0AND<br \/>\n \u00a0MEDICAL<br \/>\n \u00a0ETHICS<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\na.<br \/>\n1. Rapid advances in microbiology, molecular biology, and genetic engineering have<br \/>\ncreated extraordinary opportunities for biomedical research and hold great promise<br \/>\nfor improving human health and the quality of life. Better and more rapid diag-<br \/>\nnostic tools, novel vaccines, and therapeutic drugs can be foreseen. At the same<br \/>\ntime, there is concern about the possible misuse of research for the development of<br \/>\nmore potent biological weapons and the spread of new infectious diseases. It may<br \/>\nbe difficult to distinguish legitimate biomedical research from research by un-<br \/>\nscrupulous scientists with the malign purpose of producing more effective biologi-<br \/>\ncal weapons.<br \/>\n2. All who participate in biomedical research have a moral and ethical obligation to<br \/>\nconsider the implications of possible malicious use of their findings. Through<br \/>\ndeliberate or inadvertent means, genetic modification of microorganisms could<br \/>\ncreate organisms that are more virulent, are antibiotic-resistant, or have greater<br \/>\nstability in the environment. Genetic modification of microorganisms could alter<br \/>\ntheir immunogenicity, allowing them to evade natural- and vaccine-induced im-<br \/>\nmunity. Advances in genetic engineering and gene therapy may allow modification<br \/>\nof the immune response system of the target population to increase or decrease<br \/>\nsusceptibility to a pathogen or disrupt the functioning of normal host genes.<br \/>\n3. Research specifically for the purposes of creating biological weapons is to be<br \/>\ncondemned. As scientists and humanitarians, physicians have a societal respon-<br \/>\nsibility to decry scientific research for the development and use of biological wea-<br \/>\npons and to express abhorrence for the use of biotechnology and information<br \/>\ntechnologies for potentially harmful purposes.<br \/>\n4. Physicians and medical organizations have important societal roles in demanding a<br \/>\nglobal prohibition on biological weapons and stigmatizing their use, guarding<br \/>\nagainst unethical and illicit research, and mitigating civilian harm from use of<br \/>\nbiological weapons.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0D-\u00ad\u20102002-\u00ad\u201001-\u00ad\u20102012<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Prague<br \/>\n \u00a0<br \/>\nBiological<br \/>\n \u00a0Weapons<br \/>\n \u00a0(Washington)<br \/>\n \u00a0<br \/>\n6. E.<br \/>\n \u00a0<br \/>\n \u00a0RECOMMENDATIONS<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\na.<br \/>\n1. That the World Medical Association and National Medical Associations world-<br \/>\nwide take an active role in promoting an international ethos condemning the<br \/>\ndevelopment, production, or use of toxins and biological agents that have no justi-<br \/>\nfycation for prophylactic, protective, or other peaceful purposes.<br \/>\n2. That the World Medical Association, National Medical Associations and health-<br \/>\ncare workers worldwide promote, with the World Health Organization, the United<br \/>\nNations, and other appropriate entities, the establishment of an international con-<br \/>\nsortium of medical and public health leaders to monitor the threat of biological<br \/>\nweapons, to identify actions likely to prevent bioweapons proliferation, and to<br \/>\ndevelop a coordinated plan for monitoring the worldwide emergence of infectious<br \/>\ndiseases. This plan should address: (a) international monitoring and reporting sys-<br \/>\ntems so as to enhance the surveillance and control of infectious disease outbreaks<br \/>\nthroughout the world; (b) the development of an effective verification protocol<br \/>\nunder the UN Biological and Toxin Weapons Convention; (c) education of physi-<br \/>\ncians and public health workers about emerging infectious diseases and potential<br \/>\nbiological weapons; (d) laboratory capacity to identify biological pathogens; (e)<br \/>\navailability of appropriate vaccines and pharmaceuticals; and (f) financial, tech-<br \/>\nnical, and research needs to reduce the risk of use of biological weapons and other<br \/>\nmajor infectious disease threats.<br \/>\n3. That the World Medical Association urge physicians to be alert to the occurrence<br \/>\nof unexplained illnesses and deaths in the community and knowledgeable of<br \/>\ndisease surveillance and control capabilities for responding to unusual clusters of<br \/>\ndiseases, symptoms, or presentations.<br \/>\n4. That the World Medical Association encourage physicians, National Medical<br \/>\nAssociations and other medical societies to participate with local, national, and<br \/>\ninternational health authorities in developing and implementing disaster prepared-<br \/>\nness and response protocols for acts of bioterrorism and natural infectious disease<br \/>\noutbreaks. These protocols should be used as the basis for physician and public<br \/>\neducation.<br \/>\n5. That the World Medical Association urge all who participate in biomedical<br \/>\nresearch to consider the implications and possible applications of their work and to<br \/>\nweigh carefully in the balance the pursuit of scientific knowledge with their ethical<br \/>\nresponsibilities to society.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0D-\u00ad\u20102002-\u00ad\u201002-\u00ad\u20102002<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0DECLARATION<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nETHICAL<br \/>\n \u00a0CONSIDERATIONS<br \/>\n \u00a0REGARDING<br \/>\n \u00a0HEALTH<br \/>\n \u00a0DATABASES<br \/>\n \u00a0<br \/>\nAdopted by the 53rd<br \/>\nWMA General Assembly, Washington, DC, USA, October 2002<br \/>\n1. The right to privacy entitles people to exercise control over the use and disclosure of<br \/>\ninformation about them as individuals. The privacy of a patient&#8217;s personal health in-<br \/>\nformation is secured by the physician&#8217;s duty of confidentiality.<br \/>\n2. Confidentiality is at the heart of medical practice and is essential for maintaining trust<br \/>\nand integrity in the patient-physician relationship. Knowing that their privacy will be<br \/>\nrespected gives patients the freedom to share sensitive personal information with their<br \/>\nphysician.<br \/>\n3. These principles have been incorporated in WMA statements since the WMA was<br \/>\nfounded in 1947, in particular by:<br \/>\n1. The Declaration of Lisbon, that states: \u00abThe patient&#8217;s dignity and right to privacy<br \/>\nshall be respected at all times in medical care and teaching\u00bb;<br \/>\n2. The Declaration of Geneva, that requires physicians to \u00abpreserve absolute confi-<br \/>\ndentiality on all he knows about his patient even after the patient has died\u00bb;<br \/>\n3. The Declaration of Helsinki, that states:<br \/>\n\u00abIt is the duty of the physician in medical research to protect the life, health, pri-<br \/>\nvacy, and dignity of the human subject\u00bb<br \/>\n\u00abEvery precaution should be taken to respect the privacy of the [research] subject,<br \/>\nthe confidentiality of the patient&#8217;s information and to minimize the impact of the<br \/>\nstudy on the subject&#8217;s physical and mental integrity and on the personality of the<br \/>\nsubject\u00bb<br \/>\n\u00abIn any research on human beings, each potential subject must be adequately in-<br \/>\nformed of the aims, methods, sources of funding, any possible conflicts of in-<br \/>\nterest, institutional affiliations of the researcher, the anticipated benefits and poten-<br \/>\ntial risks of the study and the discomfort it may entail. The subject should be in-<br \/>\nformed of the right to abstain from participation in the study or to withdraw con-<br \/>\nsent to participate at any time without reprisal. After ensuring that the subject has<br \/>\nunderstood the information, the physician should then obtain the subject&#8217;s freely-<br \/>\ngiven informed consent, preferably in writing\u00bb<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0D-\u00ad\u20102002-\u00ad\u201002-\u00ad\u20102002<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Washington,<br \/>\n \u00a0DC<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nHealth<br \/>\n \u00a0Databases<br \/>\n \u00a0<br \/>\n1. The primary purpose of collecting personal health information is the provision of care<br \/>\nto the patient. Increasingly, this information is held in databases. The database might<br \/>\nhold the patient&#8217;s health record or specific information from it, for example in the case<br \/>\nof disease registries.<br \/>\n2. Progress in medicine and in health care is contingent upon the conduct of quality<br \/>\nassurance and risk management activities and health and medical research, including<br \/>\nretrospective epidemiological studies, which use information concerning the health of<br \/>\nindividuals, communities and societies. Databases are valuable sources of information<br \/>\nfor these secondary uses of health information.<br \/>\n3. Care must be taken to ensure that secondary uses of information do not inhibit pa-<br \/>\ntients from confiding information for their own health care needs, exploit their vulner-<br \/>\nability or inappropriately borrow on the trust that patients invest in their physicians.<br \/>\n4. For the purpose of this statement, the following definitions are used:<br \/>\n1. &#8216;Personal health information&#8217; is all information recorded with regard to the physical<br \/>\nor mental health of an identifiable individual;<br \/>\n2. A &#8216;database&#8217; is a system to collect, describe, save, recover and\/or use personal<br \/>\nhealth information from more than one individual whether by manual or electronic<br \/>\nmeans. This definition does not include information in the clinical record of any<br \/>\nindividual patient;<br \/>\n3. &#8216;De-identified data&#8217; are data in which the link between the patient and the infor-<br \/>\nmation has been broken and cannot be recovered;<br \/>\n4. &#8216;Consent&#8217; is a person&#8217;s voluntarily given permission for an action, based on a sound<br \/>\nunderstanding of what the action involves and its likely consequences. In some<br \/>\njurisdictions, the law allows substituted consent to be given on behalf of minors,<br \/>\non behalf of adults who do not have the capacity to consent for themselves, or on<br \/>\nbehalf of deceased persons.<br \/>\nPRINCIPLES<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. These principles apply to all new and existing health databases, including those run or<br \/>\nmanaged by commercial organisations.<br \/>\nAccess<br \/>\n \u00a0to<br \/>\n \u00a0information<br \/>\n \u00a0by<br \/>\n \u00a0patients<br \/>\n \u00a0<br \/>\n2. Patients have the right to know what information physicians hold about them, in-<br \/>\ncluding information held on health databases. In many jurisdictions, they have a right<br \/>\nto a copy of their health records.<br \/>\n3. Patients should have the right to decide that their personal health information in a<br \/>\ndatabase (as defined in 7.2) be deleted.<br \/>\n4. In rare, limited circumstances, information may be withhold from a patient if it is<br \/>\nlikely that disclosure cause serious harm to the patient or another person. Physicians<br \/>\nmust be able to justify any decision to withhold information from a patient.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0D-\u00ad\u20102002-\u00ad\u201002-\u00ad\u20102002<br \/>\n \u00a0<br \/>\nConfidentiality<br \/>\n \u00a0<br \/>\n5. All physicians are individually responsible and accountable for the confidentiality of<br \/>\nthe personal health information they hold. Physicians must also be satisfied that there<br \/>\nare appropriate arrangements for the security of personal health information when it is<br \/>\nstored, sent or received, including electronically.<br \/>\n6. In addition, medically qualified person(s) should be appointed to act as guardian of a<br \/>\nhealth database, to have responsibility for monitoring and ensuring compliance with<br \/>\nthe principles of confidentiality and security.<br \/>\n7. Safeguards must be in place to ensure that there is no inappropriate or unauthorised<br \/>\nuse of or access to personal health information in databases, and to ensure the authen-<br \/>\nticity of the data. When data is transmitted, there must be arrangements in place to en-<br \/>\nsure that the transmission is secure.<br \/>\n8. Audit systems must keep a record of who has accessed personal health information and<br \/>\nwhen. Patients should be able to review the audit record for their own information.<br \/>\nPatients&#8217;<br \/>\n \u00a0consent<br \/>\n \u00a0<br \/>\n9. Patients should be informed if their health information is to be stored on a database<br \/>\nand of the purposes for which their information may be used.<br \/>\n10. Patients&#8217; consent is needed if the inclusion of their information on a database involves<br \/>\ndisclosure to a third party or would permit access by people other than those involved<br \/>\nin the patients&#8217; care, unless there are exceptional circumstances as described in para-<br \/>\ngraph 11.<br \/>\n11. Under certain conditions, personal health information may be included on a database<br \/>\nwithout consent, for example where this conforms with applicable national law that<br \/>\nconforms to the requirements of this statement, or where ethical approval has been<br \/>\ngiven by a specially appointed ethical review committee. In these exceptional cases,<br \/>\npatients should be informed about the potential uses of their information, even if they<br \/>\nhave no right to object.<br \/>\n12. If patients object to their information being passed to others, their objections must be<br \/>\nrespected unless exceptional circumstances apply, for example where this is required<br \/>\nby applicable national law that conforms to the requirements of this statement or nec-<br \/>\nessary to prevent a risk of death or serious harm.<br \/>\n13. Authorization from the guardian of the health database is needed before information<br \/>\nheld on databases may be accessed by third parties. Procedures for granting authori-<br \/>\nzation must comply with recognised codes of confidentiality.<br \/>\n14. Approval from a specially appointed ethical review committee must be obtained for<br \/>\nall research using patient data, including for new research not envisaged at the time<br \/>\nthe data were collected. An important consideration for the committee in such cases<br \/>\nwill be whether patients should be contacted to obtain consent, or whether it is accept-<br \/>\nable to use the information for the new purpose without returning to the patient for<br \/>\nfurther consent. The committee&#8217;s decisions must be in accordance with applicable na-<br \/>\ntional law and conform to the requirements of this statement.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0D-\u00ad\u20102002-\u00ad\u201002-\u00ad\u20102002<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Washington,<br \/>\n \u00a0DC<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nHealth<br \/>\n \u00a0Databases<br \/>\n \u00a0<br \/>\n15. Data accessed must be used only for the purposes for which authorization has been<br \/>\ngiven.<br \/>\n16. People who collect, use, disclose or access health information must be subject to an<br \/>\nenforceable duty to keep the information secure.<br \/>\nDe-\u00ad\u2010identified<br \/>\n \u00a0data<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n17. Wherever possible, data for secondary purposes should be de-identified. If this is not<br \/>\npossible, however, the use of data where the patient&#8217;s identity is protected by an alias<br \/>\nor code should be used in preference to readily identifiable data.<br \/>\n18. The use of de-identified data does not usually raise issues of confidentiality. Data<br \/>\nabout people as individuals, in which they retain a legitimate interest, for example a<br \/>\ncase history or photograph, require protection.<br \/>\nData<br \/>\n \u00a0integrity<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n19. Physicians are responsible for ensuring, as far as practicable, that the information they<br \/>\nprovide to, and hold on, databases is accurate and up-to-date.<br \/>\n20. Patients who have seen their information and believe there are inaccuracies in it have<br \/>\nthe right to suggest amendments and to have their comments appended to the informa-<br \/>\ntion.<br \/>\nDocumentation<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n21. There must be documentation to explain: what information is held and why; what<br \/>\nconsent has been obtained from the patients; who may access the data; why, how and<br \/>\nwhen the data may be linked to other information; and the circumstances in which<br \/>\ndata may be made available to third parties.<br \/>\n22. Information to patients about a specific database should cover: consent to the storage<br \/>\nand use of data; rights of access to the data; and rights to have inaccurate data<br \/>\namended.<br \/>\nManagement<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n23. Procedures for addressing enquiries and complaints must be in place.<br \/>\n24. The person or persons who are accountable for policies, procedures, and to whom<br \/>\ncomplaints or enquiries can be made must be identified.<br \/>\nPolicies<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n25. National medical associations should cooperate with the relevant health authorities,<br \/>\nethical authorities and personal data authorities, at national and other appropriate ad-<br \/>\nministrative levels, to formulate health information policies based on the principles in<br \/>\nthis document.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0D-\u00ad\u20102002-\u00ad\u201003-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0DECLARATION<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nPATIENT<br \/>\n \u00a0SAFETY<br \/>\n \u00a0<br \/>\nAdopted by the 53rd<br \/>\nWMA General Assembly, Washington, DC, USA, October 2002<br \/>\nand reaffirmed by the 191st<br \/>\nWMA Council Session, Prague, Czech Republic, April 2012<br \/>\nPREAMBLE<br \/>\n \u00a0<br \/>\n1.<br \/>\n1. Physicians strive to provide the highest quality health and medical care to patients.<br \/>\nPatient safety is one of the core elements of quality in health and medical care.<br \/>\n2. Progress in medical and allied science and technology has transformed modern<br \/>\nmedicine into an advanced and complex health system.<br \/>\n3. Inherent risks have always existed in clinical medicine. Developments in modern<br \/>\nmedicine have resulted in new and sometimes greater risks &#8211; some avoidable, others<br \/>\ninherent.<br \/>\n4. Physicians should attempt to foresee these risks and manage them in the treatment of<br \/>\npatients.<br \/>\nPRINCIPLES<br \/>\n \u00a0<br \/>\n1.<br \/>\n1. Physicians must ensure that patient safety is always considered during medical<br \/>\ndecision-making.<br \/>\n2. Individuals and processes are rarely solely responsible for producing errors. Rather,<br \/>\nseparate elements combine and together produce a high-risk situation. Therefore,<br \/>\nthere should be a non-punitive culture for confidential reporting healthcare errors that<br \/>\nfocuses on preventing and correcting systems failures and not on individual or organi-<br \/>\nzation culpability.<br \/>\n3. A realistic understanding of the risks inherent in modern medicine requires that<br \/>\nphysicians must go beyond the professional boundaries of health care and cooperate<br \/>\nwith all relevant parties, including patients, to adopt a proactive systems approach to<br \/>\npatient safety.<br \/>\n4. To create such a systems approach, physicians must continuously absorb a wide range<br \/>\nof advanced scientific knowledge and continuously strive to improve medical practice.<br \/>\n5. All information that concerns a patient&#8217;s safety must be shared with all relevant<br \/>\nparties, including the patient. However, patient confidentiality must be strictly pro-<br \/>\ntected.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0D-\u00ad\u20102002-\u00ad\u201003-\u00ad\u20102012<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Prague<br \/>\n \u00a0<br \/>\nPatient<br \/>\n \u00a0Safety<br \/>\n \u00a0<br \/>\nRECOMMENDATIONS<br \/>\n \u00a0<br \/>\n1.<br \/>\n1. Hence, the WMA recommends the following to national medical associations:<br \/>\n1.<br \/>\n1. National medical associations should promote policies on patient safety to all<br \/>\nphysicians in their countries;<br \/>\n2. National medical associations should encourage individual physicians, other<br \/>\nhealth care professionals, patients and other relevant individuals and organiza-<br \/>\ntions to work together to establish systems that secure patient safety;<br \/>\n3. National medical associations should encourage the development of effective<br \/>\nmodels to promote patient safety through continuing medical education\/con-<br \/>\ntinuing professional development;<br \/>\n4. National medical associations should cooperate with one another and exchange<br \/>\ninformation about adverse events, including errors, their solutions, and \u00ablessons<br \/>\nlearned\u00bb to improve patient safety.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0D-\u00ad\u20102002-\u00ad\u201004-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0DECLARATION<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nMEDICAL<br \/>\n \u00a0ETHICS<br \/>\n \u00a0AND<br \/>\n \u00a0ADVANCED<br \/>\n \u00a0MEDICAL<br \/>\n \u00a0TECHNOLOGY<br \/>\n \u00a0<br \/>\nAdopted by the 53rd<br \/>\nWMA General Assembly, Washington, DC, USA, October 2002<br \/>\nand revised by the 63rd<br \/>\nWMA General Assembly, Bangkok, Thailand, October 2012<br \/>\nIt is essential to balance the benefits and risks for persons inherent in the development and<br \/>\napplication of advanced medical technology. Maintaining this balance is entrusted to the<br \/>\njudgment of the physician.<br \/>\nTherefore:<br \/>\nMedical technology should be used to promote health. Patient safety should be fully<br \/>\nconsidered by the physician in the development and application of medical technology.<br \/>\nIn order to foster physicians&#8217; ability to provide appropriate medical care and having<br \/>\nsufficient knowledge of medical technology efforts must be made to ensure the provision<br \/>\nof comprehensive medical education focusing on the safe and effective use and develop-<br \/>\nment of medical technology.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102008-\u00ad\u201001-\u00ad\u20102008<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0DECLARATION<br \/>\n \u00a0OF<br \/>\n \u00a0SEOUL<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nPROFESSIONAL<br \/>\n \u00a0AUTONOMY<br \/>\n \u00a0AND<br \/>\n \u00a0CLINICAL<br \/>\n \u00a0INDEPENDENCE<br \/>\n \u00a0<br \/>\nAdopted by the 59th<br \/>\nWMA General Assembly, Seoul, Korea, October 2008<br \/>\nThe World Medical Association, having explored the importance of professional auto-<br \/>\nnomy and physician clinical independence, hereby adopts the following principles:<br \/>\n1. The central element of professional autonomy and clinical independence is the assur-<br \/>\nance that individual physicians have the freedom to exercise their professional judg-<br \/>\nment in the care and treatment of their patients without undue influence by outside<br \/>\nparties or individuals.<br \/>\n2. Medicine is a highly complex art and science. Through lengthy training and experi-<br \/>\nence, physicians become medical experts and healers. Whereas patients have the right<br \/>\nto decide to a large extent which medical interventions they will undergo, they expect<br \/>\ntheir physicians to be free to make clinically appropriate recommendations.<br \/>\n3. Although physicians recognize that they must take into account the structure of the<br \/>\nhealth system and available resources, unreasonable restraints on clinical indepen-<br \/>\ndence imposed by governments and administrators are not in the best interests of pa-<br \/>\ntients, not least because they can damage the trust which is an essential component of<br \/>\nthe patient-physician relationship.<br \/>\n4. Hospital administrators and third-party payers may consider physician professional<br \/>\nautonomy to be incompatible with prudent management of health care costs. How-<br \/>\never, the restraints that administrators and third-party payers attempt to place on cli-<br \/>\nnical independence may not be in the best interests of patients. Furthermore, restraints<br \/>\non the ability of physicians to refuse demands by patients or their families for inap-<br \/>\npropriate medical services are not in the best interests of either patients or society.<br \/>\n5. The World Medical Association reaffirms the importance of professional autonomy<br \/>\nand clinical independence not only as an essential component of high quality medical<br \/>\ncare and therefore a benefit to the patient that must be preserved, but also as an essen-<br \/>\ntial principle of medical professionalism. The World Medical Association therefore<br \/>\nrededicates itself to maintaining and assuring the continuation of professional auto-<br \/>\nnomy and clinical independence in the care of patients.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0D-\u00ad\u20102009-\u00ad\u201001-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0DECLARATION<br \/>\n \u00a0OF<br \/>\n \u00a0DELHI<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nHEALTH<br \/>\n \u00a0AND<br \/>\n \u00a0CLIMATE<br \/>\n \u00a0CHANGE<br \/>\n \u00a0<br \/>\nAdopted by the 60th<br \/>\nWMA General Assembly, New Delhi, India, October 2009<br \/>\nPREAMBLE<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nThe purpose of this document is to provide a response by the WMA on behalf of its mem-<br \/>\nbers to the challenges imposed on health and healthcare systems by climate change.<br \/>\nAlthough governments and international organizations have the main responsibility for<br \/>\ncreating regulations and legislation to mitigate the effects of climate change and to help<br \/>\ntheir populations adapt to it, the World Medical Association, on behalf of its national me-<br \/>\ndical association members and their physician members, feels an obligation to highlight<br \/>\nthe health consequences of climate change and to suggest solutions. The 4th<br \/>\nAssessment<br \/>\nReport of the International Panel on Climate Change (IPCC) contains a full chapter on hu-<br \/>\nman health impacts (AR4 Chapter 8 Human Health1<br \/>\n), including a range of possibilities<br \/>\nregarding the potential effects of climate change. The following introduction includes the<br \/>\nmost likely effects of climate change from the IPCC report.<br \/>\nINTRODUCTION<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nThe response of world leaders to the impact that humans are having on climate and the<br \/>\nenvironment will permanently alter the livability of this planet.<br \/>\n1. The UN International Panel on Climate Change (IPCC) states \u201cEven the minimum<br \/>\npredicted shifts in climate for the 21st<br \/>\ncentury are likely to be significant and disrup-<br \/>\ntive\u201d 2<br \/>\n.<br \/>\n1.1. The minimum warming forecast for the next 100 years is more than twice the<br \/>\n0.6\u00b0 C increase that has occurred since 1900.<br \/>\n1.2. Extra-tropical storm tracks are projected to move toward the poles, with conse-<br \/>\nquent changes in wind, precipitation, and temperature patterns.<br \/>\n1.3. Sea levels have already risen by 10 to 20 cm over pre-industrial averages, and<br \/>\nwill continue to rise due to the time scales associated with climate processes<br \/>\nand feedbacks.<br \/>\n1.4. Projections point to continued snow cover contraction, and widespread in-<br \/>\ncreases in thaw depth over most permafrost regions, now including Antarctica.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0D-\u00ad\u20102009-\u00ad\u201001-\u00ad\u20102009<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0New<br \/>\n \u00a0Delhi<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nClimate<br \/>\n \u00a0Change<br \/>\n \u00a0(Delhi)<br \/>\n \u00a0<br \/>\n1.5. A future of more severe storms and floods along the world&#8217;s increasingly<br \/>\ncrowded coastlines is likely.<br \/>\n1.6. Increases in the amounts of precipitation in high latitudes and precipitation de-<br \/>\ncreases in most sub-tropical land regions are predicted.<br \/>\n1.7. Regional \/ local effects may differ but a reduction in potential crop yields is<br \/>\nexpected in most tropical \/ sub-tropical regions \u2013 causing further disruptions in<br \/>\nglobal food supply.<br \/>\n1.8. Salt-water intrusion from rising sea levels will reduce the quality and quantity<br \/>\nof freshwater supplies, and seawater will become more acidic from dissolved<br \/>\nCO2.<br \/>\n1.9. As many as 25% of mammals and 12% of birds may become extinct within the<br \/>\nnext few decades. Warmer conditions are altering the ecosystem and human<br \/>\ndevelopment is blocking threatened species from migrating.<br \/>\n1.10. Higher temperatures will expand the range of some vector-borne diseases, such<br \/>\nas malaria, which already kills 1 million people annually, mostly children2<br \/>\n.<br \/>\n2. The IPCC authors begin with a review of the evidence and provide the following<br \/>\ninformation (confidence levels as determined by IPCC in brackets):<br \/>\n2.1. Climate change currently contributes to the global burden of disease and pre-<br \/>\nmature deaths (very high confidence). At this early stage the effects are small<br \/>\nbut are projected to progressively increase in all countries and regions.<br \/>\n2.2. Emerging evidence of climate change effects on human health shows that cli-<br \/>\nmate change has (confidence levels in brackets):<br \/>\n2.2.1. Altered the distribution of some infectious disease vectors (medium);<br \/>\n2.2.2. Altered the seasonal distribution of some allergenic pollen species (high);<br \/>\n2.2.3. Increased heat wave related deaths (medium).<br \/>\n3. In their thorough review, the IPCC authors\u2019 project climate change related human<br \/>\nhealth impacts as follows (confidence levels in brackets):<br \/>\n3.1. Increased malnutrition and consequent disorders, including those relating to<br \/>\nchild growth and development (high).<br \/>\n3.2. Increased numbers of people suffering from death, disease and injury from heat<br \/>\nwaves, floods, storms, fires and droughts (high).<br \/>\n3.3. Continued change in the range of some infectious disease vectors (high).<br \/>\n3.4. Mixed effects on malaria; in some places the geographical range will contract,<br \/>\nelsewhere the geographical range will expand and the transmission season may<br \/>\nbe changed (very high).<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0D-\u00ad\u20102009-\u00ad\u201001-\u00ad\u20102009<br \/>\n \u00a0<br \/>\n3.5. Increased burden of diarrheal diseases (medium).<br \/>\n3.6. Increased cardio-respiratory morbidity and mortality associated with ground-<br \/>\nlevel ozone (high).<br \/>\n3.7. Increased numbers of people at risk of dengue (low).<br \/>\n3.8. Social and health inequalities due to possible desertification, natural disasters,<br \/>\nchanges in agriculture, feeding and water policy which will have consequences<br \/>\non both human health and human resources in health.<br \/>\n4. The authors note that climate change could bring some benefits to health, including<br \/>\nfewer deaths from cold, although these will be outweighed by the negative effects of<br \/>\nrising temperatures worldwide, especially in developing countries (high confidence).<br \/>\n5. The WMA notes that climate change is likely to amplify inequalities in health and<br \/>\nother existing problems within and between countries.<br \/>\n6. Early research suggests that mitigation of the effects of climate change may have a<br \/>\nlink with prevention such that mitigation might have significant health benefits for<br \/>\nboth individuals and populations3<br \/>\n.<br \/>\nSTATEMENT<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nGiven the consequences of global climate change on the health of people throughout the<br \/>\nworld, the World Medical Association, on behalf of its national medical association mem-<br \/>\nbers and their physician members supports and commits to the following actions:<br \/>\n1.<br \/>\n \u00a0ADVOCACY<br \/>\n \u00a0to<br \/>\n \u00a0Combat<br \/>\n \u00a0Global<br \/>\n \u00a0Warming<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1.1. The World Medical Association and National Medical Associations urge na-<br \/>\ntional governments to recognize the serious consequences for health as a result<br \/>\nof climate change and therefore to strive for an intergovernmental agreement in<br \/>\nCopenhagen in December 2009 with the following components:<br \/>\n1.1.1. specific goals for reductions of climate altering emissions (mitigation)<br \/>\n1.1.2. a mechanism to minimize the harms and health inequalities that are<br \/>\nglobally associated with climate change (adaptation).<br \/>\n1.1.3. because climate change will exaggerate health disparities, WMA recom-<br \/>\nmends that resources transferred to developing countries for climate<br \/>\nchange must include designated funds to support the strengthening of<br \/>\nhealth systems.<br \/>\n1.2. As a profession, physicians &#038; their medical associations will encourage advo-<br \/>\ncacy for environmental protection, reduction of green house gas production,<br \/>\nsustainable development and green adaptation practices within their commu-<br \/>\nnities, countries\/regions, especially for the right of safe water &#038; sewage dispo-<br \/>\nsal for all.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0D-\u00ad\u20102009-\u00ad\u201001-\u00ad\u20102009<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0New<br \/>\n \u00a0Delhi<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nClimate<br \/>\n \u00a0Change<br \/>\n \u00a0(Delhi)<br \/>\n \u00a0<br \/>\n1.3. As professionals, physicians are encouraged to act within their professional<br \/>\nsettings (clinics, hospitals, laboratories etc.) to reduce the environmental impact<br \/>\nof medical activities, &#038; to develop environmentally sustainable professional set-<br \/>\ntings.<br \/>\n1.4. As individuals, physicians will be encouraged to act to minimize their impact<br \/>\non the environment, reduce their carbon footprint and encourage those around<br \/>\nthem to do so.<br \/>\n2.<br \/>\n \u00a0LEADERSHIP:<br \/>\n \u00a0<br \/>\n \u00a0Help<br \/>\n \u00a0people<br \/>\n \u00a0to<br \/>\n \u00a0mitigate<br \/>\n \u00a0climate<br \/>\n \u00a0damage<br \/>\n \u00a0&#038;<br \/>\n \u00a0adapt<br \/>\n \u00a0to<br \/>\n \u00a0climate<br \/>\n \u00a0change<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n2.1. Support the Millennium Development Goals and commit to work to attain them.<br \/>\n2.2. Support and implement the principles outlined in the WHO Commission on the<br \/>\nSocial Determinants of Health report, Closing the Gap in a Generation and in<br \/>\nthe World Health Assembly Resolution on climate change and health and work<br \/>\nwith WHO and others to ensure implementation of the recommendations.<br \/>\n2.3. Work to create resilience within health systems to ensure that all health care<br \/>\nproviders are able to adapt and can fully utilize their capacity to provide care to<br \/>\nthose in need.<br \/>\n2.4. Urge local, national and international organizations focused on adaptation, miti-<br \/>\ngation, and development to involve physicians and the healthcare community<br \/>\nto ensure that unanticipated health impacts of development are minimized, while<br \/>\nopportunities for health promotion are maximized.<br \/>\n2.5. Work to improve the ability of patients to adapt to climate change and catastro-<br \/>\nphic weather events by:<br \/>\n2.5.1. encouraging health behaviors that improve overall health;<br \/>\n2.5.2. creating targeted programs designed to address specific exposures;<br \/>\n2.5.3. providing health promotion information and education on self-manage-<br \/>\nment of the symptoms of climate-associated illness.<br \/>\n3.<br \/>\n \u00a0EDUCATION<br \/>\n \u00a0&#038;<br \/>\n \u00a0CAPACITY<br \/>\n \u00a0BUILDING<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n3.1. Build professional awareness of the importance of the environment and global<br \/>\nclimate change to personal, community and societal health, and recognize that<br \/>\nuniversal equitable education improves health capacity for all.<br \/>\n3.2. Physicians have obligations for the health and health care of individual pa-<br \/>\ntients. Collectively, through their national medical associations, and through<br \/>\nWMA they also have obligations and responsibilities for the health of all<br \/>\npeople.<br \/>\n3.3. Work with others to educate the general public about the important effects of<br \/>\nclimate change on health and the need to both mitigate climate change and<br \/>\nadapt to its effects.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0D-\u00ad\u20102009-\u00ad\u201001-\u00ad\u20102009<br \/>\n \u00a0<br \/>\n3.4. Add or strengthen routine health training on environmental health\/medicine and<br \/>\npublic health for all students in health related disciplines.<br \/>\n3.5. The WMA and NMAs should develop concrete actionable plans\/practical steps<br \/>\nas tools for physicians to adopt in their practices; health authorities and govern-<br \/>\nments should do the same for hospitals and other health facilities.<br \/>\n3.6. Incorporate tools such as a patient environmental impact assessment and en-<br \/>\ncourage physicians to evaluate their patients and their families for risk from the<br \/>\nenvironment and global climate change.<br \/>\n3.7. Advocate that governments undertake community climate change health impact<br \/>\nassessments, widely disseminate the results, and incorporate the results into plan-<br \/>\nning for mitigation and adaptation.<br \/>\n3.8. Encourage recruitment of physicians for work in public health and all roles in<br \/>\nemergency planning &#038; response to extreme climate change, including the train-<br \/>\ning of other physicians.<br \/>\n3.9. Urge colleges and universities to develop locally appropriate continuing medi-<br \/>\ncal and public health education on the clinical signs, diagnosis and treatment of<br \/>\nnew diseases that are introduced into communities as a result of climate change,<br \/>\nand on the management of long-term anxiety and depression that often accom-<br \/>\npany experiences of disasters.<br \/>\n3.10. Urge governments to provide training for climate-change-related emergency<br \/>\nresponse to physicians, particularly those living in relatively isolated regions.<br \/>\n3.11. Work with policy makers on the development of concrete actions to be taken to<br \/>\nprevent or reduce the health impact of climate-related emissions, in particular<br \/>\nthose initiatives, which will also improve the general health of the population.<br \/>\nThis would include initiatives to stop the privatization of water<br \/>\n4.<br \/>\n \u00a0SURVEILLANCE<br \/>\n \u00a0AND<br \/>\n \u00a0RESEARCH<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n4.1. Work with others, including governments, to address the gaps in research re-<br \/>\ngarding climate change and health by undertaking studies to:<br \/>\n4.1.1. describe the patterns of disease that are attributed to climate change, in-<br \/>\ncluding the impacts of climate change on communities and households;<br \/>\n4.1.2. quantify and model the burden of disease that will be caused by global<br \/>\nclimate change;<br \/>\n4.1.3. describe the effects of poorly treated wastewater used for irrigation and<br \/>\n4.1.4. describe the most vulnerable populations, the particular health impacts<br \/>\nof climate change on vulnerable populations, &#038; possible new protec-<br \/>\ntions for such populations.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0D-\u00ad\u20102009-\u00ad\u201001-\u00ad\u20102009<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0New<br \/>\n \u00a0Delhi<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nClimate<br \/>\n \u00a0Change<br \/>\n \u00a0(Delhi)<br \/>\n \u00a0<br \/>\n4.2. Advocate for the collection of vital statistics and the removal of barriers to the<br \/>\nregistration of births &#038; deaths, in recognition of the special vulnerability of<br \/>\nsome populations.<br \/>\n4.3. Report diseases that emerge in conjunction with global climate change, and par-<br \/>\nticipate in field investigations, as with outbreaks of infectious diseases.<br \/>\n4.4. Support and participate in the development or expansion of surveillance sys-<br \/>\ntems to include diseases caused by global climate change.<br \/>\n4.5. WMA will and encourages all NMAs to collaborate in the collection and<br \/>\nsharing of local or regional health information within and between countries in<br \/>\norder to encourage the adoption of best practices and proven strategies<br \/>\n5.<br \/>\n \u00a0COLLABORATION:<br \/>\n \u00a0<br \/>\n \u00a0Prepare<br \/>\n \u00a0for<br \/>\n \u00a0climate<br \/>\n \u00a0emergencies<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n5.1. Collaborate with governments, NGOs and other health professionals to develop<br \/>\nknowledge about the best ways to mitigate climate change, including those<br \/>\nadaptive and mitigation strategies that will result in improved health.<br \/>\n5.2. Encourage governments to incorporate national medical associations &#038; physi-<br \/>\ncians into country &#038; community emergency planning &#038; response.<br \/>\n5.3. Work to ensure integration of physicians into the plans of civil society, govern-<br \/>\nments, public health authorities, international NGOs and WHO.<br \/>\n5.4. Encourage WHO and countries of the World Medical Assembly to review the<br \/>\nInternational Health Regulations and Planning for Pandemic Influenza and ob-<br \/>\ntain the perspective of clinicians in community practice to ensure that there are<br \/>\nappropriate responses by practicing physicians to emergency alerts, and to make<br \/>\nrecommendations regarding the most appropriate education, and tools for physi-<br \/>\ncians and other healthcare workers.<br \/>\n5.5. Call upon governments to strengthen public health systems in order to improve<br \/>\nthe capacity of communities to adapt to climate change.<br \/>\n5.6. Prepare physicians, physicians\u2019 offices, clinics, hospitals and other health care<br \/>\nfacilities for the infrastructure disruptions that accompany major emergencies,<br \/>\nin particular by planning in advance the delivery of services during times of<br \/>\nsuch disruptions.<br \/>\n5.7. Urge physicians, medical associations and governments to work collaboratively<br \/>\nto develop systems for event alerts in order to ensure that health care systems<br \/>\nand physicians are aware of climate-related events as they unfold, and receive<br \/>\ntimely accurate information regarding the management of emerging health<br \/>\nevents.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0D-\u00ad\u20102009-\u00ad\u201001-\u00ad\u20102009<br \/>\n \u00a0<br \/>\n5.8. Call upon governments to plan for environmental refugees within their coun-<br \/>\ntries.<br \/>\n5.9. In collaboration with WHO, produce locally adapted fact sheets on climate<br \/>\nchange for national medical associations, physicians, and other health pro-<br \/>\nfessionals.<br \/>\n5.10. WMA will work with others to identify funding for specific research programs<br \/>\non mitigation and adaptation related to health, and the sharing of informa-<br \/>\ntion\/research within and between countries and jurisdictions.<br \/>\n1<br \/>\nConfalonieri, U., B. Menne, R. Akhtar, K.L. Ebi, M. Hauengue, R.S. Kovats, B. Revich and A.<br \/>\nWoodward, 2007: Human health. Climate Change 2007: Impacts, Adaptation and Vulnerability.<br \/>\nContribution of Working Group II to the Fourth Assessment Report of the Intergovernmental<br \/>\nPanel on Climate Change, M.L. Parry, O.F. Canziani, J.P. Palutikof, P.J. van der Linden and C.E.<br \/>\nHanson, Eds., Cambridge University Press, Cambridge, UK, 391-431.<br \/>\n2<br \/>\nUnited Nations Framework Convention on Climate Change. http:\/\/unfccc.int\/2860.php down-<br \/>\nloaded 1 September 2008<br \/>\n3<br \/>\nIn the context of this paper, Mitigation describes the actions to reduce human effects on the cli-<br \/>\nmate system: principally strategies to reduce greenhouse gas emissions (analogous to primary pre-<br \/>\nvention) while Adaptation is understood to refer to the adjustment in natural or human systems<br \/>\ntaken in response to actual or expected climate stimuli or their effects, and that moderate harm or<br \/>\nexploit beneficial opportunities (analogous to secondary prevention). (See WHO EB122\/4, Jan 08)<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102009-\u00ad\u201002-\u00ad\u20102009<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0DECLARATION<br \/>\n \u00a0OF<br \/>\n \u00a0MADRID<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nPROFESSIONALLY-\u00ad\u2010LED<br \/>\n \u00a0REGULATION<br \/>\n \u00a0<br \/>\nAdopted by the 60th<br \/>\nWMA General Assembly, New Delhi, India, October 2009<br \/>\nThe collective action by the medical profession seeking for the benefit of patients, in<br \/>\nassuming responsibility for implementing a system of professionally-led regulation will<br \/>\nenhance and assure the individual physician&#8217;s right to treat patients without interference,<br \/>\nbased on his or her best clinical judgment. Therefore, the WMA urges the national medical<br \/>\nassociations and all physicians to take the following actions.<br \/>\n1. Physicians have been granted by society a high degree of professional autonomy and<br \/>\nclinical independence, whereby they are able to make recommendations based on the<br \/>\nbest interests of their patients without undue outside influence.<br \/>\n2. As a corollary to the right of professional autonomy and clinical independence, the<br \/>\nmedical profession has a continuing responsibility to be self-regulating. Ultimate con-<br \/>\ntrol and decision-making authority must rest with physicians, based on their specific<br \/>\nmedical training, knowledge, experience and expertise.<br \/>\n3. Physicians in each country are urged to establish, maintain and actively participate in<br \/>\na legitimate system of professionally-led regulation. This dedication is to ultimately<br \/>\nassure full clinical independence in patient care decisions.<br \/>\n4. To avoid being influenced by the inherent potential conflicts of interest that will arise<br \/>\nfrom assuming both representational and regulatory duties, National Medical Associa-<br \/>\ntions must do their utmost to promote and support the concept of professionally-led<br \/>\nregulation amongst their membership and the public.<br \/>\n5. Any system of professionally-led regulation must ensure<br \/>\na) the quality of the care provided to patients,<br \/>\nb) the competence of the physician providing that care and<br \/>\nc) the professional conduct of physician.<br \/>\nTo ensure the patient quality continuing care, physicians must participate actively in<br \/>\nthe process of Continuing Professional Development in order to update and maintain<br \/>\ntheir clinical knowledge, skills and competence.<br \/>\n6. The professional conduct of physicians must always be within the bounds of the Code<br \/>\nof Ethics governing physicians in each country. National Medical Associations must<br \/>\npromote professional and ethical conduct among physicians for the benefit of their<br \/>\npatients. Ethical violations must be promptly recognized and reported. The physicians<br \/>\nwho have erred must be appropriately disciplined and where possible be rehabilitated.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0New<br \/>\n \u00a0Delhi<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0D-\u00ad\u20102009-\u00ad\u201002-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nProfessionally-\u00ad\u2010led<br \/>\n \u00a0Regulation<br \/>\n \u00a0(Madrid)<br \/>\n \u00a0<br \/>\n7. National Medical Associations are urged to assist each other in coping with new and<br \/>\ndeveloping problems, including potential inappropriate threats to professionally-led<br \/>\nregulation. The ongoing exchange of information and experiences between National<br \/>\nMedical Associations is essential for the benefit of patients.<br \/>\n8. An effective and responsible system of professionally-led regulation by the medical<br \/>\nprofession in each country must not be self serving or internally protective of the pro-<br \/>\nfession, and the process must be fair, reasonable and sufficiently transparent to ensure<br \/>\nthis. National Medical Associations should assist their members in understanding that<br \/>\nself-regulation cannot only be perceived as being protective of physicians, but must<br \/>\nmaintain the safety, support and confidence of the general public as well as the ho-<br \/>\nnour of the profession itself.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102011-\u00ad\u201001-\u00ad\u20102011<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0DECLARATION<br \/>\n \u00a0OF<br \/>\n \u00a0MONTEVIDEO<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDISASTER<br \/>\n \u00a0PREPAREDNESS<br \/>\n \u00a0AND<br \/>\n \u00a0MEDICAL<br \/>\n \u00a0RESPONSE<br \/>\n \u00a0<br \/>\nAdopted by the 62nd<br \/>\nWMA General Assembly, Montevideo, Uruguay, October 2011<br \/>\nIn the last decade, the attention of the world has been drawn to a number of severe events<br \/>\nwhich seriously tested and overwhelmed the capacity of local healthcare and emergency<br \/>\nmedical response systems. Armed conflicts, terrorist attacks and natural distasters such as<br \/>\nearthquakes, floods and tsunamies in various parts of the world have not only affected the<br \/>\nhealth of people living in these areas but have also drawn the support and response of the<br \/>\ninternational community. Many National Medical Associations have sent groups to assist<br \/>\nin such disaster situations.<br \/>\nAccording to the World Health Organization (WHO) Center for Research on the Epide-<br \/>\nmiology of Disasters (CRED), the frequency, magnitude, and toll of natural disasters and<br \/>\nterrorism have increased throughout the world. In the previous century, about 3.5 million<br \/>\npeople were killed worldwide as a result of natural disasters; about 200 million were killed<br \/>\nas a result of human-caused disasters (e.g., wars, terrorism, genocides). Each year, dis-<br \/>\nasters cause hundreds of deaths and cost billions of dollars due to disruption of commerce<br \/>\nand destruction of homes and critical infrastructure.<br \/>\nPopulation vulnerability (e.g., due to increased population density, urbanization, aging)<br \/>\nhas increased the risk of disasters and public health emergencies. Globalization, which<br \/>\nconnects countries through economic interdependencies, has led to increased international<br \/>\ntravel and commerce. Such activity has also led to increased population density in cities<br \/>\naround the world and increased movement of people to coastal areas and other disaster-<br \/>\nprone regions. Increases in international travel may speed the rate at which an emerging<br \/>\ninfectious disease or bioterrorism agent spreads across the globe. Climate change and ter-<br \/>\nrorism have emerged as important global factors that can influence disaster trends and thus<br \/>\nrequire continued monitoring and attention.<br \/>\nThe emergence of infectious diseases, such as H1N1 influenza A and severe acute respi-<br \/>\nratory syndrome (SARS), and the recent arrival of West Nile virus and monkey pox in the<br \/>\nWestern hemisphere, reinforces the need for constant vigilance and planning to prepare for<br \/>\nand respond to new and unexpected public health emergencies.<br \/>\nThe growing likelihood of terrorist-related disasters affecting large civilian populations<br \/>\naffects all nations. Concern continues about the security of the worldwide arsenal of nu-<br \/>\nclear, chemical, and biological agents as well as the recruitment of people capable of manu-<br \/>\nfacturing or deploying them. The potentially catastrophic nature of a \u00absuccessful\u00bb terrorist<br \/>\nattack configures an event that may demand a disproportionate amount of resources and<br \/>\nhealthcare professionals preparedness. Natural disasters such as tornadoes, hurricanes,<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0Montevideo<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0D-\u00ad\u20102011-\u00ad\u201001-\u00ad\u20102011<br \/>\n \u00a0<br \/>\nDisaster<br \/>\n \u00a0Preparedness<br \/>\n \u00a0(Montevideo)<br \/>\n \u00a0<br \/>\nfloods, and earthquakes, as well as industrial and transportation-related catastrophes, are<br \/>\nfar more common and can also severely stress existing medical, public health, and emer-<br \/>\ngency response systems.<br \/>\nIn light of recent world events, it is increasingly clear that all physicians need to become<br \/>\nmore proficient in the recognition, diagnosis, and treatment of mass casualties under an<br \/>\nall-hazards approach to disaster management and response. They must be able to recog-<br \/>\nnize the general features of disasters and public health emergencies, and be knowledgeable<br \/>\nabout how to report them and where to get more information should the need arise. Physi-<br \/>\ncians are on the front lines when dealing with injury and disease-whether caused by mi-<br \/>\ncrobes, environmental hazards, natural disasters, highway collisions, terrorism, or other<br \/>\ncalamities. Early detection and reporting are critical to minimize casualties through astute<br \/>\nteamwork by public- and private-sector health and emergency response personnel.<br \/>\nThe WMA, representing the doctors of the world, calls upon its members to advocate for<br \/>\nthe following:<br \/>\n\u2022 To promote a standard competency set to ensure consistency among disaster<br \/>\ntraining programs for physicians across all specialties. Many NMAs have dis-<br \/>\naster courses and previous experiences in disaster response. These NMAs can<br \/>\nshare this knowledge and advocate for the integration of some standardized<br \/>\nlevel of training for all physicians, regardless of specialty or nationality.<br \/>\n\u2022 To work with national and local governments to establish or update regional<br \/>\ndatabases and geographic mapping of information on health system assets, ca-<br \/>\npacities, capabilities, and logistics to assist medical response efforts, domesti-<br \/>\ncally and worldwide, when needed. This could include information on local<br \/>\nresponse organizations, the condition of local hospitals and health system infra-<br \/>\nstructures, endemic and emerging diseases, and other important public health<br \/>\nand clinical information to assist medical response in the event of a disaster. In<br \/>\naddition, systems for communicating directly with physicians and other front<br \/>\nline health care providers should be identified and strengthened.<br \/>\n\u2022 To work with national and local governments to ensure the developing and<br \/>\ntesting of disaster management plans for clinical care and public health includ-<br \/>\ning the ethical basis for delivering such plans.<br \/>\n\u2022 To encourage governments at national and local levels to work across normal<br \/>\ndepartmental and other boundaries in developing the necessary planning.<br \/>\nThe WMA could serve as a channel of communication for NMAs during such times of<br \/>\ncrisis, enabling them to coordinate activities and work together.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102011-\u00ad\u201002-\u00ad\u20102011<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0DECLARATION<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\nEND-\u00ad\u2010OF-\u00ad\u2010LIFE<br \/>\n \u00a0MEDICAL<br \/>\n \u00a0CARE<br \/>\n \u00a0<br \/>\nAdopted by the 62nd<br \/>\nWMA General Assembly, Montevideo, Uruguay, October 2011<br \/>\nINTRODUCTION<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nAll people have the right to high-quality, scientifically-based, and humane healthcare.<br \/>\nTherefore, receiving appropriate end-of-life medical care must not be considered a pri-<br \/>\nvilege but a true right, independent of age or any other associated factors. The WMA reaf-<br \/>\nfirms the principles articulated in the WMA Declaration on Terminal illness and the<br \/>\nWMA Declaration on Euthanasia. These Declarations support and complement the Decla-<br \/>\nration on End of Life Medical Care.<br \/>\nPalliative care at the end of life is part of good medical care. The need for access to<br \/>\nimproved quality palliative care is great, especially in resource-poor countries. The objec-<br \/>\ntive of palliative care is to achieve the best possible quality of life through appropriate<br \/>\npalliation of pain and other distressing physical symptoms, and attention to the social, psy-<br \/>\nchological and spiritual needs of the patient.<br \/>\nPalliative care may be provided at home as well as in various levels of health care insti-<br \/>\ntutions.<br \/>\nThe physician must adopt an attitude to suffering that is compassionate and humane, and<br \/>\nact with empathy, respect and tact. Abandonment of the patient when he or she needs such<br \/>\ncare is unacceptable medical practice.<br \/>\nRECOMMENDATIONS<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1.<br \/>\n \u00a0<br \/>\n \u00a0Pain<br \/>\n \u00a0and<br \/>\n \u00a0symptom<br \/>\n \u00a0management<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1.1 It is essential to identify patients approaching the end of life as early as possible so<br \/>\nthat the physician can perform a detailed assessment of their needs. A care plan for<br \/>\nthe patient must always be developed; whenever possible, this care plan will be de-<br \/>\nveloped in direct consultation with the patient.<br \/>\nFor some this process may begin months or a year before death is anticipated. It<br \/>\nincludes recognising and addressing the likelihood of pain and other distressing<br \/>\nsymptoms and providing for patients&#8217; social, psychological and spiritual needs in<br \/>\nthe time remaining to them. The primary aim is to maintain patients&#8217; dignity and<br \/>\ntheir freedom from distressing symptoms. Care plans pay attention to keeping them<br \/>\nas comfortable and in control as possible and recognise the importance of sup-<br \/>\nporting the family and treating the body with respect after death.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0Montevideo<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0D-\u00ad\u20102011-\u00ad\u201002-\u00ad\u20102011<br \/>\n \u00a0<br \/>\nEnd-\u00ad\u2010of-\u00ad\u2010Life<br \/>\n \u00a0Medical<br \/>\n \u00a0Care<br \/>\n \u00a0<br \/>\n1.2 Important advances in the relief of pain and other distressing symptoms have been<br \/>\nmade. The appropriate use of morphine, new analgesics, and other measures can<br \/>\nsuppress or relieve pain and other distressing symptoms in the majority of cases.<br \/>\nThe appropriate health authorities must make necessary medications accessible and<br \/>\navailable to physicians and their patients. Physician groups should develop guide-<br \/>\nlines on their appropriate use, including dose escalation and the possibility of unin-<br \/>\ntended secondary effects.<br \/>\n1.3 In a very limited number of cases, generally in the very advanced stages of a phy-<br \/>\nsical illness, some symptoms may arise that are refractory to standard therapy. In<br \/>\nsuch cases, palliative sedation to unconsciousness may be offered when life ex-<br \/>\npectancy is a few days, as an extraordinary measure in response to suffering which<br \/>\nthe patient and clinician agree is intolerable. Palliative sedation must never be used<br \/>\nto intentionally cause a patient&#8217;s death or without the agreement of a patient who<br \/>\nremains mentally competent. The degree and timing of palliative sedation must be<br \/>\nproportionate to the situation. The dosage must be carefully calculated to relieve<br \/>\nsymptoms but should still be the lowest possible to achieve a benefit.<br \/>\n2.<br \/>\n \u00a0<br \/>\n \u00a0Communication<br \/>\n \u00a0and<br \/>\n \u00a0consent;<br \/>\n \u00a0ethics<br \/>\n \u00a0and<br \/>\n \u00a0values<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n2.1 Information and communication among the patient, their family and members of<br \/>\nthe health care team is one of the fundamental pillars of quality care at the end of<br \/>\nlife. The patient should be encouraged to express his or her preferences regarding<br \/>\ncare, and his or her emotions and existential angst must be taken into considera-<br \/>\ntion.<br \/>\n2.2 Ethically-appropriate care at the end of life should routinely promote patient auto-<br \/>\nnomy and shared decision-making, and be respectful of the values of the patient<br \/>\nand his or her family.<br \/>\n2.3 Physicians should directly discuss a patient&#8217;s preferences with the patient and\/or<br \/>\nthe patient&#8217;s substitute health care decision maker, as appropriate. These discus-<br \/>\nsions should be initiated early and routinely offered to all patients and should be<br \/>\nrevisited regularly to explore any changes patients may have in their wishes, espe-<br \/>\ncially as their clinical conditions change. Physicians should encourage their pa-<br \/>\ntients to formally document their goals, values and treatment preferences and to<br \/>\nappoint a substitute health care decision maker with whom the patient can discuss<br \/>\nin advance his or her values regarding health care and treatment. Patients who are<br \/>\nin denial about the implications of their condition may not want to engage in such<br \/>\ndiscussion at some stages of their illness, but should know that they can change<br \/>\ntheir minds. Because documented advance directives are often not available in<br \/>\nemergency situations, physicians should emphasize to patients the importance of<br \/>\ndiscussing treatment preferences with individuals who are likely to act as substitute<br \/>\nhealth care decision makers.<br \/>\n2.4 If a patient is capable of giving consent, care should be based on the patient&#8217;s wishes<br \/>\nas long as preferences can be justified medically, ethically and legally. Consent<br \/>\nneeds to be based on sufficient information and dialogue, and it is the physician&#8217;s<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102011-\u00ad\u201002-\u00ad\u20102011<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nobligation to make sure that the patient is adequately treated for pain and dis-<br \/>\ncomfort before consent is obtained in order to assure that unnecessary physical and<br \/>\nmental suffering do not interfere with the decision-making process.<br \/>\n2.5 The patient&#8217;s next-of-kin or family should be informed and involved in the deci-<br \/>\nsion-making process, provided the patient is not opposed to this. If the patient is<br \/>\nunable to express consent and an advance directive is not available, the views of<br \/>\nthe health care substitute decision maker, appointed by the patient on care and<br \/>\ntreatment, must be considered.<br \/>\n3.<br \/>\n \u00a0<br \/>\n \u00a0Medical<br \/>\n \u00a0records<br \/>\n \u00a0and<br \/>\n \u00a0medico-\u00ad\u2010legal<br \/>\n \u00a0aspects<br \/>\n \u00a0<br \/>\n3.1 Physicians caring for a patient in the final stages of life must carefully document<br \/>\ntreatment decisions and the reasons for choosing particular procedures, including<br \/>\nthe patient&#8217;s and family&#8217;s wishes and consent, in the progress notes of the medical<br \/>\nrecords. An adequate medical record is of the utmost importance for continuity and<br \/>\nquality of medical care in general and palliative care in particular.<br \/>\n3.2 The physician must also take into account that these notes may serve a medico-<br \/>\nlegal purpose, e.g., in determining the patient&#8217;s decision-making capacity.<br \/>\n4.<br \/>\n \u00a0<br \/>\n \u00a0Family<br \/>\n \u00a0members<br \/>\n \u00a0<br \/>\nIt is necessary to acknowledge the importance of the family and the emotional environ-<br \/>\nment of the patient. The needs of the family and other close caregivers throughout the<br \/>\ncourse of the illness must be recognized and attended to. The heath care team should pro-<br \/>\nmote collaboration in the care of the patient and provide bereavement support, when re-<br \/>\nquired, after the patient&#8217;s death. Children&#8217;s and families&#8217; needs may require special atten-<br \/>\ntion and competence, both when children are patients and dependents.<br \/>\n5.<br \/>\n \u00a0<br \/>\n \u00a0Teamwork<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nPalliative care is usually provided by multiprofessional and interdisciplinary teams of<br \/>\nhealthcare and non-healthcare professions. The physician must be the leader of the team,<br \/>\nbeing responsible, amongst other obligations, for diagnosis and medical treatment. Conti-<br \/>\nnuity of care is very important. The team should do all it can to facilitate a patient&#8217;s wish<br \/>\nto die at home, if applicable and possible.<br \/>\n6.<br \/>\n \u00a0<br \/>\n \u00a0Physician<br \/>\n \u00a0training<br \/>\n \u00a0<br \/>\nThe increasing number of people who require palliative care and the increased availability<br \/>\nof effective treatment options mean that end-of-life care issues should be an important part<br \/>\nof undergraduate and postgraduate medical training.<br \/>\n7.<br \/>\n \u00a0<br \/>\n \u00a0Research<br \/>\n \u00a0and<br \/>\n \u00a0education<br \/>\n \u00a0<br \/>\nMore research is needed to improve palliative care. This includes, but is not limited to, ge-<br \/>\nneral medical care, specific treatments, psychological implications and organization. The<br \/>\nWMA will support efforts to better educate physicians in the skills necessary to increase<br \/>\nthe prevalence and quality of meaningful advance care planning.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0Montevideo<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0D-\u00ad\u20102011-\u00ad\u201002-\u00ad\u20102011<br \/>\n \u00a0<br \/>\nEnd-\u00ad\u2010of-\u00ad\u2010Life<br \/>\n \u00a0Medical<br \/>\n \u00a0Care<br \/>\n \u00a0<br \/>\nCONCLUSION<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nThe care that a people give to dying patients, within available resources, is an indication of<br \/>\ntheir degree of civilisation. As physicians representing the best humanitarian tradition, we<br \/>\nshould always commit ourselves to delivering the best possible end-of-life care.<br \/>\nThe WMA recommends that all National Medical Associations develop a national policy<br \/>\non palliative care and palliative sedation based on the recommendations in this declara-<br \/>\ntion.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nD-\u00ad\u20102011-\u00ad\u201003-\u00ad\u20102011<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0DECLARATION<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nLEPROSY<br \/>\n \u00a0CONTROL<br \/>\n \u00a0AROUND<br \/>\n \u00a0THE<br \/>\n \u00a0WORLD<br \/>\n \u00a0AND<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nELIMINATION<br \/>\n \u00a0OF<br \/>\n \u00a0DISCRIMINATION<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nAGAINST<br \/>\n \u00a0PERSONS<br \/>\n \u00a0AFFECTED<br \/>\n \u00a0BY<br \/>\n \u00a0LEPROSY<br \/>\n \u00a0<br \/>\nAdopted by the 62nd<br \/>\nWMA General Assembly, Montevideo, Uruguay, October 2011<br \/>\nLeprosy is a widespread public health problem, with approximately 250,000 new cases<br \/>\ndiagnosed annually worldwide. It is a curable disease and after starting treatment, the<br \/>\nchain of transmission is interrupted. Leprosy is a disease that have been inadequately ad-<br \/>\ndressed from the point of view of investments in research and medical treatment.<br \/>\nThe World Medical Association recommends to all National Medical Associations to de-<br \/>\nfend the right of the people affected with leprosy and members of their families, that they<br \/>\nshould be treated with dignity and free from any kind of prejudice or discrimination. Phy-<br \/>\nsicians, health professionals and civil society should be engaged in combating all forms of<br \/>\nprejudice and discrimination. Research centers should acknowledge leprosy as a major<br \/>\npublic health problem, and continue to research this disease since there are still gaps in<br \/>\nunderstanding its patho-physiological mechanisms. These gaps in knowledge may be over-<br \/>\ncome through the allocation of resources to new research, which will contribute to more<br \/>\nefficient control worldwide. Medical schools, especially in countries with high preval-<br \/>\nence of leprosy, should enhance its importance in the curriculum. The public, private, and<br \/>\ncivil sectors should unify their best efforts in order to disseminate information that would<br \/>\ncounteract prejudice towards leprosy and that acknowledges its curability.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0D-\u00ad\u20102014-\u00ad\u201001-\u00ad\u20102014<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0DECLARATION<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nTHE<br \/>\n \u00a0PROTECTION<br \/>\n \u00a0OF<br \/>\n \u00a0HEALTH<br \/>\n \u00a0CARE<br \/>\n \u00a0WORKERS<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nIN<br \/>\n \u00a0SITUATION<br \/>\n \u00a0OF<br \/>\n \u00a0VIOLENCE<br \/>\n \u00a0<br \/>\nAdopted by the 65th<br \/>\nWMA General Assembly, Durban, South Africa, October 2014<br \/>\nPREAMBLE<br \/>\n \u00a0<br \/>\nThe right to health is a fundamental element of human rights which does not change in<br \/>\nsituations of conflict and violence. Access to medical assistance for the sick and wounded,<br \/>\nwhether they have been engaged in active combat or not, is guaranteed through various<br \/>\ninternational agreements, including the Geneva Convention and the Basic Principles on<br \/>\nthe Use of Force and Firearms by Law Enforcement Officials of the United Nations.<br \/>\nThe primary obligation of physicians is always to their patients, and physicians have the<br \/>\nsame ethical responsibilities to preserve health and save life in situations of violence or<br \/>\narmed conflicts as in peacetime. These are as set out in the WMA Regulations in Times of<br \/>\nArmed Conflict and Other Situations of Violence.<br \/>\nIt is essential to ensure the safety and personal security of healthcare workers in order to<br \/>\nenable the provision of the highest standard of care to patients. If healthcare workers are<br \/>\nnot safe, they might not be able to provide care, and patients will suffer.<br \/>\nIn situations of violence, the delivery of healthcare is frequently obstructed and the sick<br \/>\nand wounded deprived of essential treatment through:<br \/>\n1. Medical workers being prevented from attending to the injured;<br \/>\n2. Interference by the state or others in positions of power through intimidation, de-<br \/>\ntention or other legal measures;<br \/>\n3. Patients being denied access to medical facilities;<br \/>\n4. Targeted attacks upon medical facilities and medical transport;<br \/>\n5. Targeted attacks upon medical personnel, including kidnapping;<br \/>\n6. Non-targeted violent acts which result in the damage to or destruction of facilities<br \/>\nor vehicles, or cause injury or death to medical personnel.<br \/>\nSuch actions have serious humanitarian implications and violate international standards of<br \/>\nmedical neutrality as set out in the provisions of international human rights and human-<br \/>\nitarian law and codes of medical ethics.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0D-\u00ad\u20102014-\u00ad\u201001-\u00ad\u20102014<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Durban<br \/>\n \u00a0<br \/>\nProtection<br \/>\n \u00a0of<br \/>\n \u00a0Healthcare<br \/>\n \u00a0Workers<br \/>\n \u00a0<br \/>\nAttacks on the fundamental ethical principles of the medical profession, such as attempts<br \/>\nto coerce medical professionals into providing details regarding those under their care, can<br \/>\nundermine the confidence of patients and discourage injured people from seeking neces-<br \/>\nsary treatment.<br \/>\nRECOMMENDATIONS<br \/>\n \u00a0<br \/>\nThe WMA calls upon governments and all parties involved in situations of violence to:<br \/>\n1. Ensure the safety, independence and personal security of healthcare personnel at<br \/>\nall times, including during armed conflicts and other situations of violence, in ac-<br \/>\ncordance with the Geneva Conventions and their additional protocols;<br \/>\n2. Enable healthcare personnel to attend to injured and sick patients, regardless of<br \/>\ntheir role in a conflict, and to carry out their medical duties freely, independently<br \/>\nand in accordance with the principles of their profession without fear of punish-<br \/>\nment or intimidation;<br \/>\n3. Safe access to adequate medical facilities for the injured and others in need of<br \/>\nmedical aid should not be unduly impeded;<br \/>\n4. Protect medical facilities, medical transport and the people being treated in them<br \/>\nand provide the safest possible working environment for healthcare workers and<br \/>\nprotect them from interference and attack;<br \/>\n5. Respect and promote the principles of international humanitarian and human rights<br \/>\nlaw which safeguard medical neutrality in situations of conflict;<br \/>\n6. Establish reporting mechanisms to document violence against medical personnel<br \/>\nand facilities as set out in the WMA Statement on the Protection and Integrity of<br \/>\nMedical Personnel in Armed Conflicts and Other Situations of Violence.<br \/>\n7. Raise awareness of international norms on the protection of healthcare workers and<br \/>\ncooperate with different actors to identify strategies to tackle threats to healthcare.<br \/>\nThe collaboration between the WMA and the International Committee of the Red<br \/>\nCross on the Health Care in Danger project provides one example of this.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101956-\u00ad\u201001-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0REGULATIONS<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nIN<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nTIMES<br \/>\n \u00a0OF<br \/>\n \u00a0ARMED<br \/>\n \u00a0CONFLICT<br \/>\n \u00a0AND<br \/>\n \u00a0OTHER<br \/>\n \u00a0SITUATIONS<br \/>\n \u00a0OF<br \/>\n \u00a0VIOLENCE<br \/>\n \u00a0<br \/>\nAdopted by the 10th<br \/>\nWorld Medical Assembly, Havana, Cuba, October 1956<br \/>\nand edited by the 11th<br \/>\nWorld Medical Assembly, Istanbul, Turkey, October 1957<br \/>\nand revised by the 35th<br \/>\nWorld Medical Assembly, Venice, Italy, October 1983<br \/>\nand the 55th<br \/>\nWMA General Assembly, Tokyo, Japan, October 2004<br \/>\nand editorially revised by the 173rd<br \/>\nWMA Council Session, Divonne-les-Bains, France,<br \/>\nMay 2006<br \/>\nand revised by the 63rd<br \/>\nWMA General Assembly, Bangkok, Thailand, October 2012<br \/>\nGENERAL<br \/>\n \u00a0GUIDELINES<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nMedical ethics in times of armed conflict is identical to medical ethics in times of peace,<br \/>\nas stated in the International Code of Medical Ethics of the WMA. If, in performing their<br \/>\nprofessional duty, physicians have conflicting loyalties, their primary obligation is to their<br \/>\npatients; in all their professional activities, physicians should adhere to international con-<br \/>\nventions on human rights, international humanitarian law and WMA declarations on medi-<br \/>\ncal ethics.<br \/>\nThe primary task of the medical profession is to preserve health and save life. Hence it is<br \/>\ndeemed unethical for physicians to:<br \/>\n\u2022 Give advice or perform prophylactic, diagnostic or therapeutic procedures that are<br \/>\nnot justifiable for the patient&#8217;s health care;<br \/>\n\u2022 Weaken the physical or mental strength of a human being without therapeutic<br \/>\njustification;<br \/>\n\u2022 Employ scientific knowledge to imperil health or destroy life;<br \/>\n\u2022 Employ personal health information to facilitate interrogation;<br \/>\n\u2022 Condone, facilitate or participate in the practice of torture or any form of cruel, in-<br \/>\nhuman or degrading treatment.<br \/>\nDuring times of armed conflict and other situations of violence, standard ethical norms<br \/>\napply, not only in regard to treatment but also to all other interventions, such as research.<br \/>\nResearch involving experimentation on human subjects is strictly forbidden on all persons<br \/>\ndeprived of their liberty, especially civilian and military prisoners and the population of<br \/>\noccupied countries.<br \/>\nThe medical duty to treat people with humanity and respect applies to all patients. The<br \/>\nphysician must always give the necessary care impartially and without discrimination on<br \/>\nthe basis of age, disease or disability, creed, ethnic origin, gender, nationality, political af-<br \/>\nfiliation, race, sexual orientation, or social standing or any other similar criterion.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20101956-\u00ad\u201001-\u00ad\u20102012<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Bangkok<br \/>\n \u00a0<br \/>\nArmed<br \/>\n \u00a0Conflict<br \/>\n \u00a0<br \/>\nGovernments, armed forces and others in positions of power should comply with the<br \/>\nGeneva Conventions to ensure that physicians and other health care professionals can<br \/>\nprovide care to everyone in need in situations of armed conflict and other situations of<br \/>\nviolence. This obligation includes a requirement to protect health care personnel and<br \/>\nfacilities.<br \/>\nWhatever the context, medical confidentiality must be preserved by the physician. However,<br \/>\nin armed conflict or other situations of violence, and in peacetime, there may be cir-<br \/>\ncumstances in which a patient poses a significant risk to other people and physicians will<br \/>\nneed to weigh their obligation to the patient against their obligation to other individuals<br \/>\nthreatened.<br \/>\nPrivileges and facilities afforded to physicians and other health care professionals in times<br \/>\nof armed conflict and other situations of violence must never be used other than for health<br \/>\ncare purposes.<br \/>\nPhysicians have a clear duty to care for the sick and injured. Physicians should recognise<br \/>\nthe special vulnerability of some groups, including women and children. Provision of such<br \/>\ncare should not be impeded or regarded as any kind of offence. Physicians must never be<br \/>\nprosecuted or punished for complying with any of their ethical obligations.<br \/>\nPhysicians have a duty to press governments and other authorities for the provision of the<br \/>\ninfrastructure that is a prerequisite to health, including potable water, adequate food and<br \/>\nshelter.<br \/>\nWhere conflict appears to be imminent and inevitable, physicians should, as far as they are<br \/>\nable, ensure that authorities are planning for the protection of the public health infra-<br \/>\nstructure and for any necessary repair in the immediate post-conflict period.<br \/>\nIn emergencies, physicians are required to render immediate attention to the best of their<br \/>\nability. Whether civilian or combatant, the sick and wounded must receive promptly the<br \/>\ncare they need. No distinction shall be made between patients except those based upon<br \/>\nclinical need.<br \/>\nPhysicians must be granted access to patients, medical facilities and equipment and the<br \/>\nprotection needed to carry out their professional activities freely. Such access must include<br \/>\npatients in detention centres and prisons. Necessary assistance, including unimpeded<br \/>\npassage and complete professional independence, must be granted.<br \/>\nIn fulfilling their duties and where they have the legal right, physicians and other health<br \/>\ncare professionals shall be identified and protected by internationally recognized symbols<br \/>\nsuch as the Red Cross, Red Crescent or Red Crystal.<br \/>\nHospitals and health care facilities situated in areas where there is either armed conflict or<br \/>\nother situations of violence must be respected by all combatants and media personnel.<br \/>\nHealth care given to the sick and wounded, civilians or combatants, cannot be used for<br \/>\npublicity or propaganda. The privacy of the sick, wounded and dead must always be res-<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\npected. This includes visits from important political figures for media purposes and also<br \/>\nwhen important political figures are among the wounded and the sick.<br \/>\nPhysicians must be aware that, during armed conflict or other situations of violence, health<br \/>\ncare becomes increasingly susceptible to unscrupulous practice and the distribution of<br \/>\npoor quality \/ counterfeit materials and medicines, and attempt to take action on such<br \/>\npractices.<br \/>\nThe WMA supports the collection and dissemination of data related to assaults on phy-<br \/>\nsicians, other health care personnel and medical facilities, by an international body. Such<br \/>\ndata are important to understand the nature of such attacks and to set up mechanisms to<br \/>\nprevent them. Assaults against medical personnel must be investigated and those res-<br \/>\nponsible must be brought to justice.<br \/>\nCODE<br \/>\n \u00a0 OF<br \/>\n \u00a0 CONDUCT:<br \/>\n \u00a0 DUTIES<br \/>\n \u00a0 OF<br \/>\n \u00a0 PHYSICIANS<br \/>\n \u00a0 WORKING<br \/>\n \u00a0 IN<br \/>\n \u00a0 ARMED<br \/>\n \u00a0 CONFLICT<br \/>\n \u00a0 AND<br \/>\n \u00a0<br \/>\nOTHER<br \/>\n \u00a0SITUATIONS<br \/>\n \u00a0OF<br \/>\n \u00a0VIOLENCE<br \/>\n \u00a0<br \/>\nPhysicians must in all circumstances:<br \/>\n\u2022 Neither commit nor assist violations of international law (international humanitarian<br \/>\nlaw or human rights law);<br \/>\n\u2022 Not abandon the wounded and sick;<br \/>\n\u2022 Not take part in any act of hostility;<br \/>\n\u2022 Remind authorities of their obligation to search for the wounded and sick and to<br \/>\nensure access to health care without unfair discrimination;<br \/>\n\u2022 Advocate and provide effective and impartial care to the wounded and sick<br \/>\n(without reference to any ground of unfair discrimination, including whether they<br \/>\nare the \u00abenemy\u00bb);<br \/>\n\u2022 Recognise that security of individuals, patients and institutions are a major<br \/>\nconstraint to ethical behaviour and not take undue risk in the discharge of their<br \/>\nduties;<br \/>\n\u2022 Respect the individual wounded or sick person, his \/ her will, confidence and his \/<br \/>\nher dignity;<br \/>\n\u2022 Not take advantage of the situation and the vulnerability of the wounded and sick<br \/>\nfor personal financial gain;<br \/>\n\u2022 Not undertake any kind of experimentation on the wounded and sick without their<br \/>\nreal and valid consent and never where they are deprived of liberty;<br \/>\n\u2022 Give special consideration to the greater vulnerability of women and children in<br \/>\narmed conflict and other situations of violence and to their specific health-care<br \/>\nneeds;<br \/>\n\u2022 Respect the right of a family to know the fate and whereabouts of a missing family<br \/>\nmember whether or not that person is dead or receiving health care;<br \/>\n\u2022 Provide health care for anyone taken prisoner;<br \/>\n\u2022 Advocate for regular visits to prisons and prisoners by physicians, if such a me-<br \/>\nchanism is not already in place;<br \/>\n\u2022 Denounce and act, where possible, to put an end to any unscrupulous practices or<br \/>\ndistribution of poor quality\/counterfeit materials and medicines;<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20101956-\u00ad\u201001-\u00ad\u20102012<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Bangkok<br \/>\n \u00a0<br \/>\nArmed<br \/>\n \u00a0Conflict<br \/>\n \u00a0<br \/>\n\u2022 Encourage authorities to recognise their obligations under international humani-<br \/>\ntarian law and other pertinent bodies of international law with respect to protection<br \/>\nof health care personnel and infrastructure in armed conflict and other situations of<br \/>\nviolence;<br \/>\n\u2022 Be aware of the legal obligations to report to authorities the outbreak of any noti-<br \/>\nfiable disease or trauma;<br \/>\n\u2022 Do anything within their power to prevent reprisals against the wounded and sick<br \/>\nor health care;<br \/>\n\u2022 Recognise that there are other situations where health care might be compromised<br \/>\nbut in which there are dilemmas.<br \/>\nPhysicians should to the degree possible:<br \/>\n\u2022 Refuse to obey an illegal or unethical order;<br \/>\n\u2022 Give careful consideration to any dual loyalties that the physician may be bound<br \/>\nby and discuss these dual loyalties with colleagues and anyone in authority;<br \/>\n\u2022 As an exception to professional confidentiality, and in line with WMA Resolution<br \/>\non the Responsibility of Physicians in the Documentation and Denunciation of<br \/>\nActs of Torture or Cruel or Inhuman or Degrading Treatment and the Istanbul Pro-<br \/>\ntocol1<br \/>\n, denounce acts of torture or cruel, inhuman or degrading treatment of which<br \/>\nphysicians are aware, where possible with the subject&#8217;s consent, but in certain<br \/>\ncircumstances where the victim is unable to express him\/herself freely, without<br \/>\nexplicit consent;<br \/>\n\u2022 Listen to and respect the opinions of colleagues;<br \/>\n\u2022 Reflect on and try to improve the standards of care appropriate to the situation;<br \/>\n\u2022 Report unethical behaviour of a colleague to the appropriate superior;<br \/>\n\u2022 Keep adequate health care records;<br \/>\n\u2022 Support sustainability of civilian health care disrupted by the context;<br \/>\n\u2022 Report to a commander or to other appropriate authorities if health care needs are<br \/>\nnot met;<br \/>\n\u2022 Give consideration to how health care personnel might shorten or mitigate the<br \/>\neffects of the violence in question, for example by reacting to violations of interna-<br \/>\ntional humanitarian law or human rights law.<br \/>\n1<br \/>\nManual on Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or<br \/>\nDegrading Treatment or Punishment, OHCHR, 1999<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101983-\u00ad\u201001-\u00ad\u20102005<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nBOXING<br \/>\n \u00a0<br \/>\nAdopted by the 35th<br \/>\nWorld Medical Assembly, Venice, Italy, October 1983<br \/>\nand editorially revised by the 170th<br \/>\nWMA Council Session, Divonne-les-Bains, France,<br \/>\nMay 2005<br \/>\nBoxing is a dangerous sport. Unlike most other sports, its basic intent is to produce bodily<br \/>\nharm in the opponent. Boxing can result in death and produces an alarming incidence of<br \/>\nchronic brain injury. For this reason, the World Medical Association recommends that<br \/>\nboxing be banned.<br \/>\nUntil that goal is achieved, the following recommendations should be implemented:<br \/>\n1. National Medical Associations (NMAs) should encourage the establishment of a<br \/>\nnational registry of boxers for all amateur and professional boxers, including \u00abspar-<br \/>\nring mates\u00bb, in their country. The proposed functions of the registry would be to<br \/>\nrecord the results of all licensed bouts, including technical knockouts, knockouts, and<br \/>\nother boxing injuries, and to compile injury and win\/lose records for individual boxers.<br \/>\n2. NMAs should consider whether to plan and conduct conferences with interested<br \/>\nmembers of the medical profession, medical representatives of various government<br \/>\nboxing commissions, and representatives of organized professional and amateur box-<br \/>\ning organizations to review criteria for the neurological and physical examination of<br \/>\nboxers, to determine other comprehensive medical measures necessary for the preven-<br \/>\ntion of brain injury in the sport, and to develop specific criteria for the discontinu-<br \/>\nance of a bout for medical reasons.<br \/>\n3. All boxing jurisdictions should ensure that the ring physician should be authorized to<br \/>\nstop any bout in progress, at any time, to examine a contestant and, when indicated, to<br \/>\nterminate a bout that might, in his\/her opinion, result in serious injury for either con-<br \/>\ntestant.<br \/>\n4. Boxing jurisdictions should conduct frequent medical training seminars for all ring<br \/>\npersonnel.<br \/>\n5. All boxing jurisdictions should ensure that no amateur or professional boxing bout is<br \/>\npermitted unless:<br \/>\na. the contest is held in an area where adequate neurosurgical facilities are imme-<br \/>\ndiately available for skilled emergency treatment of an injured boxer;<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20101983-\u00ad\u201001-\u00ad\u20102005<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Divonne-\u00ad\u2010les-\u00ad\u2010Bains<br \/>\n \u00a0<br \/>\nBoxing<br \/>\n \u00a0<br \/>\nb. a portable resuscitator with oxygen equipment and appropriate endotracheal tubes<br \/>\nare available at ringside; and<br \/>\nc. a comprehensive evacuation plan for the removal of any seriously injured boxer<br \/>\nto hospital facilities is ready.<br \/>\n6. Boxing jurisdictions should be informed that unsupervised boxing competition be-<br \/>\ntween unlicensed boxers is a most dangerous practice that may result in serious in-<br \/>\njury or death to contestants, and should be condemned.<br \/>\n7. All boxing jurisdictions should be urged to mandate the use of safety equipment such<br \/>\nas plastic safety mats and padded cornerposts and to encourage continued develop-<br \/>\nment of safety equipment.<br \/>\n8. All boxing jurisdictions should be urged to extend all safety measures to sparring<br \/>\npartners.<br \/>\n9. All boxing jurisdictions should be urged to upgrade, standardize, and strictly enforce<br \/>\nmedical evaluations for boxers.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101984-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nCHILD<br \/>\n \u00a0ABUSE<br \/>\n \u00a0AND<br \/>\n \u00a0NEGLECT<br \/>\n \u00a0<br \/>\nAdopted by the 36th<br \/>\nWorld Medical Assembly, Singapore, October 1984<br \/>\nand amended by the 41st<br \/>\nWorld Medical Assembly, Hong Kong, September 1989<br \/>\n42nd<br \/>\nWorld Medical Assembly, Rancho Mirage, CA., USA, October 1990<br \/>\n44th<br \/>\nWorld Medical Assembly, Marbella, Spain, September 1992<br \/>\n47th<br \/>\nWMA General Assembly, Bali, Indonesia, September 1995<br \/>\nand the 57th<br \/>\nWMA General Assembly, Pilanesberg, South Africa, October 2006<br \/>\n1. One of the most destructive manifestations of family violence and upheaval is child<br \/>\nabuse and neglect. Prevention, early identification and comprehensive treatment of<br \/>\nchild abuse victims remain a challenge for the world medical community.<br \/>\n2. Definitions of child abuse vary from culture to culture. Unfortunately, cultural ra-<br \/>\ntionalizations for harmful behaviour toward children may be accepted, all too readily,<br \/>\nas proof that the treatment accorded children is neither abusive nor harmful. For<br \/>\ninstance, the work contribution of children in the everyday lives of families and in so-<br \/>\nciety should be recognized and encouraged as long as it also contributes to the child&#8217;s<br \/>\nown development. In contrast to this, exploitation of children in the labour market<br \/>\nmay deprive them of their childhood and of educational opportunities and even en-<br \/>\ndanger their present and future health. The WMA considers such exploitation of<br \/>\nchildren a serious form of child abuse and neglect.<br \/>\n3. For purposes of this Statement, the various forms of child abuse include physical,<br \/>\nsexual and emotional abuse. Child neglect represents a failure of a parent or other per-<br \/>\nson legally responsible for a child&#8217;s welfare to provide for the child&#8217;s basic needs and<br \/>\nan adequate level of care.<br \/>\n4. The World Medical Association recognizes that child maltreatment is a world health<br \/>\nproblem and recommends that National Medical Associations adopt the following<br \/>\nguidelines for physicians:<br \/>\n5. Physicians have both a unique and special role in identifying and helping abused<br \/>\nchild-ren and their troubled families.<br \/>\n6. Linkage to an experienced multidisciplinary team is strongly recommended for the<br \/>\nphysician. A team is likely to include such professionals as physicians, social workers,<br \/>\nchild and adult psychiatrists, developmental specialists, psychologists and attorneys.<br \/>\nWhen participation on a team is not possible or available, the individual physician<br \/>\nmust consult individually with other medical, social, law enforcement and mental<br \/>\nhealth personnel.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20101984-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Pilanesberg<br \/>\n \u00a0<br \/>\nChild<br \/>\n \u00a0Abuse<br \/>\n \u00a0and<br \/>\n \u00a0Neglect<br \/>\n \u00a0<br \/>\n7. Primary care physicians (family practitioners, internists, paediatricians), emergency<br \/>\nmedicine specialists, surgeons, psychiatrists and other specialists who treat children<br \/>\nmust acquire knowledge and skills in the physical assessment of child abuse and ne-<br \/>\nglect, the assessment of child development and parenting skills, the utilization of com-<br \/>\nmunity resources, and the physician&#8217;s legal responsibilities.<br \/>\n8. The medical evaluation of children who are suspected of having been abused should<br \/>\nbe performed by physicians skilled in both paediatrics and abuse evaluation. The me-<br \/>\ndical evaluation needs to be tailored to the child&#8217;s age, injuries, and condition, and<br \/>\nmay include but is not limited to blood testing, trauma radiographic survey, develop-<br \/>\nmental and behavioural screening. Follow up radiographs are strongly urged in some<br \/>\nchildren who present with serious, apparently abusive injuries.<br \/>\n9. The medical assessment and management of sexually abused children consists of a<br \/>\ncomplete history and physical examination, as physical and sexual abuses often occur<br \/>\ntogether; examination of the genitalia and anus; the collection and processing of evi-<br \/>\ndence including photographs; and the treatment and\/or prevention of pregnancy and<br \/>\nvenereal disease.<br \/>\n10. It is necessary for physicians to determine the nature and level of family functioning<br \/>\nas it relates to child protection. It is essential for the physician to understand and be<br \/>\nsensitive to how the quality of marital relationships, disciplinary styles, economic<br \/>\nstresses, emotional problems and abuse of alcohol, drugs and other substances, and<br \/>\nother forms of stress relate to child abuse.<br \/>\n11. The signs of abuse are often subtle, and the diagnosis may require comprehensive,<br \/>\ncareful interviews with the child, parents, caretakers, and siblings. Inconsistencies be-<br \/>\ntween the explanation(s) and characteristics of the injury(s) such as the severity, type<br \/>\nand age, should lead to a concern for abuse.<br \/>\n12. In any child presenting to a medical facility, the emergent medical and mental health<br \/>\nneeds should be addressed first. If abuse is suspected, safety needs must be addressed<br \/>\nprior to discharge from the facility. These measures may include but are not limited to:<br \/>\na. reporting all suspected cases to child protective services;<br \/>\nb. hospitalizing any abused child needing protection during the initial evaluation<br \/>\nperiod;<br \/>\nc. informing the parents of the diagnosis if it is safe to do so; and<br \/>\nd. reporting the child&#8217;s injuries to child protective services.<br \/>\n13. If hospitalization is required, a prompt evaluation of the child&#8217;s physical, emotional<br \/>\nand developmental problems is necessary. This comprehensive assessment should be<br \/>\nconducted by physicians with expertise or through a multidisciplinary team of experts<br \/>\nwith specialized training in child abuse.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101984-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\n14. If child abuse is suspected, the physician should discuss with the parents the fact that<br \/>\nchild maltreatment is in the differential diagnosis of their child&#8217;s problem. During<br \/>\nsuch a session, it is essential that the physician maintain objectivity and avoid accusa-<br \/>\ntory or judgmental statements in interactions with the parents.<br \/>\n15. It is essential that the physician record the findings in the medical chart during the<br \/>\nevaluation process. The medical record often provides critical evidence in court pro-<br \/>\nceedings.<br \/>\n16. Physicians should participate at all levels of prevention by providing prenatal and<br \/>\npostnatal family counselling, identifying problems in child rearing and parenting, and<br \/>\nadvising about family planning and birth control.<br \/>\n17. Public health measures such as home visits by nurses, anticipatory guidance by pa-<br \/>\nrents, well-infant and well-child examinations should be encouraged by physicians.<br \/>\nPrograms that improve the child&#8217;s general health also tend to prevent child abuse and<br \/>\nshould be supported by physicians.<br \/>\n18. Physicians should recognize that child abuse and neglect is a complex problem and<br \/>\nmore than one type of treatment or service may be needed to help abused children and<br \/>\ntheir families. The development of appropriate treatment requires contributions from<br \/>\nmany professions, including medicine, law, nursing, education, psychology and social<br \/>\nwork.<br \/>\n19. Physicians should promote the development of innovative programs that will advance<br \/>\nmedical knowledge and competence in the field of child abuse and neglect. Physicians<br \/>\nshould obtain education on child neglect and abuse during training as medical stu-<br \/>\ndents.<br \/>\n20. In the interests of the child, patient confidentiality must be waived in cases of child<br \/>\nabuse. The first duty of a doctor is to protect his or her patient if victimization is sus-<br \/>\npected. No matter what is the type of abuse (physical, mental, sexual), an official<br \/>\nreport must be made to the appropriate authorities.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101984-\u00ad\u201002-\u00ad\u20101984<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nFREEDOM<br \/>\n \u00a0TO<br \/>\n \u00a0ATTEND<br \/>\n \u00a0MEDICAL<br \/>\n \u00a0MEETINGS<br \/>\n \u00a0<br \/>\nAdopted by the 36th<br \/>\nWorld Medical Assembly, Singapore, October 1984<br \/>\nProfessional independence and professional freedom are indispensable to physicians to<br \/>\nenable them to give appropriate health care to their patients. Therefore, there should be no<br \/>\nbarriers, whether philosophical, religious, racial, political, geographic, physical or of any<br \/>\nother nature to prevent physicians from participating in professional activities that will<br \/>\nenable them to acquire the information, knowledge, skills and techniques required to pro-<br \/>\nvide appropriate health care to their patients.<br \/>\nIn as much as the purpose of the WMA is to serve humanity by endeavoring to achieve the<br \/>\nhighest international standards in medical education, medical science, medical art and<br \/>\nmedical ethics, and health care for all people of the world, there should accordingly be no<br \/>\nbarriers which will prevent physicians from attending meetings of the WMA, or other<br \/>\nmedical meetings, wherever such meetings are convened.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101985-\u00ad\u201001-\u00ad\u20102015<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nNON-\u00ad\u2010DISCRIMINATION<br \/>\n \u00a0IN<br \/>\n \u00a0PROFESSIONAL<br \/>\n \u00a0MEMBERSHIP<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nAND<br \/>\n \u00a0ACTIVITIES<br \/>\n \u00a0OF<br \/>\n \u00a0PHYSICIANS<br \/>\n \u00a0<br \/>\nAdopted by the 37th<br \/>\nWorld Medical Assembly, Brussels, Belgium, October 1985<br \/>\nand editorially revised by the 170th<br \/>\nWMA Council Session, Divonne-les-Bains, France,<br \/>\nMay 2005 and reaffirmed by the 200th<br \/>\nWMA Council Session, Oslo, Norway, April 2015<br \/>\nThe World Medical Association is in favour of equality of opportunity in medical associa-<br \/>\ntion activities, medical education and training, employment, and all other medical profes-<br \/>\nsional endeavours regardless of race, colour, religion, creed, ethnic affiliation, national<br \/>\norigin, sex, age or political affiliation.<br \/>\nThe World Medical Association is unalterably opposed to the denial of membership pri-<br \/>\nvileges and responsibilities in National Medical Associations to any duly registered physi-<br \/>\ncian because of race, colour, religion, creed, ethnic affiliation, national origin, sex, age or<br \/>\npolitical affiliation.<br \/>\nThe World Medical Association calls upon the medical profession and all individual<br \/>\nmembers of National Medical Associations to exert every effort to prevent any instance in<br \/>\nwhich such equal rights, privileges or responsibilities are denied.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101988-\u00ad\u201002-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nACCESS<br \/>\n \u00a0TO<br \/>\n \u00a0HEALTH<br \/>\n \u00a0CARE<br \/>\n \u00a0<br \/>\nAdopted by the 40th<br \/>\nWorld Medical Assembly, Vienna, Austria, September 1988<br \/>\nand revised by the 57th<br \/>\nWMA General Assembly, Pilanesberg, South Africa, October 2006<br \/>\nPREAMBLE<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. The Constitution of the World Health Organization states that the \u00abenjoyment of the<br \/>\nhighest attainable standard of health is one of the fundamental rights of every human<br \/>\nbeing\u2026.\u00bb Access to health care is a multi-dimensional concept that involves a bal-<br \/>\nancing of factors within the practical constraints of a specific country&#8217;s resources and<br \/>\ncapabilities. The factors include health human resources, financing, transportation,<br \/>\nfreedom of choice, public education, quality, and allocation of technology.<br \/>\nGUIDELINES<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nHealth<br \/>\n \u00a0Human<br \/>\n \u00a0Resources<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. National Medical Associations should join with other concerned groups from both the<br \/>\nprivate and public sectors to address issues related to the supply and distribution of<br \/>\nhealth human resources. Data should be collected to assess supply and distribution<br \/>\nand determine the appropriate mix of health professionals and health workers that can<br \/>\neffectively meet the needs of the population. Special efforts should be made to attract<br \/>\nphysicians and allied health care providers to underserved geographic areas through a<br \/>\nvariety of incentives and programs. Punitive or coercive models should not be em-<br \/>\nployed. Looking ahead to long-term needs, incentives should also be created to attract<br \/>\nmedical school students who wish to work in regions where there are health human<br \/>\nresource shortages.<br \/>\nFinancing<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n2. A pluralistic financing system should be developed that contains elements of both<br \/>\npublic and private funding. The exact mix of financing may vary significantly from<br \/>\ncountry to country. The system should be based on standards of uniform eligibility and<br \/>\nbenefits, and it should include adequate payment mechanisms for this purpose. These<br \/>\nmechanisms should be clearly explained to the public so that all concerned under-<br \/>\nstand the payment options available to them. Where appropriate, incentives should<br \/>\nbe provided for those in the private sector to provide care to patients who otherwise<br \/>\nwould not have access to it. No one who needs care should be denied it because of<br \/>\ninability to pay. Society has an obligation to provide a reasonable subsidy for care of<br \/>\nthe needy, and physicians have an obligation to participate to a reasonable degree in<br \/>\nsuch subsidized care. Governments have an obligation to ensure that such plans are<br \/>\nadministered fairly and objectively.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0Pilanesberg<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101988-\u00ad\u201002-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nAccess<br \/>\n \u00a0to<br \/>\n \u00a0Health<br \/>\n \u00a0Care<br \/>\n \u00a0<br \/>\nTransportation<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n3. Society has an obligation to provide adequate access to medical facilities for patients<br \/>\nwho live in remote areas. Transportation should also be provided to isolated rural<br \/>\npatients who require a sophisticated level of care that can be found only in metropoli-<br \/>\ntan medical centres. Telemedicine can sometimes be an acceptable substitute for trans-<br \/>\nportation of patients.<br \/>\nFreedom<br \/>\n \u00a0of<br \/>\n \u00a0Choice<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n4. All health care delivery systems should provide each individual with the greatest<br \/>\npossible personal freedom of choice in selecting a physician. To promote informed<br \/>\npersonal choice, adequate information concerning both private and public sector<br \/>\noptions should be made available to the public, employers and other payers of health<br \/>\ncare.<br \/>\nPublic<br \/>\n \u00a0Education<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n5. Educational programs that assist people in making informed choices about their per-<br \/>\nsonal health and about the appropriate uses of both self-care and professional care<br \/>\nshould be established. These programs should include information about the costs and<br \/>\nbenefits associated with alternative courses of treatment; the use of professional ser-<br \/>\nvices that permit early detection and treatment or prevention of illnesses; personal<br \/>\nresponsibilities in preventing illnesses; and the effective use of the health care system.<br \/>\nPatients should be given access to, and retain, copies of their own medical records.<br \/>\n6. In local communities, it is important that the public understand health care plans de-<br \/>\nsigned for their benefit and how these plans affect everyone concerned. Physicians<br \/>\nhave an obligation to actively participate in such educational efforts.<br \/>\nQuality<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n7. Quality assurance mechanisms should be part of every system of health care delivery.<br \/>\nPhysicians, in particular, should accept a responsibility for being guardians for the<br \/>\nquality of medical care and should not allow other considerations to jeopardize the<br \/>\nquality of care provided.<br \/>\nAllocation<br \/>\n \u00a0of<br \/>\n \u00a0Technology<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n8. Guidelines should be developed for the allocation of scarce health care technologies<br \/>\nin order to meet the needs of all patients and heath care practitioners and to ensure the<br \/>\nfair and equitable allocation of technology and resources across the health care sector.<br \/>\nCONCLUSION<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. Access is maximized when the following conditions exist:<br \/>\na. Adequate medical care is available to every individual, regardless of ability to pay.<br \/>\nb. There is maximum freedom of choice of health care providers and payment sys-<br \/>\ntems to accommodate the diverse needs of the population.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20101988-\u00ad\u201002-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Pilanesberg<br \/>\n \u00a0<br \/>\nAccess<br \/>\n \u00a0to<br \/>\n \u00a0Health<br \/>\n \u00a0Care<br \/>\n \u00a0<br \/>\nc. The entire population has easy access to adequate and comprehensive information<br \/>\non health care providers.<br \/>\nd. There is adequate opportunity for active participation by all parties in healthcare<br \/>\nsystems design and administration.<br \/>\ne. Physicians are provided with transparent and efficient ethical criteria for working<br \/>\nin overcrowded health systems that endanger health care.<br \/>\nf. Medical associations promote equal access to health care, both locally and na-<br \/>\ntionally, through dialogue and common activities with health authorities.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101988-\u00ad\u201004-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nTHE<br \/>\n \u00a0ROLE<br \/>\n \u00a0OF<br \/>\n \u00a0PHYSICIANS<br \/>\n \u00a0IN<br \/>\n \u00a0ENVIRONMENTAL<br \/>\n \u00a0ISSUES<br \/>\n \u00a0<br \/>\nAdopted by the 40th<br \/>\nWorld Medical Assembly, Vienna, Austria, September 1988<br \/>\nand revised by the 57th<br \/>\nWMA General Assembly, Pilanesberg, South Africa, October 2006<br \/>\nINTRODUCTION<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. The effective practice of medicine increasingly requires that physicians and their pro-<br \/>\nfessional associations turn their attention to environmental issues that have a bearing<br \/>\non the health of individuals and populations.<br \/>\n2. More than ever, due to diminishing natural resources, these problems relate to the<br \/>\nquality and protection of resources necessary to maintain health and indeed sustain<br \/>\nlife itself. In concrete terms, the key environmental issues are as follow:<br \/>\na. The degradation of the environment, which must be halted as a matter of urgency<br \/>\nso that resources essential to life and health &#8211; water and pure air &#8211; remain accessi-<br \/>\nble to all.<br \/>\nb. The ongoing contamination of our reserves of fresh water with hydrocarbons and<br \/>\nheavy metals, along with the contamination of ambient and indoor health by<br \/>\ntoxic agents, which have serious medical consequences, especially in the poorest<br \/>\nsegments of the globe. Moreover, the greenhouse effect with its concomitant pro-<br \/>\nven rise in temperature should drive our discussions forward and prepare us for<br \/>\nincreasingly serious environmental and public health consequences.<br \/>\nc. The need to control the use of non-renewable resources such as topsoil, which<br \/>\nshould constantly be at the forefront of our minds, as should the importance of<br \/>\nsafeguarding this vital heritage so that it can be passed on to future generations.<br \/>\nd. The need to mobilise resources beyond national frontiers and to co-ordinate<br \/>\nglobal solutions for the planet as a whole, so as to formulate a unified strategy to<br \/>\nconfront these worldwide medical and economic problems.<br \/>\ne. The foremost objective is to increase awareness of the vital balance between<br \/>\nenvironmental resources on the one hand, and on the other, biological essentials<br \/>\nfor the health of everyone everywhere.<br \/>\n3. Our growing awareness of these issues today has, however, failed to prevent an in-<br \/>\ncrease in our societies&#8217; negative impact on the environment, e.g., melting of glaciers<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20101988-\u00ad\u201004-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Pilanesberg<br \/>\n \u00a0<br \/>\nEnvironmental<br \/>\n \u00a0Issues<br \/>\n \u00a0<br \/>\nand increasing desertification, nor has it halted the over-exploitation of natural re-<br \/>\nsources, e.g. pollution of rivers and seas, air pollution, deforestation and diminishing<br \/>\narable land. In this context, the migration of people from disadvantaged or developing<br \/>\ncountries, together with the emergence of new diseases, exacerbates the lack of socio-<br \/>\neconomic policies in many parts of the world. From a medical point of view, growth<br \/>\nof the population and irresponsible destruction of the environment are unacceptable,<br \/>\nand medical organisations throughout the world should redouble their efforts, not only<br \/>\nto speak out about these problems, but also to suggest solutions.<br \/>\nPRINCIPLES<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. In their role as representatives of physicians, medical associations are duty bound to<br \/>\ngrapple with these environmental issues. They have a duty to produce analytical stu-<br \/>\ndies that include the identification of problems and current international regulations<br \/>\non environmental issues, as well as their impact on the field of health.<br \/>\n2. As physicians operate within the framework of ethics and medical deontology, the<br \/>\nenvironmental regulations advocated should not seek to limit individual autonomy,<br \/>\nbut rather to enrich the quality of life for all and to perpetuate life-forms on the planet.<br \/>\n3. The WMA should therefore act as an international platform for research, education,<br \/>\nand advocacy to help further sustain the environment and its potential to promote<br \/>\nhealth.<br \/>\n4. Thus, when new environmental diseases or syndromes are identified, the WMA<br \/>\nshould help coordinate the scientific\/medical discussions on the available data and<br \/>\ntheir implications for human health. It should foster the development of consensus<br \/>\nthinking within medicine, and help to stimulate preventive measures, accurate diagno-<br \/>\nsis and treatment of these emerging disorders.<br \/>\n5. The WMA should therefore provide a framework for the international co-ordination<br \/>\nof medical associations, NGOs, research clinicians, international health organisations,<br \/>\ndecision-makers and funding providers, in their examination of the human health ef-<br \/>\nfects of environmental problems, their prevention, remediation and treatment for indi-<br \/>\nviduals and communities.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101988-\u00ad\u201005-\u00ad\u20102011<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nHEALTH<br \/>\n \u00a0HAZARDS<br \/>\n \u00a0OF<br \/>\n \u00a0TOBACCO<br \/>\n \u00a0PRODUCTS<br \/>\n \u00a0AND<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nTOBACCO-\u00ad\u2010DERIVED<br \/>\n \u00a0PRODUCTS<br \/>\n \u00a0<br \/>\nAdopted by the 40th<br \/>\nWMA General Assembly, Vienna, Austria, September 1988<br \/>\nand amended by the 49th<br \/>\nWMA General Assembly, Hamburg, Germany, November 1997<br \/>\nand the 58th<br \/>\nWMA General Assembly, Copenhagen, Denmark, October 2007<br \/>\nand the 62nd<br \/>\nWMA General Assembly, Montevideo, Uruguay, October 2011<br \/>\nPREAMBLE<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nMore than one in three adults worldwide (more than 1.1 billion people) smokes, 80 per-<br \/>\ncent of whom live in low- and middle-income countries. Smoking and other forms of<br \/>\ntobacco use affect every organ system in the body, and are major causes of cancer, heart<br \/>\ndisease, stroke, chronic obstructive pulmonary disease, fetal damage, and many other con-<br \/>\nditions. Five million deaths occur worldwide each year due to tobacco use. If current<br \/>\nsmoking patterns continue, it will cause some 10 million deaths each year by 2020 and 70<br \/>\npercent of these will occur in developing countries. Tobacco use was responsible for 100<br \/>\nmillion deaths in the 20th century and will kill one billion people in the 21st century<br \/>\nunless effective interventions are implemented. Furthermore, secondhand smoke &#8211; which<br \/>\ncontains more than 4000 chemicals, including more than 50 carcinogens and many other<br \/>\ntoxins &#8211; causes lung cancer, heart disease, and other illnesses in nonsmokers.<br \/>\nThe global public health community, through the World Health Organization (WHO), has<br \/>\nexpressed increasing concern about the alarming trends in tobacco use and tobacco-<br \/>\nattributable disease. As of 20 September 2007, 150 countries had ratified the Framework<br \/>\nConvention on Tobacco Control (FCTC), whose provisions call for ratifying countries to<br \/>\ntake strong action against tobacco use by increasing tobacco taxation, banning tobacco<br \/>\nadvertising and promotion, prohibiting smoking in public places and worksites, imple-<br \/>\nmenting effective health warnings on tobacco packaging, improving access to tobacco<br \/>\ncessation treatment services and medications, regulating the contents and emissions of<br \/>\ntobacco products, and eliminating illegal trade in tobacco products.<br \/>\nExposure to secondhand smoke occurs anywhere smoking is permitted: homes, work-<br \/>\nplaces, and other public places. According to the WHO, some 200,000 workers die each<br \/>\nyear due to exposure to smoke at work, while about 700 million children, around half the<br \/>\nworld&#8217;s total, breathe air polluted by tobacco smoke, particularly in the home. Based on<br \/>\nthe evidence of three recent comprehensive reports (the International Agency for Research<br \/>\non Cancer&#8217;s Monograph 83, Tobacco Smoke and Involuntary Smoking; the United States<br \/>\nSurgeon General&#8217;s Report on The Health Consequences of Involuntary Exposure to<br \/>\nTobacco Smoke; and the California Environmental Protection Agency&#8217;s Proposed Identifi-<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20101988-\u00ad\u201005-\u00ad\u20102011<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Montevideo<br \/>\n \u00a0<br \/>\nTobacco<br \/>\n \u00a0Products<br \/>\n \u00a0Health<br \/>\n \u00a0Hazards<br \/>\n \u00a0<br \/>\ncation of Environmental Tobacco Smoke as a Toxic Air Contaminant), on May 29, 2007,<br \/>\nthe WHO called for a global ban on smoking at work and in enclosed public places.<br \/>\nThe tobacco industry claims that it is committed to determining the scientific truth about<br \/>\nthe health effects of tobacco, both by conducting internal research and by funding external<br \/>\nresearch through jointly funded industry programs. However, the industry has consistently<br \/>\ndenied, withheld, and suppressed information concerning the deleterious effects of tobacco<br \/>\nsmoking. For many years the industry claimed that there was no conclusive proof that<br \/>\nsmoking tobacco causes diseases such as cancer and heart disease. It has also claimed that<br \/>\nnicotine is not addictive. These claims have been repeatedly refuted by the global medical<br \/>\nprofession, which because of this is also resolutely opposed to the massive advertising<br \/>\ncampaigns mounted by the industry and believes strongly that the medical associations<br \/>\nthemselves must provide a firm leadership role in the campaign against tobacco.<br \/>\nThe tobacco industry and its subsidiaries have for many years supported research and the<br \/>\npreparation of reports on various aspects of tobacco and health. By being involved in such<br \/>\nactivities, individual researchers and\/or their organizations give the tobacco industry an<br \/>\nappearance of credibility even in cases where the industry is not able to use the results<br \/>\ndirectly in its marketing. Such involvement also raises major conflicts of interest with the<br \/>\ngoals of health promotion.<br \/>\nRECOMMENDATIONS<br \/>\n \u00a0<br \/>\nThe WMA urges the national medical associations and all physicians to take the following<br \/>\nactions to help reduce the health hazards related to tobacco use:<br \/>\n1. Adopt a policy position opposing smoking and the use of tobacco products, and<br \/>\npublicize the policy so adopted.<br \/>\n2. Prohibit smoking, including use of smokeless tobacco, at all business, social,<br \/>\nscientific, and ceremonial meetings of the National Medical Association, in line<br \/>\nwith the decision of the World Medical Association to impose a similar ban at all<br \/>\nits own such meetings.<br \/>\n3. Develop, support, and participate in programs to educate the profession and the<br \/>\npublic about the health hazards of tobacco use (including addiction) and exposure<br \/>\nto secondhand smoke. Programs aimed at convincing and helping smokers and<br \/>\nsmokeless tobacco users to cease the use of tobacco products and programs for<br \/>\nnon-smokers and non-users of smokeless tobacco products aimed at avoidance are<br \/>\nboth important.<br \/>\n4. Encourage individual physicians to be role models (by not using tobacco products)<br \/>\nand spokespersons for the campaign to educate the public about the deleterious<br \/>\nhealth effects of tobacco use and the benefits of tobacco-use cessation. Ask all<br \/>\nmedical schools, biomedical research institutions, hospitals, and other health care<br \/>\nfacilities to prohibit smoking, use of smokeless tobacco on their premises.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101988-\u00ad\u201005-\u00ad\u20102011<br \/>\n \u00a0<br \/>\n5. Introduce or strengthen educational programs for medical students and physicians<br \/>\nto prepare them to identify and treat tobacco dependence in their patients.<br \/>\n6. Support widespread access to evidence-based treatment for tobacco dependence &#8211;<br \/>\nincluding counseling and pharmacotherapy &#8211; through individual patient encounters,<br \/>\ncessation classes, telephone quit-lines, web-based cessation services, and other ap-<br \/>\npropriate means.<br \/>\n7. Develop or endorse a clinical practice guideline on the treatment of tobacco use<br \/>\nand dependence.<br \/>\n8. Join the WMA in urging the World Health Organization to add tobacco cessation<br \/>\nmedications with established efficacy to the WHO&#8217;s Model List of Essential Medi-<br \/>\ncines.<br \/>\n9. Refrain from accepting any funding or educational materials from the tobacco<br \/>\nindustry, and to urge medical schools, research institutions, and individual re-<br \/>\nsearchers to do the same, in order to avoid giving any credibility to that industry.<br \/>\n10. Urge national governments to ratify and fully implement the Framework Conven-<br \/>\ntion on Tobacco Control in order to protect public health.<br \/>\n11. Speak out against the shift in focus of tobacco marketing from developed to less<br \/>\ndeveloped nations and urge national governments to do the same.<br \/>\n12. Advocate the enactment and enforcement of laws that:<br \/>\n\u2022 provide for comprehensive regulation of the manufacture, sale, distribution, and<br \/>\npromotion of tobacco and tobacco-derived products, including the specific pro-<br \/>\nvisions listed below.<br \/>\n\u2022 require written and pictorial warnings about health hazards to be printed on all<br \/>\npackages in which tobacco products are sold and in all advertising and pro-<br \/>\nmotional materials for tobacco products. Such warnings should be prominent<br \/>\nand should refer those interested in quitting to available telephone quit-lines,<br \/>\nwebsites, or other sources of assistance.<br \/>\n\u2022 prohibit smoking in all enclosed public places (including health care facilities,<br \/>\nschools, and education facilities), workplaces (including restaurants, bars and<br \/>\nnightclubs) and public transport. Mental health and chemical dependence treat-<br \/>\nment centers should also be smoke-free. Smoking in prisons should not be per-<br \/>\nmitted.<br \/>\n\u2022 ban all advertising and promotion of tobacco and tobacco-derived products.<br \/>\n\u2022 encourage the development of plain packaging legislation<br \/>\n\u2022 prohibit the sale, distribution, and accessibility of cigarettes, and other tobacco<br \/>\nproducts to children and adolescents. Ban the production, distribution and sale<br \/>\nof candy products that depict or resemble tobacco products.<br \/>\n\u2022 prohibit smoking on all commercial airline flights within national borders and<br \/>\non all international commercial airline flights, and prohibit the sale of tax-free<br \/>\ntobacco products at airports and all other locations.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20101988-\u00ad\u201005-\u00ad\u20102011<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Montevideo<br \/>\n \u00a0<br \/>\nTobacco<br \/>\n \u00a0Products<br \/>\n \u00a0Health<br \/>\n \u00a0Hazards<br \/>\n \u00a0<br \/>\n\u2022 prohibit all government subsidies for tobacco and tobacco-derived products.<br \/>\n\u2022 provide for research into the prevalence of tobacco use and the effects of tobac-<br \/>\nco products on the health status of the population.<br \/>\n\u2022 prohibit the promotion, distribution, and sale of any new forms of tobacco pro-<br \/>\nducts that are not currently available.<br \/>\n\u2022 increase taxation of tobacco products, using the increased revenues for preven-<br \/>\ntion programs, evidence-based cessation programs and services, and other<br \/>\nhealth care measures.<br \/>\n\u2022 curtail or eliminate illegal trade in tobacco products and the sale of smuggled<br \/>\ntobacco products.<br \/>\n\u2022 help tobacco farmers switch to alternative crops.<br \/>\n\u2022 urge governments to exclude tobacco products from international trade agree-<br \/>\nments.<br \/>\n13. Recognize that tobacco use may lead to pediatric disease because of the harm done<br \/>\nto children caused by tobacco use and second-hand smoke exposure, the relation-<br \/>\nship of tobacco use by children and exposure to adult tobacco use, and the existence<br \/>\nof effective interventions to reduce tobacco use. Special efforts should be made by<br \/>\nphysicians to:<br \/>\n\u2022 provide tobacco-free environments for children<br \/>\n\u2022 target parents who smoke for tobacco cessation interventions<br \/>\n\u2022 promote programs that contribute to the prevention and decrease of tobacco use<br \/>\nby youth<br \/>\n\u2022 control access to and marketing of tobacco products, and<br \/>\n\u2022 make pediatric tobacco-control research a high priority<br \/>\n14. Refuse to invest in companies or firms producing or promoting the use or sale of<br \/>\ntobacco.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101989-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nANIMAL<br \/>\n \u00a0USE<br \/>\n \u00a0IN<br \/>\n \u00a0BIOMEDICAL<br \/>\n \u00a0RESEARCH<br \/>\n \u00a0<br \/>\nAdopted by the 41st<br \/>\nWorld Medical Assembly, Hong Kong, September 1989<br \/>\nand revised by the 57th<br \/>\nWMA General Assembly, Pilanesberg, South Africa, October 2006<br \/>\nPREAMBLE<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. Biomedical research is essential to the health and well-being of our society. Advances<br \/>\nin biomedical research have dramatically improved the quality and prolonged the<br \/>\nduration of life throughout the world. However, the ability of the scientific commu-<br \/>\nnity to continue its efforts to improve personal and public health is being threatened<br \/>\nby a movement to eliminate the use of animals in biomedical research. This move-<br \/>\nment is spearheaded by groups of radical animal rights activists whose views are<br \/>\nconsidered to be far outside mainstream public attitudes and whose tactics range from<br \/>\nsophisticated lobbying, fund-raising, propaganda and misinformation campaigns to<br \/>\nviolent attacks on biomedical research facilities and individual scientists. These violent<br \/>\nattacks are carried out by a relatively small number of activists compared with those<br \/>\nwho use peaceful means of protest, but they have profound and wide-ranging effects.<br \/>\n2. The magnitude of violent animal rights activities is staggering, and these activities<br \/>\ntake place in many different parts of the world. Various animal rights groups have<br \/>\nclaimed responsibility for the bombing of cars, institutions, stores, and the private<br \/>\nhomes of researchers.<br \/>\n3. Animal rights violence has had a chilling effect on the scientific community inter-<br \/>\nnationally. Scientists, research organizations, and universities have been intimidated<br \/>\ninto altering or even terminating important research efforts that depend on the use of<br \/>\nanimals. Laboratories have been forced to divert thousands of research dollars for the<br \/>\npurchase of sophisticated security equipment. Young people who might otherwise<br \/>\npursue a career in biomedical research are turning their sights to alternative profes-<br \/>\nsions.<br \/>\n4. Despite the efforts of many groups striving to protect biomedical research from<br \/>\nradical animal activism, the response to the animal rights movement has been frag-<br \/>\nmented, underfunded, and primarily defensive. Many groups within the biomedical<br \/>\ncommunity are hesitant to take a public stand about animal activism because of fear of<br \/>\nreprisal. As a result, the research establishment has been backed into a defensive pos-<br \/>\nture. Its motivations are questioned, and the need for using animals in research is re-<br \/>\npeatedly challenged.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20101989-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Pilanesberg<br \/>\n \u00a0<br \/>\nAnimal<br \/>\n \u00a0Use<br \/>\n \u00a0in<br \/>\n \u00a0Biomedical<br \/>\n \u00a0Research<br \/>\n \u00a0<br \/>\n5. While properly designed and executed research involving animals is necessary to<br \/>\nenhance the medical care of all persons, we recognize also that humane treatment of<br \/>\nresearch animals must be ensured. Appropriate training for all research personnel<br \/>\nshould be prescribed and adequate veterinary care should be available. Experiments<br \/>\nmust comply with any rules or regulations promulgated to govern humane handling,<br \/>\nhousing, care, treatment and transportation of animals.<br \/>\n6. International medical and scientific organizations must develop a stronger and more<br \/>\ncohesive campaign to counter the growing threat to public health posed by animal<br \/>\nactivists. Leadership and coordination must be provided. In addition, there must be a<br \/>\nclear understanding of the rights of animals who are part of medical research, and the<br \/>\nobligations of those who undertake it.<br \/>\nThe World Medical Association therefore affirms the following principles:<br \/>\n1. Animal use in biomedical research is essential for continued medical progress.<br \/>\n2. The WMA Declaration of Helsinki requires that biomedical research involving human<br \/>\nsubjects should be based, where appropriate, on animal experimentation, but also re-<br \/>\nquires that the welfare of animals used for research be respected.<br \/>\n3. Humane treatment of animals used in biomedical research is essential and research<br \/>\nfacilities should be required to comply with all guiding principles for humane treat-<br \/>\nment. Education about these principles should be provided to all researchers in train-<br \/>\ning.<br \/>\n4. Animals should only be used in biomedical research when it is clear that their use is<br \/>\nrequired to achieve an important outcome, and where no other feasible method is<br \/>\navailable.<br \/>\n5. Duplication of animal experiments should not occur unless scientifically justified.<br \/>\n6. The use of animals for the futile testing of cosmetic products and their ingredients,<br \/>\nalcohol and tobacco should not be supported.<br \/>\n7. Although rights to free speech should not be compromised, the anarchistic element<br \/>\namong animal right activists should be condemned.<br \/>\n8. The use of threats, intimidation, violence, and personal harassment of scientists and<br \/>\ntheir families should be condemned internationally.<br \/>\n9. A maximum coordinated effort from international law enforcement agencies should<br \/>\nbe sought to protect researchers and research facilities from activities of a terrorist<br \/>\nnature.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101990-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nINJURY<br \/>\n \u00a0CONTROL<br \/>\n \u00a0<br \/>\nAdopted by the 42nd<br \/>\nWorld Medical Assembly, Rancho Mirage, CA., USA, October 1990<br \/>\nand revised by the 57th<br \/>\nWMA General Assembly, Pilanesberg, South Africa, October 2006<br \/>\nInjuries are the leading cause of death and disability in children and young adults. Injuries<br \/>\ndestroy the health, lives and livelihoods of millions of people each year. Yet many injuries<br \/>\nare preventable. Injury control should be recognized as a public health priority requiring<br \/>\ncoordination among health, transportation and social service agencies in each country.<br \/>\nPhysician participation and leadership is necessary to assure the success of such injury<br \/>\ncontrol programmes.<br \/>\nThe World Medical Association urges National Medical Associations to work with appro-<br \/>\npriate public and private agencies to develop and implement programmes to prevent and<br \/>\ntreat injuries. Included in the programmes must be efforts to improve medical treatment<br \/>\nand rehabilitation of injured patients. Research and education on injury control must be in-<br \/>\ncreased, and international cooperation is a vital and necessary component of successful<br \/>\nprogrammes.<br \/>\nNational Medical Associations should recommend that the following basic elements be<br \/>\nincorporated in their countries&#8217; programmes:<br \/>\nEPIDEMIOLOGY<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nThe initial activity of such programmes must be the acquisition of more adequate data on<br \/>\nwhich to base priorities, interventions and research. An effective injury surveillance<br \/>\nsystem should be implemented in each country to gather and integrate information. A<br \/>\nconsistent and accurate system for coding injuries must be implemented by hospitals and<br \/>\nhealth agencies. There should also be uniform coding of injury severity.<br \/>\nPREVENTION<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nInjury prevention requires education and training to teach and persuade people to alter<br \/>\ntheir behaviour and thereby control their risk of injury. Laws and regulations based on sci-<br \/>\nentifically sound methods of preventing injuries may be appropriate for effecting changes<br \/>\nin behaviour (for example, the use of seatbelts and protective helmets). These laws must<br \/>\nbe strictly enforced in order to effectively influence behaviour changes. Improvements in<br \/>\nproduct and environmental design of various products to provide automatic protection<br \/>\nagainst injuries must be encouraged, as they will be the most effective means of prevent-<br \/>\ning injuries. Implementing a reporting system to encourage learning from mistakes could<br \/>\nalso be beneficial in preventing future injuries.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20101990-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Pilanesberg<br \/>\n \u00a0<br \/>\nInjury<br \/>\n \u00a0Control<br \/>\n \u00a0<br \/>\nBIOMECHANICS<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nBiomedical research on injury causation and prevention should be given priority. A better<br \/>\nunderstanding of the biomechanics of injury and disability could enable the development<br \/>\nof improved protection for humans. Regulations pertaining to product design must incor-<br \/>\nporate product safety standards developed from an improved understanding of the bio-<br \/>\nmechanics of injury.<br \/>\nTREATMENT<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nInjury management at the scene of the occurrence must be enhanced by an effective sys-<br \/>\ntem of communication with medical practitioners, to facilitate decision-making. Rapid and<br \/>\nsafe transportation to the hospital should be provided. An experienced team of trauma<br \/>\npractitioners should be available at the hospital. There should also be adequate equipment<br \/>\nand supplies available for the care of the injured patient, including immediate access to a<br \/>\nblood bank. Education and training of medical practitioners in trauma care must be en-<br \/>\ncouraged to assure optimal technique by an adequate number of physicians at all times.<br \/>\nREHABILITATION<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nTrauma victims need continuity of care emphasizing not only survival but also the identi-<br \/>\nfication and preservation of residual functions. Rehabilitation to restore biological, psy-<br \/>\nchological and social functions must be undertaken in an effort to allow the injured person<br \/>\nto achieve maximal personal autonomy and an independent lifestyle. Where feasible, com-<br \/>\nmunity integration is a desirable goal for people chronically disabled by injury. Rehabili-<br \/>\ntation may also require changes in the patient&#8217;s physical and social environment.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101990-\u00ad\u201004-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nTRAFFIC<br \/>\n \u00a0INJURY<br \/>\n \u00a0<br \/>\nAdopted by the 42nd<br \/>\nWorld Medical Assembly, Rancho Mirage, CA., USA, October 1990<br \/>\nand revised by the 57th<br \/>\nWMA General Assembly, Pilanesberg, South Africa, October 2006<br \/>\nPREAMBLE<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. Serious injuries and mortality in road collisions are a public health problem with<br \/>\nconsequences similar to those of major diseases such as cancer and cardiovascular<br \/>\ndisease. Worldwide, about 1.2 million persons are killed each year on the roads and<br \/>\nan additional 20~50 million are injured. By 2020, road traffic injuries are expected to<br \/>\nbe the third largest contributor to the global burden of disease and injury.<br \/>\n2. In addition to the immeasurable personal and social price paid by the victims of road<br \/>\ncrashes and their relatives, traffic injury has a significant economic impact. The direct<br \/>\nand economic cost of injury and disability resulting from traffic injuries, including<br \/>\nemergency and rehabilitative health care, costs of disability, disability adjusted life<br \/>\nyears (DALYs) and other costs, amount to 1% of the GDP in poorer countries and<br \/>\n1.5~2% in wealthier countries. Much of this burden is borne by the health sector.<br \/>\n3. Road injuries continue to increase in many countries, particularly low and middle-<br \/>\nincome nations that currently account for 85% for all road traffic deaths, and are the<br \/>\nsecond leading cause of death among youth worldwide.<br \/>\n4. Most traffic injuries could be prevented by better countermeasures. Combating traffic<br \/>\ninjury is the shared responsibility of many bodies, groups and individuals, including<br \/>\ngovernments, NGOs, industry, international, national and community groups, public<br \/>\nhealth professionals, engineers and law enforcement personnel.<br \/>\n5. Speed is widely recognized as the most important determinant of road safety, af-<br \/>\nfecting the likelihood that a crash will occur and the severity of resulting injuries if a<br \/>\ncrash does occur. An average increase in speed of 1 km\/h is associated with a 3%<br \/>\nhigher risk of a crash involving injury and a 5% higher risk of serious or fatal injury.<br \/>\n6. However, efforts to decrease road crashes and injury also require a \u00absystems ap-<br \/>\nproach\u00bb that recognizes and addresses the many factors that combine to increase the<br \/>\nrisk of traffic accidents and resulting injury, including human, vehicle and road design<br \/>\nvariables.<br \/>\n7. Human, vehicular and environmental factors interact before, during and after a col-<br \/>\nlision. Intervention at each of these stages will help reduce crashes and injury. Effec-<br \/>\ntive intervention requires public education as well as professional involvement in the<br \/>\nfields of engineering, law enforcement and medical care.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20101990-\u00ad\u201004-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Pilanesberg<br \/>\n \u00a0<br \/>\nTraffic<br \/>\n \u00a0Injury<br \/>\n \u00a0<br \/>\n8. Pre-collision intervention is aimed at preventing crashes and reducing risk factors.<br \/>\nExamples include: preventing drivers from driving when fatigued (especially drivers<br \/>\nof heavy vehicles), distracted (including prohibiting the use of hand-held cellular<br \/>\nphones) or under the influence of drugs or alcohol, and measures such as night cur-<br \/>\nfews or graduated licensing for young drivers. Pre-collision intervention also includes<br \/>\nsetting vehicle design standards that ensure that vehicles are roadworthy and cannot<br \/>\nbe driven at excessive speeds. Other interventions include setting and enforcing appro-<br \/>\npriate speed limits, installing speed cameras, and optimizing road design and layout to<br \/>\nprevent crashes.<br \/>\n9. A second level of intervention is aimed at preventing or reducing injury during the<br \/>\ncrash. Such interventions include: enforcing the use of seat belts and child restraints,<br \/>\nrequiring helmets for cyclists, manufacturing vehicles equipped with safety devices<br \/>\nand crash-protective design, lowering and enforcing speed limits and removing heavy,<br \/>\nrigid objects such as concrete or metal dividers, light posts and abutments from the<br \/>\nsides of roads.<br \/>\n10. Post-crash intervention is aimed at maximizing life saving and injury reducing treat-<br \/>\nment and includes improved pre-hospital and emergency trauma care and rehabilita-<br \/>\ntion.<br \/>\nRECOMMENDATIONS<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. The WMA adopts the findings and key recommendations of the WHO Report on road<br \/>\ntraffic injury prevention (2004) and calls for their implementation by its member Na-<br \/>\ntional Medical Associations and their governments and relevant bodies.<br \/>\n2. Physicians must view traffic injury as a public health problem and recognize their res-<br \/>\nponsibility in fighting this global problem.<br \/>\n3. National Medical Associations and their member physicians should work to persuade<br \/>\ngovernments and policy makers of the importance of this issue and should assist in<br \/>\nadapting empirical and scientific information into workable policies.<br \/>\n4. National Medical Associations and physicians should be key players in public educa-<br \/>\ntion, and should include road safety in health promotion activities.<br \/>\n5. Physicians should be involved in the collection and analysis of data regarding road<br \/>\ncrashes and concomitant injuries, including injury surveillance systems.<br \/>\n6. Physicians should work towards changing the public attitude toward road travel,<br \/>\nincluding pressing for improved public transportation, bicycle paths and proper side-<br \/>\nwalks to encourage less car use and the adoption of healthier options such as walking<br \/>\nand cycling.<br \/>\n7. Physicians should be active in addressing the human factor and medical reasons for<br \/>\nroad crashes, including, but not limited to, the use of prescription drugs or medical<br \/>\nconditions that may impair driving ability, and explore ways to prevent and reduce the<br \/>\nseverity of injuries.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101990-\u00ad\u201004-\u00ad\u20102006<br \/>\n \u00a0<br \/>\n8. Physicians should lobby for the implementation and enforcement of the measures<br \/>\nlisted above, which have been shown to decrease the risk and severity of vehicle<br \/>\ncrashes, and the evaluation of their impact.<br \/>\n9. National Medical Associations and their member physicians should encourage<br \/>\nresearch and development of improved training systems and medical care at all stages,<br \/>\nincluding effective communication and transport systems to locate and evacuate the<br \/>\nvictims, emergency medical care systems to provide life-saving first aid services, and<br \/>\nexpert trauma and rehabilitative care, and should lobby for increased resources to help<br \/>\nprovide these services.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101991-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nADOLESCENT<br \/>\n \u00a0SUICIDE<br \/>\n \u00a0<br \/>\nAdopted by the 43rd<br \/>\nWorld Medical Assembly, Malta, November 1991<br \/>\nand revised by the 57th<br \/>\nWMA General Assembly, Pilanesberg, South Africa, October 2006<br \/>\n1. The past several decades have witnessed a dramatic change in causes of adolescent<br \/>\nmortality. Previously, adolescents mostly died of natural causes, whereas they now<br \/>\nmore likely die from preventable causes. Part of this change has been a worldwide<br \/>\nrise in adolescent suicide rates in both developed and developing countries. In the<br \/>\nadolescent population, suicide is currently one of the leading causes of death. Suicides<br \/>\nare probably under-reported due to cultural and religious stigma attached to self-des-<br \/>\ntruction and to an unwillingness to recognize certain traumas, such as some automo-<br \/>\nbile accidents, as self-inflicted.<br \/>\n2. Adolescent suicide is a tragedy that affects not only the individual but also the family,<br \/>\npeers and larger community in which the adolescent lived. Suicide is often ex-<br \/>\nperienced as a personal failure by parents, friends and physicians who blame them-<br \/>\nselves for not detecting warning signs. It is also viewed as a failure by the community<br \/>\nby serving as a vivid reminder that modern society often does not provide a nurturing,<br \/>\nsupportive and healthy environment in which children can grow and develop.<br \/>\n3. Factors contributing to adolescent suicide are varied and include: affective disorders,<br \/>\ntrauma, anxiety disorders, emotional isolation, self-esteem, excessive emotional stress<br \/>\n(such as teasing and harassment), romantic fantasies, thrill-seeking, drug and alcohol<br \/>\nabuse, the availability of firearms and other agents of self-destruction, and media<br \/>\nreports of other adolescent suicides resulting in copycat acts. Most often suicide is the<br \/>\nresult of several factors acting together, rather that any one isolated factor. Youth<br \/>\nwithin correctional facilities are at higher risk for suicide than the general population<br \/>\nyet have fewer resources available to them. However, the lack of a consistent personal<br \/>\nprofile makes it difficult to identify those adolescents at risk for suicide.<br \/>\n4. The health care of adolescents is best achieved when physicians provide compre-<br \/>\nhensive services, including both medical and psychosocial evaluation and treatment.<br \/>\nContinuous, comprehensive care provides the physician the opportunity to obtain the<br \/>\ninformation necessary to detect adolescents at risk for suicide or other self-destructive<br \/>\nbehaviour. This service model also helps to build a socially supportive patient-physi-<br \/>\ncian relationship that may moderate adverse influences adolescents experience in their<br \/>\nenvironment.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0Pilanesberg<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101991-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nAdolescent<br \/>\n \u00a0Suicide<br \/>\n \u00a0<br \/>\n5. In working to prevent adolescent suicide, the World Medical Association recognizes<br \/>\nthe complex nature of adolescent bio-psycho-social development, the changing social<br \/>\nworld faced by adolescents, and the introduction of new, more lethal, agents of self-<br \/>\ndestruction. In response to these concerns, the World Medical Association recom-<br \/>\nmends that National Medical Associations adopt the following guidelines for physi-<br \/>\ncians. In doing so, we recognise that many other players &#8211; parents, governmental<br \/>\nagencies, schools, communities, social services &#8211; also have important roles in this area.<br \/>\nGUIDELINES<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. All physicians should receive, during medical school and postgraduate training, edu-<br \/>\ncation in child psychiatry and adolescent bio-psycho-social development, including<br \/>\nthe risk factors for suicide.<br \/>\n2. Physicians should be trained to identify early signs and symptoms of physical, emo-<br \/>\ntional, and social distress of adolescent patients and the signs and symptoms of psy-<br \/>\nchiatric disorders that may contribute to suicide as well as other self destructive be-<br \/>\nhaviours, including depression, bipolar disorder, substance use disorders and a pre-<br \/>\nvious suicide attempt.<br \/>\n3. Physicians should be taught how and when to assess suicidal risk in their adolescent<br \/>\npatients.<br \/>\n4. Physicians should be taught and keep up-to-date on the treatment and referral options<br \/>\nappropriate for all levels of self-destructive behaviours of their adolescent patients.<br \/>\nThe physicians with the most significant training in adolescent suicide are child and<br \/>\nadolescent psychiatrists, and the patient should be referred to one if available.<br \/>\n5. When caring for adolescents with any type of trauma, physicians should evaluate the<br \/>\npossibility that the injuries might have been self-inflicted.<br \/>\n6. When caring for adolescents who demonstrate a deterioration in thinking, feeling or<br \/>\nbehaviour, the possibility of substance abuse and addiction should be raised and the<br \/>\nthreshold should be low for urine toxicology assessment.<br \/>\n7. Health care systems should facilitate the establishment of mental health consultation<br \/>\nservices aimed at preventing suicide, and should pay for the socio-medical care given<br \/>\nto patients who have attempted suicide. Services should be tailored to the specific<br \/>\nneeds of adolescent patients.<br \/>\n8. Epidemiological studies on suicide, its risk factors and methods of prevention should<br \/>\nbe conducted.<br \/>\n9. When caring for adolescents with psychiatric disorders or risk factors for suicide,<br \/>\nphysicians should educate parents or guardians to watch for the signs of suicide and<br \/>\neducate them as to the options for evaluation.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101992-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nALCOHOL<br \/>\n \u00a0AND<br \/>\n \u00a0ROAD<br \/>\n \u00a0SAFETY<br \/>\n \u00a0<br \/>\nAdopted by the 44th<br \/>\nWorld Medical Assembly, Marbella, Spain, September 1992<br \/>\nand revised by the 57th<br \/>\nWMA General Assembly, Pilanesberg, South Africa, October 2006<br \/>\nINTRODUCTION<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. On a worldwide scale, the anticipated growth in the number of vehicles in circulation<br \/>\n(barely 1% per capita in China in 2001, 74% in the United States) has led the World<br \/>\nHealth Organisation (WHO) to forecast a considerable rise in the global death toll.<br \/>\nRoad crashes are set to become the 3rd greatest cause of death in the world by 2020,<br \/>\nwhereas in 1990 they were in 9th place. The WHO estimates that during this period<br \/>\nthe number of road deaths will fall by 30% in rich countries, while lower and middle<br \/>\nincome countries will see an increase of 20%.<br \/>\n2. Deaths and injuries resulting from road crashes along with collisions between vehicles<br \/>\nand pedestrians are a major public health problem. In many countries where alcohol<br \/>\nconsumption is an integral part of daily life, driving while under the influence of<br \/>\nalcohol has been shown to be the cause of around half of all the deaths and serious<br \/>\ninjuries in road crashes.<br \/>\n3. A change in the behaviour of road users with regard to alcohol consumption would<br \/>\nappear to be the most promising approach to preventing traffic deaths and injuries.<br \/>\nMeasures forbidding driving while under the influence of alcohol will lead to a con-<br \/>\nsiderable improvement in road safety and an appreciable reduction in the number of<br \/>\ndead and injured.<br \/>\n4. Driving a vehicle implies the acceptance of a certain number of risks. The careful<br \/>\ndriver will always be aware of the risks, while at the same time ensuring that the level<br \/>\nof risk never rises to an unacceptable level. Alcohol alters a driver&#8217;s subjective assess-<br \/>\nment of risk so that he or she drives more recklessly, while at the same time the ability<br \/>\nto drive is impaired.<br \/>\n5. Irrespective of the amount of alcohol consumed, the maximum concentration of al-<br \/>\ncohol in the body is reached:<br \/>\n\u2022 after half an hour when taken on an empty stomach;<br \/>\n\u2022 after an hour when taken with a meal.<br \/>\nOn the other hand, it takes the body a long time to eliminate alcohol. An individual in<br \/>\ngood health eliminates alcohol at a rate that reduces blood alcohol concentration by 0.1 to<br \/>\n0.15 gram\/litre\/hour.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0Pilanesberg<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101992-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nAlcohol<br \/>\n \u00a0and<br \/>\n \u00a0Road<br \/>\n \u00a0Safety<br \/>\n \u00a0<br \/>\n6. At the present time, permitted blood alcohol levels vary from country to country. It<br \/>\nwould be desirable to introduce a uniform maximum permissible level of blood<br \/>\nalcohol of 0.5 gram per litre, low enough to allow the average driver to retain the<br \/>\nability to assess risk.<br \/>\n7. The information dispensed by health professionals and physicians should be aimed at<br \/>\nmaking every driver aware of these risks. When motorists have been thus informed, it<br \/>\nis important that they make the decision whether or not to drive before consuming<br \/>\nalcohol in sufficient quantities to alter their perception.<br \/>\n8. Alcohol is a psychotropic substance that acts on the central nervous system. In<br \/>\nessence, alcohol abuse or drug dependency are addictive practices that can lead to<br \/>\nneurological or psychiatric difficulties, which can in turn trigger a sudden alteration in<br \/>\nbrain function and thus endanger road safety. Certain drugs interact negatively with<br \/>\nalcohol, and in particular some combinations are known to reduce alertness. When<br \/>\ndrugs, whether legal or illegal, are taken with alcohol, the effect of the latter is intensi-<br \/>\nfied. This mixture can trigger mental dysfunctions that are extremely dangerous for<br \/>\nroad users. Physicians should be educated and informed about these pharma-cological<br \/>\nfacts.<br \/>\n9. When physicians and other health professionals issue fitness-to-drive certificates, they<br \/>\ncan use this opportunity to educate road users and pass on a message of prevention<br \/>\nand personal responsibility. In certain countries, the significant public health problems<br \/>\ncaused by alcohol on the roads justify more coercive policies requiring the co-<br \/>\nordination of different initiatives. Physicians could also play a part in this, by com-<br \/>\nplying with current legislation and by exercising the high level of vigilance required<br \/>\nby the scale and seriousness of the road safety issue. In the event of a second offence,<br \/>\nor of heavy dependency on alcohol indicating regular excessive drinking, the driver<br \/>\nmay be declared unfit to drive for a period of time sufficient to ensure that when he is<br \/>\nagain certified fit to drive, he will no longer be a threat to road safety.<br \/>\n10. In most countries, road crashes linked to alcohol consumption affect adolescents and<br \/>\nyoung adults to a disproportionately high degree, and every available resource should<br \/>\nbe mobilised to reduce their consumption of alcohol. Physicians should also be in-<br \/>\nvolved in reducing the likelihood of impaired driving by participating in the detoxify-<br \/>\ncation and rehabilitation of drunk drivers. These initiatives should be based on a<br \/>\ndetailed analysis of the problem as it manifests itself within each country or culture.<br \/>\nGenerally speaking, however, alcoholism is a medical condition with concomitant<br \/>\npsychological or social and interpersonal difficulties that affect the family, work or<br \/>\nsocial environment.<br \/>\n11. In order to be effective, educational and preventive initiatives should:<br \/>\na. Educate the population, especially young people, about the seriousness of the<br \/>\nproblem and the dangers of drinking and driving, with the aim of changing indi-<br \/>\nvidual attitudes and behaviour in terms of driving and consuming alcohol and\/or<br \/>\ndrugs;<br \/>\nb. Support this change in behaviour by implementing appropriate legal expectations<br \/>\nand coercive measures, such as fines or the revocation of licenses;<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101992-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nc. Identify alcoholic subjects, which requires setting up practical measures such as a<br \/>\nquestionnaire, psychological tests and random checks;<br \/>\nd. Restrict the promotion of alcoholic beverages, including advertising and event<br \/>\nsponsorship.<br \/>\nAdditional measures should be examined and adopted as appropriate. For exam-<br \/>\nple:<br \/>\ne. Development of strategies to assure safe transportation home in situations where<br \/>\nalcohol consumption occurs;<br \/>\nf. Experimenting with devices that prevent individuals with an unauthorised level of<br \/>\nblood alcohol from starting the engine of or operating the vehicle;<br \/>\ng. Wider use of breath alcohol tests (chemical or electronic);<br \/>\nh. Adoption of a minimum legal age for alcohol purchase and consumption in each<br \/>\ncountry; countries should also adopt policies that penalize the driver and with-<br \/>\ndraw the driver&#8217;s license if the driver is under legal age and is convicted of<br \/>\ndriving under the influence of alcohol.<br \/>\nRECOMMENDATIONS<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. The WMA urges National Medical Associations and individual physicians to continue<br \/>\npromoting the following principles:<br \/>\na. Road accidents linked to the consumption of alcohol are a major but avoidable<br \/>\npublic health problem. The authorities should allocate public health resources that<br \/>\nare proportionate to the scale of the problem.<br \/>\nb. When preventive measures are introduced and followed through, a good under-<br \/>\nstanding of age and social groupings involved is required, as well as a grasp of<br \/>\nthe social conditions which often lie at the root of their problems.<br \/>\nc. Where specific social groupings are concerned, overall response strategies should<br \/>\nbe set up that could include limiting the consumption of alcohol and asking those<br \/>\ninvolved in selling alcoholic beverages to take on a share of responsibility for the<br \/>\nconsequences of selling such products. Education and policies should promote<br \/>\nmoderation and responsibility in the consumption of alcohol and seek to reduce<br \/>\nthe likelihood that someone will consume alcohol and drive afterwards. In parti-<br \/>\ncular, eliminating alcohol from the workplace and in situations where consumers<br \/>\nmust drive after drinking should be a goal of organizational policies. The promo-<br \/>\ntion of non-alcoholic drinks is an important tool to facilitate these policies.<br \/>\nd. Road accidents linked to the consumption of alcohol can be considered as pos-<br \/>\nsible predictors of other addictive and violent behaviours. This should be taken<br \/>\ninto consideration in the medical treatment of the patient.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0Pilanesberg<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101992-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nAlcohol<br \/>\n \u00a0and<br \/>\n \u00a0Road<br \/>\n \u00a0Safety<br \/>\n \u00a0<br \/>\ne. Alcoholic subjects should be given access to rehabilitation services. When mo-<br \/>\ntorists are found to have excess alcohol in their blood (or their breath), other<br \/>\nfactors linked to their excessive drinking should be examined and included in a<br \/>\nrehabilitation programme. These rehabilitation programmes should be publicly<br \/>\nfunded.<br \/>\nf. Educating the population about alcohol should focus on making people aware of<br \/>\nalcohol&#8217;s negative influence on one&#8217;s ability to drive and one&#8217;s assessment of risk.<br \/>\nThe public should understand the risks and medical complications linked to<br \/>\ndrinking while under the influence of alcohol.<br \/>\ng. The problem of alcohol consumption in adolescents and young adults and its<br \/>\nrelation to road safety should be addressed in the school curricula and in com-<br \/>\nmunity preventive measures and policies so that a responsible attitude becomes<br \/>\nthe norm.<br \/>\nh. As even small amounts of alcohol have a direct effect on the brain, with disturb-<br \/>\nances noted at levels as low as 0.3 gram per litre, physicians should argue the<br \/>\ncase for setting the blood alcohol level considered acceptable to drive a vehicle as<br \/>\nlow as possible and no higher than 0.5 gram per litre.<br \/>\ni. Any motorist who has been in a road traffic accident must undergo a blood al-<br \/>\ncohol concentration test or a breath test.<br \/>\nj. The practice of random driver testing for breath alcohol levels should become<br \/>\nmore widespread, and there should be further research into other ways to test<br \/>\nurine, breath and saliva to identify impaired drivers and prevent subsequent opera-<br \/>\ntion of motor vehicles.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101992-\u00ad\u201005-\u00ad\u20102007<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nNOISE<br \/>\n \u00a0POLLUTION<br \/>\n \u00a0<br \/>\nAdopted by the 44th<br \/>\nWorld Medical Assembly, Marbella, Spain, September 1992<br \/>\nand amended by the 58th<br \/>\nWMA General Assembly, Copenhagen, Denmark, October 2007<br \/>\nPREAMBLE<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nGiven growing environmental awareness and knowledge of the impact of noise on health,<br \/>\nthe psyche, performance and well-being, the fight against environmental noise is be-<br \/>\ncoming increasingly important. The World Health Organization (WHO) describes noise as<br \/>\nthe principal environmental nuisance in industrial nations.<br \/>\nNoise affects people in various ways. Its effects relate to hearing, the vegetative nervous<br \/>\nsystem, the psyche, spoken communication, sleep and performance. Since noise acts as a<br \/>\nstressor, an increased burden on the body leads to higher energy consumption and greater<br \/>\nwear. It is thus suspected that noise can primarily favour diseases in which stress plays a<br \/>\ncontributory role, such as cardiovascular diseases, which can then be manifested in the<br \/>\nform of hypertension, myocardial infarction, angina pectoris, or even apoplexy.<br \/>\nThe effects in the psychosocial field are likewise dramatic. The stress caused by environ-<br \/>\nmental noise &#8211; particularly road traffic noise &#8211; is a central concern, not only in the indus-<br \/>\ntrial nations, but increasingly also in the developing countries.<br \/>\nOwing to the continuous and massive growth of traffic volumes, both on the roads and in<br \/>\nthe air, the stress caused by environmental noise has increased steadily in terms of both its<br \/>\nduration and the area affected.<br \/>\nDamage to hearing caused by leisure-time noise is also of growing concern. The most<br \/>\ncommon source of noise in this context is music, to which the ear is exposed by different<br \/>\naudio media at different places (portable music players, stereo systems, discotheques, con-<br \/>\ncerts). The risk of suffering hearing damage is underestimated by most people, or even<br \/>\nconsciously denied. The greatest issue (or aspect) lies in creating awareness of the pro-<br \/>\nblem in the high-risk group &#8211; which generally means young people. In this respect, the<br \/>\nlegislature is called upon to intervene and reduce the potential for damage by introducing<br \/>\nsound level limiters in audio playback units and maximum permissible sound levels at<br \/>\nmusic events, or by banning children&#8217;s toys that are excessively loud or produce excessive<br \/>\nnoise levels.<br \/>\nIn keeping with its socio-medical commitment, the World Medical Association is issuing a<br \/>\nstatement on the problem of noise pollution with the aim of making a contribution to the<br \/>\nfight against environmental noise through more extensive information and more acute<br \/>\nawareness.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0Copenhagen<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101992-\u00ad\u201005-\u00ad\u20102007<br \/>\n \u00a0<br \/>\nNoise<br \/>\n \u00a0Pollution<br \/>\n \u00a0<br \/>\nRECOMMENDATIONS<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nThe World Medical Association calls upon the National Medical Associations to:<br \/>\n1. Inform the public, especially persons affected by environmental noise, as well as poli-<br \/>\ncy and decision makers, of the dangers of noise pollution.<br \/>\n2. Call upon ministers of transport and urban planners to develop alternative concepts<br \/>\nthat are capable of countering the growing level of environmental noise pollution.<br \/>\n3. Advocate appropriate statutory regulations for combating environmental noise pollu-<br \/>\ntion.<br \/>\n4. Support enforcement of noise pollution legislation and monitor the effectiveness of<br \/>\ncontrol measures.<br \/>\n5. Inform young people of the risks associated with listening to excessively loud music,<br \/>\nsuch as that which emanates, for example, from portable music players, use of stereo<br \/>\nsystems with earphones, audio systems in cars, and attendance at rock concerts and<br \/>\ndiscotheques.<br \/>\n6. Prompt the educational authorities to inform pupils at an early stage regarding the<br \/>\neffects of noise on people, how stress due to environmental noise can be counteracted,<br \/>\nthe role of the individual in contributing to noise pollution, and the risks associated<br \/>\nwith listening to excessively loud music.<br \/>\n7. Provide information about risks of damage to hearing that arise in the private sector as<br \/>\na result of working with power tools or operating excessively loud motor vehicles.<br \/>\n8. Emphasize to those individuals who are exposed to excessive levels of noise in the<br \/>\nworkplace the importance of protecting themselves against irreducible noise.<br \/>\n9. Call upon the persons responsible for occupational safety and health in businesses to<br \/>\ntake further action to reduce noise emission, in order to ensure protection of the health<br \/>\nof employees at the workplace.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101992-\u00ad\u201006-\u00ad\u20102015<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nPHYSICIAN-\u00ad\u2010ASSISTED<br \/>\n \u00a0SUICIDE<br \/>\n \u00a0<br \/>\nAdopted by the 44th<br \/>\nWorld Medical Assembly, Marbella, Spain, September 1992<br \/>\nand editorially revised by the 170th<br \/>\nWMA Council Session, Divonne-les-Bains, France,<br \/>\nMay 2005 and reaffirmed by the 200th<br \/>\nWMA Council Session, Oslo, Norway, April 2015<br \/>\nPhysician-assisted suicide, like euthanasia, is unethical and must be condemned by the<br \/>\nmedical profession. Where the assistance of the physician is intentionally and deliberately<br \/>\ndirected at enabling an individual to end his or her own life, the physician acts unethically.<br \/>\nHowever the right to decline medical treatment is a basic right of the patient and the phy-<br \/>\nsician does not act unethically even if respecting such a wish results in the death of the<br \/>\npatient.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101993-\u00ad\u201001-\u00ad\u20102005<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nBODY<br \/>\n \u00a0SEARCHES<br \/>\n \u00a0OF<br \/>\n \u00a0PRISONERS<br \/>\n \u00a0<br \/>\nAdopted by the 45th<br \/>\nWorld Medical Assembly, Budapest, Hungary, October 1993<br \/>\nand editorially revised by the 170th<br \/>\nWMA Council Session, Divonne-les-Bains, France,<br \/>\nMay 2005<br \/>\nThe prison systems in many countries mandate body cavity searches of prisoners. Such<br \/>\nsearches, which include rectal and pelvic examination, may be performed when an indi-<br \/>\nvidual enters the prison population and thereafter whenever the individual is permitted to<br \/>\nhave personal contact with someone outside the prison population, or when there is a<br \/>\nreason to believe a breach of security or of prison regulations has occurred. For example,<br \/>\nwhen a prisoner is taken to Court for a hearing, or to the hospital for treatment, or to work<br \/>\noutside the prison, the prisoner, upon returning to the institution, may be subjected to a<br \/>\nbody cavity search that will include all body orifices. The purpose of the search is pri-<br \/>\nmarily security and\/or to prevent contraband, such as weapons or drugs, from entering the<br \/>\nprison.<br \/>\nThese searches are performed for security reasons and not for medical reasons. Never-<br \/>\ntheless, they should not be done by anyone other than a person with appropriate medical<br \/>\ntraining. This non-medical act may be performed by a physician to protect the prisoner<br \/>\nfrom the harm that might result from a search by a non-medically trained examiner. In<br \/>\nsuch a case the physician should explain this to the prisoner. The physician should further-<br \/>\nmore explain to the prisoner that the usual conditions of medical confidentiality do not<br \/>\napply during this imposed procedure and that the results of the search will be revealed to<br \/>\nthe authorities. If a physician is duly mandated by an authority and agrees to perform a<br \/>\nbody cavity search on a prisoner, the authority should be duly informed that it is necessary<br \/>\nfor this procedure to be done in a humane manner.<br \/>\nIf the search is conducted by a physician, it should not be done by the physician who will<br \/>\nalso subsequently provide medical care to the prisoner.<br \/>\nThe physician&#8217;s obligation to provide medical care to the prisoner should not be compro-<br \/>\nmised by an obligation to participate in the prison&#8217;s security system.<br \/>\nThe World Medical Association urges all governments and public officials with responsi-<br \/>\nbility for public safety to recognize that such invasive search procedures are serious<br \/>\nassaults on a person&#8217;s privacy and dignity, and they also carry some risk of physical and<br \/>\npsychological injury. Therefore, the World Medical Association exhorts that, to the extent<br \/>\nfeasible without compromising public security,<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20101993-\u00ad\u201001-\u00ad\u20102005<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Divonne-\u00ad\u2010les-\u00ad\u2010Bains<br \/>\n \u00a0<br \/>\nBody<br \/>\n \u00a0Searches<br \/>\n \u00a0of<br \/>\n \u00a0Prisoners<br \/>\n \u00a0<br \/>\n\u2022 alternate methods be used for routine screening of prisoners, and body cavity<br \/>\nsearches be used only as a last resort;<br \/>\n\u2022 if a body cavity search must be conducted, the responsible public official must<br \/>\nensure that the search is conducted by personnel with sufficient medical know-<br \/>\nledge and skills to safely perform the search;<br \/>\n\u2022 the same responsible authority ensure that the individual&#8217;s privacy and dignity be<br \/>\nguaranteed.<br \/>\nFinally, the World Medical Association urges all governments and responsible public<br \/>\nofficials to provide body searches that are performed by a qualified physician whenever<br \/>\nwarranted by the individual&#8217;s physical condition. A specific request by a prisoner for a<br \/>\nphysician shall be respected, so far as possible.<br \/>\nThe World Medical Association adopts this statement for the purpose of providing guid-<br \/>\nance for National Medical Associations as they develop ethical guidelines for their physi-<br \/>\ncian members.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101993-\u00ad\u201002-\u00ad\u20102005<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nFEMALE<br \/>\n \u00a0GENITAL<br \/>\n \u00a0MUTILATION<br \/>\n \u00a0<br \/>\nAdopted by the 45th<br \/>\nWorld Medical Assembly, Budapest, Hungary, October 1993<br \/>\nand editorially revised by the 170th<br \/>\nWMA Council Session, Divonne-les-Bains, France,<br \/>\nMay 2005<br \/>\nPREAMBLE<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nFemale genital mutilation (FGM) is a common practice in over thirty countries.<br \/>\nIn many other countries the problem has arisen more recently due to the presence of ethnic<br \/>\ngroups from countries in which FGM is common practice, including immigrants and refu-<br \/>\ngees who fled from hunger and war.<br \/>\nBecause of its impact on the physical and mental health of women and children, FGM is a<br \/>\nmatter of concern to physicians. Physicians worldwide are confronted with the effects of<br \/>\nthis traditional practice. Sometimes they are asked to perform this mutilating procedure.<br \/>\nThere are various forms of FGM. It can be a primary circumcision for young girls, usually<br \/>\nbetween 5 and 12 years of age, or a secondary circumcision, e.g., after childbirth. The ex-<br \/>\ntent of a primary circumcision may vary: from an incision in the foreskin of the clitoris up<br \/>\nto a pharaonic circumcision or infibulation removing the clitoris and labia minora and<br \/>\nstitching up the labia majora so that only a minimal opening remains to allow for urine and<br \/>\nmenstrual blood.<br \/>\nRegardless of the extent of the circumcision, FGM affects the health of women and girls.<br \/>\nResearch evidence shows the grave permanent damage to health. Acute complications of<br \/>\nFGM are: hemorrhage, infections, bleeding of adjacent organs, and excruciating pain.<br \/>\nLong-term complications include severe scarring, chronic infections, urologic and obste-<br \/>\ntric complications, and psychological and social problems. FGM has serious consequences<br \/>\nfor sexuality and how it is experienced. There is a multiplicity of complications during<br \/>\nchildbirth including expulsion disturbances, formation of fistulae, ruptures and inconti-<br \/>\nnence.<br \/>\nEven with the least drastic version of circumcision, complications and functional conse-<br \/>\nquences can occur, including the loss of all capacity for orgasm.<br \/>\nThere are various reasons to explain the existence and continuation of the practice of<br \/>\nFGM: custom, tradition (preserving virginity of young girls and limiting the sexual ex-<br \/>\npression of women) and social reasons. These reasons do not justify the considerable da-<br \/>\nmages to health.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20101993-\u00ad\u201002-\u00ad\u20102005<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Divonne-\u00ad\u2010les-\u00ad\u2010Bains<br \/>\n \u00a0<br \/>\nFemale<br \/>\n \u00a0Genital<br \/>\n \u00a0Mutilation<br \/>\n \u00a0<br \/>\nNone of the major religions supports this practice. The current medical opinion is that<br \/>\nFGM is detrimental to the physical and mental health of girls and women. FGM is seen by<br \/>\nmany as a form of oppression of women.<br \/>\nBy and large there is a strong tendency to condemn FGM more overtly:<br \/>\n\u2022 There are active campaigns against the practice in Africa. Many African women<br \/>\nleaders as well as African heads of state have issued strong statements against the<br \/>\npractice.<br \/>\n\u2022 International agencies such as the World Health Organization, the United Nations<br \/>\nCommission on Human Rights and UNICEF have recommended that specific<br \/>\nmeasures be aimed at the eradication of FGM.<br \/>\n\u2022 Governments in several countries have developed legislation, such as prohibiting<br \/>\nFGM in their criminal codes.<br \/>\nRECOMMENDATIONS<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. Taking into account the psychological needs and &#8216;cultural identity&#8217; of the people in-<br \/>\nvolved, physicians should inform women, men and children about FGM and dis-<br \/>\ncourage them from performing or promoting FGM. Physicians should integrate health<br \/>\npromotion and counselling against FGM into their work.<br \/>\n2. As a consequence, physicians should have adequate information and support for<br \/>\ndoing so. Educational programmes concerning FGM should be expanded and\/or<br \/>\ndeveloped.<br \/>\n3. National Medical Associations should stimulate public and professional awareness of<br \/>\nthe damaging effects of FGM.<br \/>\n4. National Medical Associations should stimulate governmental action in preventing<br \/>\nthe practice of FGM.<br \/>\n5. National Medical Associations should cooperate in organising an appropriate preven-<br \/>\ntive and legal strategy when a child is at risk of undergoing FGM.<br \/>\nCONCLUSION<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nThe World Medical Association condemns the practice of genital mutilation including the<br \/>\ncircumcision of women and girls and condemns the participation of physicians in such<br \/>\npractices.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101993-\u00ad\u201003-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nPATIENT<br \/>\n \u00a0ADVOCACY<br \/>\n \u00a0AND<br \/>\n \u00a0CONFIDENTIALITY<br \/>\n \u00a0<br \/>\nAdopted by the 45th<br \/>\nWorld Medical Assembly, Budapest, Hungary, October 1993<br \/>\nand revised by the 57th<br \/>\nWMA General Assembly, Pilanesberg, South Africa, October 2006<br \/>\nPREAMBLE<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nMedical practitioners have an ethical duty and a professional responsibility to act in the<br \/>\nbest interests of their patients without regard to age, gender, sexual orientation, physical<br \/>\nability or disability, race, religion, culture, beliefs, political affiliation, financial means or<br \/>\nnationality.<br \/>\nThis duty includes advocating for patients, both as a group (such as advocating on public<br \/>\nhealth issues) and as individuals.<br \/>\nOccasionally, this duty may conflict with a physician&#8217;s other legal, ethical and\/or pro-<br \/>\nfessional duties, creating social, professional and ethical dilemmas for the physician.<br \/>\nPotential conflicts with the physician&#8217;s obligation of advocacy on behalf of his or her pa-<br \/>\ntient may arise in a number of contexts:<br \/>\n1. Conflict between the obligation of advocacy and confidentiality &#8211; A physician is<br \/>\nethically and often legally obligated to preserve in confidence a patient&#8217;s personal<br \/>\nhealth information and any information conveyed to the physician by the patient in<br \/>\nthe course of his or her professional duties. This may conflict with the physician&#8217;s<br \/>\nobligation to advocate for and protect patients where the patients may be incapable of<br \/>\ndoing so themselves.<br \/>\n2. Conflict between the best interest of the patient and employer or insurer dictates &#8211;<br \/>\nOften there exists potential for conflict between a physician&#8217;s duty to act in the best<br \/>\ninterest of his or her patients, and the dictates of the physician&#8217;s employer or the in-<br \/>\nsurance body, whose decision may be shaped by economic or administrative factors<br \/>\nunrelated to the patient&#8217;s health. Examples of such might be an insurer&#8217;s instructions to<br \/>\nprescribe a specific drug only, where the physician believes a different drug would<br \/>\nbetter suit a particular patient, or an insurer&#8217;s denial of coverage for treatment that a<br \/>\nphysician believes is necessary.<br \/>\n3. Conflict between the best interests of the individual patient and society &#8211; Although the<br \/>\nphysician&#8217;s primary obligation is to his or her patient, the physician may, in certain<br \/>\ncircumstances, have responsibilities to a patient&#8217;s family and\/or to society as well.<br \/>\nThis may arise in cases of conflict between the patient and his or her family, in the<br \/>\ncase of minor or incapacitated patients, or in the context of limited resources.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20101993-\u00ad\u201003-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Pilanesberg<br \/>\n \u00a0<br \/>\nPatient<br \/>\n \u00a0Advocacy<br \/>\n \u00a0and<br \/>\n \u00a0Confidentiality<br \/>\n \u00a0<br \/>\n4. Conflict between the patient&#8217;s wishes and the physician&#8217;s professional judgment or<br \/>\nmoral values &#8211; Patients are presumed to be the best arbiters of their best interests and,<br \/>\nin general, a physician should advocate for and accede to the wishes of his or her pa-<br \/>\ntient. However, in certain instances such wishes may be contrary to the physician&#8217;s<br \/>\nprofessional judgment or personal values.<br \/>\nRECOMMENDATION<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. The duty of confidentiality must be paramount except in cases where the physician is<br \/>\nlegally or ethically obligated to disclose such information in order to protect the wel-<br \/>\nfare of the individual patient, third parties or society. In such cases, the physician<br \/>\nmust make a reasonable effort to notify the patient of the obligation to breach confi-<br \/>\ndentiality, and explain the reasons for doing so, unless this is clearly inadvisable (such<br \/>\nas where telling the patient would exacerbate a threat). In certain cases, such as gene-<br \/>\ntic or HIV testing, physicians should discuss with their patients, prior to performing<br \/>\nthe test, instances in which confidentiality might need to be breached.<br \/>\nA physician should breach confidentiality in order to protect the individual patient<br \/>\nonly in cases of minor or incompetent patients (such as certain cases of child or elder<br \/>\nabuse) and only where alternative measures are not available. In all other cases,<br \/>\nconfidentiality may be breached only with the specific consent of the patient or his\/<br \/>\nher legal representative or where necessary for the treatment of the patient, such as in<br \/>\nconsultations between medical practitioners.<br \/>\nWhenever confidentiality must be breached, it should be done so only to the extent<br \/>\nnecessary and only to the relevant party or authority.<br \/>\n2. In all cases where a physician&#8217;s obligation to his or her patient conflicts with the<br \/>\nadministrative dictates of the employer or the insurer, a physician must strive to change<br \/>\nthe decision of the employing\/insuring body. His or her ultimate obligation must be to<br \/>\nthe patient.<br \/>\nMechanisms should be in place to protect physicians who wish to challenge decisions<br \/>\nof employers\/insurers without jeopardizing their jobs, and to resolve disagreements<br \/>\nbetween medical professionals and administrators with regard to allocation of re-<br \/>\nsources.<br \/>\nSuch mechanisms should be embodied in medical practitioners&#8217; employment con-<br \/>\ntracts. These employment contracts should acknowledge that medical practitioners&#8217;<br \/>\nethical obligations override purely contractual obligations related to employment.<br \/>\n3. A physician should be aware of and take into account economic and other factors<br \/>\nbefore making a decision regarding treatment. Nonetheless, a physician has an obliga-<br \/>\ntion to advocate on behalf of his or her patient for access to the best available treat-<br \/>\nment.<br \/>\nIn all cases of conflict between a physician&#8217;s obligation to the individual patient and<br \/>\nthe obligation to the patient&#8217;s family or to society, the obligation to the individual pa-<br \/>\ntient should typically take precedence.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101993-\u00ad\u201003-\u00ad\u20102006<br \/>\n \u00a0<br \/>\n4. Competent patients have the right to determine, on the basis of their needs, values and<br \/>\npreferences, what constitutes for them the best course of treatment in any given situa-<br \/>\ntion.<br \/>\nUnless it is an emergency situation, physicians should not be required to participate in<br \/>\nany procedures that conflict with their personal values or professional judgment. In<br \/>\nsuch non-emergency cases, the physician should explain to the patient his or her in-<br \/>\nability to carry out the patient&#8217;s wishes, and the patient should be referred to another<br \/>\nphysician, if required.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101994-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nMEDICAL<br \/>\n \u00a0ETHICS<br \/>\n \u00a0IN<br \/>\n \u00a0THE<br \/>\n \u00a0EVENT<br \/>\n \u00a0OF<br \/>\n \u00a0DISASTERS<br \/>\n \u00a0<br \/>\nAdopted by the 46th<br \/>\nWMA General Assembly, Stockholm, Sweden, September 1994<br \/>\nand revised by the 57th<br \/>\nWMA General Assembly, Pilanesberg, South Africa, October 2006<br \/>\n1. The definition of a disaster for the purpose of this document focuses particularly on<br \/>\nthe medical aspects.<br \/>\nA disaster is the sudden occurrence of a calamitous, usually violent, event resulting in<br \/>\nsubstantial material damage, considerable displacement of people, a large number of<br \/>\nvictims and\/or significant social disruption. This definition excludes situations arising<br \/>\nfrom conflicts and wars, whether international or internal, which give rise to other<br \/>\nproblems in addition to those considered in this paper. From the medical standpoint,<br \/>\ndisaster situations are characterized by an acute and unforeseen imbalance between<br \/>\nthe capacity and resources of the medical profession and the needs of survivors who<br \/>\nare injured whose health is threatened, over a given period of time.<br \/>\n2. Disasters, irrespective of cause, share several features:<br \/>\na. their sudden and unexpected occurrence, demanding prompt action;<br \/>\nb. material or natural damage making access to the survivors difficult and\/or dan-<br \/>\ngerous;<br \/>\nc. adverse effects on health due to pollution, and the risks of epidemics, and emo-<br \/>\ntional and psychological factors;<br \/>\nd. a context of insecurity requiring police or military measures to maintain order;<br \/>\ne. media coverage.<br \/>\nDisasters require multifaceted responses involving many different types of relief<br \/>\nranging from transportation and food supplies to medical services. Physicians are<br \/>\nlikely to be part of coordinated operations involving other responders such as law en-<br \/>\nforcement personnel. These operations require an effective and centralized authority<br \/>\nto coordinate public and private efforts. Rescue workers and physicians are con-<br \/>\nfronted with an exceptional situation in which their normal professional ethics must<br \/>\nbe brought to the situation to ensure that the treatment of disaster survivors conforms<br \/>\nto basic ethical tenets and is not influenced by other motivations. Ethical rules defined<br \/>\nand taught beforehand should complement the individual ethics of physicians.<br \/>\nInadequate and\/or disrupted medical resources on site and the large number of people<br \/>\ninjured in a short time present specific ethical challenges.<br \/>\nThe World Medical Association therefore recommends the following ethical princi-<br \/>\nples and procedures with regard to the physician&#8217;s role in disaster situations.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0Pilanesberg<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101994-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nDisasters<br \/>\n \u00a0<br \/>\n3. TRIAGE<br \/>\n1. Triage is a medical action of prioritizing treatment and management based on a<br \/>\nrapid diagnosis and prognosis for each patient. Triage must be carried out sys-<br \/>\ntematically, taking into account the medical needs, medical intervention capa-<br \/>\nbilities and available resources. Vital acts of reanimation may have to be carried<br \/>\nout at the same time as triage. Triage may pose an ethical problem owing to the<br \/>\nlimited treatment resources immediately available in relation to the large number<br \/>\nof injured persons in varying states of health.<br \/>\n2. Ideally, triage should be entrusted to authorized, experienced physicians or to<br \/>\nphysician teams, assisted by a competent staff.<br \/>\n3. The physician should separate patients into categories and then treat them in the<br \/>\nfollowing order, subject to national guidelines:<br \/>\na. patients who can be saved but whose lives are in immediate danger should be<br \/>\ngiven treatment straight away or as a matter of priority within the next few<br \/>\nhours;<br \/>\nb. patients whose lives are not in immediate danger and who are in need of ur-<br \/>\ngent but not immediate medical care should be treated next;<br \/>\nc. injured persons requiring only minor treatment can be treated later or by<br \/>\nrelief workers;<br \/>\nd. psychologically traumatized individuals who do not require treatment for<br \/>\nbodily harm but might need reassurance or sedation if acutely disturbed;<br \/>\ne. patients whose condition exceeds the available therapeutic resources, who<br \/>\nsuffer from extremely severe injuries such as irradiation or burns to such an<br \/>\nextent and degree that they cannot be saved in the specific circumstances of<br \/>\ntime and place, or complex surgical cases requiring a particularly delicate<br \/>\noperation which would take too long, thereby obliging the physician to make<br \/>\na choice between them and other patients. Such patients may be classified as<br \/>\n\u00abbeyond emergency care\u00bb.<br \/>\nf. Since cases may evolve and thus change category, it is essential that the situa-<br \/>\ntion be regularly reassessed by the official in charge of the triage.<br \/>\n4. The following statements apply to treatment beyond emergency care:<br \/>\na. It is ethical for a physician not to persist, at all costs, in treating individuals<br \/>\n\u00abbeyond emergency care\u00bb, thereby wasting scarce resources needed else-<br \/>\nwhere. The decision not to treat an injured person on account of priorities dic-<br \/>\ntated by the disaster situation cannot be considered a failure to come to the<br \/>\nassistance of a person in mortal danger. It is justified when it is intended to<br \/>\nsave the maximum number of individuals. However, the physician must show<br \/>\nsuch patients compassion and respect for their dignity, for example by sepa-<br \/>\nrating them from others and administering appropriate pain relief and sedatives.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101994-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nb. The physician must act according to the needs of patients and the resources<br \/>\navailable. He\/she should attempt to set an order of priorities for treatment that<br \/>\nwill save the greatest number of lives and restrict morbidity to a minimum.<br \/>\n4. RELATIONS WITH THE PATIENTS<br \/>\n1. In selecting the patients who may be saved, the physician should consider only<br \/>\ntheir medical status, and should exclude any other consideration based on non-<br \/>\nmedical criteria.<br \/>\n2. Survivors of a disaster are entitled to the same respect as other patients, and the<br \/>\nmost appropriate treatment available should be administered with the patient&#8217;s<br \/>\nconsent. However, it should be recognized that in a disaster response there may<br \/>\nnot be enough time for informed consent to be a realistic possibility.<br \/>\n5. AFTERMATH OF DISASTER<br \/>\n1. In the post-disaster period the needs of survivors must be considered. Many may<br \/>\nhave lost family members and may be suffering psychological distress. The dig-<br \/>\nnity of survivors and their families must be respected.<br \/>\n2. The physician must respect the customs, rites and religions of the patients and act<br \/>\nin all impartiality.<br \/>\n3. If possible, the difficulties encountered and the identification of the patients<br \/>\nshould be reported for medical follow-up.<br \/>\n6. MEDIA AND OTHER THIRD PARTIES<br \/>\nThe physician has a duty to each patient to exercise discretion and ensure confi-<br \/>\ndentiality when dealing with third parties, and to exercise caution and objectivity and<br \/>\nact with dignity with respect to the emotional and political atmosphere surrounding<br \/>\ndisaster situations. This implies that physicians are empowered to restrict the entrance<br \/>\nof reporters to the medical premises. Media relations should always be handled by<br \/>\nappropriately trained personnel.<br \/>\n7. DUTIES OF PARAMEDICAL PERSONNEL<br \/>\nThe ethical principles that apply to physicians also apply to personnel under the phy-<br \/>\nsician&#8217;s direction.<br \/>\n8. TRAINING<br \/>\nThe World Medical Association recommends that disaster medicine training be<br \/>\nincluded in the curricula of university and post-graduate courses in medicine.<br \/>\n9. RESPONSIBILITY<br \/>\nThe World Medical Association calls upon governments and insurance companies to<br \/>\ncover both civil liability and any personal damages to which physicians might be sub-<br \/>\nject when working in disaster or emergency situations.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0Pilanesberg<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101994-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nDisasters<br \/>\n \u00a0<br \/>\nThe WMA requests that governments:<br \/>\na. accept the presence of foreign physicians and, where demonstrably qualified,<br \/>\ntheir participation, without discrimination on the basis of factors such as affilia-<br \/>\ntion (e.g. Red Cross, Red Crescent, ICRC, and other qualified organizations),<br \/>\nrace, or religion.<br \/>\nb. give priority to the rendering of medical services over visits of dignitaries.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101995-\u00ad\u201002-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nETHICAL<br \/>\n \u00a0ISSUES<br \/>\n \u00a0CONCERNING<br \/>\n \u00a0PATIENTS<br \/>\n \u00a0WITH<br \/>\n \u00a0MENTAL<br \/>\n \u00a0ILLNESS<br \/>\n \u00a0<br \/>\nAdopted by the 47th<br \/>\nWMA General Assembly, Bali, Indonesia, September 1995<br \/>\nand revised by the 57th<br \/>\nWMA General Assembly, Pilanesberg, South Africa, October 2006<br \/>\nPREAMBLE<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. Historically, many societies have regarded patients with mental illness as a threat to<br \/>\nthose around them rather than as people in need of support and care. Therefore, in the<br \/>\nabsence of effective treatment, many patients with mental illness were confined to<br \/>\nasylums for all or part of their lives. The aim of such confinement in these cases was<br \/>\nto prevent behaviour that was self-destructive or aggressive toward others.<br \/>\n2. At the present time, progress in psychiatric therapy allows for better care of patients<br \/>\nwith mental illness. Efficacious drugs and other treatments can result in patient out-<br \/>\ncomes ranging from complete alleviation of symptoms to long remissions for patients<br \/>\nwhose conditions are more serious.<br \/>\n3. Patients with mental illness should be viewed, treated and granted the same access to<br \/>\ncare as any other medical patient. However, this is often not enough since patients<br \/>\nwith mental illnesses may not know when to seek treatment for somatic problems.<br \/>\nTherefore, the physician should actively refer these patients to other physicians when<br \/>\nnecessary.<br \/>\n4. A physician has the same obligations toward patients with mental illness as toward<br \/>\nany other patient.<br \/>\n5. The physician&#8217;s primary role as healer of patients must not be undermined by serving<br \/>\nas the agent of the greater society, except in instances of danger to the public.<br \/>\n6. Recognition must be given to the fact that a large proportion of patients with mental<br \/>\nillness are treated by physicians who are not psychiatrists. The same ethical obliga-<br \/>\ntions and limitations would apply to these physicians.<br \/>\nETHICAL<br \/>\n \u00a0PRINCIPLES<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. The discrimination associated with psychiatry and the mentally ill should be elimi-<br \/>\nnated. This stigma often discourages people in need from seeking psychiatric help,<br \/>\nthereby aggravating their situation and placing them at risk of emotional or physical<br \/>\nharm.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0Pilanesberg<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101995-\u00ad\u201002-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nPatients<br \/>\n \u00a0with<br \/>\n \u00a0Mental<br \/>\n \u00a0Illness<br \/>\n \u00a0<br \/>\n2. The physician aspires for a therapeutic relationship founded on mutual trust. He\/she<br \/>\nshould inform the patient of the nature of the patient&#8217;s condition, standard therapeutic<br \/>\nprocedures (including possible alternatives and the risk of each), and the expected<br \/>\noutcomes for the available therapeutic choices.<br \/>\n3. In the absence of legally adjudicated incompetence, psychiatric patients must be dealt<br \/>\nwith as though they are legally competent. The patient&#8217;s judgment should be respected<br \/>\nin areas where he\/she is legally capable of making decisions, unless they present a<br \/>\nrisk of serious harm to themselves or others. A patient with mental illness who is in-<br \/>\ncapable of legally exercising his\/her autonomy should be treated like any other patient<br \/>\nwho is temporarily or permanently legally incompetent. If the patient lacks the capa-<br \/>\ncity to make a decision as to his\/her medical care, surrogate consent should be sought<br \/>\nfrom an authorized representative in accordance with applicable law.<br \/>\n4. Involuntary hospitalization of psychiatric patients evokes ethical controversy. While<br \/>\nlaws regarding involuntary hospitalization and treatment vary worldwide, it is gen-<br \/>\nerally acknowledged that this treatment decision requires the following: (a) a severe<br \/>\nmental disorder that prevents the individual from making his\/her own treat-ment<br \/>\ndecisions; and\/or (b) the likelihood that the patient may harm him\/her self or others.<br \/>\nPhysicians should consider compulsory hospitalization to be exceptional and should<br \/>\nutilize it only when it is medically necessary and for the shortest duration feasible<br \/>\nunder the circumstances.<br \/>\n5. Every physician should offer the patient the best available therapy to his\/her know-<br \/>\nledge, and should treat the patient with the solicitude and respect due all human<br \/>\nbeings. The physician practising in a psychiatric institution, the military or a prison<br \/>\ncan be faced with a conflict between his\/her responsibilities to society and the res-<br \/>\nponsibilities to the patient. The physician&#8217;s primary loyalty and duty must be to the<br \/>\npatient&#8217;s best interest. The physician should ensure that the patient is made aware of<br \/>\nthe conflict in order to minimize feelings of betrayal, and should offer the patient the<br \/>\nopportunity to understand measures mandated by legal authority.<br \/>\n6. The confidentiality and privacy of all patients should be safeguarded. When required<br \/>\nby law, the physician should disclose only the required relevant material and should<br \/>\ndisclose such material only to the entity having legal authority to make such a request<br \/>\nor demand. Data banks that allow access to or transfer of information from one au-<br \/>\nthority to another may be used provided that medical confidentiality is respected and<br \/>\nsuch access or transfer is fully compliant with applicable law.<br \/>\n7. A physician must never use his\/her professional position to violate the dignity or<br \/>\nhuman rights of any individual or group and should never allow his\/her personal<br \/>\ndesires, needs, feelings, prejudices or beliefs to interfere with the treatment. Neither<br \/>\nshould a physician take advantage of his\/her professional position or the vulnerability<br \/>\nof a patient to abuse his\/her authority.<br \/>\nRECOMMENDATION<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. National Medical Associations should publicize this Statement and use it as a basis<br \/>\nfor affirming the ethical foundations for treatment of patients with mental illness.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101995-\u00ad\u201004-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nPHYSICIANS<br \/>\n \u00a0AND<br \/>\n \u00a0PUBLIC<br \/>\n \u00a0HEALTH<br \/>\n \u00a0<br \/>\nAdopted by the 47th<br \/>\nWMA General Assembly, Bali, Indonesia, September 1995<br \/>\nand revised by the 57th<br \/>\nWMA General Assembly, Pilanesberg, South Africa, October 2006<br \/>\n1. Physicians and their professional associations have an ethical and professional res-<br \/>\nponsibility to act in the best interests of patients at all times. This involves collabora-<br \/>\ntion with public health agencies to integrate medical care of individual patients with a<br \/>\nbroader promotion of the health of the public.<br \/>\n2. The health of a community or population is determined by several factors that go be-<br \/>\nyond traditionally understood causes of disease. Classically defined determinants of<br \/>\nhealth, aside from the genetic and biological constitution of individuals, include fac-<br \/>\ntors that affect behavioural lifestyle choices, factors that affect the physical, psycho-<br \/>\nsocial and economic environments in which individuals live, and factors that affect<br \/>\nthe health services available to people. Public health traditionally involves monitor-<br \/>\ning, assessing and planning a variety of programs and activities targeted to the identi-<br \/>\nfied needs of the population, and the public health sector should have the capacity to<br \/>\ncarry out those functions effectively to optimise community health. The key functions<br \/>\nof public health agencies are:<br \/>\na. Health promotion:<br \/>\n1. Working with health care providers to inform and enable the general public to<br \/>\ntake an active role in preventing and controlling disease, adopting healthful<br \/>\nlifestyles, and using medical services appropriately;<br \/>\n2. Assuring that conditions contributing to good health, including high-quality<br \/>\nmedical services, safe water supplies, good nutrition, an unpolluted atmos-<br \/>\nphere, and opportunities for exercise and recreation are accessible for the en-<br \/>\ntire population;<br \/>\n3. Working with the responsible public authorities to create healthy public policy<br \/>\nand supportive environments in which healthy behavioural choices are the<br \/>\neasy choices, and to develop human and social capital.<br \/>\nb. Prevention: assuring access to screening and other preventive services and cura-<br \/>\ntive care to the entire population.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0Pilanesberg<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101995-\u00ad\u201004-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nPublic<br \/>\n \u00a0Health<br \/>\n \u00a0<br \/>\nc. Protection: monitoring and protecting the health of communities against commu-<br \/>\nnicable diseases and exposure to toxic environmental pollutants, occupational<br \/>\nhazards, harmful products, and poor quality health services. This function includes<br \/>\nthe need to set priorities, establish essential programs, obtain requisite resources<br \/>\nand assure the availability of necessary public health laboratory services.<br \/>\nd. Surveillance: identifying outbreaks of infectious disease and patterns of chronic<br \/>\ndisease and injury and establishing appropriate control or prevention programs;<br \/>\ne. Population Health Assessment: assessing community health needs and marshal-<br \/>\nling the resources for responding to them, and developing health policy in res-<br \/>\nponse to specific community and national health needs.<br \/>\n3. The specific programs and activities carried out in each jurisdiction will depend on<br \/>\nthe problems and needs identified, the organization of the health care delivery system,<br \/>\nthe types and scope of the partnerships developed and the resources available to ad-<br \/>\ndress the identified needs.<br \/>\n4. Public health agencies benefit greatly from the support and close cooperation of phy-<br \/>\nsicians and their professional associations. The health of a community or a nation is<br \/>\nmeasured by the health of all its residents, and the preventable health or medical<br \/>\nproblems that affect an individual person affect the health and resources of the com-<br \/>\nmunity. The effectiveness of many public health programs, therefore, depends on the<br \/>\nactive collaboration of physicians and their professional associations with public<br \/>\nhealth agencies and other governmental and nongovernmental agencies.<br \/>\n5. The medical sector and the public health sector should effectively cooperate on the<br \/>\ndissemination of public health information and education programs that promote<br \/>\nhealthful lifestyles and reduce preventable risks to health, including those from the<br \/>\nuse of tobacco, alcohol and other drugs; sexual activities that increase the risk of HIV<br \/>\ntransmission and sexually transmitted diseases; poor diet and physical inactivity; and<br \/>\ninadequate childhood immunization levels. In many countries, health education is one<br \/>\nway to reduce infant morbidity and mortality by promoting breast-feeding and pro-<br \/>\nviding nutrition education to parents together with providing supportive conditions (at<br \/>\nwork and in the community).<br \/>\n6. Other types of activities, such as disease surveillance, investigation, and control are<br \/>\nprimarily the formal responsibility of public health agencies. These activities cannot<br \/>\nbe conducted effectively, however, without the active cooperation and support of phy-<br \/>\nsicians at the community level who are aware of individual and community illness<br \/>\npatterns and can notify health authorities promptly of problems that might require<br \/>\nfurther investigation and action. For example, physicians can help identify popula-<br \/>\ntions at high risk for particular diseases, such as tuberculosis, and report cases of com-<br \/>\nmunicable diseases such as measles, whooping cough, or infectious causes of diar-<br \/>\nrhoea, as well as cases of exposure to lead or other toxic chemicals and substances in<br \/>\nthe community or work place. A spirit of collaboration could be greatly enhanced if<br \/>\npublic health agencies respond adequately and appropriately to the information pro-<br \/>\nvided by physicians and others.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20101995-\u00ad\u201004-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Pilanesberg<br \/>\n \u00a0<br \/>\nPublic<br \/>\n \u00a0Health<br \/>\n \u00a0<br \/>\n7. Regardless of the effectiveness of existing public health programs in a jurisdiction,<br \/>\nprofessional medical associations should be aware of unmet health needs in their com-<br \/>\nmunities and nations and advocate for activities, programs, and resources to meet<br \/>\nthose needs. These efforts might be in areas of public education for health promotion<br \/>\nand disease prevention; monitoring and controlling environmental hazards; identi-<br \/>\nfying and publicizing adverse health effects resulting from social problems, such as<br \/>\ninterpersonal violence or social practices that affect health; or identifying and advo-<br \/>\ncating for services such as improvements in emergency treatment preparedness.<br \/>\n8. In areas or jurisdictions in which basic public health services are not being provided<br \/>\nadequately, medical associations must work with other health agencies and groups to<br \/>\nestablish priorities for advocacy and action. For example, in a country or area with<br \/>\nlimited resources in which potable water and sewage facilities are not available to<br \/>\nmost residents, these needs should be given priority over medical technologies that<br \/>\nwould provide service to only a small portion of the population.<br \/>\n9. Some health-related issues are extremely complex and involve multiple levels of res-<br \/>\nponse. For example, those diagnosed with high blood lead levels need not only appro-<br \/>\npriate medical treatment, but the source of contamination must also be determined,<br \/>\nand measures taken to eliminate the danger. At times policies that promote public<br \/>\nhealth create concern because of their potential economic impact. For example, strong<br \/>\nopposition to the potential economic impact of tobacco control policies could come<br \/>\nfrom regions or groups that derive significant revenue from growing or processing<br \/>\ntobacco. However, economic concerns should not deter a strong public health advo-<br \/>\ncacy program against the use of tobacco products. The promotion of tobacco products<br \/>\nshould be rigorously opposed, and every effort should be made to reduce tobacco<br \/>\nconsumption in both developed and developing countries.<br \/>\n10. Physicians and their associations should collaborate with political authorities and other<br \/>\norganizations to encourage the media to send positive messages for health education<br \/>\nregarding diet, drug use, sexually transmitted diseases, cardiovascular risk, etc.<br \/>\n11. Medical associations should ask their members to educate their patients on the<br \/>\navailability of public health services.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101996-\u00ad\u201001-\u00ad\u20102008<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nRESISTANCE<br \/>\n \u00a0TO<br \/>\n \u00a0ANTIMICROBIAL<br \/>\n \u00a0DRUGS<br \/>\n \u00a0<br \/>\nAdopted by the 48th<br \/>\nWMA General Assembly, Somerset West, South Africa, October 1996<br \/>\nand amended by the 59th<br \/>\nWMA General Assembly, Seoul, Korea, October 2008<br \/>\nPREAMBLE<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nThe global increase in resistance to antimicrobial drugs, including the emergence of bac-<br \/>\nterial strains resistant to all available antibacterial agents, has created a multi-faceted<br \/>\npublic health problem of crisis proportions with significant economic and human implica-<br \/>\ntions. The development of resistant microorganisms is a problem whenever antimicrobial<br \/>\nagents are used. The increase in high-risk populations who frequently require antimicro-<br \/>\nbial therapy, including immunocompromised patients, those undergoing invasive medical<br \/>\ninterventions, those with implanted medical devices and patients with chronic debilitating<br \/>\ndiseases, has amplified the problem. The fact that certain infectious diseases have been<br \/>\nlinked to the development of chronic disease and cancer adds another dimension to the<br \/>\nproblem.<br \/>\nA renewed effort to increase awareness of antimicrobial resistance is needed in order to<br \/>\ncontain and slow its development. International cooperation is essential in accomplishing<br \/>\nthis objective, including global, national, and local components. In particular, implement-<br \/>\ntation of national and global efforts to contain the development and spread of antimicro-<br \/>\nbial resistance is vital; policy statements without international will to accomplish results<br \/>\nare not enough. Given the dynamics of antimicrobial resistance, the need for continuing<br \/>\ndevelopment of new antimicrobials by the pharmaceutical industry can be anticipated.<br \/>\nSubstantial misuse and overuse of antimicrobial agents have exacerbated the problem by<br \/>\nadding selection pressures to microbial populations that favor mutation to antibiotic resist-<br \/>\nance. These include inappropriate prescribing of antibacterial prophylactics and\/or treat-<br \/>\nment of bacterial infections by physicians and poor compliance with antimicrobial regi-<br \/>\nmens by patients. Thus, there is a need for enhanced training and education to improve the<br \/>\nappropriate clinical use of antimicrobials and prevent the development of resistance. There<br \/>\nis a need at every level to educate the public about the appropriate use of antimicrobials<br \/>\nand the problem of antimicrobial resistance.<br \/>\nThe availability of antimicrobial agents without a prescription in many developing coun-<br \/>\ntries is escalating antibiotic resistance, and this practice must be discontinued. The in-<br \/>\ncreasing prevalence of counterfeit medications is another critical and expanding risk fac-<br \/>\ntor. Successfully addressing this problem will require substantial cooperation among<br \/>\nnations and the development and use of better technologies to verify the authenticity of<br \/>\npharmaceutical products and assure the security of deployment from point of manufacture<br \/>\nto the point of need. Similarly, the inappropriate use of antibiotics in veterinary medicine<br \/>\nand livestock production in many countries needs to be controlled.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20101996-\u00ad\u201001-\u00ad\u20102008<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Seoul<br \/>\n \u00a0<br \/>\nAntimicrobial<br \/>\n \u00a0Resistance<br \/>\n \u00a0<br \/>\nRECOMMENDATIONS<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nGlobal<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nIndividual governments should work to create cross-sectional national task forces to col-<br \/>\nlect national data on the use of antibiotics and antimicrobial resistance and to prioritize<br \/>\nregulation, intervention, and other measures to reduce antimicrobial resistance.<br \/>\nThe World Medical Association and its member national medical associations should<br \/>\nadvocate for:<br \/>\n\u2022 Individual governments to cooperate with the World Health Organization (WHO)<br \/>\nto enhance the effectiveness of the WHO&#8217;s global network of antimicrobial resist-<br \/>\nance surveillance. This will foster the collection, quality and sharing of data; the<br \/>\nmonitoring of progress in combating antimicrobial resistance; the establishment of<br \/>\nappropriate formularies; and scientific support for interventions.<br \/>\n\u2022 The WHO to examine the role of international travel and trade agreements on the<br \/>\ndevelopment of antimicrobial resistance.<br \/>\n\u2022 The widespread application of verifiable technology to ensure the authenticity of<br \/>\npharmaceutical products.<br \/>\nThe World Medical Association and its national medical associations should encourage<br \/>\ntheir governments to:<br \/>\n\u2022 Fund more basic and applied research directed toward the development of inno-<br \/>\nvative antimicrobial agents and vaccines, and on the appropriate and safe use of<br \/>\nsuch therapeutic tools.<br \/>\n\u2022 Create incentives for the pharmaceutical industry to pursue research and develop-<br \/>\nment programs leading to the availability of innovative antimicrobial agents, vac-<br \/>\ncines, and rapid diagnostic methods.<br \/>\nNational<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nNational medical associations should:<br \/>\n\u2022 urge their governments to require that antimicrobial agents be available only<br \/>\nthrough a prescription provided by licensed and qualified health care and\/or veteri-<br \/>\nnary professionals.<br \/>\n\u2022 urge their governments to initiate a national media campaign explaining to the pu-<br \/>\nblic the harmful consequences of overuse and misuse of antibiotics.<br \/>\n\u2022 actively pursue the development of a national surveillance system for antimicrobial<br \/>\nresistance that will provide physicians with the information necessary to deliver<br \/>\ntimely, evidence-based, high-quality care. Data from this system should be linked<br \/>\nwith, or at minimum, fed into, the WHO&#8217;s global network of antimicrobial resist-<br \/>\nance surveillance.<br \/>\n\u2022 create guidelines on the appropriate use of antibiotics for common medical con-<br \/>\nditions, such as respiratory infections, tonsillitis, pneumonia and urinary tract in-<br \/>\nfection; pursue the development of a national surveillance system for sales of anti-<br \/>\nmicrobials.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101996-\u00ad\u201001-\u00ad\u20102008<br \/>\n \u00a0<br \/>\n\u2022 encourage medical schools and continuing medical education programs to renew<br \/>\ntheir efforts to educate physicians about the appropriate use of antimicrobial agents<br \/>\nand appropriate infection control practices, including antibiotic use in the out-<br \/>\npatient setting.<br \/>\n\u2022 in collaboration with veterinary authorities, encourage their governments to restrict<br \/>\nthe use of antimicrobial agents as feed additives for animals strictly to those anti-<br \/>\nmicrobials that do not have a human public health impact.<br \/>\nLocal<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nPhysicians should:<br \/>\n\u2022 assume leadership roles in their local hospitals, clinics, and communities regarding<br \/>\nappropriate antiseptic habits, antimicrobial agent usage, and antimicrobial resist-<br \/>\nance prevention and control programs. This applies especially to those trained in<br \/>\ninfectious diseases and clinical microbiology.<br \/>\n\u2022 raise awareness amongst their patients about antimicrobial therapy, its risks and<br \/>\nbenefits, the importance of compliance with the prescribed regimen, optimal hy-<br \/>\ngienic practices, and the problem of antimicrobial drug resistance.<br \/>\n\u2022 herever possible, explore strategies for reducing the use of antibiotics that do not<br \/>\ncompromise the quality of patient care, such as \u00abwait-and-see\u00bb prescriptions for the<br \/>\ntreatment of acute otitis media.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101996-\u00ad\u201002-\u00ad\u20102010<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nFAMILY<br \/>\n \u00a0VIOLENCE<br \/>\n \u00a0<br \/>\nAdopted by the 48th<br \/>\nWMA General Assembly, Somerset West, South Africa, October 1996<br \/>\neditorially revised by the 174th<br \/>\nWMA Council Session, Pilanesberg, South Africa,<br \/>\nOctober 2006<br \/>\nand amended by the 61st<br \/>\nWMA General Assembly, Vancouver, Canada, October 2010<br \/>\nPREAMBLE<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nRecalling the World Medical Association Declaration of Hong Kong on the Abuse of the<br \/>\nElderly and the World Medical Association Statement on Child Abuse and Neglect, and<br \/>\nprofoundly concerned with violence as a public health issue, the World Medical Associa-<br \/>\ntion calls upon National Medical Associations to intensify and broaden their efforts to<br \/>\naddress the universal problem of family violence.<br \/>\nFamily violence is a term applied to physical and\/or emotional mistreatment of a person<br \/>\nby someone in an intimate relationship with the victim. The term includes domestic vio-<br \/>\nlence (sometimes referred to as partner, spouse, or wife battering), child physical abuse<br \/>\nand neglect, child sexual abuse, maltreatment of older people, and many cases of sexual<br \/>\nassault. Family violence can be found in every country in the world, cutting across gender<br \/>\nand all racial, ethnic, religious and socio-economic lines. Although case definitions vary<br \/>\nfrom culture to culture, family violence represents a major public health problem by virtue<br \/>\nof the many deaths, injuries, and adverse psychological consequences that it causes. The<br \/>\nphysical and emotional harm may represent chronic or even lifetime disabilities for many<br \/>\nvictims. Family violence is associated with increased risk of depression, anxiety, sub-<br \/>\nstance abuse, and self-injurious behaviour, including suicide. Victims often become per-<br \/>\npetrators or become involved in violent relationships later on. Although the focus of this<br \/>\ndocument is the welfare of the victim, the needs of the perpetrator should not be over-<br \/>\nlooked.<br \/>\nAlthough the causes of family violence are complex, a number of contributing factors are<br \/>\nknown. These include poverty, unemployment, other exogenous stresses, attitudes of ac-<br \/>\nceptance of violence for dispute resolution, substance abuse (particularly alcohol), rigid<br \/>\ngender roles, poor parenting skills, ambiguous family roles, unrealistic expectations of<br \/>\nother family members, interpersonal conflicts within the family, actual or perceived physi-<br \/>\ncal or psychological vulnerability of victims by perpetrators, perpetrator pre-occupation<br \/>\nwith power and control, and familial social isolation, among others.<br \/>\nPOSITION<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nThere is a growing awareness of the need to think about and take action against family<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0Vancouver<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101996-\u00ad\u201002-\u00ad\u20102010<br \/>\n \u00a0<br \/>\nFamily<br \/>\n \u00a0Violence<br \/>\n \u00a0<br \/>\nviolence in a unified way, rather than focusing on the particular type of victim or com-<br \/>\nmunity affected. In many families where partner battering occurs, for example, there may<br \/>\nbe abuse of children and\/or of older people as well, often carried out by a single perpe-<br \/>\ntrator. In addition, there is substantial evidence that children who are victimized or who<br \/>\nwitness violence against others in the family are later at increased risk as adolescents or<br \/>\nadults of being re-victimized and\/or becoming perpetrators of violence themselves. Final-<br \/>\nly, more recent data suggest that victims of family violence are more likely to become<br \/>\nperpetrators of violence against non-intimates as well. All of this suggests that each in-<br \/>\nstance of family violence may have implications not only for further family violence, but<br \/>\nalso for the broader spread of violence throughout a society.<br \/>\nPhysicians and NMAs should oppose violent practices such as dowry killings and honour<br \/>\nkillings.<br \/>\nPhysicians and NMAs should oppose the practice of child marriage.<br \/>\nPhysicians have important roles to play in the prevention and treatment of family violence.<br \/>\nOf course they will manage injuries, illnesses, and psychiatric problems deriving from the<br \/>\nabuse. The therapeutic relationships physicians have with patients may allow victims to<br \/>\nconfide in them about current or past victimization. Physicians should inquire about vio-<br \/>\nlence routinely, as well as when they see particular clinical presentations that may be as-<br \/>\nsociated with abuse. They can help patients to find methods of achieving safety and access<br \/>\nto community resources that will allow protection and\/or intervention in the abusive rela-<br \/>\ntionship. They can educate patients about the progression and adverse consequences of<br \/>\nfamily violence, stress management and availability of relevant mental health treatment,<br \/>\nand parenting skills as ways of preventing the violence before it occurs. Finally, physi-<br \/>\ncians as citizens and as community leaders and medical experts can become involved in<br \/>\nlocal and national activities designed to decrease family violence.<br \/>\nPhysicians recognise that victims of violence may find it difficult to trust their physician at<br \/>\nfirst. Physicians must be prepared to develop a trusting relationship with their patient over<br \/>\ntime until s\/he is ready to accept advice, help and intervention.<br \/>\nRECOMMENDATION<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nThe World Medical Association recommends that National Medical Associations adopt<br \/>\nthe following guidelines for physicians:<br \/>\n\u2022 All physicians should receive adequate training in the medical, sociological, psy-<br \/>\nchological and preventive aspects of all types of family violence. This would in-<br \/>\nclude medical school training in the general principles, specialty-specific infor-<br \/>\nmation during postgraduate training, and continuing medical education about<br \/>\nfamily violence. Trainees must receive adequate instruction in the role of gender,<br \/>\npower and other issues of family dynamics in contributing to family violence. The<br \/>\ntraining should also include adequate collecting of evidence, documentation and<br \/>\nreporting in cases of abuse.<br \/>\n\u2022 Physicians should know how to take an appropriate and culturally sensitive history<br \/>\nof current and past victimization.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20101996-\u00ad\u201002-\u00ad\u20102010<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Vancouver<br \/>\n \u00a0<br \/>\nFamily<br \/>\n \u00a0Violence<br \/>\n \u00a0<br \/>\n\u2022 Physicians should routinely consider and be sensitive to signs indicating the need<br \/>\nfor further evaluations about current or past victimization as part of their general<br \/>\nhealth screen or in response to suggestive clinical findings.<br \/>\n\u2022 Physicians should be encouraged to provide pocket cards, booklets, videotapes,<br \/>\nand\/or other educational materials in reception rooms and emergency departments<br \/>\nto offer patients general information about family violence as well as to inform<br \/>\nthem about local help and services.<br \/>\n\u2022 Physicians should be aware of social, community and other services of use to vic-<br \/>\ntims of violence, and refer to and use these routinely.<br \/>\n\u2022 Physicians have the obligation to consider reporting to appropriate protection<br \/>\nservices suspected violence against children and other family members without<br \/>\nlegal capacity.<br \/>\n\u2022 Physicians should be acutely aware of the need for maintaining confidentiality in<br \/>\ncases of family violence.<br \/>\n\u2022 Physicians should be encouraged to participate in coordinated community acti-<br \/>\nvities that seek to reduce the amount and impact of family violence.<br \/>\n\u2022 Physicians should be encouraged to develop non-judgemental attitudes toward<br \/>\nthose involved in family violence so their ability to influence victims, survivors<br \/>\nand perpetrators is enhanced. For example, the behaviour should be judged but not<br \/>\nthe person.<br \/>\n\u2022 National Medical Associations should encourage and facilitate coordination of<br \/>\naction against family violence between and among components of the health care<br \/>\nsystem, criminal justice systems, law enforcement authorities, family and juvenile<br \/>\ncourts, and victims&#8217; services organizations. They should also support public aware-<br \/>\nness and community education.<br \/>\n\u2022 National Medical Associations should encourage and facilitate research to under-<br \/>\nstand the prevalence, risk factors, outcomes and optimal care for victims of family<br \/>\nviolence.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101996-\u00ad\u201003-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nPROFESSIONAL<br \/>\n \u00a0RESPONSIBILITY<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nFOR<br \/>\n \u00a0STANDARDS<br \/>\n \u00a0OF<br \/>\n \u00a0MEDICAL<br \/>\n \u00a0CARE<br \/>\n \u00a0<br \/>\nAdopted by the 48th<br \/>\nWMA General Assembly, Somerset West, South Africa, October 1996<br \/>\nand editorially revised by the 174th<br \/>\nWMA Council Session, Pilanesberg, South Africa,<br \/>\nOctober 2006<br \/>\nRecognising<br \/>\n \u00a0that:<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. The physician has an obligation to provide his or her patients with competent medical<br \/>\nservice and to report to the appropriate authorities those physicians who practice<br \/>\nunethically and incompetently or who engage in fraud or deception (International<br \/>\nCode of Medical Ethics); and<br \/>\n2. The physician should be free to make clinical and ethical judgements without inap-<br \/>\npropriate outside interference; and<br \/>\n3. Ethics committees, credentials committees and other forms of peer review have been<br \/>\nlong established, recognised and accepted by organised medicine to scrutinise physi-<br \/>\ncians&#8217; professional conduct and, where appropriate, impose reasonable restrictions on<br \/>\nthe absolute professional freedom of physicians; and<br \/>\nReaffirming<br \/>\n \u00a0that:<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. Professional autonomy and the duty to engage in vigilant self-regulation are essential<br \/>\nrequirements for high quality care and therefore are patient benefits that must be pre-<br \/>\nserved;<br \/>\n2. And, as a corollary, the medical profession has a continuing responsibility to support,<br \/>\nparticipate in, and accept appropriate peer review activity that is conducted in good<br \/>\nfaith;<br \/>\nPOSITION<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. A physician&#8217;s professional service should be considered distinct from commercial<br \/>\ngoods and services, not least because a physician is bound by specific ethical duties,<br \/>\nwhich include the dedication to provide competent medical practice (International<br \/>\nCode of Medical Ethics).<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20101996-\u00ad\u201003-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Pilanesberg<br \/>\n \u00a0<br \/>\nProfessional<br \/>\n \u00a0Responsibility<br \/>\n \u00a0<\/p>\n<p> \u00a02. Whatever judicial or regulatory process a country has established, any judgement on a<br \/>\nphysician&#8217;s professional conduct or performance must incorporate evaluation by the<br \/>\nphysician&#8217;s professional peers who, by their training and experience, understand the<br \/>\ncomplexity of the medical issues involved.<br \/>\n3. Any procedure for considering complaints from patients which fails to be based upon<br \/>\ngood faith evaluation of the physician&#8217;s actions or omissions by the physician&#8217;s peers<br \/>\nis unacceptable. Such a procedure would undermine the overall quality of medical<br \/>\ncare provided to all patients.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101996-\u00ad\u201004-\u00ad\u20102007<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nFAMILY<br \/>\n \u00a0PLANNING<br \/>\n \u00a0AND<br \/>\n \u00a0THE<br \/>\n \u00a0RIGHT<br \/>\n \u00a0OF<br \/>\n \u00a0A<br \/>\n \u00a0WOMAN<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nTO<br \/>\n \u00a0CONTRACEPTION<br \/>\n \u00a0<br \/>\nAdopted by the 48th<br \/>\nWMA General Assembly, Somerset West, South Africa, October 1996<br \/>\nand amended by the 58th<br \/>\nWMA General Assembly, Copenhagen, Denmark, October 2007<br \/>\nThe WMA recognizes that unwanted pregnancies and pregnancies that are too closely<br \/>\nspaced can have a serious adverse effect on the health of a woman and of her children.<br \/>\nThese adverse effects can include the premature deaths of women. Existing children in the<br \/>\nfamily can also suffer starvation, neglect or abandonment resulting in their death or im-<br \/>\npaired health, when families are unable to provide for all their children. Social function-<br \/>\ning and the ability to reach their full potential can also be impaired.<br \/>\nThe WMA recognizes the benefits for women who are able to control their fertility. They<br \/>\nshould be helped to make such choices themselves, as well as in discussion with their<br \/>\npartners. The ability to do so by choice and not chance is a principal component of wo-<br \/>\nmen&#8217;s physical and mental health and social well being.<br \/>\nAccess to adequate fertility control methods is not universal; many of the poorest women<br \/>\nin the world have the least access. Knowledge about how their bodies work, information<br \/>\non how to control their fertility and the materials necessary to make those choices are uni-<br \/>\nversal and basic human rights for all women.<br \/>\nThe role of family planning and secure access to appropriate methods is recognized in the<br \/>\n5th Millennium Development goal as a major factor promoting maternal and child health.<br \/>\nThe WMA recommends that National Medical Associations:<br \/>\nPromote family planning education by working with governments, NGOs and others to<br \/>\nprovide secure and high-quality services and assistance.<br \/>\nAttempt to ensure that such information, materials, products and services are available<br \/>\nwithout regard to nationality, creed, race, religion or socioeconomic status.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101996-\u00ad\u201005-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWEAPONS<br \/>\n \u00a0OF<br \/>\n \u00a0WARFARE<br \/>\n \u00a0AND<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nTHEIR<br \/>\n \u00a0RELATION<br \/>\n \u00a0TO<br \/>\n \u00a0LIFE<br \/>\n \u00a0AND<br \/>\n \u00a0HEALTH<br \/>\n \u00a0<br \/>\nAdopted by the 48th<br \/>\nWMA General Assembly, Somerset West, South Africa, October 1996<br \/>\nand editorially revised by the 174th<br \/>\nWMA Council Session, Pilanesberg, South Africa,<br \/>\nOctober 2006<br \/>\nPREAMBLE<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. When nations enter into warfare or into weapons development, they do not usually<br \/>\nconsider the effects of the use of weapons on the health of individual non-combatants<br \/>\nand on public health in general, either in the short or in the longer term.<br \/>\n2. Nevertheless the medical profession is required to deal with both the immediate and<br \/>\nlong term health effects of warfare, and in particular with the effects of different<br \/>\nforms of weapons.<br \/>\n3. The potential for scientific and medical knowledge to contribute to the development<br \/>\nof new weapons systems, targeted against specific individuals, specific populations or<br \/>\nagainst body systems, is considerable. This includes the development of weapons de-<br \/>\nsigned to target anatomical or physiological systems, including vision, or which use<br \/>\nknowledge of human genetic similarities and differences to target weapons.<br \/>\n4. There are no current and commonly used criteria to measure weapons effects on<br \/>\nhealth. International Humanitarian Law states that weapons that cause injuries which<br \/>\nwould constitute \u00abunnecessary suffering or superfluous injury\u00bb are illegal. These<br \/>\nterms are not defined and require interpretation against objective criteria for the law to<br \/>\nbe effective.<br \/>\n5. Physicians can aid in developing criteria for weapons that cause injury or suffering so<br \/>\nextreme as to invoke the terms of International Humanitarian Law.<br \/>\n6. Such criteria could aid lawyers in the use of International Humanitarian Law, allow<br \/>\nassessment of the legality of new weapons currently in development against an<br \/>\nagreed, objective system of assessment of their medical effects, and identify breaches<br \/>\nof the Law once it is developed.<br \/>\n7. Physician involvement in the delineation of such objective criteria is essential if it is<br \/>\nto become part of the legal process. However, it should be recognised that physicians<br \/>\nare opposed to any use of weapons against human beings.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0Pilanesberg<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101996-\u00ad\u201005-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nWeapons<br \/>\n \u00a0of<br \/>\n \u00a0Warfare<br \/>\n \u00a0<br \/>\nRECOMMENDATIONS<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. The WMA believes that the development, manufacture and sale of weapons for use<br \/>\nagainst human beings are abhorrent. To support the prevention and reduction of wea-<br \/>\npons injuries the WMA:<br \/>\na. Supports international efforts to define objective criteria to measure the effects of<br \/>\ncurrent and future weapons, which could be used to stop the development, manu-<br \/>\nfacture, sale and use of those weapons;<br \/>\nb. Calls on National Medical Associations to urge national governments to co-<br \/>\noperate with the collection of such data as are necessary for establishing objective<br \/>\ncriteria;<br \/>\nc. Calls on National Medical Associations to support and encourage research into<br \/>\nthe global public health effects of weapons use, and to publicise the results of that<br \/>\nresearch both nationally and internationally to ensure that both the public and<br \/>\ngovernments are aware of the long term health consequences of weapons use on<br \/>\nnon-combatant individuals and populations.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101997-\u00ad\u201001-\u00ad\u20102007<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0PROPOSAL<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nFOR<br \/>\n \u00a0<\/p>\n<p> \u00a0A<br \/>\n \u00a0UNITED<br \/>\n \u00a0NATIONS<br \/>\n \u00a0RAPPORTEUR<br \/>\n \u00a0ON<br \/>\n \u00a0THE<br \/>\n \u00a0INDEPENDENCE<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nAND<br \/>\n \u00a0INTEGRITY<br \/>\n \u00a0OF<br \/>\n \u00a0HEALTH<br \/>\n \u00a0PROFESSIONALS<br \/>\n \u00a0<br \/>\nAdopted by the 49th<br \/>\nWMA General Assembly, Hamburg, Germany, November 1997<br \/>\nand reaffirmed by the 176th<br \/>\nWMA Council Session, Berlin, Germany, May 2007<br \/>\nThe British Medical Association (BMA) requests that the World Medical Association<br \/>\n(WMA) supports a proposal, put forward by a network of medical organizations*<br \/>\ncon-<br \/>\ncerned with human rights issues, for the establishment of a new UN post of rapporteur on<br \/>\nthe independence and integrity of health professionals.<br \/>\nIt is envisaged that the role of the rapporteur will supplement the work already done by a<br \/>\nseries of existing UN rapporteurs on issues such as torture, arbitrary execution, violence<br \/>\nagainst women, etc. The new rapporteur would be charged with the task of monitoring that<br \/>\ndoctors are allowed to move freely and that patients have access to medical treatment,<br \/>\nwithout discrimination as to nationality or ethnic origin, in war zones or in situations of<br \/>\npolitical tension. The role of the proposed rapporteur is detailed on pages two, three and<br \/>\nfour of this submission.<br \/>\nThe original proposal was drawn up by a lawyer, Cees Flinterman, who is a professor of<br \/>\nconstitutional and international law at the University of Limburg, Maastricht, in The<br \/>\nNetherlands. It has the support of a range of doctors&#8217; organizations listed below*<br \/>\n, whose<br \/>\ninterests are in protection of human rights and protection of doctors who act impartially in<br \/>\nconflict situations. This group will be consulting widely and acting with the help of the<br \/>\nInternational Commission of Jurists to interest the United Nations in this proposal.<br \/>\nThe Council of the BMA supported this proposal after debate in 1996. It would lend con-<br \/>\nsiderable weight to the campaign if the WMA would also support this concept whose<br \/>\nfundamental aim is to protect doctors and their patients in war situations and other cases<br \/>\nwhere medical independence may come under threat from political or military factions.<br \/>\nPROPOSAL<br \/>\n \u00a0FOR<br \/>\n \u00a0A<br \/>\n \u00a0RAPPORTEUR<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0THE<br \/>\n \u00a0INDEPENDENCE<br \/>\n \u00a0AND<br \/>\n \u00a0INTEGRITY<br \/>\n \u00a0OF<br \/>\n \u00a0HEALTH<br \/>\n \u00a0PROFESSIONALS<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nGoals<br \/>\n \u00a0<br \/>\naccepting that in many situations of political conflict (such as civil or international war) or<br \/>\npolitical tension (such as during suspension of civil rights in a government-declared state<br \/>\nof emergency), health professionals are often the first people outside military of govern-<br \/>\nment circles to have detailed knowledge of human rights violations, including viola-tions<br \/>\nof the right of populations to access medical treatment, a network of physicians is anxious<br \/>\nthat a range of national and international reporting mechanisms be established to achieve<br \/>\nthe following goals:<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0Berlin<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101997-\u00ad\u201001-\u00ad\u20102007<br \/>\n \u00a0<br \/>\nUN<br \/>\n \u00a0Rapporteur<br \/>\n \u00a0on<br \/>\n \u00a0the<br \/>\n \u00a0Independence<br \/>\n \u00a0and<br \/>\n \u00a0Integrity<br \/>\n \u00a0of<br \/>\n \u00a0Health<br \/>\n \u00a0Professionals<br \/>\n \u00a0<br \/>\n1. To monitor the role of health professionals working in situations where either their<br \/>\nrights to give, or the rights of their patients to receive, treatment are threatened;<br \/>\n2. To make appeals for the protection of health professionals when they are in danger<br \/>\nsolely because of their professional or human rights activities;<br \/>\n3. To defend patients who are in danger of suffering human rights violations solely be-<br \/>\ncause of seeking medical treatment;<br \/>\n4. To encourage reporting of human rights violations by health professionals;<br \/>\n5. To analyse information about health professionals voluntarily adopting discriminatory<br \/>\npractices. The group consider that existing UN reporting mechanisms need expansion.<br \/>\nKey among proposals for new mechanisms is the development of a new UN rap-<br \/>\nporteur&#8217;s post which would link together relevant information emerging from other<br \/>\nexisting UN mechanisms and also suggest where other useful local and national<br \/>\nreporting networks could be developed in the long-term. Therefore, on the basis of<br \/>\nmaterials prepared by the Law Department at the University of Limburg, Maastricht<br \/>\nand circulated by the Dutch medical group, the Johannes Wier Foundation, the group<br \/>\nis campaigning for a new post of UN Rapporteur of the Independence and Integrity of<br \/>\nHealth Professionals.<br \/>\nDefining<br \/>\n \u00a0the<br \/>\n \u00a0Role<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nThe potential role of a UN Rapporteur need not be exhaustively defined in advance since<br \/>\nthe experience of the individual and the practical applicability of the goals must have an<br \/>\ninfluence.<br \/>\nIt should include the following:<br \/>\n\u2022 Receive, evaluate, investigate and report allegations of repression directed at health<br \/>\nprofessionals or intended to prevent individuals receiving medical care. The rap-<br \/>\nporteur should be a clearing house for reports from individuals, groups of doctors,<br \/>\nNGOs etc. and as well as simply receiving information, should pro-actively seek<br \/>\nour information, including on-site visits.<br \/>\n\u2022 To build upon existing principles as found in humanitarian lay and the codes of<br \/>\nmedical ethics applicable in armed conflicts to develop specific guidelines on the<br \/>\nsubject of medical impartiality in relation to the treatment of patients in situations<br \/>\nof political or armed conflict.<br \/>\nThe World Medical Association and national medical association should be en-<br \/>\ncouraged to disseminate such information to health professionals during their train-<br \/>\ning. Arising also form such guidance should be the institution of mechanisms to<br \/>\nhelp health professionals protect themselves in situations where human rights are<br \/>\nat risk.<br \/>\n\u2022 The rapporteur should also have a consultative role, seeking the views of interna-<br \/>\ntional and national professional associations, human rights bodies and humani-<br \/>\ntarian organizations with regards to the protection of health professionals and the<br \/>\ndefence of the right to treat patients impartially.<br \/>\n\u2022 The rapporteur should investigate reports of health professionals voluntarily trans-<br \/>\ngressing guidelines about impartiality and non-discrimination.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101997-\u00ad\u201001-\u00ad\u20102007<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nIssues<br \/>\n \u00a0within<br \/>\n \u00a0the<br \/>\n \u00a0Remit<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n\u2022 The fundamental concern is to protect the nature of the doctor-patient relationship<br \/>\nfrom unjustified external interference although it will also include voluntary trans-<br \/>\ngressing of impartiality by health professionals. The rapporteur&#8217;s role will be to en-<br \/>\nsure the independence, integrity and impartiality of health professionals.<br \/>\nEnsuring these aims requires analysis of whether:<br \/>\n\u2022 the treatment decisions of health professionals can be carried out without coming<br \/>\ninto conflict with improper pressure from authorities;<br \/>\n\u2022 the physical integrity and ability of health professionals to act in accordance<br \/>\nwith their professional principles are both protected;<br \/>\n\u2022 health professionals are able to provide treatment on the basis of patient need;<br \/>\n\u2022 people in need of medical treatment are able to access it safely;<br \/>\n\u2022 health professionals are ensured their freedom of movement, in the capacity as<br \/>\nmedical care providers, and be able to have access to people in need of medical<br \/>\nservices.<br \/>\nMonitoring the degree to which external pressures influence negatively the provision<br \/>\nof medical treatment will be within the remit of the rapporteur.<br \/>\n\u2022 The remit will be global.<br \/>\n\u2022 For lack of a reporting mechanism, health professionals are often disempowered<br \/>\nform taking action on violations of patient rights. One of the issues of the rap-<br \/>\nporteur to monitor would be the introduction of national or local legislation, civil<br \/>\nor military regulations or other rules prohibiting or limiting the provision of medi-<br \/>\ncal or nursing care to certain categories of patient.<br \/>\n\u2022 It will be within the remit of the rapporteur to bring the evidence or reports of viola-<br \/>\ntions of medical impartiality, including those in health professionals cooperating<br \/>\nvoluntarily, to responsible bodies in the medical field and to the governments<br \/>\nconcerned.<br \/>\n\u2022 Blanket restrictions on the medical or nursing services to be provided to members<br \/>\nof vulnerable groups, such as refugees, asylum seekers, prisoners, minority ethnic<br \/>\ngroups, should be among the issues monitored by the rapporteur. The rapporteur<br \/>\nshould contribute to the empowerment of the health professionals to resist col-<br \/>\nlectively the erosion of such patients&#8217; rights.<br \/>\n\u2022 Threats, intimidation or pressures on health professionals to discriminate against<br \/>\npatients on the basis solely of non-medical related considerations such as ethics,<br \/>\nreligious or racial affiliation should be investigated even if the threats do not ma-<br \/>\nterialize into action.<br \/>\n\u2022 Reports of health professionals being harassed or detained simply because of their<br \/>\nprofession or because of the exercise of professional skills will be investigated by<br \/>\nthe rapporteur. Similarly repressive measures designed to prevent health profes-<br \/>\nsionals reporting infringements of medical integrity will be investigated. Measures<br \/>\nto encourage health professionals actively to document and report such violations<br \/>\nshould be put forward by the rapporteur in consultation with other bodies.<br \/>\n\u2022 Reports of patients being impeded or discouraged from gaining access to the avail-<br \/>\nable medical treatment will be investigated.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0Berlin<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101997-\u00ad\u201001-\u00ad\u20102007<br \/>\n \u00a0<br \/>\nUN<br \/>\n \u00a0Rapporteur<br \/>\n \u00a0on<br \/>\n \u00a0the<br \/>\n \u00a0Independence<br \/>\n \u00a0and<br \/>\n \u00a0Integrity<br \/>\n \u00a0of<br \/>\n \u00a0Health<br \/>\n \u00a0Professionals<br \/>\n \u00a0<br \/>\nIssues<br \/>\n \u00a0Outside<br \/>\n \u00a0the<br \/>\n \u00a0Remit<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nJust as important as defining what is within the rapporteur&#8217;s remit is the matter of<br \/>\nclarifying those issues which fall outside it. We anticipate that this too will become clearer<br \/>\nas practice and experience develop. In the meantime, however, we suggest that:<br \/>\n\u2022 health professionals in every country should be educated about the ethical res-<br \/>\nponsibilities they owe to patients and potential patients. Whereas such education is<br \/>\nnot within the remit of the rapproteur, acting as a resource for advice about medi-<br \/>\ncal impartiality would be within the rapporteur&#8217;s remit. In the long term this func-<br \/>\ntion should ideally be dealt with by delegation through medical schools, profes-<br \/>\nsional bodies and voluntary national networks;<br \/>\n\u2022 while government measures to regulate aspects of care, (such as the equitable dis-<br \/>\ntribution of medical resources of the prioritizing of treatment on basis of need)<br \/>\nwould not generally be a matter for monitoring for the rapporteur, extreme meas-<br \/>\nures likely to result in the disenfranchising of groups of patients from medical or<br \/>\nnursing services would be monitored and investigated;<br \/>\n\u2022 governments&#8217; indiscriminate failure to provide health promotion or treatment to<br \/>\nmany or all sectors of the community does not fall within the remit of the rappor-<br \/>\nteur;<br \/>\n\u2022 since a principal concern is to ensure access to medical treatment by patients who<br \/>\nneed and want it, the voluntary decision of some individuals or patient groups to<br \/>\nexclude themselves (for example on religious or cultural grounds) from orthodox<br \/>\nmedicine does not fall within the remit of the rapporteur.<br \/>\n*<br \/>\norganizations participating in the network include: Amnesty International; British Medical Asso-<br \/>\nciation; Centre for Enquiry into Health &#038; Allied Themes (Bombay); Graza Community Mental<br \/>\nHealth; International Committee of the Red Cross; Physicians for Human Rights (in Denmark,<br \/>\nIsrael, South Africa, the UK, &#038; the USA); Turkish Medical Association; and, the Johannes Weir<br \/>\nFoundation.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101997-\u00ad\u201002-\u00ad\u20102007<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nTHE<br \/>\n \u00a0LICENSING<br \/>\n \u00a0OF<br \/>\n \u00a0PHYSICIANS<br \/>\n \u00a0FLEEING<br \/>\n \u00a0PROSECUTION<br \/>\n \u00a0FOR<br \/>\n \u00a0<br \/>\nSERIOUS<br \/>\n \u00a0CRIMINAL<br \/>\n \u00a0OFFENCES<br \/>\n \u00a0<br \/>\nAdopted by the 49th<br \/>\nWMA General Assembly, Hamburg, Germany, November 1997<br \/>\nand reaffirmed by the 176th<br \/>\nWMA Council Session, Berlin, Germany, May 2007<br \/>\nPREAMBLE<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nPhysicians are bound by medical ethics to work for the good of their patients. Involvement<br \/>\nby a physician in torture, war crimes or crimes against humanity is contrary to medical<br \/>\nethics, human rights and international law. A physician who perpetrates such crimes is<br \/>\nunfit to practice medicine.<br \/>\nDEFINITION<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n \u00a0<br \/>\nPhysicians seeking to work in any country are subject to the licensing arrangements of that<br \/>\ncountry. The duty to demonstrate suitability to practice lies with the person seeking regis-<br \/>\ntration. Licensing bodies in some countries are distinct from the national medical asso-<br \/>\nciation.<br \/>\nPhysicians who lose their licenses in one country after being found guilty by their li-<br \/>\ncensing authority of serious professional misconduct, or following a criminal conviction,<br \/>\nwill usually be unsuccessful if they apply to practise in a second country. This is because<br \/>\nmost licensing authorities require not only proof of qualification but also proof that an<br \/>\napplicant who is an immigrant continues to be in good professional standing in his or her<br \/>\ncountry of origin.<br \/>\nYet physicians who have been accused by international agencies of torture, war crimes or<br \/>\ncrimes against humanity have sometimes been able to escape from the country in which<br \/>\nthese crimes were committed and to obtain registration to practice medicine from the<br \/>\nlicensing authority in another country. This is clearly contrary to the public interest and is<br \/>\ndamaging to the reputation of physicians.<br \/>\nRECOMMENDATION<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nNational medical associations should use their own licensing powers to ensure that<br \/>\nphysicians against whom serious allegations of participation in torture, war crimes or<br \/>\ncrimes against humanity have been made are not able to obtain licences to practice until<br \/>\nthey have satisfactorily answered these allegations. National medical associations that do<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0Berlin<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101997-\u00ad\u201002-\u00ad\u20102007<br \/>\n \u00a0<br \/>\nCriminal<br \/>\n \u00a0Offences<br \/>\n \u00a0and<br \/>\n \u00a0Licensing<br \/>\n \u00a0<br \/>\nnot have licensing powers should inform the appropriate licensing authorities of infor-<br \/>\nmation they receive regarding physicians against whom serious allegations of participation<br \/>\nin torture, war crimes or crimes against humanity have been made , and should encourage<br \/>\nthe licensing authorities to take appropriate actions to ensure that such physicians have<br \/>\nsatisfactorily answered these allegations before granting them licenses to practice. Where<br \/>\nevidence of involvement in abuses is compelling, national member associations or licens-<br \/>\ning authorities should draw such evidence to the attention of the appropriate authorities.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101998-\u00ad\u201001-\u00ad\u20102008<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nNUCLEAR<br \/>\n \u00a0WEAPONS<br \/>\n \u00a0<br \/>\nAdopted by the 50th<br \/>\nWorld Medical Assembly, Ottawa, Canada, October 1998<br \/>\nand amended by the 59th<br \/>\nWMA General Assembly, Seoul, Korea, October 2008<br \/>\nThe WMA Declarations of Geneva, of Helsinki and of Tokyo make clear the duties and<br \/>\nresponsibilities of the medical profession to preserve and safeguard the health of the pa-<br \/>\ntient and to consecrate itself to the service of humanity. The WMA considers that it has a<br \/>\nduty to work for the elimination of nuclear weapons.<br \/>\nTherefore the WMA:<br \/>\n\u2022 condemns the development, testing, production, stockpiling, transfer, deployment,<br \/>\nthreat and use of nuclear weapons;<br \/>\n\u2022 requests all governments to refrain from the development, testing, production, stock-<br \/>\npiling, transfer, deployment, threat and use of nuclear weapons and to work in<br \/>\ngood faith towards the elimination of nuclear weapons; and<br \/>\n\u2022 requests all National Medical Associations to join the WMA in supporting this<br \/>\nDeclaration and to urge their respective governments to work towards the elimi-<br \/>\nnation of nuclear weapons.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101998-\u00ad\u201002-\u00ad\u20102010<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nMEDICAL<br \/>\n \u00a0CARE<br \/>\n \u00a0FOR<br \/>\n \u00a0REFUGEES,<br \/>\n \u00a0INCLUDING<br \/>\n \u00a0ASYLUM<br \/>\n \u00a0SEEKERS,<br \/>\n \u00a0<br \/>\nREFUSED<br \/>\n \u00a0ASYLUM<br \/>\n \u00a0SEEKERS<br \/>\n \u00a0AND<br \/>\n \u00a0UNDOCUMENTED<br \/>\n \u00a0MIGRANTS,<br \/>\n \u00a0<br \/>\nAND<br \/>\n \u00a0INTERNALLY<br \/>\n \u00a0DISPLACED<br \/>\n \u00a0PERSONS<br \/>\n \u00a0<br \/>\nAdopted by the 50th<br \/>\nWorld Medical Assembly, Ottawa, Canada, October 1998<br \/>\nreaffirmed by the 59th<br \/>\nWMA General Assembly, Seoul, Korea, October 2008<br \/>\nand amended by the 61st<br \/>\nWMA General Assembly, Vancouver, Canada, October 2010<br \/>\nPREAMBLE<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nInternational and civil conflicts as well as poverty and hunger result in large numbers of<br \/>\nrefugees, including asylum seekers, refused asylum seekers and undocumented migrants,<br \/>\nas well as internally displaced persons (IDPs) in all regions. These persons are among the<br \/>\nmost vulnerable in society.<br \/>\nInternational codes of human rights and medical ethics, including the WMA Declaration<br \/>\nof Lisbon on the Rights of the Patient, declare that all people are entitled without discrimi-<br \/>\nnation to appropriate medical care. However, national legislation varies and is often not in<br \/>\naccordance with this important principle.<br \/>\nSTATEMENT<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nPhysicians have a duty to provide appropriate medical care regardless of the civil or poli-<br \/>\ntical status of the patient, and governments should not deny patients the right to receive<br \/>\nsuch care, nor should they interfere with physicians&#8217; obligation to administer treatment on<br \/>\nthe basis of clinical need alone.<br \/>\nPhysicians cannot be compelled to participate in any punitive or judicial action involving<br \/>\nrefugees, including asylum seekers, refused asylum seekers and undocumented migrants,<br \/>\nor IDPs or to administer any non-medically justified diagnostic measure or treatment, such<br \/>\nas sedatives to facilitate easy deportation from the country or relocation.<br \/>\nPhysicians must be allowed adequate time and sufficient resources to assess the physical<br \/>\nand psychological condition of refugees who are seeking asylum.<br \/>\nNational Medical Associations and physicians should actively support and promote the<br \/>\nright of all people to receive medical care on the basis of clinical need alone and speak out<br \/>\nagainst legislation and practices that are in opposition to this fundamental right.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nS-\u00ad\u20101999-\u00ad\u201001-\u00ad\u20102009<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nPATENTING<br \/>\n \u00a0MEDICAL<br \/>\n \u00a0PROCEDURES<br \/>\n \u00a0<br \/>\nAdopted by the 51st<br \/>\nWorld Medical Assembly, Tel Aviv, Israel, October 1999<br \/>\nand amended by the 60th<br \/>\nWMA General Assembly, New Delhi, India, October 2009<br \/>\nPREAMBLE<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nUnder the law of some jurisdictions medical procedures are patentable. Patents on medical<br \/>\nprocedures are often called medical procedure patents. A medical procedure patent or pa-<br \/>\ntent claim is one that only confers rights over procedural steps and does not confer rights<br \/>\nover any new devices.<br \/>\nOver 80 countries prohibit medical procedure patents. The practice of excluding medical<br \/>\nprocedures from patentability is consistent with the Uruguay Round of Amendments to the<br \/>\nGeneral Agreements on Tariffs and Trade Agreement on Trade Related Aspects of Inter-<br \/>\nnational Property Rights (GATT-TRIPs), which states: \u00abMembers may also exclude from<br \/>\npatentability: (a) diagnostic, therapeutic and surgical methods for the treatment of humans<br \/>\nor animals\u00bb (Article 27).<br \/>\nThe purpose of patents is to encourage private investment in research and development.<br \/>\nHowever, physicians, particularly those who work in research institutions, already have<br \/>\nincentives to innovate and improve their skills. These incentives include professional repu-<br \/>\ntation, professional advancement, and ethical and legal obligations to provide competent<br \/>\nmedical care (International Code of Medical Ethics, 17.A). Physicians are already paid for<br \/>\nthese activities, and public funding is sometimes available for medical research. The argu-<br \/>\nment that patents are necessary to spur invention of medical procedures, and that without<br \/>\nprocedure there would be fewer beneficial medical procedures for patients, is not parti-<br \/>\ncularly persuasive when these other incentives and financing mechanisms are available.<br \/>\nAnother argument is that patents are necessary, not so much for invention but for product<br \/>\ndevelopment. This argument also is not persuasive in the case of medical procedure pa-<br \/>\ntents. Unlike device development, which requires investment in engineers, production<br \/>\nprocesses, and factories, development of medical procedures consists of physicians attain-<br \/>\ning and perfecting manual and intellectual skills. As discussed above, physicians already<br \/>\nhave both obligations to engage in these professional activities as well as rewards for<br \/>\ndoing so.<br \/>\nWhether or not it is ethical to patent medical devices does not bear directly on whether it<br \/>\nis ethical for physicians to patent medical procedures. Devices are manufactured and dis-<br \/>\nseminated by companies, whereas medical procedures are \u00abproduced and disseminated\u00bb by<br \/>\nphysicians. Physicians have ethical or legal obligations to patients and professional oblige-<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0New<br \/>\n \u00a0Delhi<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101999-\u00ad\u201001-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nPatenting<br \/>\n \u00a0Medical<br \/>\n \u00a0Procedures<br \/>\n \u00a0<br \/>\ntions towards each other, which companies do not have. Having particular ethical obliga-<br \/>\ntions is part of what defines medicine as a profession.<br \/>\nThere is no a priori reason to believe that those holding medical procedure patents would<br \/>\nmake patented medical procedures widely available. Patentees might attempt to maximize<br \/>\ntheir profits by making the procedure widely available through nonexclusive licensing<br \/>\nwith low fees. Alternatively, they might attempt to maximize profits by limiting avail-<br \/>\nability of the procedure and charging higher prices to those for whom the procedure is ex-<br \/>\ntremely important and who have the means to pay.<br \/>\nCompetition between organizations providing health care could provide incentives for<br \/>\nsome organizations to negotiate exclusive licenses, or licenses which sharply limit who<br \/>\nelse could practice the procedure. Such a license might provide the organization with an<br \/>\nadvantage in attracting patients, if the organization could advertise that it was the only<br \/>\norganization in a region which could provide a particularly desirable service. Thus, at least<br \/>\nsome of the time patentees will probably limit access to patented medical procedures.<br \/>\nMedical procedure patents may negatively affect patient care. If medical procedure patents<br \/>\nare obtained, then patients&#8217; access to necessary medical treatments might diminish and<br \/>\nthereby undermine the quality of medical care. Access could diminish for the following<br \/>\nreasons:<br \/>\n\u2022 the cost of medical practice would likely increase because of licensing and royalty<br \/>\nfees, and because the cost of physicians&#8217; insurance would likely increase to cover<br \/>\npatent litigation expenses.<br \/>\n\u2022 some physicians capable of performing the patented procedure might not obtain<br \/>\nlicenses to perform it. The number of licensed physicians might be restricted be-<br \/>\ncause certain physicians cannot or will not pay the licensing fees or royalties, or<br \/>\nbecause the patentee refuses to make the license widely available. Limiting the<br \/>\nnumber of licenses would, in some circumstances, limit patients&#8217; choice of physi-<br \/>\ncians.<br \/>\n\u2022 The presence of patents may prevent physicians from undertaking even those pro-<br \/>\ncedures which do not infringe. It may also deter a physician from introducing new<br \/>\nor modified procedures into his or her practice. Devices can be labelled if they are<br \/>\npatented, but procedures cannot, and therefore it is not immediately obvious<br \/>\nwhether what one is doing infringes somebody else&#8217;s medical procedure patent.<br \/>\nHowever, lack of knowledge is no defence against patent infringement, so if a<br \/>\nphysician is uncertain he or she may simply refrain from performing the procedure.<br \/>\nEnforcement of medical procedure patents can also result in invasion of patients&#8217; privacy<br \/>\nor in the undermining of physicians&#8217; ethical obligation to maintain the confidentiality of<br \/>\npatients&#8217; medical information. Where physicians practice in small groups or as sole practi-<br \/>\ntioners, the most expedient methods for a patentee to identify instances of infringement<br \/>\nmight be to look through patients&#8217; medical records or to interview patients. Removing ob-<br \/>\nvious identifiers for the record review would not guarantee confidentiality, because iden-<br \/>\ntity can often be \u00abreconstructed\u00bb with very few pieces of information. This would be parti-<br \/>\ncularly true in small towns or small practices.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20101999-\u00ad\u201001-\u00ad\u20102009<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0New<br \/>\n \u00a0Delhi<br \/>\n \u00a0<br \/>\nPatenting<br \/>\n \u00a0Medical<br \/>\n \u00a0Procedures<br \/>\n \u00a0<br \/>\nPhysicians have ethical obligations both to teach skills and techniques to their colleagues,<br \/>\nand to continuously learn and update their own skills. Medical procedure patents can<br \/>\nundermine these obligations. Once a patent has issued on a procedure, the procedure<br \/>\nwould be fully disclosed (this is one requirement for obtaining a patent); however, those<br \/>\nwithout licenses would not be able to practice it. Limiting who can practice the procedure<br \/>\nundermines the spirit of the ethical mandate to teach and disseminate knowledge. It also<br \/>\nundermines the obligation to update one&#8217;s skills, because it does not do much good to<br \/>\nacquire skills which cannot be used legally.<br \/>\nThe obligation to teach and impart skills may also be impaired if the possibility of patents<br \/>\ncauses physicians to delay publishing new results or presenting them at conferences. Phy-<br \/>\nsicians may be inclined to keep new techniques secret while waiting to complete a patent<br \/>\napplication. This is because public use of a procedure, or publication of a description of<br \/>\nthe procedure, prior to applying for a patent may invalidate the application.<br \/>\nPhysicians also have an ethical obligation not to permit profit motives to influence their<br \/>\nfree and independent medical judgment (International Code of Medical Ethics, 17.A). For<br \/>\nphysicians to pursue, obtain, or enforce medical procedure patents could violate this<br \/>\nrequirement. Physicians holding patents or licenses for procedures might advocate for the<br \/>\nuse of those procedures even when they are not indicated, or not the best procedure under<br \/>\nthe circumstances. Physicians who are not licensed to perform a particular procedure<br \/>\nmight advocate against that procedure, even when it is the best procedure under the cir-<br \/>\ncumstances.<br \/>\nFinally, physicians&#8217; professional obligations to practice their profession with conscience<br \/>\nand dignity (Declaration of Geneva) might be violated by the enforcement of medical pro-<br \/>\ncedure patents. The spectacle of physicians suing each other on a regular basis is unlikely<br \/>\nto enhance the standing of the profession.<br \/>\nPOSITION<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nThe World Medical Association<br \/>\n\u2022 states that physicians have an ethical responsibility to make relevant scientific in-<br \/>\nformation available to colleagues and the public, when possible.<br \/>\n\u2022 states that the patenting of medical procedures poses serious risks to the effective<br \/>\npractice of medicine by potentially limiting the availability of new procedures to<br \/>\npatients.<br \/>\n\u2022 considers that the patenting of medical procedures is unethical and contrary to the<br \/>\nvalues of the medical profession that should guide physicians&#8217; service to their pa-<br \/>\ntients and relations with their colleagues.<br \/>\n\u2022 encourages national medical associations to make every effort to protect physi-<br \/>\ncians&#8217; incentives to advance medical knowledge and develop new medical proce-<br \/>\ndures.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101999-\u00ad\u201002-\u00ad\u20102010<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nTHE<br \/>\n \u00a0RELATIONSHIP<br \/>\n \u00a0BETWEEN<br \/>\n \u00a0PHYSICIANS<br \/>\n \u00a0AND<br \/>\n \u00a0PHARMACISTS<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nIN<br \/>\n \u00a0MEDICINAL<br \/>\n \u00a0THERAPY<br \/>\n \u00a0<br \/>\nAdopted by the 51st<br \/>\nWorld Medical Assembly, Tel Aviv, Israel, October 1999<br \/>\nand amended by the 61st<br \/>\nWMA General Assembly, Vancouver, Canada, October 2010<br \/>\nINTRODUCTION<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nThe goal of pharmacological treatment is to improve patients\u00b4 health and quality of life.<br \/>\nOptimal pharmacological treatment should be safe, effective and efficient. There should<br \/>\nbe equity of access to this kind of treatment and an accurate and up-to-date information<br \/>\nbase that meets the needs of patients and practitioners.<br \/>\nPharmacological treatment has become increasingly complex, often requiring the input of<br \/>\na multi-disciplinary team to administer and monitor the chosen therapy. In the hospital set-<br \/>\nting the inclusion of a clinical pharmacist in such a team is increasingly common and help-<br \/>\nful. The right to prescribe medicine should be competency based and ideally the responsi-<br \/>\nbility of the physician.<br \/>\nPhysicians and pharmacists have complementary and supportive responsibilities in<br \/>\nachieving the goal of providing optimal pharmacological treatment. This requires com-<br \/>\nmunication, respect, trust and mutual recognition of each other&#8217;s professional competence.<br \/>\nAccess by both physicians and pharmacists to the same accurate and up-to-date informa-<br \/>\ntion base is important to avoid providing patients with conflicting information.<br \/>\nPhysicians and pharmacists must provide quality service to their patients and ensure safe<br \/>\nuse of drugs. Therefore collaboration between these professions is imperative, including<br \/>\nwith respect to the development of training and in terms of information sharing with one<br \/>\nanother and with patients. It is necessary to keep an open and continued dialogue between<br \/>\nphysicians\u2019 and pharmacists\u2019 representative organizations in order to define each profes-<br \/>\nsion\u2019s respective functions and promote the optimal use of drugs within a framework of<br \/>\ntransparency and cooperation, all in the best interests of patients.<br \/>\nTHE<br \/>\n \u00a0PHYSICIAN&#8217;S<br \/>\n \u00a0RESPONSIBILITIES<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nDiagnosing diseases on the basis of the physician&#8217;s education and specialized skills and<br \/>\ncompetence.<br \/>\nAssessing the need for pharmacological treatment and prescribing the corresponding medi-<br \/>\ncines in consultation with patients, pharmacists and other health care professionals, when<br \/>\nappropriate.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20101999-\u00ad\u201002-\u00ad\u20102010<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Vancouver<br \/>\n \u00a0<br \/>\nPhysicians<br \/>\n \u00a0and<br \/>\n \u00a0Pharmacists<br \/>\n \u00a0in<br \/>\n \u00a0Medical<br \/>\n \u00a0Therapy<br \/>\n \u00a0<br \/>\nProviding information to patients about diagnosis, indications and treatment goals, as well<br \/>\nas action, benefits, risks and potential side effects of pharmacological treatment. In the<br \/>\ncase of off-label prescriptions the patient must be informed about the character of the pre-<br \/>\nscription.<br \/>\nMonitoring and assessing response to pharmacological treatment, progress toward thera-<br \/>\npeutic goals, and, as necessary, revising the therapeutic plan in collaboration with pharma-<br \/>\ncists, other health professionals and, when appropriate, caregivers.<br \/>\nProviding and sharing information in relation to pharmacological treatment with other<br \/>\nhealth care practitioners.<br \/>\nLeading the multi-disciplinary team of health professionals responsible for managing com-<br \/>\nplex pharmacological treatment.<br \/>\nMaintaining adequate records for each patient, according to the need for therapy and in<br \/>\ncompliance with legislation respecting confidentiality and protecting the patient\u2019s data.<br \/>\nWhere practically possible, actively participating in establishing electronic drug delivery<br \/>\nsystems within their workplace and supporting those systems with their professional<br \/>\nknowledge.<br \/>\nMaintaining a high level of knowledge of pharmacological treatment through continuing<br \/>\nprofessional development.<br \/>\nEnsuring safe procurement and storage of medicines that the physician is required to<br \/>\nsupply or permitted to dispense.<br \/>\nReviewing prescription orders to identify interactions, allergic reactions, contra-indica-<br \/>\ntions and therapeutic duplications.<br \/>\nReporting adverse reactions to medicines to health authorities, in accordance with national<br \/>\nlegislation.<br \/>\nMonitoring and limiting, where appropriate, prescriptions of medications that may have<br \/>\naddictive properties.<br \/>\nDocumenting adverse reactions to medicines in the patient\u2019s medical record.<br \/>\nTHE<br \/>\n \u00a0PHARMACIST&#8217;S<br \/>\n \u00a0RESPONSIBILITIES<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nEnsuring safe procurement, adequate storage and dispensing of medicines in compliance<br \/>\nwith the relevant regulations.<br \/>\nProviding information to patients, which may include the information leaflet, name of the<br \/>\nmedicine, its purpose, potential interactions and side effects, as well as correct usage and<br \/>\nstorage.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20101999-\u00ad\u201002-\u00ad\u20102010<br \/>\n \u00a0<br \/>\nReviewing prescription orders to identify interactions, allergic reactions, contra-indica-<br \/>\ntions and therapeutic duplications. Concerns should be discussed with the prescribing phy-<br \/>\nsician but the pharmacist should not change the prescription without consulting the<br \/>\nprescriber.<br \/>\nDiscussing medicine-related problems or concerns with regard to the prescribed medicines<br \/>\nwhen appropriate and when requested by the patient.<br \/>\nAdvising patients, when appropriate, on the selection and the use of non-prescription<br \/>\nmedicines and the patient&#8217;s management of minor symptoms or ailments. Where self-<br \/>\nmedication is not appropriate, advising patients to consult their physician for diagnosis<br \/>\nand treatment.<br \/>\nParticipating in multi-disciplinary teams concerning complex pharmacological treatment<br \/>\nin collaboration with physicians and other health care providers, typically in a hospital<br \/>\nsetting.<br \/>\nReporting adverse reactions to medicines to the prescribing physician and to health au-<br \/>\nthorities in accordance with national legislation.<br \/>\nProviding and sharing general as well as specific medicine-related information and advice<br \/>\nwith the public and health care practitioners.<br \/>\nMaintaining a high level of knowledge of pharmacological treatment through continuing<br \/>\nprofessional development.<br \/>\nCONCLUSION<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nThe patient will best be served when pharmacists and physicians collaborate, recognizing<br \/>\nand respecting each other&#8217;s roles, to ensure that medicines are used safely and appropriately<br \/>\nto achieve the best outcome for the patient\u2019s health.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102000-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nHUMAN<br \/>\n \u00a0ORGAN<br \/>\n \u00a0DONATION<br \/>\n \u00a0AND<br \/>\n \u00a0TRANSPLANTATION<br \/>\n \u00a0<br \/>\nAdopted by the 52nd<br \/>\nWMA General Assembly, Edinburgh, Scotland, October 2000<br \/>\nand revised by the 57th<br \/>\nWMA General Assembly, Pilanesberg, South Africa, October 2006<br \/>\nA.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0INTRODUCTION<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. Advances in medical sciences, especially surgical techniques, tissue typing and im-<br \/>\nmuno-suppressive drugs, have made possible a significant increase in the rates of suc-<br \/>\ncessful transplantation of organs. In the light of these developments, there is a need<br \/>\nfor renewed reflection on ethical issues concerning organ donation and transplan-<br \/>\ntation and on principles relevant to the resolution of these issues. Therefore, the<br \/>\nWorld Medical Association has undertaken a review of issues and principles con-<br \/>\ncerning transplantation and has developed this policy to provide guidance to medical<br \/>\nassociations, physicians and other health care providers as well as to those who de-<br \/>\nvelop policy and protocols bearing on these issues.<br \/>\n2. This policy is based on principles of general and medical ethics. In matters of ethics,<br \/>\nconflicts of values and principles are unavoidable; for example, there is a tension<br \/>\nbetween a desire to procure organs for the purpose of providing important medical<br \/>\ntreatments on the one hand and the preservation of choice and personal liberty on the<br \/>\nother. Applicable principles are referenced throughout this policy where they may<br \/>\nhelp to clarify and make explicit the reasoning behind a given statement.<br \/>\nB.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0PROFESSIONAL<br \/>\n \u00a0OBLIGATIONS<br \/>\n \u00a0OF<br \/>\n \u00a0PHYSICIANS<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. The primary obligation of physicians is to their individual patients, whether they are<br \/>\npotential donors or recipients of transplanted organs. In conjunction with this obliga-<br \/>\ntion physicians may also have responsibilities to the family members and close<br \/>\nfriends of their patients, for example, to seek and consider their views on organ re-<br \/>\ntrieval from their deceased relative or friend. The obligation to the patient has primacy<br \/>\nover any obligations that may exist in relationship to family members. Nevertheless,<br \/>\nthis obligation is not absolute; for example, the physician&#8217;s responsibility for the well-<br \/>\nbeing of a patient who needs a transplant does not justify unethical or illegal procure-<br \/>\nment of organs.<br \/>\n2. Physicians have responsibilities to society, which include promoting the fair use of<br \/>\nresources, preventing harm and promoting health benefit for all; this may include pro-<br \/>\nmoting donation of organs.<br \/>\n3. Transplant surgeons should attempt to ensure that the organs they transplant have<br \/>\nbeen obtained in accordance with the provisions of this policy and shall refrain from<br \/>\ntransplanting organs that they know or suspect have not been procured in a legal and<br \/>\nethical manner.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0Pilanesberg<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20102000-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nOrgan<br \/>\n \u00a0Donation<br \/>\n \u00a0and<br \/>\n \u00a0Transplantation<br \/>\n \u00a0<br \/>\nC.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0ORGAN<br \/>\n \u00a0PROCUREMENT:<br \/>\n \u00a0SOCIAL<br \/>\n \u00a0ASPECTS<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. The WMA encourages its members to support the development of comprehensive,<br \/>\ncoordinated national strategies concerning organ procurement in consultation and<br \/>\ncooperation with all relevant stakeholders. In developing strategy, due consideration<br \/>\nshould be given to human rights, ethical principles and medical ethics. Ethical, cul-<br \/>\ntural and societal issues arising in connection with such a strategy, and with the sub-<br \/>\nject of donation and transplantation in general, should be resolved, wherever possible,<br \/>\nin an open process involving public dialogue and debate informed by sound evidence.<br \/>\n2. Some types of organ transplantation have become established and important health<br \/>\ncare services. To the extent that the lack of organs is a barrier to the provision of<br \/>\nneeded treatment, the medical profession has an obligation to promote policies and<br \/>\nprotocols to procure organs for needed treatment consistent with societal values.<br \/>\n3. It is important that individuals become aware of the option of donation and have the<br \/>\nopportunity to choose whether or not to donate (e.g. facilitated choice). Awareness<br \/>\nand choice should be facilitated in a coordinated multi-faceted approach by a variety<br \/>\nof stakeholders and means, including media awareness and public campaigns. Physi-<br \/>\ncians should provide their patients with the opportunity to make a choice with respect<br \/>\nto organ donation, ideally in the context of an ongoing relationship with the patient<br \/>\nand in advance of any crisis giving urgency to the choice.<br \/>\n4. The WMA supports informed donor choice. National Medical Associations in countries<br \/>\nthat have adopted or are considering a policy of \u00abpresumed consent\u00bb, where-by there<br \/>\nis a presumption that consent has been given unless there is evidence to the contrary,<br \/>\nor \u00abmandated choice\u00bb, whereby all persons would be required to declare whether they<br \/>\nwish to donate, should make every effort to ensure that these policies do not diminish<br \/>\ninformed donor choice, including the patient&#8217;s right to refuse to donate.<br \/>\n5. Consideration should be given to the establishment of national donor registries to<br \/>\ncollect and maintain a list of country citizens who have chosen either to donate or not<br \/>\nto donate their organs. Any such registry must protect individual privacy and the in-<br \/>\ndividual&#8217;s ability to control the collection, use, disclosure of and access to his or her<br \/>\nhealth information for purposes other than registration. Provisions must be in place to<br \/>\nensure that the decision is adequately informed and that registrants can withdraw from<br \/>\nthe registry without penalty.<br \/>\nD.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0ORGAN<br \/>\n \u00a0PROCUREMENT<br \/>\n \u00a0AT<br \/>\n \u00a0THE<br \/>\n \u00a0INSTITUTIONAL<br \/>\n \u00a0AND<br \/>\n \u00a0INDIVIDUAL<br \/>\n \u00a0LEVELS<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. Organ donation can be enhanced by local policies and protocols. The WMA recom-<br \/>\nmends that organ procurement programmes, hospitals and other institutions in which<br \/>\nprocurement occurs should:<br \/>\na. Develop policies and protocols encouraging the procurement of organs consistent<br \/>\nwith the statements in this policy. Such policies should be consistent with physi-<br \/>\ncians&#8217; professional obligations and societal values, including free and informed<br \/>\ndecision making, privacy, and equitable access to needed medical care.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102000-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nb. Make these policies and protocols known to transplant coordinators, physicians<br \/>\nand other health care providers in the institution.<br \/>\nc. Ensure that adequate resources are available to support proper implementation of<br \/>\nthe policies and protocols.<br \/>\nE.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0DONATION<br \/>\n \u00a0AFTER<br \/>\n \u00a0DEATH<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. Physicians have an obligation to ensure that interactions at the bedside, including<br \/>\nthose discussions related to organ donation, are sensitive and consistent with ethical<br \/>\nprinciples and with their fiduciary obligations to their patients. This is particularly so<br \/>\ngiven that conditions at the bedside of dying patients are not ideal for the process of<br \/>\nfree and informed decision making. Protocols should specify that whoever approaches<br \/>\nthe patient, family members or other designated decision maker about the donation of<br \/>\norgans should possess the appropriate combination of knowledge, skill and sensitivity<br \/>\nfor engaging in such discussions. Medical students and practising physicians should<br \/>\nseek the necessary training for this task, and the appropriate authorities should<br \/>\nprovide the resources necessary to secure that training. It is mandatory that the person<br \/>\nwho approaches the patient or family about the donation decision not be a member of<br \/>\nthe transplant team.<br \/>\nF.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0FREE<br \/>\n \u00a0AND<br \/>\n \u00a0INFORMED<br \/>\n \u00a0DECISION<br \/>\n \u00a0MAKING<br \/>\n \u00a0ABOUT<br \/>\n \u00a0ORGAN<br \/>\n \u00a0DONATION<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. The WMA considers that the potential donor&#8217;s wishes are paramount. In the event that<br \/>\nthe potential donor&#8217;s wishes about donation are unknown and the potential donor has<br \/>\ndied without expressing a clear wish about donation, the family or a specified other<br \/>\nperson may serve as a substitute decision-maker and may be entitled to give or refuse<br \/>\npermission for donation unless there are previously expressed wishes to the contrary.<br \/>\n2. Evidence of the free and informed decision of the potential donor, or, where legally<br \/>\nrelevant, of the appropriate substitute decision-maker, must be ascertained before<br \/>\norgan procurement can begin. In countries where presumed consent is the legal norm,<br \/>\nthe organ procurement process should include reasonable steps to discover whether<br \/>\nthe potential donor has opted out of donation.<br \/>\n3. Success in procuring organs for transplant should not be construed as a criterion for<br \/>\nmeasuring the quality of the process of free and informed decision-making. The<br \/>\nquality of this process depends on whether the choice was adequately informed and<br \/>\nfree of coercion and not on whether the outcome is a decision to donate.<br \/>\n4. Free and informed decision making is a process requiring the exchange and<br \/>\nunderstanding of information and the absence of coercion. Because prisoners and<br \/>\nother individuals in custody are not in a position to give consent freely and can be<br \/>\nsubject to coercion, their organs must not be used for transplantation except for<br \/>\nmembers of their immediate family.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0Pilanesberg<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20102000-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nOrgan<br \/>\n \u00a0Donation<br \/>\n \u00a0and<br \/>\n \u00a0Transplantation<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n5. In order for the choice to donate organs to be duly informed, prospective donors or<br \/>\ntheir substitute decision makers should, if they desire, be provided with meaningful<br \/>\nand relevant information. Normally, this will include information about:<br \/>\na. in the case of living donors, the benefits and risks of transplantation,<br \/>\nb. in the case of deceased donors, procedures and definitions involved in the deter-<br \/>\nmination of death,<br \/>\nc. testing of organs to determine their suitability for transplantation, which may re-<br \/>\nveal unsuspected health risks in the prospective donors and their families,<br \/>\nd. in the case of deceased donors measures that may be required to preserve organ<br \/>\nfunction until death is determined and transplantation can occur,<br \/>\ne. in the case of deceased donors what will happen to the body once death has been<br \/>\ndeclared,<br \/>\nf. what organs they are agreeing to donate,<br \/>\ng. the protocol that will be followed concerning the family in the event that the fa-<br \/>\nmily objects to donation, and<br \/>\nh. in the case of living donors, the implications of living without the donated organ.<br \/>\n6. Prospective donors should be informed that families sometimes object to donation;<br \/>\ndonors should be encouraged to discuss their choice with their family to prevent con-<br \/>\nflict.<br \/>\n7. Prospective donors or their substitute decision makers should be given the opportunity<br \/>\nto ask questions about donation and should have their questions answered sensitively<br \/>\nand intelligibly.<br \/>\n8. Where the wishes of the patient are known and there is no reason to believe that the<br \/>\nchoice to donate has been coerced, has not been adequately informed, or has changed,<br \/>\nthese wishes should be carried out. This should be clarified in law, policy and proto-<br \/>\ncols. Under these circumstances, families should be encouraged to respect the pa-<br \/>\ntient&#8217;s clearly expressed wishes.<br \/>\n9. Where the wishes of the patient are unknown or there is uncertainty about the patient&#8217;s<br \/>\nwishes, national law should prevail.<br \/>\n10. Protocols for free and informed decision making should also be followed in the case<br \/>\nof recipients of organs. Normally, this should include information about:<br \/>\na. the risks of the procedure,<br \/>\nb. the likely short, medium and long-term survival, morbidity, and quality-of-life<br \/>\nprospects,<br \/>\nc. alternatives to transplantation, and<br \/>\nd. how organs are obtained.<br \/>\n11. In the case of living donors, special efforts should be made to ensure that the choice<br \/>\nabout donation is free of coercion. Financial incentives for providing or obtaining or-<br \/>\ngans for transplantation can be coercive and should be prohibited. Individuals who are<br \/>\nincapable of making informed decisions, for example minors or mentally incompe-<br \/>\ntent persons, should not be considered as potential living donors except in extraordi-<br \/>\nnary circumstances and in accordance with ethics committee review or established<br \/>\nprotocols. In order to avoid a conflict of interest, the physician who obtains informed<br \/>\nconsent from the living donor should not be part of the transplant team for the re-<br \/>\ncipient.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102000-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n \u00a0<br \/>\nG.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0DETERMINATION<br \/>\n \u00a0OF<br \/>\n \u00a0DEATH<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. The WMA considers that the determination of death is a clinical matter that should be<br \/>\nmade according to widely accepted guidelines established by expert medical groups,<br \/>\nand as outlined in The World Medical Association&#8217;s Declaration of Sydney on the De-<br \/>\ntermination of Death and the Recovery of Organs.<br \/>\n2. Protocols and procedures should be developed to educate patients and families about<br \/>\nprocedures for diagnosing death and the opportunities for donation after death.<br \/>\n3. In order to avoid a conflict of interest, the physician who determines and\/or certifies<br \/>\nthe death of a potential organ donor should not be involved in the organ removal or in<br \/>\nsubsequent transplantation procedures or responsible for the care of potential reci-<br \/>\npients of these organs.<br \/>\nH.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0JUSTICE<br \/>\n \u00a0IN<br \/>\n \u00a0ACCESS<br \/>\n \u00a0TO<br \/>\n \u00a0ORGANS<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. The WMA considers there should be explicit policies open to public scrutiny go-<br \/>\nverning all aspects of organ donation and transplantation, including the manage-ment<br \/>\nof waiting lists for organs to ensure fair and appropriate access.<br \/>\n2. Policies governing the management of waiting lists should ensure efficiency and fair-<br \/>\nness. Criteria that should be considered in allocating organs include severity of me-<br \/>\ndical need, length of time on the waiting list, and medical probability of success<br \/>\nmeasured by such factors as type of disease, other complications, and histocompati-<br \/>\nbility. There should be no discrimination based on social status, lifestyle or behaviour.<br \/>\n3. Special appeals for organs for a specific recipient require further study and ethical<br \/>\nexamination to evaluate the potential impact on the fairness of allocation.<br \/>\n4. Payment for organs for donation and transplantation must be prohibited. A financial<br \/>\nincentive compromises the voluntariness of the choice and the altruistic basis for or-<br \/>\ngan donation. Furthermore, access to needed medical treatment based on ability to pay<br \/>\nis inconsistent with the principles of justice. Organs suspected to have been obtained<br \/>\nthrough commercial transaction must not be accepted for transplantation. In addition,<br \/>\nthe advertisement of organs in exchange for money should be prohibited. However,<br \/>\nreasonable reimbursement of expenses such as those incurred in procurement, trans-<br \/>\nport, processing, preservation, and implantation is permissible.<br \/>\n5. Physicians who are asked to transplant an organ that has been obtained through a<br \/>\ncommercial transaction should refuse to do so and should explain to the patient why<br \/>\nsuch a medical act would be unethical: because the person who provided the organ<br \/>\nrisked his or her future health for financial rather than altruistic motives, and because<br \/>\nsuch transactions are contrary to the principle of justice in the allocation of organs for<br \/>\ntransplantation.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0Pilanesberg<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20102000-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nOrgan<br \/>\n \u00a0Donation<br \/>\n \u00a0and<br \/>\n \u00a0Transplantation<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nI.<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n \u00a0EXPERIMENTAL<br \/>\n \u00a0AND<br \/>\n \u00a0NEWLY<br \/>\n \u00a0DEVELOPING<br \/>\n \u00a0TRANSPLANTATION<br \/>\n \u00a0PROCEDURES<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. The WMA considers that, although many transplantation procedures have become<br \/>\nstandard medical care for a range of medical conditions, others are experimental and\/<br \/>\nor morally controversial and require further research, safeguards, guidelines, and pu-<br \/>\nblic debate.<br \/>\n2. Experimental procedures require protocols, including ethics review, that are different<br \/>\nand more rigorous than those for standard medical procedures.<br \/>\n3. Xenotransplantation raises special issues, particularly in light of the risk of unwitting<br \/>\ncross-species transmission of viruses and other pathogens. There is an urgent need for<br \/>\nextensive public debate about xenotransplantation to ensure that developments in this<br \/>\nfield are consistent with societal values. International guidelines to govern these prac-<br \/>\ntices should be developed.<br \/>\n4. Transplantation of organs developed using cell nuclear replacement technologies re-<br \/>\nquires scientific review, public debate and appropriate guidelines before becoming ac-<br \/>\ncepted.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102002-\u00ad\u201001-\u00ad\u20102012<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nSAFE<br \/>\n \u00a0INJECTIONS<br \/>\n \u00a0IN<br \/>\n \u00a0HEALTH<br \/>\n \u00a0CARE<br \/>\n \u00a0<br \/>\nAdopted by the 53rd<br \/>\nWMA General Assembly, Washington, DC, USA, October 2002<br \/>\nand amended with minor resivion by the 192nd<br \/>\nWMA Council Session,<br \/>\nBangkok, Thailand, October 2012<br \/>\nPREAMBLE<br \/>\n \u00a0<br \/>\nAccording to the World Health Organization, billions of injections are administered world-<br \/>\nwide each year in health care. Of these injections, many millions are unsafe, especially<br \/>\nthose that are administered with a re-used syringe and\/or needle.<br \/>\nThe most common diseases acquired from unsafe injections are hepatitis B, hepatitis C<br \/>\nand HIV.<br \/>\nIn many countries disposable equipment is always used in health care settings, and the<br \/>\nmajor problem is the safe use and disposal of sharps.<br \/>\nPhysicians are involved in the prescription and\/or administration of injections. Therefore,<br \/>\nthey are in a prime position to bring about changes in behaviour, which could lead to the<br \/>\nappropriate and safe use of injections.<br \/>\nSafe and appropriate use of injections is a necessary component of HIV prevention. Safe<br \/>\npractices to prevent HIV infection also yield substantial spin-off benefits outside the HIV<br \/>\nprevention area, such as hepatitis B and C infections.<br \/>\nBASIC<br \/>\n \u00a0CONSIDERATIONS<br \/>\n \u00a0<br \/>\nUnsafe injections result from the overuse of therapeutic injections and unsafe injection<br \/>\npractices. These practices include the use of unsterilized or inadequately sterilized needles,<br \/>\nthe re-use of syringes and the inappropriate and unsafe disposal of syringes and needles.<br \/>\nSafe injection practices prevent harm to the recipient, the provider and the community.<br \/>\nUnsafe injections cause widespread harm by spreading pathogens on a large scale.<br \/>\nPhysician attitudes and inappropriate practice standards may be important determinants in<br \/>\nthe overuse of \u00abtherapeutic\u00bb injections in certain countries. These are a result of the as-<br \/>\nsumption that some patients only feel satisfied with a treatment if it includes an injection.<br \/>\nScientific evidence has shown that this assumption is incorrect. Patients prefer good<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0Bangkok<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20102002-\u00ad\u201001-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nSafe<br \/>\n \u00a0Injections<br \/>\n \u00a0in<br \/>\n \u00a0Health<br \/>\n \u00a0Care<br \/>\n \u00a0<br \/>\ncommunication with physicians to receiving injections. Furthermore, the payment schemes<br \/>\nin some health care systems may be structured in a way that they provide perverse in-<br \/>\ncentives for unnecessary use of injections.<br \/>\nMost non-injectable medications are equivalent in action and efficacy to those which are<br \/>\ninjectable.<br \/>\nUnsafe injections are a waste of precious healthcare resources and can easily be prevented<br \/>\nthrough integrated interventions. For an effective national, regional or local strategy to<br \/>\npromote safe injections, the following primary elements are necessary:<br \/>\n\u2022 The use of injections should be limited to suitably trained health care professionals<br \/>\nand trained lay persons;<br \/>\n\u2022 Behaviour change among patients and health care professionals to decrease injec-<br \/>\ntion overuse and achieve injection safety;<br \/>\n\u2022 The availability of necessary equipment and supplies, preferably disposable;<br \/>\n\u2022 The use of auto-disable syringes where appropriate;<br \/>\n\u2022 The appropriate management of sharps waste.<br \/>\nIncreased availability of appropriate injection equipment and supplies, preferably dis-<br \/>\nposable, increases the safety of injections without necessarily increasing the number of<br \/>\nunnecessary injections.<br \/>\nRECOMMENDATIONS<br \/>\n \u00a0<br \/>\nThat National Medical Associations cooperate with their national governments or other<br \/>\nappropriate authorities to develop effective policies on the safe and appropriate use of<br \/>\ninjections. These policies would demand appropriate financing and include the assessment<br \/>\nof current injection practices and the development of an integrated plan. Such a plan<br \/>\nshould support the provision of adequate supplies of injection equipment, measures to<br \/>\nenforce proper standards of sterilisation where needed, the management of sharps waste<br \/>\nand training programs to deter the overuse of injections and promote safe injection prac-<br \/>\ntices.<br \/>\nThat physicians worldwide are urged to:<br \/>\n\u2022 Prescribe non-injectable medication rather than injectable medication whenever<br \/>\npossible and promote the use of non-injectable medication with patients and their<br \/>\ncolleagues;<br \/>\n\u2022 Use injectable medications only if safe and appropriate and administer injections in<br \/>\na way that does not harm the recipient, the provider and the community;<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20102002-\u00ad\u201001-\u00ad\u20102012<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Bangkok<br \/>\n \u00a0<br \/>\nSafe<br \/>\n \u00a0Injections<br \/>\n \u00a0in<br \/>\n \u00a0Health<br \/>\n \u00a0Care<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n \u00a0<br \/>\n\u2022 Ensure that only waste disposal containers for sharp objects be used to safely dis-<br \/>\npose of used surgical material (e.g. needles, blades, etc.), and that the covers of<br \/>\nsharp instruments not be re-utilised.<br \/>\n\u2022 Raise awareness regarding the risks involved with unsafe injections and help bring<br \/>\nabout behaviour changes in patients and health professionals to promote safe and<br \/>\nappropriate injections. Training in this area should emphasise that needles should<br \/>\nnot be re-sheathed.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20102002-\u00ad\u201002-\u00ad\u20102012<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nSELF-\u00ad\u2010MEDICATION<br \/>\n \u00a0<br \/>\nAdopted by the 53rd<br \/>\nWMA General Assembly, Washington, DC, USA, October 2002<br \/>\nand reaffirmed by the 191st<br \/>\nWMA Council Session, Prague, Czech Republic, April 2012<br \/>\nPREAMBLE<br \/>\n \u00a0<br \/>\nThe World Medical Association has developed this statement to provide guidance to phy-<br \/>\nsicians and their patients regarding responsible self-medication.<br \/>\n1. Distinction between Self-Medication and Prescription Medicine<br \/>\n1. Medicinal products can generally be divided into two separate categories: pre-<br \/>\nscription and non-prescription medicines. This classification may differ from<br \/>\ncountry to country. The national authorities must assure that medicines, cate-<br \/>\ngorized as non-prescription medicines, are sufficiently safe not to be harmful<br \/>\nto health.<br \/>\n2. Prescription medicines are those which are only available to individuals on<br \/>\nprescription from a physician following a consultation. Prescription medicines<br \/>\nare not safe for use except under the supervision of a physician because of<br \/>\ntoxicity, other potential or harmful effects (e.g. addictiveness), the method of<br \/>\nuse, or the collateral measures necessary for use.<br \/>\n3. Responsible self-medication, as used in this document, is the use of a re-<br \/>\ngistered or monographed medicine legally available without a physician&#8217;s pre-<br \/>\nscription, either on an individual&#8217;s own initiative or following advice of a<br \/>\nhealthcare professional. The use of prescription medicines without a prior me-<br \/>\ndical prescription is not part of responsible self-medication.<br \/>\n4. The safety, efficacy and quality of non-prescription medicines must be proved<br \/>\naccording to the same principles as prescription medicines.<br \/>\n2. Use of Self-Medication in conjunction with Prescription Medication A course of<br \/>\ntreatment may combine self-medication and prescription medication, either con-<br \/>\ncurrently or sequentially. The patient must be informed about possible interactions<br \/>\nbetween prescription medicines and non-prescription medicines. For this reason<br \/>\nthe patient should be encouraged to inform the physician about his \/ her self-<br \/>\nmedication.<br \/>\n3. Roles &#038; Responsibilities in Self-Medication<br \/>\n1. In self-medication the individual bears primary responsibility for the use of<br \/>\nself-medication products. Special caution must be exercised when vulnerable<br \/>\ngroups such as children, elderly people or pregnant women use self-medication.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20102002-\u00ad\u201002-\u00ad\u20102012<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Prague<br \/>\n \u00a0<br \/>\nSelf-\u00ad\u2010Medication<br \/>\n \u00a0<br \/>\n2. If individuals choose to use self-medication, they should be able:<br \/>\n1. to recognize the symptoms they are treating;<br \/>\n2. to determine that their condition is suitable for self-medication;<br \/>\n3. to choose an appropriate self-medication product;<br \/>\n4. to follow the directions for use of the product as provided in the product<br \/>\nlabelling.<br \/>\n3.<br \/>\n3. In order to limit the potential risks involved in self-medication it is important<br \/>\nthat all health professionals who look after patients should provide:<br \/>\n1. Education regarding the non-prescription medicine and its appropriate use,<br \/>\nand instructions to seek further advice from a physician if they are unsure.<br \/>\nThis is particularly important where self-medication is inappropriate for<br \/>\ncertain conditions the patient may suffer from;<br \/>\n2. Encouragement to read carefully a product&#8217;s label and leaflet (if provided),<br \/>\nto seek further advice if necessary, and to recognize circumstances in which<br \/>\nself-medication is not, or is no longer, appropriate.<br \/>\n4. All parties involved in self-medication should be aware of the benefits and<br \/>\nrisks of any self-medication product. The benefit-risk balance should be com-<br \/>\nmunicated in a fair, rational manner without overemphasizing either the risks<br \/>\nor the benefits.<br \/>\n5. Manufacturers in particular are obliged to follow the various codes or regula-<br \/>\ntions already in place to ensure that information provided to consumers is<br \/>\nappropriate in style and content. This refers in particular to the labelling, ad-<br \/>\nvertising and all notices concerning non-prescription medicines.<br \/>\n6. The pharmacist has a professional responsibility to recommend, in appropriate<br \/>\ncircumstances, that medical advice be sought.<br \/>\n4. Role of Governments in Self-Medication Governments should recognize and en-<br \/>\nforce the distinction between prescription and non-prescription medicines, and<br \/>\nensure that the users of self-medication are well informed and protected from<br \/>\npossible harm or negative long-term effects.<br \/>\n5. The Promotion and Marketing of Self-Medication Products<br \/>\n1. Advertising and marketing of non-prescription medicines should be responsi-<br \/>\nble, provide clear and accurate information and exhibit a fair balance between<br \/>\nbenefit and risk information. Promotion and marketing should not encourage<br \/>\nirresponsible self-medication, purchase of medicines that are inappropriate, or<br \/>\npurchases of larger quantities of medicines than are necessary.<br \/>\n2. People must be encouraged to treat medicines (prescription and non-prescrip-<br \/>\ntion) as special products and that standard precautions should be followed in<br \/>\nterms of safe storage and usage, in accordance with professional advice.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20102003-\u00ad\u201001-\u00ad\u20102013<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nFORENSIC<br \/>\n \u00a0INVESTIGATIONS<br \/>\n \u00a0OF<br \/>\n \u00a0THE<br \/>\n \u00a0MISSING<br \/>\n \u00a0<br \/>\nAdopted by the 54th<br \/>\nWMA General Assembly, Helsinki, Finland, September 2003<br \/>\nand amended by the 64th<br \/>\nWMA General Assembly, Fortaleza, Brazil, October 2013<br \/>\nPREAMBLE<br \/>\n \u00a0<br \/>\nOver the last three decades, forensic investigations into the whereabouts and fate of people<br \/>\nkilled and missing as a result of armed conflict, other situations of violence and catas-<br \/>\ntrophes, have made an important contribution to humanitarian action on behalf of victims,<br \/>\nincluding [the deceased and] bereaved families. Forensic investigations have also helped<br \/>\nin achieving justice and reparations for victims.<br \/>\nIn 2003 the International Conference on The Missing and their Families, organized by the<br \/>\nInternational Committee of the Red Cross (ICRC), adopted a set of recommendations to<br \/>\nhelp prevent people going missing, and resolve the cases of those already missing, as a<br \/>\nresult of armed conflicts and other situations of violence. The recommendations include<br \/>\nethical, scientific and legal principles that must apply to forensic investigations in the<br \/>\nsearch, recovery, management and identification of human remains. These principles have<br \/>\nsince been further developed by the ICRC&#8217;s forensic services and they provide a frame-<br \/>\nwork for humanitarian forensic action in situations of armed conflicts, other situations of<br \/>\nviolence and catastrophes.1<br \/>\nThe principles also ensure the proper and dignified manage-<br \/>\nment and identification of the dead, and help provide answers to the bereaved.<br \/>\nNational Medical Associations have a role in promoting these principles and encouraging<br \/>\ncompliance with them, and for ensuring the highest possible ethical, scientific and legal<br \/>\nstandards in forensic investigations aimed at addressing the humanitarian consequences of<br \/>\narmed conflicts, other situations of violence and catastrophes.<br \/>\nIn many countries NMAs will not have a role in certifying the qualifications and experi-<br \/>\nence of forensic medical practitioners. NMAs should draw the attention of practitioners to<br \/>\nthe best practice guidelines produced by the ICRC, the United Nations and Interpol, and<br \/>\nrecommend or, where possible, require compliance with those standards.<br \/>\nRECOMMENDATIONS<br \/>\n \u00a0<br \/>\nThe WMA calls upon all NMAs to help ensure that, when its members take part in<br \/>\nforensic investigations for humanitarian and human rights purposes, such investigations<br \/>\nare established with a clear mandate based upon the highest ethical, scientific and legal<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20102003-\u00ad\u201001-\u00ad\u20102013<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Fortaleza<br \/>\n \u00a0<br \/>\nForensic<br \/>\n \u00a0Investigations<br \/>\n \u00a0of<br \/>\n \u00a0the<br \/>\n \u00a0Missing<br \/>\n \u00a0<br \/>\nstandards, and conform with the principles and practice of humanitarian forensic action<br \/>\ndeveloped by the ICRC.<br \/>\nThe WMA calls upon NMAs to develop expertise in the principles collated by the dif-<br \/>\nferent authorities on forensic investigations for humanitarian and human rights purposes,<br \/>\nincluding those developed by the ICRC to prevent new cases and resolve those of existing<br \/>\nmissing persons, and to assist their members in applying these principles to forensic<br \/>\ninvestigations worldwide.<br \/>\nThe WMA calls upon NMAs to disseminate the principles that should apply to such<br \/>\ninvestigations, including those developed by the ICRC, and to attempt to ensure that phy-<br \/>\nsicians refuse to take part in investigations that are ethically or otherwise unacceptable.<br \/>\nThe WMA calls upon NMAs to help ensure compliance by forensic medical practitioners<br \/>\nwith the principles enshrined in international humanitarian law for the dignified and<br \/>\nproper management, documentation and identification of the dead, and, where possible,<br \/>\nproviding answers to the bereaved.<br \/>\nThe WMA invites NMAs to be mindful of academic qualifications and ethical under-<br \/>\nstanding, ensuring that forensic doctors practice with competence and independence.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\n1<br \/>\nThe ICRC defines catastrophes as disasters beyond expectations. See: M. Tidball-Binz, Man-<br \/>\naging the dead in catastrophes: guiding principles and practical recommendations for first<br \/>\nresponders. International review of the Red Cross, Vol 89 Number 866 June 2007; 421- 442<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20102003-\u00ad\u201002-\u00ad\u20102013<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nADVANCE<br \/>\n \u00a0DIRECTIVES<br \/>\n \u00a0(\u00abLIVING<br \/>\n \u00a0WILLS\u00bb)<br \/>\n \u00a0<br \/>\nAdopted by the 54th<br \/>\nWMA General Assembly, Helsinki, Finland, September 2003<br \/>\nand reaffirmed by the 194th<br \/>\nWMA Council Session, Bali, Indonesia, April 2013<br \/>\nA.<br \/>\n \u00a0<br \/>\n \u00a0PREAMBLE<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. An advance directive is a written and signed document or a witnessed verbal<br \/>\nstatement whereby persons record their wishes regarding the medical care they<br \/>\nwish to receive, or not receive, if they become unconscious or otherwise unable to<br \/>\nexpress their will.<br \/>\n2. This type of document may have different names in different countries (e.g.,<br \/>\n\u00abliving will\u00bb or \u00abbiological wills\u00bb). The acceptability and legal status of such<br \/>\ndirectives may differ from one country to another, depending on social, cultural<br \/>\nand religious and other factors.<br \/>\n3. The majority of persons who draw up such directives are particularly concerned<br \/>\nabout excessive, ineffective or prolonged therapeutic interventions in the terminal<br \/>\nphases of life, in situations where there is clear and irreversible physical or mental<br \/>\ndegeneration.<br \/>\n4. The WMA Declaration of Lisbon on the Rights of the Patient states that \u00abIf the<br \/>\npatient is unconscious and if a legally entitled representative is not available but a<br \/>\nmedical intervention is urgently needed, consent of the patient may be presumed<br \/>\nunless it is obvious and beyond any doubt on the basis of the patient&#8217;s previous<br \/>\nfirm expression or conviction that he\/she would refuse consent to the intervention<br \/>\nin that situation.\u00bb<br \/>\nB.<br \/>\n \u00a0<br \/>\n \u00a0RECOMMENDATIONS<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. A patient&#8217;s duly executed advance directive should be honoured unless there are<br \/>\nreasonable grounds to suppose that it is not valid because it no longer represents<br \/>\nthe wishes of the patient or that the patient&#8217;s understanding was incomplete at the<br \/>\ntime the directive was prepared. If the advance directive is contrary to the physi-<br \/>\ncian&#8217;s convictions, provisions should be made to transfer the care of the patient to<br \/>\nanother consenting physician.<br \/>\n2. If the physician is uncertain about the validity of an advance directive to terminate<br \/>\nlife-prolonging treatment, he\/she should consult family members or legal guardians<br \/>\nof the patient concerned and should seek advice from at least one other physician<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20102003-\u00ad\u201002-\u00ad\u20102013<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Bali<br \/>\n \u00a0<br \/>\nLiving<br \/>\n \u00a0Wills<br \/>\n \u00a0<br \/>\nor the relevant ethics committee. The family members or legal guardians should be<br \/>\ndesignated in the advance directive, be trustworthy and willing to testify as to the<br \/>\nintention(s) expressed in the advance directive by the signatory. The physician<br \/>\nshould consider any relevant legislation concerning substitute decision making for<br \/>\nincompetent patients.<br \/>\n3. Patients should be advised to review their advance directives periodically.<br \/>\n4. In the absence of an advance directive or a legally designated substitute decision<br \/>\nmaker, physicians should render such treatment as they believe to be in the pa-<br \/>\ntient&#8217;s best interests.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20102003-\u00ad\u201003-\u00ad\u20102014<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nETHICAL<br \/>\n \u00a0GUIDELINES<br \/>\n \u00a0FOR<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nTHE<br \/>\n \u00a0INTERNATIONAL<br \/>\n \u00a0MIGRATION<br \/>\n \u00a0OF<br \/>\n \u00a0HEALTH<br \/>\n \u00a0WORKERS<br \/>\n \u00a0<br \/>\nAdopted by the 54th<br \/>\nWMA General Assembly, Helsinki, Finland, September 2003<br \/>\nand revised by the 65th<br \/>\nWMA General Assembly, Durban, South Africa, October 2014<br \/>\nPREAMBLE<br \/>\n \u00a0<br \/>\nThe WMA acknowledges that temporary stays of physicians in other countries help both<br \/>\nthe receiving and the sending countries to exchange medical knowledge, skills and atti-<br \/>\ntudes. The exchange of medical professionals is therefore beneficial for the development<br \/>\nof medicine and healthcare systems and in general deserves the support of national medi-<br \/>\ncal associations as well as governments.<br \/>\nThe WMA Statement on Medical Manpower &#8211; 1 (1983, 1986) called upon all National<br \/>\nMedical Associations to work with their governments towards solutions to the emerging<br \/>\nproblems related to the medical workforce.<br \/>\nThe WMA Resolution on the Medical Workforce (1998) identified the major components<br \/>\nof the medical workforce situation that need to be taken into account when developing a<br \/>\nnational workforce policy.<br \/>\nFor several decades many governments, employers and medical associations have mis-<br \/>\ninterpreted demographical data regarding the number of physicians that are required.<br \/>\nYoung people seeing employment as physicians have often been seriously affected by<br \/>\npoor medical workforce planning.<br \/>\nIn many countries, including the wealthiest ones, there is a shortage of physicians. A<br \/>\nmajor reason for the shortage is a failure to educate enough physicians to meet the needs<br \/>\nof the country. Other reasons for the net loss of physicians are the recruitment of physi-<br \/>\ncians to other professions, early retirement and emigration, and the problems of combining<br \/>\nprofessional and family responsibilities, all of which are often due to poor working con-<br \/>\nditions for physicians.<br \/>\nSome countries have traditionally solved their need for physicians by recruiting medical<br \/>\ngraduates from other countries. This practice continues today.<br \/>\nThe flow of international migration of physicians is generally from poorer to wealthier<br \/>\ncountries. The poorer countries bear the expense of educating the migrating physicians<br \/>\nand receive no recompense when they enter other countries. The receiving countries gain a<br \/>\nvaluable resource without paying for it, and in the process they save the cost of educating<br \/>\ntheir own physicians.<br \/>\nPhysicians do have valid reasons for migrating, for example, to seek better career oppor-<br \/>\ntunities and to escape poor working and living conditions, which may include the pursuit<br \/>\nof more political and personal freedoms and other benefits.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20102003-\u00ad\u201003-\u00ad\u20102014<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Durban<br \/>\n \u00a0<br \/>\nInternational<br \/>\n \u00a0Migration<br \/>\n \u00a0of<br \/>\n \u00a0Health<br \/>\n \u00a0Workers<br \/>\n \u00a0<br \/>\nRECOMMENDATIONS<br \/>\n \u00a0<br \/>\n1.<br \/>\n1. National medical associations, governments and employers should exercise utmost<br \/>\ncare in utilizing demographic data to make projections about future requirements<br \/>\nfor physicians and in communicating these projections to young people contem-<br \/>\nplating a medical career.<br \/>\n2. Every country should do its utmost to educate an adequate number of physicians,<br \/>\ntaking into account its needs and resources. A country should not rely on immi-<br \/>\ngration from other countries to meet its need for physicians.<br \/>\n3. Every country should do its utmost to retain its physicians in the profession as well<br \/>\nas in the country by providing them with the support they need to meet their<br \/>\npersonal and professional goals, taking into account the country&#8217;s needs and re-<br \/>\nsources.<br \/>\n4. Countries that wish to recruit physicians from another country should only do so in<br \/>\nterms of and in accordance with the provisions of a Memorandum of Under-<br \/>\nstanding entered into between the countries.<br \/>\n5. Physicians should not be prevented from leaving their home or adopted country to<br \/>\npursue career opportunities in another country.<br \/>\n6. Countries that recruit physicians from other countries should ensure that recruiters<br \/>\nprovide full and accurate information to potential recruits on the nature and re-<br \/>\nquirements of the position to be filled, on immigration, administrative and con-<br \/>\ntractual requirements, and on the legal and regulatory conditions for the practice of<br \/>\nmedicine in the recruiting country, including language skills.<br \/>\n7. Physicians who are working, either permanently or temporarily, in a country other<br \/>\nthan their home country should be treated fairly in relation to other physicians in<br \/>\nthat country (for example, equal opportunity career options and equal payment for<br \/>\nthe same work).<br \/>\n8. Nothing should prevent countries from entering into bilateral agreements and<br \/>\nagreements of understanding, as provided for in international law and with due<br \/>\ncognizance of international human rights law, so as to effect meaningful co-<br \/>\noperation on health care delivery, including the exchange of physicians.<br \/>\n9. The WHO Global Code of Practice on the International Recruitment of Health<br \/>\nPersonnel (May 2010) was established to promote voluntary principles and prac-<br \/>\ntices for the ethical international recruitment of health professionals and to facilitate<br \/>\nthe strengthening of health systems. The Code takes into account the rights, obliga-<br \/>\ntions and expectations of source countries and migrant health professionals. The<br \/>\nWMA was involved in the drafting of the Code and supports its implementation.<br \/>\n10. The WHO Code states that international recruitment should be \u201cconducted in ac-<br \/>\ncordance with the principles of transparency, fairness and promotion of sustain-<br \/>\nability of health systems in developing countries.\u201d<br \/>\n11. The monitoring and information-sharing system established by the WHO should be<br \/>\nrobustly supported with the goal of international cooperation. Stakeholders should<br \/>\nregularly collate and share data, which should be monitored and anlaysed by the<br \/>\nWHO. The WHO should provide substantive critical feedback to governments.<br \/>\nInformation should be shared about how to overcome challenges encountered.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20102003-\u00ad\u201004-\u00ad\u20102008<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nVIOLENCE<br \/>\n \u00a0AND<br \/>\n \u00a0HEALTH<br \/>\n \u00a0<br \/>\nAdopted by the 54th<br \/>\nWMA General Assembly, Helsinki, Finland, September 2003<br \/>\nand reaffirmed by the 59th<br \/>\nWMA General Assembly, Seoul, Korea, October 2008<br \/>\nINTRODUCTION<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nIn the year 2000 there were over 1.6 million people who lost their lives to violence &#8211;<br \/>\nmeaning that every day more than 4,000 people around the world die a violent death.<br \/>\nRoughly half of these deaths are due to suicide, almost a third due to homicide, and the<br \/>\nremainder arise from conflict-related violence. These fatalities are only the tip of the ice-<br \/>\nberg &#8211; available data tends to come from higher income countries with established re-<br \/>\nporting systems and it is known that many forms of violence are more prevalent in lower<br \/>\nincome settings that may not provide data to the World Health Organization. In addition to<br \/>\npotential data collection problems, a variety of different forms of violence, child abuse and<br \/>\nneglect, intimate partner violence and elder abuse, to name a few, are systematically under-<br \/>\nreported, owing to fear, shame, or cultural norms.<br \/>\nFor every young person killed by homicide, at least 20-40 other youth receive hospital<br \/>\ntreatment for violence-related injuries. One in five females and 5-10% of males report<br \/>\nbeing sexually abused during childhood. International population-based studies indicate<br \/>\nthat between 10 and 69 percent of women report having been physically assaulted by an<br \/>\nintimate partner. In addition to the direct effects of injury arising from violence there are a<br \/>\nwide range of health effects, including mental and reproductive health problems, sexually<br \/>\ntransmitted diseases, and other health problems. Health effects arising from violence can<br \/>\nlast for years, and may include permanent mental or physical disability. From a societal<br \/>\nperspective, the economic costs associated with violence are substantial, with direct costs<br \/>\nfor health services alone amounting to 5.0% of GDP in some countries.<br \/>\nNo single factor drives violence, either at the level of the community or the individual.<br \/>\nViolence arises out of a complex interplay of individual, relationship, community, societal<br \/>\nand political factors.<br \/>\nIn 1996 the World Health Assembly adopted resolution WHA49.25, which declared vio-<br \/>\nlence a global public health priority. One year later, resolution WHA50.19 was adopted,<br \/>\nwhich endorsed the World Health Organization&#8217;s integrated plan of action for a science-<br \/>\nbased public health approach to the prevention of violence and called for further work in<br \/>\nthis field.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20102003-\u00ad\u201004-\u00ad\u20102008<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Seoul<br \/>\n \u00a0<br \/>\nViolence<br \/>\n \u00a0and<br \/>\n \u00a0Health<br \/>\n \u00a0<br \/>\nINVOLVEMENT<br \/>\n \u00a0OF<br \/>\n \u00a0THE<br \/>\n \u00a0INTERNATIONAL<br \/>\n \u00a0MEDICAL<br \/>\n \u00a0COMMUNITY<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nIrrespective of the diversity of factors that give rise to violence, there is one feature com-<br \/>\nmon to all forms of violence: the health effects suffered are a direct concern for the medi-<br \/>\ncal community.<br \/>\nDoctors can be victims of violence in the workplace or in other settings. In some cases<br \/>\ndoctors can be involved in committing acts of violence or neglect. Doctors of every<br \/>\ndescription also deal with the victims of violence on a daily basis. They make decisions<br \/>\nregarding referral and coordinated care across specialties and health sectors, they plan for<br \/>\nlong-term follow-up and care of disabilities, and in some settings they have contributed as<br \/>\na profession to the prevention of violence. Whether as a pediatrician assessing if a child is<br \/>\na victim of abuse, an emergency physician or surgeon tending to a shooting victim, a psy-<br \/>\nchiatrist dealing with the psychosocial impacts of intimate partner violence or any number<br \/>\nof other possible encounters, the reality is that more than any other profession the medical<br \/>\ncommunity is absolutely central in terms of responding to the health effects of violence.<br \/>\nThe manner in which the medical community can respond is varied and will depend as<br \/>\nmuch as anything else upon contextual features and realities. In some settings more struc-<br \/>\ntured forms of data collection are of paramount concern and doctors may be the only<br \/>\ngroup within such settings with the ability to lobby for health systems to adequately inte-<br \/>\ngrate systematic data collection related to violent injury. In other settings that are more<br \/>\nadvanced, clinicians and public health practitioners can play a major role in facilitating or<br \/>\nconducting focused studies that examine an aspect of violence or violence prevention. The<br \/>\nprovision of such data to policy-makers in a timely and appropriate fashion can contribute<br \/>\nto further development of evidence-based policies to reduce violence.<br \/>\nRECOMMENDATIONS<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nNational Medical Associations are encouraged to contribute to more systematic appro-<br \/>\naches to dealing with violence, including:<br \/>\nAdvocacy &#8211; violence is a global health problem and its victims are frequently among the<br \/>\npoorest, most powerless or otherwise most vulnerable within society. The medical profes-<br \/>\nsion should advocate at local, national and international levels for effective strategies to<br \/>\nprevent violence and limit its impact on health. Moreover, the medical profession should<br \/>\ndenounce all depictions or uses of violent behaviour as solutions for personal, societal or<br \/>\npolitical problems.<br \/>\nData collection &#8211; the medical profession should play a central role in ensuring that routine<br \/>\ndata collection occurs and is of a sufficient standard and comprehensive enough to be a<br \/>\nvaluable tool to guide public health policy. Research has shown that a large proportion of<br \/>\nvictims of violence are not reported in police statistics because they are not the victims of<br \/>\na crime (e.g. forms of family violence, bullying, etc.) or have avoided being reported to<br \/>\nthe police.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20102003-\u00ad\u201004-\u00ad\u20102008<br \/>\n \u00a0<br \/>\nMedical training &#8211; in recognition of the substantial burden of global morbidity and mor-<br \/>\ntality that is related to violence and the fact that violence and injury as a threat to health is<br \/>\nlargely absent from medical training, the medical profession should take steps to ensure<br \/>\nthe integration of injury and violence prevention into medical school curricula.<br \/>\nPrevention &#8211; the medical profession should use the unique opportunity during clinical en-<br \/>\ncounters, where appropriate, to counsel patients and families with respect to creating safer,<br \/>\nless violent household environments. They can also use their clinical judgment to detect<br \/>\nvictims of violence or those at potential risk for violence and make arrangements for ap-<br \/>\npropriate care.<br \/>\nCoordination of victim assistance &#8211; whether through detecting victims that may suffer<br \/>\nfrom violence but do not know how to bring themselves to medical attention, or through<br \/>\nappropriate referral to deal with the related health conditions or the physical, psychosocial<br \/>\nor long-term disability associated with injury, doctors can play a vital role in enhancing<br \/>\nthe quality and comprehensiveness of victim assistance.<br \/>\nResearch &#8211; violence is an under-documented global public health problem. Better under-<br \/>\nstanding of causes and consequences of violence is necessary, along with an enhanced<br \/>\nunderstanding of the effectiveness of various strategies to prevent violence.<br \/>\nSocial example &#8211; the medical profession should contribute to the creation and reinforce-<br \/>\nment of social norms by not participating in or tolerating various forms of violence, such<br \/>\nas torture or mistreatment or neglect of certain populations such as prisoners, and actively<br \/>\nopposing such violence.<br \/>\nPolicy-making &#8211; many countries still lack comprehensive national or local violence pre-<br \/>\nvention policies and plans of action. The medical profession should encourage the develop-<br \/>\nment of such policies and in some cases take a leading role in developing them.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102004-\u00ad\u201002-\u00ad\u20102009<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nCONCERNING<br \/>\n \u00a0THE<br \/>\n \u00a0RELATIONSHIP<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nBETWEEN<br \/>\n \u00a0PHYSICIANS<br \/>\n \u00a0AND<br \/>\n \u00a0COMMERCIAL<br \/>\n \u00a0ENTERPRISES<br \/>\n \u00a0<br \/>\nAdopted by the 55th<br \/>\nWMA General Assembly, Tokyo, Japan, October 2004<br \/>\nand amended by the 60th<br \/>\nWMA General Assembly, New Delhi, India, October 2009<br \/>\nPREAMBLE<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nIn the treatment of their patients, physicians use drugs, instruments, diagnostic tools,<br \/>\nequipment and materials developed and produced by commercial enterprises. Industry<br \/>\npossesses resources to finance expensive research and development programmes, for<br \/>\nwhich the knowledge and experience of physicians are essential. Moreover, industry sup-<br \/>\nport enables the furtherance of medical research, scientific conferences and continuing<br \/>\nmedical education that can be of benefit to patients and the entire health care system. The<br \/>\ncombination of financial resources and product knowledge contributed by industry and the<br \/>\nmedical knowledge possessed by physicians enables the development of new diagnostic<br \/>\nprocedures, drugs, therapies, and treatments and can lead to great advances in medicine.<br \/>\nHowever, conflicts of interest between commercial enterprises and physicians occur that<br \/>\ncan affect the care of patients and the reputation of the medical profession. The duty of the<br \/>\nphysician is to objectively evaluate what is best for the patient, while commercial enter-<br \/>\nprises are expected to bring profit to owners by selling their own products and competing<br \/>\nfor customers. Commercial considerations can affect the physician&#8217;s objectivity, especially<br \/>\nif the physician is in any way dependent on the enterprise.<br \/>\nRather than forbidding any relationships between physicians and industry, it is preferable<br \/>\nto establish guidelines for such relationships. These guidelines must incorporate the key<br \/>\nprinciples of disclosure, avoidance of obvious conflicts of interest and the physician&#8217;s cli-<br \/>\nnical autonomy to act in the best interests of patients.<br \/>\nThese guidelines should serve as the basis for the review of existing guidelines and the de-<br \/>\nvelopment of any future guidelines.<br \/>\nMEDICAL<br \/>\n \u00a0CONFERENCES<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nPhysicians may attend medical conferences sponsored in whole or in part by a commercial<br \/>\nentity if these conform to the following principles:<br \/>\n1. The main purpose of the conference is the exchange of professional or scientific infor-<br \/>\nmation.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0New<br \/>\n \u00a0Delhi<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20102004-\u00ad\u201002-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nPhysicians<br \/>\n \u00a0and<br \/>\n \u00a0Commercial<br \/>\n \u00a0Enterprises<br \/>\n \u00a0<br \/>\n2. Hospitality during the conference is secondary to the professional exchange of infor-<br \/>\nmation and does not exceed what is locally customary and generally acceptable.<br \/>\n3. Physicians do not receive payment directly from a commercial entity to cover travel-<br \/>\nling expenses, room and board at the conference or compensation for their time unless<br \/>\nprovided for by law and\/or the policy of their National Medical Association.<br \/>\n4. Physicians may not accept unjustified hospitality and may not receive payment from a<br \/>\ncommercial entity to cover room and board for accompanying persons.<br \/>\n5. The name of a commercial entity providing financial support is publicly disclosed in<br \/>\norder to allow the medical community and the public to assess the information pre-<br \/>\nsented in light of the source of funding. In addition, conference organizers and lec-<br \/>\nturers disclose to conference participants any financial affiliations they may have with<br \/>\nmanufacturers of products mentioned at the event or with manufacturers of competing<br \/>\nproducts.<br \/>\n6. Presentation of material by a physician is scientifically accurate, gives a balanced<br \/>\nreview of possible treatment options, and is not influenced by the sponsoring organi-<br \/>\nzation.<br \/>\n7. A conference can be recognised for purposes of continuing medical education \/ conti-<br \/>\nnuing professional development (CME\/CPD) only if it conforms to the following<br \/>\nprinciples:<br \/>\n7.1. The commercial entities acting as sponsors, such as pharmaceutical companies,<br \/>\nhave no influence on the content, presentation, choice of lecturers, or publica-<br \/>\ntion of results.<br \/>\n7.2. Funding for the conference is accepted only as a contribution to the general<br \/>\ncosts of the meeting.<br \/>\nGIFTS<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nPhysicians may not receive a gift from a commercial entity unless this is permitted by law<br \/>\nand\/or by the policy of their National Medical Association and it conforms to the fol-<br \/>\nlowing conditions:<br \/>\n1. Physicians may not receive payments in cash or cash equivalents from a commercial<br \/>\nentity.<br \/>\n2. Physicians may not receive gifts for their personal benefit.<br \/>\n3. Gifts designed to influence clinical practice are always unacceptable. Promotional<br \/>\naids may be accepted provided that the gift is of minimal value and is not connected<br \/>\nto any stipulation that the physician prescribes a certain medication, uses certain<br \/>\ninstruments or materials or refers patients to a certain facility.<br \/>\n4. Cultural courtesy gifts may be received on an infrequent basis according to local<br \/>\nstandards if the gift is inexpensive and not related to the practice of medicine.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20102004-\u00ad\u201002-\u00ad\u20102009<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0New<br \/>\n \u00a0Delhi<br \/>\n \u00a0<br \/>\nPhysicians<br \/>\n \u00a0and<br \/>\n \u00a0Commercial<br \/>\n \u00a0Enterprises<br \/>\n \u00a0<br \/>\nRESEARCH<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nA physician may carry out research funded by a commercial entity, whether individually<br \/>\nor in an institutional setting, if it conforms to the following principles:<br \/>\n1. The physician is subject only to the law, the ethical principles and guidelines of the<br \/>\nDeclaration of Helsinki, and clinical judgment in performing research and does not<br \/>\nallow himself or herself to be subject to external pressure regarding the results of his<br \/>\nor her research or their publication.<br \/>\n2. If possible, a physician or institution wishing to undertake research approaches more<br \/>\nthan one company to request funding for the research.<br \/>\n3. Identifiable information about research patients or voluntary participants is not passed<br \/>\nto the sponsoring company without the consent of the individuals concerned.<br \/>\n4. A physician&#8217;s compensation for research is based on his or her time and effort and<br \/>\nsuch compensation is in no way connected to the results of the research.<br \/>\n5. The results of research are made public with the name of the sponsoring entity<br \/>\ndisclosed, along with a statement disclosing who requested the research. This applies<br \/>\nwhether the sponsorship is direct or indirect, full or partial.<br \/>\n6. Commercial entities do not suppress the publication of research results. If results of<br \/>\nresearch are not made public, especially if they are negative, the research may be re-<br \/>\npeated unnecessarily and thereby expose future participants to potential harm.<br \/>\nAFFILIATIONS<br \/>\n \u00a0WITH<br \/>\n \u00a0COMMERCIAL<br \/>\n \u00a0ENTITIES<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nA physician may not enter into an affiliation with a commercial entity such as consulting<br \/>\nor membership on an advisory board unless the affiliation conforms to the following prin-<br \/>\nciples:<br \/>\n1. The affiliation does not compromise the physician&#8217;s integrity.<br \/>\n2. The affiliation does not conflict with the physician&#8217;s obligations to his or her patients.<br \/>\n3. Affiliations and\/or other relationships with commercial entities are fully disclosed in<br \/>\nall relevant situations such as lectures, articles and reports.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20102004-\u00ad\u201003-\u00ad\u20102014<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWATER<br \/>\n \u00a0AND<br \/>\n \u00a0HEALTH<br \/>\n \u00a0<br \/>\nApproved by the 55th<br \/>\nWMA General Assembly, Tokyo, Japan, October 2004<br \/>\nand revised by the 65th<br \/>\nWMA General Assembly, Durban, South Africa, October 2014<br \/>\nPREAMBLE<br \/>\n \u00a0<br \/>\nAn adequate supply of fresh (i.e. clean and uncontaminated) water is essential for<br \/>\nindividual and public health. It is central to living a life in dignity and upholding human<br \/>\nrights. Unfortunately, over half of the world&#8217;s population does not have access to such a<br \/>\nsupply, and even in those places where there is an abundance of fresh water, it is<br \/>\nthreatened by pollution and other negative forces.<br \/>\nIn keeping with its mission to serve humanity by endeavoring to achieve the highest<br \/>\ninternational standards in health care for all people in the world, the World Medical Asso-<br \/>\nciation has developed this statement to encourage all those responsible for health to<br \/>\nconsider the importance of water for individual and public health.<br \/>\nCONSIDERATIONS<br \/>\n \u00a0<br \/>\n1. Water-borne diseases account for a large proportion of mortality and morbidity,<br \/>\nespecially in developing countries. These problems are accentuated in times of<br \/>\ndisasters such as wars, nuclear and man-made accidents with oil and\/or chemicals,<br \/>\nearthquakes, epidemics, droughts and floods.<br \/>\n2. Anthropogenic changes to ecosystems, lowered retention by the earth&#8217;s surface,<br \/>\nand the limitation of the inherent capacity of nature to filter dirt from the water are<br \/>\ncausing increasing damage to the natural environment, especially the water environ-<br \/>\nment.<br \/>\n3. The commodification of water, whereby it is provided for profit rather than as a<br \/>\npublic service, has implications for access to an adequate supply of drinking water.<br \/>\n4. The development of sustainable infrastructure for the provision of safe water con-<br \/>\ntributes greatly to sound public health and national well-being. Curtailing infec-<br \/>\ntious diseases and other ailments that are caused by unsafe water alleviates the<br \/>\nburden of health care costs and improves productivity. This creates a positive<br \/>\nripple effect on national economies.<br \/>\n5. Water as a vital and necessary resource for life has become scarce in many parts of<br \/>\nthe world and therefore has to be used reasonably and with care.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20102004-\u00ad\u201003-\u00ad\u20102014<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Durban<br \/>\n \u00a0<br \/>\nWater<br \/>\n \u00a0and<br \/>\n \u00a0Health<br \/>\n \u00a0<br \/>\n6. Water is an asset that is shared by humanity and the earth. Thus, water-related<br \/>\nissues should be addressed collaboratively by the global community.<br \/>\nRECOMMENDATIONS<br \/>\n \u00a0<br \/>\nPhysicians, National Medical Associations and health authorities are encouraged to sup-<br \/>\nport the following measures related to water and health:<br \/>\n1. International and national programmes to provide access to safe drinking water at<br \/>\nlow cost to every human on the planet and to prevent the pollution of water sup-<br \/>\nplies.<br \/>\n2. International, national and regional programmes to provide access to sanitation and<br \/>\nto prevent the degradation of water resources.<br \/>\n3. Research on the relationship between water supply systems, including waste- water<br \/>\ntreatment, and health.<br \/>\n4. The development of plans for providing potable water and proper wastewater<br \/>\ndisposal during emergencies. These will vary according to the nature of the emer-<br \/>\ngency, but may include on-site water disinfection, identifying sources of water, and<br \/>\nback-up power to run pumps.<br \/>\n5. Preventive measures to secure safe water for health care institutions after the oc-<br \/>\ncurrence of natural disasters, especially earthquakes. Such measures should include<br \/>\nthe development of infrastructure and training programs to help health care institu-<br \/>\ntions cope with such crises. The implementation of continued emergency water<br \/>\nsupply programs should be done in conjunction with regional authorities and with<br \/>\ncommunity involvement.<br \/>\n6. More efficient use of water resources by each nation. The WMA especially urges<br \/>\nhospitals and health institutions to examine their impact on sustainable water re-<br \/>\nsources.<br \/>\n7. Preventive measures and emergency preparedness to save water from pollution.<br \/>\n8. The promotion of the universal access to clean and affordable water as a human<br \/>\nright1<br \/>\nand as a common good of humanity.<br \/>\n1<br \/>\nIn 2010, the United Nations General Assembly and the Human Rights Council explicitly recog-<br \/>\nnized the human right to water and sanitation, derived from the right to an adequate standard of<br \/>\nliving as stipulated in article 11 of the International Covenant on Economic, Social and Cultural<br \/>\nRights and other international human rights treaties. Hence, it is part of international human<br \/>\nrights law.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20102005-\u00ad\u201001-\u00ad\u20102005<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nREDUCING<br \/>\n \u00a0THE<br \/>\n \u00a0GLOBAL<br \/>\n \u00a0IMPACT<br \/>\n \u00a0OF<br \/>\n \u00a0ALCOHOL<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0HEALTH<br \/>\n \u00a0AND<br \/>\n \u00a0SOCIETY<br \/>\n \u00a0<br \/>\nAdopted by the 56th<br \/>\nWMA General Assembly, Santiago, Chile, October 2005<br \/>\nPREAMBLE<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. Alcohol use is deeply embedded in many societies. Overall, 4% of the global burden<br \/>\nof disease is attributable to alcohol, which accounts for about as much death and dis-<br \/>\nability globally as tobacco or hypertension. Overall, there are causal relationships<br \/>\nbetween alcohol consumption and more than 60 types of disease and injury including<br \/>\ntraffic fatalities. Alcohol consumption is the leading risk factor for disease burden in<br \/>\nlow mortality developing countries and the third largest risk factor in developed<br \/>\ncountries. Beyond the numerous chronic and acute health effects, alcohol use is asso-<br \/>\nciated with widespread social, mental and emotional consequences. The global burden<br \/>\nrelated to alcohol consumption, both in terms of morbidity and mortality, is consider-<br \/>\nable.<br \/>\n2. Alcohol-related problems are the result of a complex interplay between individual use<br \/>\nof alcoholic beverages and the surrounding cultural, economic, physical environment,<br \/>\npolitical and social contexts.<br \/>\n3. Alcohol cannot be considered an ordinary beverage or consumer commodity since it<br \/>\nis a drug that causes substantial medical, psychological and social harm by means of<br \/>\nphysical toxicity, intoxication and dependence. There is increasing evidence that gene-<br \/>\ntic vulnerability to alcohol dependence is a risk factor for some individuals. Fetal al-<br \/>\ncohol syndrome and fetal alcohol effects, preventable causes of mental retardation,<br \/>\nmay result from alcohol consumption during pregnancy. Growing scientific evidence<br \/>\nhas demonstrated the harmful effects of consumption prior to adulthood on the brains,<br \/>\nmental, cognitive and social functioning of youth and increased likelihood of adult<br \/>\nalcohol dependence and alcohol related problems among those who drink before full<br \/>\nphysiological maturity. Regular alcohol consumption and binge drinking in adoles-<br \/>\ncents can negatively affect school performance, increase participation in crime and<br \/>\nadversely affect sexual performance and behaviour.<br \/>\n4. Alcohol advertising and promotion is rapidly expanding throughout the world and is<br \/>\nincreasingly sophisticated and carefully targeted, including to youth. It is aimed to<br \/>\nattract, influence, and recruit new generations of potential drinkers despite industry<br \/>\ncodes of self-regulation that are widely ignored and often not enforced.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20102005-\u00ad\u201001-\u00ad\u20102005<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Santiago<br \/>\n \u00a0<br \/>\nAlcohol<br \/>\n \u00a0on<br \/>\n \u00a0Health<br \/>\n \u00a0and<br \/>\n \u00a0Society<br \/>\n \u00a0<br \/>\n5. Effective alcohol social policy can put into place measures that control the supply of<br \/>\nalcohol and\/or affect population-wide demand for alcohol beverages. Comprehensive<br \/>\npolicies address legal measures to: control supply and demand, control access to al-<br \/>\ncohol (by age, location and time), provide public education and treatment for those<br \/>\nwho need assistance, levy taxation to affect prices and to pay for problems generated<br \/>\nby consumption, and harm-reduction strategies to limit alcohol-related problems such<br \/>\nas impaired driving and domestic violence.<br \/>\n6. Alcohol problems are highly correlated with per capita consumption so that reduc-<br \/>\ntions of use can lead to decreases in alcohol problems. Because alcohol is an econo-<br \/>\nmic commodity, alcohol beverage sales are sensitive to prices, i.e., as prices increase,<br \/>\ndemand declines, and visa versa. Price can be influenced through taxation and effec-<br \/>\ntive penalties for inappropriate sales and promotion activities. Such policy measures<br \/>\naffect even heavy drinkers, and they are particularly effective among young people.<br \/>\n7. Heavy drinkers and those with alcohol-related problems or alcohol dependence cause<br \/>\na significant share of the problems resulting from consumption. However, in most<br \/>\ncountries, the majority of alcohol-related problems in a population are associated with<br \/>\nharmful or hazardous drinking by non-dependent &#8216;social&#8217; drinkers, particularly when<br \/>\nintoxicated. This is particularly a problem of young people in many regions of the<br \/>\nworld who drink with the intent of becoming intoxicated.<br \/>\n8. Although research has found some limited positive health effects of low levels of al-<br \/>\ncohol consumption in some populations, this must be weighed against potential harms<br \/>\nfrom consumption in those same populations as well as in population as a whole.<br \/>\n9. Thus, population-based approaches that affect the social drinking environment and the<br \/>\navailability of alcoholic beverages are more effective than individual approaches<br \/>\n(such as education) for preventing alcohol related problems and illness. Alcohol poli-<br \/>\ncies that affect drinking patterns by limiting access and by discouraging drinking by<br \/>\nyoung people through setting a minimum legal purchasing age are especially likely to<br \/>\nreduce harms. Laws to reduce permitted blood alcohol levels for drivers and to control<br \/>\nthe number of sales outlets have been effective in lowering alcohol problems.<br \/>\n10. In recent years some constraints on the production, mass marketing and patterns of<br \/>\nconsumption of alcohol have been weakened and have resulted in increased avail-<br \/>\nability and accessibility of alcoholic beverages and changes in drinking patterns<br \/>\nacross the world. This has created a global health problem that urgently requires go-<br \/>\nvernmental, citizen, medical and health care intervention.<br \/>\nRECOMMENDATIONS<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nThe WMA urges National Medical Associations and all physicians to take the following<br \/>\nactions to help reduce the impact of alcohol on health and society:<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20102005-\u00ad\u201001-\u00ad\u20102005<br \/>\n \u00a0<br \/>\n1. Advocate for comprehensive national policies that<br \/>\na. incorporate measures to educate the public about the dangers of hazardous and<br \/>\nunhealthy use of alcohol (from risky amounts through dependence), including,<br \/>\nbut not limited to, education programs targeted specifically at youth;<br \/>\nb. create legal interventions that focus primarily on treating or provide evidence-<br \/>\nbased legal sanctions that deter those who place themselves or others at risk, and<br \/>\nc. put in place regulatory and other environmental supports that promote the health<br \/>\nof the population as a whole.<br \/>\n2. Promote national and sub-national policies that follow &#8216;best practices&#8217; from the de-<br \/>\nveloped countries that with appropriate modification may also be effective in de-<br \/>\nveloping nations. These may include setting of a minimum legal purchase age, res-<br \/>\ntricted sales policies, restricting hours or days of sale and the number of sales outlets,<br \/>\nincreasing alcohol taxes, and implementing effective countermeasures for alcohol im-<br \/>\npaired driving (such as lowered blood alcohol concentration limits for driving, active<br \/>\nenforcement of traffic safety measures, random breath testing, and legal and medical<br \/>\ninterventions for repeat intoxicated drivers).<br \/>\n3. Be aware of and counter non-evidence-based alcohol control strategies promoted by<br \/>\nthe alcohol industry or their social aspect organizations.<br \/>\n4. Restrict the promotion, advertising and provision of alcohol to youth so that youth can<br \/>\ngrow up with fewer social pressures to consume alcohol. Support the creation of an<br \/>\nindependent monitoring capability that assures that alcohol advertising conforms to<br \/>\nthe content and exposure guidelines described in alcohol industry self-regulation codes.<br \/>\n5. Work collaboratively with national and local medical societies, specialty medical<br \/>\norganizations, concerned social, religious and economic groups (including govern-<br \/>\nmental, scientific, professional, nongovernmental and voluntary bodies, the private<br \/>\nsector, and civil society) to:<br \/>\na. reduce harmful use of alcohol, especially among young people and pregnant<br \/>\nwomen, in the workplace, and when driving;<br \/>\nb. increase the likelihood that everyone will be free of pressures to consume alcohol<br \/>\nand free from the harmful and unhealthy effects of drinking by others; and<br \/>\nc. promote evidence-based prevention strategies in schools.<br \/>\n6. Undertake to<br \/>\na. screen patients for alcohol use disorders and at-risk drinking, or arrange to have<br \/>\nscreening conducted systematically by qualified personnel using evidence-based<br \/>\nscreening tools that can be used in clinical practice;<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20102005-\u00ad\u201001-\u00ad\u20102005<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Santiago<br \/>\n \u00a0<br \/>\nAlcohol<br \/>\n \u00a0on<br \/>\n \u00a0Health<br \/>\n \u00a0and<br \/>\n \u00a0Society<br \/>\n \u00a0<br \/>\nb. promote self-screening\/mass screening with questionnaires that could then select<br \/>\nthose needing to be seen by a provider for assessment;<br \/>\nc. provide brief interventions to motivate high-risk drinkers to moderate their con-<br \/>\nsumption; and<br \/>\nd. provide specialized treatment, including use of evidence-based pharmaceuticals,<br \/>\nand rehabilitation for alcohol-dependent individuals and assistance to their fa-<br \/>\nmilies.<br \/>\n7. Encourage physicians to facilitate epidemiologic and health service data collection on<br \/>\nthe impact of alcohol.<br \/>\n8. Promote consideration of a Framework Convention on Alcohol Control similar to that<br \/>\nof the WHO Framework Convention on Tobacco Control that took effect on February<br \/>\n27, 2005.<br \/>\n9. Furthermore, in order to protect current and future alcohol control measures, advocate<br \/>\nfor consideration of alcohol as an extraordinary commodity and that measures affect-<br \/>\ning the supply, distribution, sale, advertising, promotion or investment in alcoholic<br \/>\nbeverages be excluded from international trade agreements.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20102005-\u00ad\u201002-\u00ad\u20102015<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nDRUG<br \/>\n \u00a0SUBSTITUTION<br \/>\n \u00a0<br \/>\nAdopted by the 56th<br \/>\nWMA General Assembly, Santiago, Chile, October 2005<br \/>\nand reaffirmed by the 200th<br \/>\nWMA Council Session, Oslo, Norway, April 2015<br \/>\nINTRODUCTION<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. The prescription of a drug represents the culmination of a careful deliberative process<br \/>\nbetween physician and patient aimed at the prevention, amelioration or cure of a<br \/>\ndisease or problem. This deliberative process requires that the physician evaluate a<br \/>\nvariety of scientific and other data including costs and make an individualized choice<br \/>\nof therapy for the patient. Sometimes, however, a pharmacist is required to substitute<br \/>\na different drug for the one prescribed by the physician. The World Medical Associa-<br \/>\ntion has serious concerns about this practice.<br \/>\n2. Drug substitution can take two forms: generic substitution and therapeutic substitu-<br \/>\ntion.<br \/>\n3. In generic substitution, a generic drug is substituted for a brand name drug. However,<br \/>\nboth drugs have the same active chemical ingredient, same dosage strength, and same<br \/>\ndosage form.<br \/>\n4. Therapeutic substitution occurs when a pharmacist substitutes a chemically different<br \/>\ndrug for the drug that the physician prescribed. The drug substituted by the pharmacist<br \/>\nbelongs to the same pharmacologic class and\/or to the same therapeutic class. How-<br \/>\never since the two drugs have different chemical structures, adverse outcomes for the<br \/>\npatient can occur.<br \/>\n5. The respective roles of physicians and pharmacists in serving the patient&#8217;s need for<br \/>\noptimal drug therapy are outlined in the WMA Statement on the Working Relation-<br \/>\nship between Physicians and Pharmacists in Medicinal Therapy.<br \/>\n6. The physician should be assured by national regulatory authorities of the bioequi-<br \/>\nvalence and the chemical and therapeutic equivalence of prescription drug products<br \/>\nfrom both multiple and single sources. Quality assurance procedures should be in<br \/>\nplace to ensure their lot-to-lot bioequivalence and their chemical and therapeutic equi-<br \/>\nvalence.<br \/>\n7. Many considerations should be addressed before prescribing the drug of choice for a<br \/>\nparticular indication in any given patient. Drug therapy should be individualized<br \/>\nbased on a complete clinical patient history, current physical findings, all relevant<br \/>\nlaboratory data, and psychosocial factors. Once these primary considerations are met,<br \/>\nthe physician should then consider comparative costs of similar drug products avail-<br \/>\nable to best serve the patient&#8217;s needs. The physician should select the type and quan-<br \/>\ntity of drug product that he or she considers to be in the best medical and financial<br \/>\ninterest of the patient.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20102005-\u00ad\u201002-\u00ad\u20102015<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Oslo<br \/>\n \u00a0<br \/>\nDrug<br \/>\n \u00a0Substitution<br \/>\n \u00a0<br \/>\n8. Once the patient gives his or her consent to the drug selected, that drug should not be<br \/>\nchanged without the consent of the patient and his or her physician. Failure to follow<br \/>\nthis principle can result in harm to patients. On behalf of patients and physicians alike,<br \/>\nNational Medical Associations should do everything possible to ensure the imple-<br \/>\nmentation of the following recommendations:<br \/>\nRECOMMENDATIONS<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. Physicians should become familiar with specific laws and\/or regulations governing<br \/>\ndrug substitution where they practise.<br \/>\n2. Pharmacists should be required to dispense the exact chemical, dose, and dosage form<br \/>\nprescribed by the physician. Once medication has been prescribed and begun, no drug<br \/>\nsubstitution should be made without the prescribing physician&#8217;s permission.<br \/>\n3. If substitution of a drug product occurs, the physician should carefully monitor and<br \/>\nadjust the dose to ensure therapeutic equivalence of the drug products.<br \/>\n4. If drug substitution leads to serious adverse drug reaction or therapeutic failure, the<br \/>\nphysician should document this finding and report it to appropriate drug regulatory<br \/>\nauthorities.<br \/>\n5. National Medical Associations should regularly monitor drug substitution issues and<br \/>\nkeep their members advised on developments that have special relevance for patient<br \/>\ncare. Collection and evaluation of information reports on significant developments in<br \/>\nthis area is encouraged.<br \/>\n6. Appropriate drug regulatory bodies should evaluate and ensure the bioequivalence<br \/>\nand the chemical and therapeutic equivalence of all similar drug products, whether<br \/>\ngeneric or brand-name, in order to ensure safe and effective treatment.<br \/>\n7. National Medical Associations should oppose any action to restrict the freedom and<br \/>\nthe responsibility of the physician to prescribe in the best medical and financial<br \/>\ninterest of the patient.<br \/>\n8. National Medical Associations should urge national regulatory authorities to declare<br \/>\ntherapeutic substitution illegal, unless such substitution has the immediate prior con-<br \/>\nsent of the prescribing physician.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20102005-\u00ad\u201003-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nGENETICS<br \/>\n \u00a0AND<br \/>\n \u00a0MEDICINE<br \/>\n \u00a0<br \/>\nAdopted by the 56th<br \/>\nWMA General Assembly, Santiago, Chile, October 2005<br \/>\nand amended by the 60th<br \/>\nWMA General Assembly, New Delhi, India, October 2009<br \/>\nPREAMBLE<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. In recent years, the field of genetics has undergone rapid change and development.<br \/>\nThe areas of gene therapy and genetic engineering and the development of new tech-<br \/>\nnology have presented possibilities inconceivable only decades ago.<br \/>\n2. The Human Genome Project opened new spheres of research. Its applications also<br \/>\nproved useful to clinical care, by allowing physicians to utilize knowledge of the<br \/>\nhuman genome in order to diagnose future disease as well as to individualize drug<br \/>\ntherapy (pharmacogenomics).<br \/>\n3. Because of this, genetics has become an integral part of primary care medicine.<br \/>\nWhereas at one time, medical genetics was devoted to the study of relatively rare<br \/>\ngenetic disorders, the Human Genome Project has established a genetic contribution<br \/>\nto a variety of common diseases. It is therefore incumbent upon all physicians to have<br \/>\na working knowledge of the field.<br \/>\n4. Genetics is an area of medicine with enormous medical, social, ethical and legal<br \/>\nimplications. The WMA has developed this statement in order to address some of<br \/>\nthese concerns and provide guidance to physicians. These guidelines should be up-<br \/>\ndated in accordance with developments in the field of genetics.<br \/>\nMAJOR<br \/>\n \u00a0ISSUES:<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nGenetic<br \/>\n \u00a0testing<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n5. The identification of disease-related genes has led to an increase in the number of<br \/>\navailable genetic tests that detect disease or an individual&#8217;s risk of disease. As the<br \/>\nnumber and types of such tests and the diseases they detect increases, there is concern<br \/>\nabout the reliability and limitations of such tests, as well as the implications of testing<br \/>\nand disclosure. The ability of physicians to interpret test results and counsel their pa-<br \/>\ntients has also been challenged by the proliferation of knowledge.<br \/>\n6. Genetic testing may be undergone prior to marriage or childbearing to detect the pre-<br \/>\nsence of carrier genes that might affect the health of future offspring. Physicians<br \/>\nshould actively inform those from populations with high incidence of certain genetic<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20102005-\u00ad\u201003-\u00ad\u20102009<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0New<br \/>\n \u00a0Delhi<br \/>\n \u00a0<br \/>\nGenetics<br \/>\n \u00a0and<br \/>\n \u00a0Medicine<br \/>\n \u00a0<br \/>\ndiseases about the possibility of pre-marital and pre-pregnancy testing, and genetic<br \/>\ncounselling should be made available to those individuals or couples who are consi-<br \/>\ndering such testing.<br \/>\n7. Genetic counselling and testing during pregnancy should be offered as an option. In<br \/>\ncases where no medical intervention is possible following diagnosis, this should be<br \/>\nexplained to the couple prior to their decision to test.<br \/>\n8. In recent years, with the advent of IVF, genetic testing has been extended to pre-<br \/>\nimplantation genetic diagnosis of embryos (PGD). This can be a useful tool in cases<br \/>\nwhere a couple has a high chance of conceiving a child with genetic disease.<br \/>\n9. Since the purpose of medicine is to treat, in cases where no sickness or disability is<br \/>\ninvolved, genetic screening should not be employed as a means of producing children<br \/>\nwith pre-determined characteristics. For example, genetic screening should not be<br \/>\nused to enable sex selection unless there is a gender-based illness involved. Similarly,<br \/>\nphysicians should not countenance the use of such screening to promote non-health<br \/>\nrelated personal attributes.<br \/>\n10. Genetic testing should be done only with informed consent of the individual or his\/her<br \/>\nlegal guardian. Genetic testing for predisposition to disease should be performed only<br \/>\non consenting adults, unless there is treatment available for the condition and the test<br \/>\nresults would facilitate earlier instigation of this treatment.<br \/>\n11. Valid consent to genetic testing should include the following factors:<br \/>\n\u2022 The limitations of genetic testing, including the fact that the presence of a specific<br \/>\ngene may denote predisposition to disease rather than the disease itself and does<br \/>\nnot definitively predict the likelihood of developing a certain disease, particularly<br \/>\nin multi-factorial disorders.<br \/>\n\u2022 The fact that a disease may manifest itself in one of several forms and in varying<br \/>\ndegrees. Information about the nature and predictability of information received<br \/>\nfrom the tests.<br \/>\n\u2022 The benefits of testing including the relief of uncertainty and the ability to make<br \/>\ninformed choices, including the possible need to increase or reduce regular screen-<br \/>\nings and checkups and to implement risk reduction measures.<br \/>\n\u2022 The implications of a positive result and the prevention, screening and\/or treatment<br \/>\npossibilities.<br \/>\n\u2022 The possible implications for the family members of the patient involved.<br \/>\n12. In the case of a positive test result that may have implications for third parties such as<br \/>\nclose relatives, the individual tested should be encouraged to discuss the results of the<br \/>\ntest with such third parties. In cases where not disclosing the results involves a direct<br \/>\nand imminent threat to the life or health of an individual, the physician may reveal the<br \/>\nresults to such third parties, but should usually discuss this with the patient first. If the<br \/>\nphysician has access to an ethics committee, it is preferable to consult such a com-<br \/>\nmittee prior to revealing results to third parties.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20102005-\u00ad\u201003-\u00ad\u20102009<br \/>\n \u00a0<br \/>\nGenetic<br \/>\n \u00a0counselling<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n13. Genetic counselling is generally offered prior to marriage or conception, in order to<br \/>\npredict the likelihood of conceiving an affected child, during pregnancy, in order to<br \/>\ndetermine the condition of the fetus, or to an adult, in order to determine susceptibility<br \/>\nto a certain disease.<br \/>\n14. Individuals at higher risk for conceiving a child with a specific disease should be<br \/>\noffered genetic counselling prior to conception or during pregnancy. In addition,<br \/>\nadults at higher risk for various diseases such as cancer, mental illness or neuro-<br \/>\ndegenerative diseases in which the risk can be tested for, should be made aware of the<br \/>\navailability of genetic counselling.<br \/>\n15. Because of the scientific complexity involved in genetic testing as well as the prac-<br \/>\ntical and emotional implications of the results, the WMA sees great importance in<br \/>\neducating and training medical students and physicians in genetic counselling, parti-<br \/>\ncularly counselling related to pre-symptomatic diagnosis of disease. Independent ge-<br \/>\nnetic counsellors also have an important role to play. The WMA acknowledges that<br \/>\nthere can be very complex situations requiring the involvement of medical genetics<br \/>\nspecialists.<br \/>\n16. In all cases where genetic counselling is offered, it should be non-directive and<br \/>\nprotect the individual&#8217;s right not to be tested.<br \/>\n17. In cases of counselling prior to or during pregnancy, the prospective parents should be<br \/>\ngiven information to provide the basis for an informed decision regarding child-<br \/>\nbearing, but should not be influenced by the physicians&#8217; personal views in this matter<br \/>\nand physicians should be careful not to substitute their own moral judgment for that of<br \/>\nthe prospective parents. In cases where a physician is morally opposed to contracep-<br \/>\ntion or abortion, he\/she may choose not to provide these services but should alert pro-<br \/>\nspective parents that a potential genetic problem exists and make note of the option of<br \/>\ncontraception or abortion as well as treatment alternatives, relevant genetic tests, and<br \/>\nthe availability of genetic counselling.<br \/>\nConfidentiality<br \/>\n \u00a0of<br \/>\n \u00a0results<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n18. Like all medical records, the results of genetic testing should be kept strictly<br \/>\nconfidential, and should not be revealed to outside parties without the consent of the<br \/>\nindividual tested. Third parties to whom results may in certain circumstances be<br \/>\nreleased are identified in paragraph 12.<br \/>\n19. Physicians should support the passage of laws guaranteeing that no individual shall be<br \/>\ndiscriminated against on the basis of genetic makeup in the fields of human rights,<br \/>\nemployment and insurance.<br \/>\nGene<br \/>\n \u00a0therapy<br \/>\n \u00a0and<br \/>\n \u00a0genetic<br \/>\n \u00a0research<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n20. Gene therapy represents a combination of techniques used to correct defective genes<br \/>\nthat cause disease, especially in the fields of oncology, hematology and immune dis-<br \/>\norders. Gene therapy is not yet an active current therapy but is still in a stage of clini-<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20102005-\u00ad\u201003-\u00ad\u20102009<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0New<br \/>\n \u00a0Delhi<br \/>\n \u00a0<br \/>\nGenetics<br \/>\n \u00a0and<br \/>\n \u00a0Medicine<br \/>\n \u00a0<br \/>\ncal investigation. However, with the continued development of this field, it should<br \/>\nproceed according to the following guidelines:<br \/>\n\u2022 Gene therapy performed in a research context should conform to the requirements<br \/>\nof the Declaration of Helsinki while therapy performed in a treatment context<br \/>\nshould conform to standards of medical practice and professional responsibility.<br \/>\n\u2022 Informed consent should always be obtained from the patient undergoing the<br \/>\ntherapy. This informed consent should include disclosure of the risks of gene<br \/>\ntherapy, including the fact that the patient may have to undergo multiple rounds of<br \/>\ngene therapy, the risk of an immune response, and the potential problems arising<br \/>\nfrom the use of viral vectors.<br \/>\n\u2022 Gene therapy should only be undertaken after a careful analysis of the risks and<br \/>\nbenefits involved and an evaluation of the perceived effectiveness of the therapy,<br \/>\nas compared to the risks, side effects, availability and effectiveness of other treat-<br \/>\nments.<br \/>\n21. It is currently possible to undertake screening of an embryo in order to provide stem<br \/>\ncell or other therapies for an existing sibling with a genetic disorder. This may be<br \/>\nconsidered acceptable medical practice where no evidence exists that the embryo is<br \/>\nbeing created exclusively for this purpose.<br \/>\n22. Genetic discoveries should be shared as much as possible between countries so as to<br \/>\nbenefit humankind and reduce duplication of research and the risk inherent in research<br \/>\nin this area.<br \/>\n23. The mapping of human genomes must be anonymous but the information acquired<br \/>\nwill apply to every human being. The genetic information should be general property.<br \/>\nTherefore, no patents should be given for the human genome or parts of it.<br \/>\n24. In the case of genetic research performed on large, defined population groups, efforts<br \/>\nshould be made to avoid potential stigmatization.<br \/>\nCloning<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n25. Recent developments in science have led to the cloning of a mammal and raise the<br \/>\npossibility of such cloning techniques being used in humans.<br \/>\n26. Cloning includes both therapeutic cloning, namely the cloning of individual stem cells<br \/>\nin order to produce a healthy copy of a diseased tissue or organ for transplant, and re-<br \/>\nproductive cloning, namely the cloning of an existing mammal to produce a duplicate<br \/>\nof such mammal. The WMA currently opposes reproductive cloning, and in many<br \/>\ncountries it is considered to pose more of an ethical problem than therapeutic cloning.<br \/>\n27. Physicians should act in accordance with the codes of medical ethics in their countries<br \/>\nregarding the use of cloning and be mindful of the law governing this activity.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20102005-\u00ad\u201004-\u00ad\u20102015<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nMEDICAL<br \/>\n \u00a0LIABILITY<br \/>\n \u00a0REFORM<br \/>\n \u00a0<br \/>\nAdopted by the 56th<br \/>\nWMA General Assembly, Santiago, Chile, October 2005<br \/>\nand reaffirmed by the 200th<br \/>\nWMA Council Session, Oslo, Norway, April 2015<br \/>\n1. A culture of litigation is growing around the world that is adversely affecting the<br \/>\npractice of medicine and eroding the availability and quality of health care services.<br \/>\nSome National Medical Associations report a medical liability crisis whereby the<br \/>\nlawsuit culture is increasing health care costs, restraining access to health care ser-<br \/>\nvices, and hindering efforts to improve patient safety and quality. In other countries,<br \/>\nmedical liability claims are less rampant, but National Medical Associations in those<br \/>\ncountries should be alert to the issues and circumstances that could result in an in-<br \/>\ncrease in the frequency and severity of medical liability claims brought against physi-<br \/>\ncians.<br \/>\n2. Medical liability claims have greatly increased health care costs, diverting scarce<br \/>\nhealth care resources to the legal system and away from direct patient care, research,<br \/>\nand physician training. The lawsuit culture has also blurred the distinction between<br \/>\nnegligence and unavoidable adverse outcomes, often resulting in a random determi-<br \/>\nnation of the standard of care. This has led to the broad perception that anyone can<br \/>\nsue for almost anything, betting on a chance to win a big award. Such a culture breeds<br \/>\ncynicism and distrust in both the medical and legal systems with damaging conse-<br \/>\nquences to the patient-physician relationship.<br \/>\n3. In adopting this Statement, the World Medical Association makes an urgent call to all<br \/>\nNational Medical Associations to demand the establishment of a reliable system of<br \/>\nmedical justice in their respective countries. Legal systems should ensure that patients<br \/>\nare protected against harmful practices, physicians are protected against unmeritorious<br \/>\nlawsuits, and standard of care determinations are consistent and reliable so that all<br \/>\nparties know where they stand.<br \/>\n4. In this Statement the World Medical Association wishes to inform National Medical<br \/>\nAssociations of some of the facts and issues related to medical liability claims. The<br \/>\nlaws and legal systems in each country, as well as the social traditions and the econo-<br \/>\nmic conditions of the country, will affect the relevance of some portions of this State-<br \/>\nment to each National Medical Association but do not detract from the fundamental<br \/>\nimportance of such a Statement.<br \/>\n5. An increase in the frequency and severity of medical liability claims may result, in<br \/>\npart, from one or more of the following circumstances:<br \/>\na. Increases in medical knowledge and medical technology that have enabled phy-<br \/>\nsicians to accomplish medical feats that were not possible in the past, but that<br \/>\ninvolve considerable risks in many instances.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20102005-\u00ad\u201004-\u00ad\u20102015<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Oslo<br \/>\n \u00a0<br \/>\nMedical<br \/>\n \u00a0Liability<br \/>\n \u00a0Reform<br \/>\n \u00a0<br \/>\nb. Pressures on physicians by private managed care organizations or government-<br \/>\nmanaged health care systems to limit the costs of medical care.<br \/>\nc. Confusing the right to access to health care, which is attainable, with the right to<br \/>\nachieve and maintain health, which cannot be guaranteed.<br \/>\nd. The role of the media in fostering mistrust of physicians by questioning their<br \/>\nability, knowledge, behaviour, and management of patients, and by prompting pa-<br \/>\ntients to submit complaints against physicians.<br \/>\n6. A distinction must be made between harm caused by medical negligence and an un-<br \/>\ntoward result occurring in the course of medical care and treatment that is not the fault<br \/>\nof the physician.<br \/>\na. Injury caused by negligence is the direct result of the physician&#8217;s failure to con-<br \/>\nform to the standard of care for treatment of the patient&#8217;s condition, or the physi-<br \/>\ncian&#8217;s lack of skill in providing care to the patient.<br \/>\nb. An untoward result is an injury occurring in the course of medical treatment that<br \/>\nwas not the result of any lack of skill or knowledge on the part of the treating<br \/>\nphysician, and for which the physician should not bear any liability.<br \/>\n7. Compensation for patients suffering a medical injury should be determined differently<br \/>\nfor medical liability claims than for the untoward results that occur during medical<br \/>\ncare and treatment, unless there is an alternative system in place such as a no-fault<br \/>\nsystem or alternate resolution system.<br \/>\na. Where an untoward result occurs without fault on the part of the physician, each<br \/>\ncountry must determine if the patient should be compensated for the injuries suf-<br \/>\nfered, and if so, the source from which the funds will be paid. The economic con-<br \/>\nditions of the country will determine if such solidarity funds are available to com-<br \/>\npensate the patient without being at the expense of the physician.<br \/>\nb. The laws of each jurisdiction should provide the procedures for deciding liability<br \/>\nfor medical liability claims and for determining the amount of compensation<br \/>\nowed to the patient in those cases where negligence is proven.<br \/>\n8. National Medical Associations should consider some or all of the following activities<br \/>\nin an effort to provide fair and equitable treatment for both physicians and patients:<br \/>\na. Establish public education programs on the risks inherent in some of the new<br \/>\nadvances in treatment modalities and surgery, and professional education pro-<br \/>\ngrams on the need for obtaining the patient&#8217;s informed consent to such treatment<br \/>\nand surgery.<br \/>\nb. Implement public advocacy programs to demonstrate the problems in medicine<br \/>\nand health care delivery resulting from strict cost containment limitations.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20102005-\u00ad\u201004-\u00ad\u20102015<br \/>\n \u00a0<br \/>\nc. Enhance the level and quality of medical education for all physicians, including<br \/>\nimproved clinical training experiences.<br \/>\nd. Develop and participate in programs for physicians to improve the quality of<br \/>\nmedical care and treatment.<br \/>\ne. Develop appropriate policy positions on remedial training for physicians found to<br \/>\nbe deficient in knowledge or skills, including policy positions on limiting the<br \/>\nphysician&#8217;s medical practice until the deficiencies are corrected.<br \/>\nf. Inform the public and government of the dangers that various manifestations of<br \/>\ndefensive medicine may pose (the multiplication of medical acts or, on the con-<br \/>\ntrary, the abstention of the physicians, the disaffection of young physicians for<br \/>\ncertain higher risk specialties or the reluctance by physicians or hospitals to treat<br \/>\nhigher-risk patients).<br \/>\ng. Educate the public on the possible occurrence of injuries during medical treat-<br \/>\nment that are not the result of physician negligence, and establish simple proce-<br \/>\ndures to allow patients to receive explanations in the case of adverse events and<br \/>\nto be informed of the steps that must be taken to obtain compensation, if avail-<br \/>\nable.<br \/>\nh. Advocate for legal protection for physicians when patients are injured by un-<br \/>\ntoward results not caused by any negligence, and participate in decisions relating<br \/>\nto the advisability of providing compensation for patients injured during medical<br \/>\ntreatment without any negligence.<br \/>\ni. Participate in the development of the laws and procedures applicable to medical<br \/>\nliability claims.<br \/>\nj. Develop active opposition to meritless or frivolous claims and to contingency<br \/>\nbilling by lawyers.<br \/>\nk. Explore innovative alternative dispute resolution procedures for handling medical<br \/>\nliability claims, such as arbitration, rather than court proceedings.<br \/>\nl. Encourage self-insurance by physicians against medical liability claims, paid by<br \/>\nthe practitioners themselves or by the employer if the physician is employed.<br \/>\nm. Encourage the development of voluntary, confidential, and legally protected sys-<br \/>\ntems for reporting untoward outcomes or medical errors for the purpose of analy-<br \/>\nsis and for making recommendations on reducing untoward outcomes and im-<br \/>\nproving patient safety and health care quality.<br \/>\nn. Advocate against the increasing criminalization or penal liability of medical acts<br \/>\nby the courts.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102006-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nASSISTED<br \/>\n \u00a0REPRODUCTIVE<br \/>\n \u00a0TECHNOLOGIES<br \/>\n \u00a0<br \/>\nAdopted by the 57th<br \/>\nWMA General Assembly, Pilanesberg, South Africa, October 2006<br \/>\nPREAMBLE<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. Assisted reproductive technology encompasses a wide range of techniques designed<br \/>\nprimarily to aid couples unable to conceive without medical assistance. Since the birth<br \/>\nof the first so-called &#8216;test-tube baby&#8217; in 1978, more than 1.5 million children world-<br \/>\nwide have been born following IVF treatment.<br \/>\n2. The term &#8216;assisted reproductive technology&#8217; includes techniques such as in-vitro fer-<br \/>\ntilisation (IVF) and intra-cytoplasmic sperm injection (ICSI). It can be defined as in-<br \/>\ncluding all treatments that include medical and scientific manipulation of human gam-<br \/>\netes and embryos in order to produce a term pregnancy. Although some legislatures<br \/>\nhave considered artificial insemination, whether using donor semen or semen from the<br \/>\npatient&#8217;s partner, as different, many of the issues about regulation in relation to obtain-<br \/>\ning, storing, using and disposing of gametes and embryos are closely inter-linked. In<br \/>\nthis statement treatments such as artificial insemination are excluded.<br \/>\n3. Assisted reproductive technologies raise profound moral issues. Views and beliefs<br \/>\nabout the moral status of the embryo, which are central to much of the debate in this<br \/>\narea, vary both within and among countries. Assisted conception is also regulated dif-<br \/>\nferently in various countries. Whilst consensus can be reached on some issues, there<br \/>\nremain fundamental differences of opinion that cannot be resolved. This statement<br \/>\nidentifies areas of agreement and also highlights those matters on which agreement<br \/>\ncannot be reached. Physicians faced with such situations should comply with applica-<br \/>\nble laws and regulations as well as the ethical requirements and professional standards<br \/>\nestablished by their National Medical Association and other appropriate organisations<br \/>\nin the community.<br \/>\n4. Physicians involved in providing assisted reproductive technologies should always<br \/>\nconsider their ethical responsibilities towards any child who may be born as a result of<br \/>\nthe treatment. If there is evidence that a future child would be exposed to serious<br \/>\nharm, treatment should not be provided.<br \/>\n5. As with all other medical procedures, physicians also have an ethical obligation to<br \/>\nlimit their practice to areas in which they have relevant expertise and experience and<br \/>\nto respect the rights of patients. These rights include that of personal bodily integrity<br \/>\nand freedom from coercion. In practice this means that valid or real consent is re-<br \/>\nquired as with other medical procedures; the validity of such consent is dependent<br \/>\nupon the adequacy of the information offered to the patient and their freedom to make<br \/>\na decision, including freedom from coercion or other pressures to decide in a parti-<br \/>\ncular way.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0Pilanesberg<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20102006-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nAssisted<br \/>\n \u00a0Reproductive<br \/>\n \u00a0Technologies<br \/>\n \u00a0<br \/>\n6. Assisted conception differs from the treatment of illness in that the inability to be-<br \/>\ncome a parent without medical intervention is not always regarded as an illness.<br \/>\nWhile it may have profound psychosocial, and thus medical, consequences, it is not in<br \/>\nitself life limiting. It is, however, a significant cause of major psychological illness<br \/>\nand its treatment is clearly medical.<br \/>\n7. Obtaining informed consent from those considering undertaking treatment must in-<br \/>\nclude consideration of the alternatives, including accepting childlessness or pursuing<br \/>\nadoption, the risks associated with the various techniques, and the possibility of failure.<br \/>\nIn many jurisdictions the process of obtaining consent must follow a process of infor-<br \/>\nmation giving and the offer of counselling and might also include a formal assessment<br \/>\nof the patient in terms of the welfare of the potential child.<br \/>\n8. Patients seeking assisted reproductive technologies are entitled to the same level of<br \/>\nconfidentiality and privacy as for any other medical treatment.<br \/>\n9. Assisted reproductive technology always involves handling and manipulation of hu-<br \/>\nman gametes and embryos. Different individuals regard this with different levels of<br \/>\nconcern but there is general agreement that these special concerns should be met by<br \/>\nspecific safeguards to protect from abuse. In some jurisdictions all centres handling<br \/>\nsuch materials require a licence and must demonstrate compliance with high norma-<br \/>\ntive standards.<br \/>\nSUCCESS<br \/>\n \u00a0OF<br \/>\n \u00a0THE<br \/>\n \u00a0TECHNIQUES<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. The success of different techniques may differ widely from centre to centre. Physi-<br \/>\ncians have an obligation to give realistic information about success rates to potential<br \/>\npatients. If their success rates are widely different from the current norm they should<br \/>\ndisclose this fact to patients. They also have an obligation to consider the reasons for<br \/>\nthis as they might relate to poor practice, and if so, to correct their deficiencies.<br \/>\nMULTIPLE<br \/>\n \u00a0PREGNANCIES<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. Replacement of more than one embryo may raise the likelihood of at least one embryo<br \/>\nimplanting. This is offset by the increased risk, especially of premature labour, in<br \/>\nmultiple pregnancies. The risk of twin pregnancies, while higher than that of singleton<br \/>\npregnancies, is considered acceptable by most people. Practitioners should follow pro-<br \/>\nfessional guidance on the maximum number of embryos to be transferred per treat-<br \/>\nment cycle. If multiple pregnancies occur, selective termination might be considered<br \/>\non medical grounds to increase the chances of the pregnancy proceeding to term<br \/>\nwhere this is compatible with the national law and code of ethics.<br \/>\nDONATION<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. Some patients are unable to produce usable gametes. They require ova or sperm from<br \/>\ndonors. Donation should follow counselling and be carefully controlled to avoid<br \/>\nabuses, including coercion of potential donors. It is inappropriate to offer money or<br \/>\nbenefits in kind (for example free or lower cost treatment cycles) to encourage dona-<br \/>\ntion but donors may be reimbursed for reasonable expenses.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102006-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n2. Where a child is born following donation, families should be encouraged to be open<br \/>\nwith him\/her about this, irrespective of whether domestic law entitles the child to<br \/>\ninformation about the donor. Keeping secrets within families is difficult and can be<br \/>\nharmful to children if information about donor conception is disclosed inadvertently<br \/>\nand without appropriate support.<br \/>\nPRE-\u00ad\u2010IMPLANTATION<br \/>\n \u00a0GENETIC<br \/>\n \u00a0DIAGNOSIS<br \/>\n \u00a0(PGD)<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. Pre-implantation genetic diagnosis (PGD) may be performed on early embryos to<br \/>\nsearch for the presence of genetic or chromosomal abnormalities, especially those<br \/>\nassociated with severe illness and very premature death and for other reasons, includ-<br \/>\ning identifying those embryos most likely to implant successfully in women who have<br \/>\nhad multiple spontaneous abortions. Embryos carrying the abnormality are discarded;<br \/>\nonly embryos with apparently normal genetic and chromosomal complements are im-<br \/>\nplanted.<br \/>\n2. Neither this powerful technique nor simpler means should be used for trivial reasons<br \/>\nsuch as sex selection for reasons of gender preference. The WMA holds that physi-<br \/>\ncians should only be involved with sex selection where it is used to avoid a serious<br \/>\nsex-chromosome related condition such as Duchenne&#8217;s Muscular Dystrophy.<br \/>\n3. PGD can also be combined with HLA matching to select embryos on the basis that<br \/>\nstem cells from the resulting child&#8217;s umbilical cord blood could be used to treat a<br \/>\nseriously ill sibling. Views on the acceptability of this practice vary and physicians<br \/>\nshould follow national laws and local ethical and professional standards if confronted<br \/>\nwith such requests.<br \/>\nUSE<br \/>\n \u00a0OF<br \/>\n \u00a0SPARE<br \/>\n \u00a0GAMETES<br \/>\n \u00a0AND<br \/>\n \u00a0EMBRYOS<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nAND<br \/>\n \u00a0DISPOSAL<br \/>\n \u00a0OF<br \/>\n \u00a0UNUSED<br \/>\n \u00a0GAMETES<br \/>\n \u00a0AND<br \/>\n \u00a0EMBRYOS<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. In most cases, assisted conception results in the production of gametes and embryos<br \/>\nthat will not be used to treat those from whom they are procured. Such so-called spare<br \/>\ngametes and embryos may be stored, cryo-preserved for future use, donated to other<br \/>\npatients or disposed of. One alternative to disposal, in countries that permit embryo<br \/>\nresearch, is donation to a research facility. The available options must be explained<br \/>\nclearly and precisely to individuals before donations are made or retrievals performed.<br \/>\nSURROGACY<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. Where a woman is unable, for medical reasons, to carry a child to term, surrogacy<br \/>\nmay be used to overcome childlessness, unless prohibited by national law or the ethi-<br \/>\ncal rules of the National Medical Association or other relevant organisation. Where<br \/>\nsurrogacy is practised, great care must be taken to protect the interests of all parties<br \/>\ninvolved.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0Pilanesberg<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20102006-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nAssisted<br \/>\n \u00a0Reproductive<br \/>\n \u00a0Technologies<br \/>\n \u00a0<br \/>\nRESEARCH<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. Physicians should promote the importance of research using tissues obtained during<br \/>\nassisted conception procedures. Because of the special status of the material being<br \/>\nused, research on human gametes and especially on human embryos is, in many juris-<br \/>\ndictions, specifically regulated. Physicians have an ethical duty to comply with such<br \/>\nregulation and to help inform public debate and understanding of the issues.<br \/>\n2. Due to the special nature of human embryos, research should be carefully controlled<br \/>\nand should be limited to areas in which the use of alternative materials will not pro-<br \/>\nvide an adequate alternative.<br \/>\n3. Views, and legislation, differ on whether embryos may be created specifically for, or<br \/>\nin the course of, research. Physicians should act in accordance with national legisla-<br \/>\ntion and local ethical advice.<br \/>\nCELL<br \/>\n \u00a0NUCLEAR<br \/>\n \u00a0REPLACEMENT<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. The WMA opposes the use of cell nuclear replacement with the aim of cloning human<br \/>\nbeings.<br \/>\n2. Cell nuclear replacement may also be used to develop embryonic stem cells for<br \/>\nresearch and ultimately, it is hoped, for therapy for many serious diseases. Views on<br \/>\nthe acceptability of such research differ and physicians wishing to participate in such<br \/>\nresearch should ensure that they are acting in accordance with national laws and local<br \/>\nethical guidance.<br \/>\nRECOMMENDATIONS<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. Assisted reproductive technology is a dynamic, rapidly developing field of medical<br \/>\npractice. Developments should be subject to careful ethical consideration alongside<br \/>\nthe scientific monitoring.<br \/>\n2. Human gametes and embryos are accorded a special status. Their use, including for<br \/>\nresearch, donation to others and disposal, should be carefully explained to potential<br \/>\ndonors and subject to local regulation.<br \/>\n3. Embryo research should only be carried out if local law and ethical standards permit it<br \/>\nand should be limited to areas where the use of alternative materials or computer<br \/>\nmodelling does not provide an adequate alternative.<br \/>\n4. Physicians should follow professional guidance on the maximum number of embryos<br \/>\nto transfer in any treatment cycle.<br \/>\n5. It is inappropriate to offer money or benefits in kind (for example free or lower cost<br \/>\ntreatment cycles) to encourage donation but donors may be reimbursed for reasonable<br \/>\nexpenses.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102006-\u00ad\u201001-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\n6. Families using donated embryos or gametes should be encouraged and supported to<br \/>\nbe open with the child about this.<br \/>\n7. Sex selection should only be carried out to avoid serious, including life threatening,<br \/>\nmedical conditions.<br \/>\n8. Physicians have an important role in ensuring that public debate about the possibilities<br \/>\nof assisted conception, and the limits to be applied to its practice, is informed.<br \/>\n9. Physicians should comply with national legislation and should demonstrate com-<br \/>\npliance with high normative standards.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20102006-\u00ad\u201002-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nAVIAN<br \/>\n \u00a0AND<br \/>\n \u00a0PANDEMIC<br \/>\n \u00a0INFLUENZA<br \/>\n \u00a0<br \/>\nAdopted by the 57th<br \/>\nWMA General Assembly, Pilanesberg, South Africa, October 2006<br \/>\n1. This statement provides guidance to National Medical Associations and physicians on<br \/>\nhow they should be involved in their respective country&#8217;s pandemic planning process.<br \/>\nIt also encourages governments to involve their National Medical Associations when<br \/>\nplanning for pandemic influenza. Finally, it provides broadly stated recommendations<br \/>\nabout activities that physicians should consider in preparing themselves for pandemic<br \/>\ninfluenza.<br \/>\nAVIAN<br \/>\n \u00a0INFLUENZA<br \/>\n \u00a0VERSUS<br \/>\n \u00a0PANDEMIC<br \/>\n \u00a0INFLUENZA<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. Avian influenza (bird flu) is a contagious common viral infection of birds and, less<br \/>\ncommonly, pigs. Two forms have been identified: less pathogenic avian influenza<br \/>\n(LPAI) and highly pathogenic avian influenza (HPAI), which is extremely contagious<br \/>\nand has nearly a 100% mortality rate in birds. Avian influenza viruses differ from<br \/>\nhuman influenza viruses. While avian influenza viruses do not normally infect hu-<br \/>\nmans, since 1997 several cases of human infection have been documented.<br \/>\n2. The current H5N1 HPAI virus is a subtype of influenza type A viruses and was first<br \/>\nisolated from South African terns in 1961. The current outbreak started in late 2003<br \/>\nand early 2004 in eight countries in Asia. While originally reported as controlled,<br \/>\nsince June 2004 new outbreaks of H5N1 have reappeared. Migratory and smuggled<br \/>\nbirds are likely to be responsible for the spread of H5N1. The infected birds shed<br \/>\nlarge quantities of virus in their feces, and exposure to infected droppings or to en-<br \/>\nvironments contaminated by the virus is common. It is anticipated that H5N1 will<br \/>\ncontinue to spread along the migratory pathways of wild birds. Most human infections<br \/>\nhave occurred in rural areas where freely-roaming small poultry flocks are kept.<br \/>\n3. HPAI is controlled by rapidly destroying all infected and\/or exposed birds, by proper<br \/>\ndisposal of the carcasses, and by quarantining and rigorous disinfection of farms. In<br \/>\norder to contain an outbreak, aggressive measures are needed immediately after the<br \/>\noutbreak is detected.<br \/>\n4. Human pandemic influenza occurs three to four times a century and can take place in<br \/>\nany season, not just winter. Pandemic influenza results from the emergence of a new<br \/>\nhuman influenza strain to which no human immunity exists. This new human pan-<br \/>\ndemic strain can arise from either avian influenza strains or from influenza viruses<br \/>\ninfecting swine and potentially other mammalian species. It is usually associated with<br \/>\na higher severity of illness and, consequently, a higher risk of death. All age groups<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20102006-\u00ad\u201002-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Pilanesberg<br \/>\n \u00a0<br \/>\nAvian<br \/>\n \u00a0and<br \/>\n \u00a0Pandemic<br \/>\n \u00a0Influenza<br \/>\n \u00a0<br \/>\nmay be at risk, and experts predict an infection rate of 25-50% of the population,<br \/>\ndepending on the severity of the strain. Since the virus strain cannot be accurately<br \/>\npredicted, a vaccine against pandemic flu may not be available until several months<br \/>\nafter the pandemic begins. A major factor in protecting populations will be the time<br \/>\nfrom emergence of a new strain to the development and manufacture of vaccine. It is<br \/>\nhypothesized that use of anti-virals may control the progression of a pandemic fol-<br \/>\nlowing its emergence, so adequate supplies of anti-virals are important. At all phases<br \/>\nof a pandemic outbreak, but especially during the period when vaccine is unavailable,<br \/>\ninfection control is critical.<br \/>\n5. Health officials are concerned that avian influenza, if given the right opportunities,<br \/>\ncould mutate to form a new strain of human influenza virus against which humans<br \/>\nhave no immunity or existing vaccine &#8211; a pandemic strain. It is apparent that H5N1<br \/>\nhas the capacity to directly jump the species barrier and cause serious disease in<br \/>\nhumans but thus far, H5N1 has demonstrated very limited, if any, human transmission<br \/>\npotential. A new pandemic virus could develop if a human became simultaneously<br \/>\ninfected with H5N1 and a human influenza virus, resulting in gene swapping. Also,<br \/>\nthe H5N1 virus could mutate on its own. With this new virus strain, direct human-to-<br \/>\nhuman transmission could result, and if the virus remains highly pathogenic, a<br \/>\npandemic with high mortality rates could occur. This is believed to have happened in<br \/>\nthe worst pandemic of the 20th century, the \u00abSpanish Flu\u00bb of 1918, that killed 50<br \/>\nmillion people worldwide.<br \/>\n6. Even though the H5N1 virus is not easily transmitted to humans, any H5N1 human<br \/>\ninfection provides an opportunity for co-existence with a human influenza virus.<br \/>\nConsequently, the World Health Organization (WHO) and other health organizations<br \/>\nrecommend that any person coming in contact with infected poultry receive the cur-<br \/>\nrent annual flu vaccine. Since it is not yet known whether residual immunity to the N1<br \/>\ncomponent of the annual vaccine provides any immunity to H5N1, there is no way to<br \/>\naccurately predict the severity of the next pandemic. It is important to recognize that<br \/>\nwhile there is current concern surrounding H5N1, a pandemic influenza strain may<br \/>\nnot arise from H5N1 but may come from another HPAI strain. Regardless, the odds<br \/>\nare great that another pandemic will occur.<br \/>\nPRINCIPLES<br \/>\n \u00a0OF<br \/>\n \u00a0PANDEMIC<br \/>\n \u00a0INFLUENZA<br \/>\n \u00a0PLANNING<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nThe<br \/>\n \u00a0Role<br \/>\n \u00a0of<br \/>\n \u00a0Governments<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. The WHO has responsibility for co-ordinating the international response to an in-<br \/>\nfluenza pandemic. It has defined phases in the evolution of a pandemic that allow an<br \/>\nescalating approach to preparedness planning and response leading up to a declaration<br \/>\nof onset of a pandemic.<br \/>\n2. The development of a national pandemic plan, will, by necessity, be led by the na-<br \/>\ntional government, but physicians should be involved at all stages. While each nation<br \/>\nwill have unique situations to address, the following pandemic preparedness princi-<br \/>\nples apply:<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20102006-\u00ad\u201002-\u00ad\u20102006<br \/>\n \u00a0<br \/>\na. Define key preparedness issues, needs, and goals.<br \/>\n1. The prioritization of one or two goals for the nation&#8217;s pandemic planning is<br \/>\nessential. Depending on these goals, the prioritization and use of vaccines<br \/>\nand antivirals will vary. For example, a goal of reducing morbidity and mor-<br \/>\ntality due to influenza will have very different planning criteria from a goal<br \/>\nof preserving societal infrastructure.<br \/>\n2. Defining the nation&#8217;s needs in the event of a pandemic will require making<br \/>\nsome basic assumptions about the severity of the pandemic in the nation.<br \/>\nBased upon that assumption, it will then be possible to make some predic-<br \/>\ntions about the issues and needs facing the country. It will be useful to con-<br \/>\nsult with other nations that have prepared pandemic plans to see what<br \/>\nchallenges they faced in identifying their needs and issues.<br \/>\nb. In countries where there is a substantial presence of healthcare professionals in<br \/>\nthe private sector, involve those in the private sector, who will be managing the<br \/>\npandemic on the ground, particularly physicians, in the decision-making process.<br \/>\nThe administration of millions of doses of antivirals and vaccine to the manage-<br \/>\nment of surge capacity and hospital beds will all require specific participation of<br \/>\nthose most knowledgeable and involved in the process.<br \/>\nc. Prepare risk communication and crisis communication strategies and messages in<br \/>\nanticipation of public and media fear and anxiety.<br \/>\nd. Provide guidance and timely information to regional health departments, health<br \/>\ncare organizations, and physicians. Utilize physicians as spokespeople to explain<br \/>\nthe medical and ethical issues to the public. Ensure that communications mecha-<br \/>\nnisms and infrastructure continue to function efficiently.<br \/>\n1. As planning proceeds, timely and clear information not only of the plan, but<br \/>\nalso of the rationale behind decisions, needs to be made available to public<br \/>\nhealth authorities and the medical establishment as well as to the public.<br \/>\nPhysician leaders in a community are well-respected and frequently can<br \/>\nserve as excellent spokespersons to educate the public about the issues sur-<br \/>\nrounding pandemic planning. Public feedback into important decisions that<br \/>\nmay have moral and ethical implications will help secure public acceptance<br \/>\nof the plan. For example, holding a public engagement process to assess the<br \/>\npublic&#8217;s opinion about rationing of vaccine during a pandemic can be useful.<br \/>\n2. It is important that government representatives and physicians speak with<br \/>\none voice in order to avoid confusion and panic during a pandemic event.<br \/>\ne. Identify the legal issues and authorities for pandemic responses, e.g. liability,<br \/>\nquarantine, closing borders.<br \/>\nAuthorities will need to make decisions that range in complexity from local deci-<br \/>\nsions to close public areas to national decisions regarding border closings and\/or<br \/>\nquarantine\/isolation of exposed\/infected citizens. The legal and ethical issues sur-<br \/>\nrounding these decisions need to be in place prior to a pandemic.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20102006-\u00ad\u201002-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Pilanesberg<br \/>\n \u00a0<br \/>\nAvian<br \/>\n \u00a0and<br \/>\n \u00a0Pandemic<br \/>\n \u00a0Influenza<br \/>\n \u00a0<br \/>\nf. Determine the order of importance for use of scarce resources such as vaccines<br \/>\nand antivirals based on pandemic response goals. Priority groups chosen for vac-<br \/>\ncine should be those that help maintain essential community services and those at<br \/>\nhighest risk.<br \/>\ng. Do not put physicians in the position of being responsible for decisions regarding<br \/>\nthe rationing of vaccine, antivirals and other scarce resources during a pandemic.<br \/>\nThose decisions must be made by the government.<br \/>\nh. Outline coordination and implementation of a response by stages of the pande-<br \/>\nmic.<br \/>\nDepending on the size of a country, this response may be at a national level or at<br \/>\na regional level. Large countries may see the pandemic occur in waves in which<br \/>\ncase affected regions will need to have their own response ready to be imple-<br \/>\nmented.<br \/>\ni. Consider the surge capacity of hospitals, laboratories, and the public health infra-<br \/>\nstructure and improve them if necessary. Prepare for absences of key staff and the<br \/>\nneed to maintain health services for conditions other than influenza.<br \/>\nj. Prepare for the psychosocial impact on health care workers in managing the<br \/>\nwaves of a pandemic.<br \/>\nk. Consider whether the safety of those in facilities managing the pandemic must be<br \/>\nensured, such as police protection of the supply chain for vaccines and antivirals.<br \/>\nAddress what might be needed to control a pandemic in the absence of a vaccine.<br \/>\nl. Assess whether there is sufficient funding available to adequately prepare for<br \/>\npandemic influenza.<br \/>\nPolitical will to fund public health preparedness is essential. Resources spent on<br \/>\npandemic planning should be framed in the context of general preparedness; pan-<br \/>\ndemic preparedness and public health preparedness share many of the same<br \/>\nissues.<br \/>\nm. Identify key issues that remain to be resolved, which may include management of<br \/>\npatients in the community, triage in hospitals, ventilation management, safe<br \/>\nhandling of bodies, and death investigations and reports.<br \/>\nThe<br \/>\n \u00a0Role<br \/>\n \u00a0of<br \/>\n \u00a0the<br \/>\n \u00a0National<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0(NMA)<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. In any disaster situation or infectious disease outbreak, physicians and their pro-<br \/>\nfessional organisations will be challenged to continue to provide needed care to the<br \/>\nvulnerable and sick, as well as to aid in the emergency response called for in the spe-<br \/>\ncific situation. The following issues should be considered in this regard:<br \/>\na. NMAs should have their own organization-specific business contingency plan in<br \/>\nplace to ensure continued support of their members.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20102006-\u00ad\u201002-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nMany existing plans anticipate disruptions such as fires, earthquakes, and floods<br \/>\nthat are geographically restricted and have fairly well defined timeframes. How-<br \/>\never, pandemic influenza planning requires assumptions that the influenza will be<br \/>\nwidely dispersed geographically and will potentially last many months.<br \/>\nb. NMAs should clearly identify their responsibilities during a pandemic.<br \/>\nThe NMA should actively seek participation in the nation&#8217;s pandemic planning<br \/>\nprocess. If this is achieved, the NMA&#8217;s responsibilities will also be clearly de-<br \/>\nfined to its physicians as well as to the government.<br \/>\nc. For effective global pandemic influenza planning, NMAs should collaborate and<br \/>\nnetwork with NMAs from other countries.<br \/>\nMany NMAs have already been involved in their countries&#8217; pandemic planning<br \/>\nprocess. Challenges and key roles for the NMA that have been identified should<br \/>\nbe shared.<br \/>\nd. NMAs should have an essential role in communicating vital information:<br \/>\n1. To the public. As the authoritative medical voice, an NMA engenders public<br \/>\ntrust and should use that trust to communicate accurate and timely informa-<br \/>\ntion regarding pandemic planning and the current state of the pandemic to the<br \/>\npublic;<br \/>\n2. Between authorities and physicians, and between physicians in affected areas<br \/>\nand their colleagues elsewhere;<br \/>\n3. Between health care professionals. NMAs should work with other health care<br \/>\nprovider organizations (e.g., nurses, hospital groups) to identify common<br \/>\nissues and congruent policies and messages regarding pandemic prepared-<br \/>\nness and response.<br \/>\ne. NMAs should offer training seminars and clinical support tools, such as online<br \/>\nand e-published self-help training materials, for physicians and regional medical<br \/>\nassociations.<br \/>\nSuch training\/tools should consider how, in a worst-case pandemic scenario,<br \/>\nphysicians will manage respiratory crises without intensive or critical care facili-<br \/>\nties. Training should also be given in triage strategies and how infected patients<br \/>\nshould be counselled.<br \/>\nf. NMAs should consider what new programs and services they might offer during<br \/>\na pandemic, such as coordination or provision of mental health crisis support<br \/>\nprograms for affected members and their families, facilitation of health emer-<br \/>\ngency response teams, emergency locum relief, and facilitation of equipment<br \/>\nsupply lines.<br \/>\ng. NMAs should be involved in and support the development and implementation of<br \/>\ngovernment plans while still considering their own professional code of ethics.<br \/>\nThey should monitor and assess the implementation of said plans to ensure that as<br \/>\npandemic outbreaks cycle through their natural history, health interests remain<br \/>\nparamount.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20102006-\u00ad\u201002-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Pilanesberg<br \/>\n \u00a0<br \/>\nAvian<br \/>\n \u00a0and<br \/>\n \u00a0Pandemic<br \/>\n \u00a0Influenza<br \/>\n \u00a0<br \/>\nh. NMAs should advocate for adequate government funding to prepare for pandemic<br \/>\ninfluenza.<br \/>\ni. NMAs should anticipate the different practice environments that may evolve<br \/>\nduring pandemic conditions and be prepared to discuss liability and related issues<br \/>\nwith health authorities and advise members on such issues.<br \/>\nj. NMAs should be prepared to advocate on behalf of members who, during a pan-<br \/>\ndemic, will have rapidly emerging professional needs that must be met, and on<br \/>\nbehalf of patients and the public who will be affected by the unfolding events.<br \/>\nThe<br \/>\n \u00a0Role<br \/>\n \u00a0of<br \/>\n \u00a0the<br \/>\n \u00a0Physician<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. Physicians will be the first point of contact and source for advice for many as a<br \/>\npandemic evolves. The following are broad issues that physicians should consider in<br \/>\nthe event of a pandemic:<br \/>\na. Be sufficiently educated about pandemic influenza and transmission risks.<br \/>\nCommunication about the actual risks of pandemic influenza is important to<br \/>\nimpart a sense of urgency without creating undue public alarm. Consider active<br \/>\nphysician participation in the media response to a pandemic.<br \/>\nb. Be vigilant for the possibility of severe or emerging respiratory diseases, espe-<br \/>\ncially in patients who have recently travelled internationally.<br \/>\nAs with any emerging infection, the astute physician is one of the important sur-<br \/>\nveillance tools for detecting and managing an outbreak.<br \/>\nc. Plan for how to manage high-risk patients in the office\/clinic setting and com-<br \/>\nmunicate the plan to clinic staff.<br \/>\nIsolation and infection control plans must be available and staff should be well-<br \/>\nversed in them. Be aware of what regional public health authorities are requesting<br \/>\nbe done with potential patients and their exposed contacts.<br \/>\nd. Plan how to concurrently manage patients with chronic illnesses who require<br \/>\nroutine medical management.<br \/>\ne. Plan accordingly for possible interruptions of essential services like sanitation,<br \/>\nwater, power, and disruptions to the food supply. Plan for the possibility of staff<br \/>\nshortages because of personal illness and\/or the care of next-of-kin who are ill.<br \/>\nIt is vital to have contingency plans in place to deal with possible societal disrup-<br \/>\ntion. Recognize that usual sources of these essential services may not be function-<br \/>\ning so identifying alternative sources for these essentials may be necessary.<br \/>\nf. Prepare educational materials for patients and staff, including recommendations<br \/>\nfor proper infection control.<br \/>\nAn educated patient\/public that recognizes the necessity for stringent measures<br \/>\nsuch as quarantine and isolation will make a physician&#8217;s job easier should s\/he<br \/>\nhave to utilize such procedures when a pandemic occurs.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20102006-\u00ad\u201002-\u00ad\u20102006<br \/>\n \u00a0<br \/>\ng. Remain involved in local pandemic planning efforts and understand how the plan<br \/>\nwill affect the physician. Participate in local simulation exercises.<br \/>\nSince physicians will be on the frontlines of monitoring, reporting, and event-<br \/>\nually managing pandemic influenza patients, they must be closely involved in the<br \/>\nplanning process. They must continuously provide feedback as to what is logisti-<br \/>\ncally possible regarding physicians&#8217; efforts on the ground when a pandemic arrives.<br \/>\nh. Physicians have an ethical responsibility to provide services to the injured or ill.<br \/>\nThey should have resources in place in the event they and\/or their own families<br \/>\nbecome infected.<br \/>\n1. A physician will have a strong public health duty in the time of a pandemic<br \/>\nand his\/her services will be critical at a time when surge capacity will be<br \/>\nstressed. Physicians should make arrangements for the care of their families<br \/>\nand dependents in the event of a pandemic.<br \/>\n2. Physicians should take all measures necessary to protect their own health and<br \/>\nthe health of their staff.<br \/>\n3. Physicians can also consult the WMA Statement on Medical Ethics in the<br \/>\nEvent of Disasters for additional guidance.<br \/>\ni. Develop a clinic plan to decrease potential for contact including isolation areas<br \/>\nfor infected patients, use of close-fitting surgical masks, designating separate<br \/>\nblocks of time for non-influenza-related patient care, and postponing non-<br \/>\nessential medical visits.<br \/>\nj. Review staff infection control procedures and train staff in the use of personal<br \/>\nprotective equipment. Provide signage in the office instructing patients on respi-<br \/>\nratory hygiene practices; provide tissues, receptacles for their disposal, and hand<br \/>\nhygiene materials in waiting areas and examination rooms.<br \/>\nk. Get vaccinated against annual influenza each year and urge all staff to be vac-<br \/>\ncinated.<br \/>\nAnnual influenza readiness goes a long way for pandemic preparedness. Addi-<br \/>\ntionally, it is possible that components in the annual vaccine (e.g., N1) may pro-<br \/>\nvide some immunity against H5N1.<br \/>\nl. Work to ensure that the office\/clinic has access to adequate supplies of antibiotic<br \/>\nand antiviral medications as well as commonly prescribed drugs like insulin or<br \/>\nwarfarin, in case the pharmaceutical supply line is disrupted.<br \/>\nRECOMMENDATIONS<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. That the WMA increase its collaboration with the WHO on pandemic planning and<br \/>\ncommit to becoming an important participant in the decision-making process.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20102006-\u00ad\u201002-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Pilanesberg<br \/>\n \u00a0<br \/>\nAvian<br \/>\n \u00a0and<br \/>\n \u00a0Pandemic<br \/>\n \u00a0Influenza<br \/>\n \u00a0<br \/>\n2. That the WMA communicate to the WHO its capabilities and the capabilities of its<br \/>\nNMA members to provide a credible voice that can efficiently reach many practising<br \/>\nphysicians.<br \/>\n3. That the WMA acknowledge that although pandemic planning is a country-specific<br \/>\ntask, it can provide general principles for guidance. Additionally, the WMA can pro-<br \/>\nvide basic advice that can be given by its member NMAs to practising physicians.<br \/>\n4. That the WMA establish an operational capacity to develop and maintain emergency<br \/>\ncommunication channels between the WMA and NMAs during a pandemic.<br \/>\n5. That the WMA provide timely evidence-based control measures to countries with no<br \/>\nor limited up-dated information about pandemics.<br \/>\n6. That NMAs be actively involved in the national pandemic planning process.<br \/>\n7. That physicians participate in local pandemic planning efforts and be involved in<br \/>\ncommunicating vital information to the public.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20102006-\u00ad\u201003-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nHIV\/AIDS<br \/>\n \u00a0AND<br \/>\n \u00a0THE<br \/>\n \u00a0MEDICAL<br \/>\n \u00a0PROFESSION<br \/>\n \u00a0<br \/>\nAdopted by the 57th<br \/>\nWMA General Assembly, Pilanesberg, South Africa, October 2006<br \/>\nINTRODUCTION<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. HIV\/AIDS is a global pandemic that has created unprecedented challenges for physi-<br \/>\ncians and health infrastructures. In addition to representing a staggering public health<br \/>\ncrisis, HIV\/AIDS is also fundamentally a human rights issue. Many factors drive the<br \/>\nspread of the disease, such as poverty, homelessness, illiteracy, prostitution, human<br \/>\ntrafficking, stigma, discrimination and gender-based inequality. Efforts to tackle the<br \/>\ndisease are constrained by the lack of human and financial resources available in<br \/>\nhealth care systems. These social, economic, legal and human rights factors affect not<br \/>\nonly the public health dimension of HIV\/AIDS but also individual physicians\/health<br \/>\nworkers and patients, their decisions and relationships.<br \/>\nDISCRIMINATION<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. Unfair discrimination against HIV\/AIDS patients by physicians must be eliminated<br \/>\ncompletely from the practice of medicine.<br \/>\na. All persons infected or affected by HIV\/AIDS are entitled to adequate preven-<br \/>\ntion, support, treatment and care with compassion and respect for human dignity.<br \/>\nb. A physician may not ethically refuse to treat a patient whose condition is within<br \/>\nhis or her current realm of competence, solely because the patient is seropositive.<br \/>\nc. National Medical Associations should work with governments, patient groups<br \/>\nand relevant national and international organizations to ensure that national<br \/>\nhealth policies clearly and explicitly prohibit discrimination against people in-<br \/>\nfected with or affected by HIV\/AIDS.<br \/>\nAPPROPRIATE<br \/>\n \u00a0\/<br \/>\n \u00a0COMPETENT<br \/>\n \u00a0MEDICAL<br \/>\n \u00a0CARE<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. Patients with HIV\/AIDS must be provided with competent and appropriate medical<br \/>\ncare at all stages of the disease.<br \/>\n2. A physician who is not able to provide the care and services required by patients with<br \/>\nHIV\/AIDS should make an appropriate referral to those physicians or facilities that<br \/>\nare equipped to provide such services. Unless or until the referral can be accom-<br \/>\nplished, the physician must care for the patient to the best of his or her ability.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20102006-\u00ad\u201003-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Pilanesberg<br \/>\n \u00a0<br \/>\nHIV\/AIDS<br \/>\n \u00a0and<br \/>\n \u00a0the<br \/>\n \u00a0Medical<br \/>\n \u00a0Profession<br \/>\n \u00a0<br \/>\n3. Physicians and other appropriate bodies should ensure that patients have accurate<br \/>\ninformation regarding means of transmission of HIV\/AIDS and strategies to protect<br \/>\nthemselves against infection. Proactive measures should be taken to ensure that all<br \/>\nmembers of the population, and at-risk groups in particular, are educated to this effect.<br \/>\n4. With reference to those patients who are found to be seropositive, physicians must be<br \/>\nable to effectively counsel them regarding: (a) responsible behaviour to prevent the<br \/>\nspread of the disease; (b) strategies for their own health protection; and (c) the<br \/>\nnecessity of alerting sexual and needle-sharing contacts, past and present, as well as<br \/>\nother relevant contacts (such as medical and dental personnel) regarding their possible<br \/>\ninfection.<br \/>\n5. Physicians must recognize that many people still believe HIV\/AIDS to be an auto-<br \/>\nmatic and immediate death sentence and therefore will not seek testing. Physicians<br \/>\nmust ensure that patients have accurate information regarding the treatment options<br \/>\navailable to them. Patients should understand the potential of antiretroviral treatment<br \/>\n(ART) to improve not only their medical condition but also the quality of their lives.<br \/>\nEffective ART can greatly extend the period of time that patients are able to lead<br \/>\nhealthy productive lives, functioning socially and in the workplace and maintaining<br \/>\ntheir independence. HIV\/AIDS is increasingly looked upon as a manageable chronic<br \/>\ncondi-tion.<br \/>\n6. While strongly advocating ART as the best course of action for HIV\/AIDS patients,<br \/>\nphysicians must also ensure that their patients are fully and accurately informed about<br \/>\nall aspects of ART, including potential toxicity and side effects. Physicians must also<br \/>\ncounsel patients honestly about the possibility of failure of first line ART, and the<br \/>\nsubsequent options should failure occur. The importance of adhering to the regimens<br \/>\nand thereby reducing the risk of failure should be emphasized.<br \/>\n7. Physicians should be aware that misinformation regarding the negative aspects of<br \/>\nART has created resistance toward treatment by patients in some areas. Where mis-<br \/>\ninformation is being spread about ART, physicians and medical associations must<br \/>\nmake it an immediate priority to publicly challenge the source of the misinformation<br \/>\nand to work with the HIV\/AIDS community to counteract the negative effects of the<br \/>\nmisinformation.<br \/>\n8. Physicians should encourage the involvement of support networks to assist patients in<br \/>\nadhering to ART regimens. With the patient&#8217;s consent, counselling and training should<br \/>\nbe available to family members to assist them in providing family based care. Physi-<br \/>\ncians must recognize families and other support networks as crucial partners in ad-<br \/>\nherence strategies and, in many places, the only means to adequately expand the care<br \/>\nsystem so that patients receive the required attention.<br \/>\n9. Physicians must be aware of the discriminatory attitudes toward HIV\/AIDS that are<br \/>\nprevalent in society and local culture. Because physicians are the first, and sometimes<br \/>\nthe only, people who are informed of their patients&#8217; HIV status, physicians should be<br \/>\nable to counsel them about their basic social and legal rights and responsibilities or<br \/>\nshould refer them to counsellors who specialize in the rights of persons living with<br \/>\nHIV\/AIDS.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20102006-\u00ad\u201003-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nTESTING<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. Mandatory testing for HIV must be required of: donated blood and blood fractions<br \/>\ncollected for donation or to be used in the manufacture of blood products; organs and<br \/>\nother tissues intended for transplantation; and semen or ova collected for assisted<br \/>\nreproduction procedures.<br \/>\n2. Mandatory HIV testing of an individual against his or her will is a violation of<br \/>\nmedical ethics and human rights. Exceptions to this rule may be made only in the<br \/>\nmost extreme cases and should be subject to review by an ethics panel or to judicial<br \/>\nreview.<br \/>\n3. Physicians must clearly explain the purpose of an HIV test, the reasons it is recom-<br \/>\nmended and the implications of a positive test result. Before a test is administered, the<br \/>\nphysician should have an action plan in place in case of a positive test result.<br \/>\nInformed consent must be obtained from the patient prior to testing.<br \/>\n4. While certain groups are labelled \u00abhigh risk\u00bb, anyone who has had unprotected sex<br \/>\nshould be considered at some risk. Physicians must become increasingly proactive<br \/>\nabout recommending testing to patients, based on a mutual understanding of the level<br \/>\nof risk and the potential to benefit from testing. Pregnant women should routinely be<br \/>\noffered testing.<br \/>\n5. Counselling and voluntary anonymous testing for HIV should be available to all<br \/>\npersons who request it, along with adequate post-testing support mechanisms.<br \/>\nPROTECTION<br \/>\n \u00a0FROM<br \/>\n \u00a0HIV<br \/>\n \u00a0IN<br \/>\n \u00a0THE<br \/>\n \u00a0HEALTH<br \/>\n \u00a0CARE<br \/>\n \u00a0ENVIRONMENT<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. Physicians and all health care workers have the right to a safe work environment.<br \/>\nEspecially in developing countries, the problem of occupational exposure to HIV has<br \/>\ncontributed to high attrition rates of the health labour force. In some cases, employees<br \/>\nbecome infected with HIV, and in other cases fear of infection causes health care<br \/>\nworkers to leave their jobs voluntarily. Fear of infection among health workers can<br \/>\nalso lead to refusal to treat HIV\/AIDS patients. Likewise, patients have the right to be<br \/>\nprotected to the greatest degree possible from transmission of HIV from health<br \/>\nprofessionals and in health care institutions.<br \/>\na. Proper infection control procedures and universal precautions consistent with the<br \/>\nmost current national or international standards, as appropriate, should be imple-<br \/>\nmented in all health care facilities. This includes procedures for the use of pre-<br \/>\nventive ART for health professionals who have been exposed to HIV.<br \/>\nb. If the appropriate safeguards for protecting physicians or patients against infec-<br \/>\ntion are not in place, physicians and National Medical Associations should take<br \/>\naction to correct the situation.<br \/>\nc. Physicians who are infected with HIV should not engage in any activity that<br \/>\ncreates a risk of transmission of the disease to others. In the context of possible<br \/>\nexposure to HIV, the activity in which the physician wishes to engage will be the<br \/>\ndetermining factor. Whether or not an activity is acceptable should be determined<br \/>\nby a panel or committee of health care workers with specific expertise in infec-<br \/>\ntious diseases.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20102006-\u00ad\u201003-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Pilanesberg<br \/>\n \u00a0<br \/>\nHIV\/AIDS<br \/>\n \u00a0and<br \/>\n \u00a0the<br \/>\n \u00a0Medical<br \/>\n \u00a0Profession<br \/>\n \u00a0<br \/>\nd. In the provision of medical care, if a risk of transmission of an infectious disease<br \/>\nfrom a physician to a patient exists, disclosure of that risk to patients is not<br \/>\nenough; patients are entitled to expect that their physicians will not increase their<br \/>\nexposure to the risk of contracting an infectious disease.<br \/>\ne. If no risk exists, disclosure of the physician&#8217;s medical condition to his or her<br \/>\npatients will serve no rational purpose.<br \/>\nPROTECTING<br \/>\n \u00a0PATIENT<br \/>\n \u00a0PRIVACY<br \/>\n \u00a0AND<br \/>\n \u00a0ISSUES<br \/>\n \u00a0RELATED<br \/>\n \u00a0TO<br \/>\n \u00a0NOTIFICATION<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. Fear of stigma and discrimination is a driving force behind the spread of HIV\/AIDS.<br \/>\nThe social and economic repercussions of being identified as infected can be devasta-<br \/>\nting and can include violence, rejection by family and community members, loss of<br \/>\nhousing and loss of employment, to name only a few. Normalizing the presence of<br \/>\nHIV\/AIDS in society through public education is the only way to reduce discrimi-<br \/>\nnatory attitudes and practices. Until that can be universally achieved, or a cure is<br \/>\ndeveloped, potentially infected individuals will refuse testing to avoid these conse-<br \/>\nquences. The result of individuals not knowing their HIV status is not only disastrous<br \/>\non a personal level in terms of not receiving treatment, but may also lead to high rates<br \/>\nof avoidable transmission of the disease. Fear of unauthorized disclosure of informa-<br \/>\ntion also provides a disincentive to participate in HIV\/AIDS research and generally<br \/>\nthwarts the efficacy of prevention programs. Lack of confidence in protection of per-<br \/>\nsonal medical information regarding HIV status is a threat to public health globally<br \/>\nand a core factor in the continued spread of HIV\/AIDS. At the same time, in certain<br \/>\ncircumstances, the right to privacy must be balanced with the right of partners (sexual<br \/>\nand injection drug) of persons with HIV\/AIDS to be informed of their potential<br \/>\ninfection. Failure to inform partners not only violates their rights but also leads to the<br \/>\nsame health problems of avoidable transmission and delay in treatment.<br \/>\n2. All standard ethical principles and duties related to confidentiality and protection of<br \/>\npatients&#8217; health information, as articulated in the WMA Declaration of Lisbon on the<br \/>\nRights of the Patient, apply equally in the context of HIV\/AIDS. In addition, National<br \/>\nMedical Associations and physicians should take note of the special circumstances<br \/>\nand obligations (outlined below) associated with the treatment of HIV\/AIDS patients.<br \/>\na. National Medical Associations and physicians must, as a matter of priority, en-<br \/>\nsure that HIV\/AIDS public education, prevention and counselling programs con-<br \/>\ntain explicit information related to protection of patient information as a matter<br \/>\nnot only of medical ethics but of their human right to privacy.<br \/>\nb. Special safeguards are required when HIV\/AIDS care involves a physically dis-<br \/>\npersed care team that includes home-based service providers, family members,<br \/>\ncounsellors, case workers or others who require medical information to provide<br \/>\ncomprehensive care and assist in adherence to treatment regimens. In addition to<br \/>\nimplementing protection mechanisms regarding transfer of information, ethics<br \/>\ntraining regarding patient privacy should be given to all team members.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20102006-\u00ad\u201003-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nc. Physicians must make all efforts to convince HIV\/AIDS patients to take action to<br \/>\nnotify all partners (sexual and\/or injection drug) about their exposure and poten-<br \/>\ntial infection. Physicians must be competent to counsel patients about the options<br \/>\nfor notifying partners.<br \/>\nThese options should include:<br \/>\n1. notification of the partner(s) by the patient. In this case, the patient should<br \/>\nreceive counselling regarding the information that must be provided to the<br \/>\npartner and strategies for delivering it with sensitivity and in a manner that is<br \/>\neasily understood. A timetable for notification should be established and the<br \/>\nphysician should follow-up with the patient to ensure that notification has oc-<br \/>\ncurred.<br \/>\n2. notification of the partner(s) by a third party. In this case, the third party must<br \/>\nmake every effort to protect the identity of the patient.<br \/>\nd. When all strategies to convince the patient to take such action have been ex-<br \/>\nhausted, and if the physician knows the identity of the patient&#8217;s partner(s), the<br \/>\nphysician is compelled, either by law or by moral obligation, to take action to<br \/>\nnotify the partner(s) of their potential infection. Depending on the system in place,<br \/>\nthe physician will either notify directly the person at risk or report the informa-<br \/>\ntion to a designated authority responsible for notification. In cases where a phy-<br \/>\nsician must disclose the information regarding exposure, the physician must:<br \/>\n1. inform the patient of his or her intentions,<br \/>\n2. to the extent possible, ensure that the identity of the patient is protected,<br \/>\n3. take the appropriate measures to protect the safety of the patient, especially<br \/>\nin the case of a female patient vulnerable to domestic violence.<br \/>\ne. Regardless of whether it is the patient, the physician or a third party who under-<br \/>\ntakes notification, the person learning of his or her potential infection should be<br \/>\noffered support and assistance in order to access testing and treatment.<br \/>\nf. National Medical Associations should develop guidelines to assist physicians in<br \/>\ndecision-making related to notification. These guidelines should help physicians<br \/>\nunderstand the legal requirements and consequences of notification decisions as<br \/>\nwell as the medical, psychological, social and ethical considerations.<br \/>\ng. National Medical Associations should work with governments to ensure that<br \/>\nphysicians who carry out their ethical obligation to notify individuals at risk, and<br \/>\nwho take precautions to protect the identity of their patient, are afforded adequate<br \/>\nlegal protection.<br \/>\nMEDICAL<br \/>\n \u00a0EDUCATION<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. National Medical Associations should assist in ensuring that there is training and<br \/>\neducation of physicians in the most current prevention strategies and medical treat-<br \/>\nments available for all stages of HIV\/AIDS, including prevention and support.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20102006-\u00ad\u201003-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Pilanesberg<br \/>\n \u00a0<br \/>\nHIV\/AIDS<br \/>\n \u00a0and<br \/>\n \u00a0the<br \/>\n \u00a0Medical<br \/>\n \u00a0Profession<br \/>\n \u00a0<br \/>\n2. National Medical Associations should insist upon, and assist with when possible, the<br \/>\neducation of physicians in the relevant psychological, legal, cultural and social di-<br \/>\nmensions of HIV\/AIDS.<br \/>\n3. National Medical Associations should fully support the efforts of physicians wishing<br \/>\nto concentrate their expertise in HIV\/AIDS care, even where HIV\/AIDS is not recog-<br \/>\nnized as an official specialty or sub-specialty within the medical education system.<br \/>\n4. The WMA encourages its National Medical Associations to promote the inclusion of<br \/>\ndesignated, comprehensive courses on HIV\/AIDS in undergraduate and postgraduate<br \/>\nmedical education programs, as well as continuing medical education.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20102006-\u00ad\u201004-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nMEDICAL<br \/>\n \u00a0EDUCATION<br \/>\n \u00a0<br \/>\nAdopted by the 57th<br \/>\nWMA General Assembly, Pilanesberg, South Africa, October 2006<br \/>\nPREAMBLE<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nThe practice of medicine is dynamic and continues to evolve. edical education represents a<br \/>\ncontinuum of learning that commences with undergraduate medical school and endures<br \/>\nuntil a physician retires from active practice. Its goal is to prepare practitioners of medi-<br \/>\ncine to apply the latest scientific knowledge for the promotion of health and the prevention<br \/>\nand cure of human diseases and the mitigation of symptoms of presently incurable dis-<br \/>\neases. Medical education also comprises the ethical standards governing the thought and<br \/>\nbehaviour of physicians. All physicians have a responsibility to themselves, the profes-<br \/>\nsion and their patients to maintain a high standard for their medical education.<br \/>\nBASIC<br \/>\n \u00a0PRINCIPLES<br \/>\n \u00a0OF<br \/>\n \u00a0MEDICAL<br \/>\n \u00a0EDUCATION<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nMedical education consists of basic medical education, postgraduate medical education,<br \/>\nand continuing professional development. The profession, the faculties and educational<br \/>\ninstitutions, and the government share the responsibility for guaranteeing that medical edu-<br \/>\ncation meets a high quality standard throughout this continuum. The aim of medical edu-<br \/>\ncation is to develop competent and ethical physicians that deliver high quality healthcare<br \/>\nto the public.<br \/>\nBASIC<br \/>\n \u00a0MEDICAL<br \/>\n \u00a0EDUCATION<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nThe goal of basic medical education is to instruct students in the practice of the profession,<br \/>\nand to supply the public with well-qualified physicians. The first professional degree<br \/>\nshould represent the completion of a curriculum that qualifies the student for a spectrum of<br \/>\ncareer choices, including, but not limited to, patient care, public health, clinical or basic<br \/>\nresearch, or medical education. Each of these choices will require additional education<br \/>\nbeyond the first professional degree.<br \/>\nSELECTION<br \/>\n \u00a0OF<br \/>\n \u00a0STUDENTS<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nA general liberal education is beneficial for anyone embarking on the study of medicine.<br \/>\nA broad cultural education in the arts, humanities, and social sciences, as well as bio-<br \/>\nlogical and physical sciences, is advantageous. Students should be chosen for the study of<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20102006-\u00ad\u201004-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Pilanesberg<br \/>\n \u00a0<br \/>\nMedical<br \/>\n \u00a0Education<br \/>\n \u00a0<br \/>\nmedicine on the basis of their intellectual ability, motivation, previous experiences, and<br \/>\ncharacter and integrity. The numbers admitted for training must meet the needs of the<br \/>\npopulation and be matched by appropriate resources. Selection of students should not be<br \/>\ninfluenced by age, sex, race, creed, political persuasion or national origin, although the<br \/>\nmix of students should reflect the population.<br \/>\nFACULTY<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nBasic medical education must be taught by a structured faculty. The faculty must possess<br \/>\nthe appropriate qualifications that can only be achieved through formal training and<br \/>\nexperience. The selection should not be based on age, race, creed, political affiliation, or<br \/>\nnational origin.<br \/>\nThe faculty must foster an academic environment in which learning and inquiry are en-<br \/>\ncouraged and can thrive. As such, active research to advance the body of medical know-<br \/>\nledge and the quality of care must take place in academic settings that promote the highest<br \/>\nmedical standards. The goals, content, format and evaluation of the education provided are<br \/>\nthe responsibility of the faculty. Medical schools should ensure continued growth of the<br \/>\nteaching skills of the faculty.<br \/>\nThe faculty is accountable for providing its own basic curriculum in an academic environ-<br \/>\nment that allows learning to flourish. The faculty should review the curriculum frequently,<br \/>\nallowing for the needs of the community and for input from practising physicians.<br \/>\nFurthermore, the faculty is responsible for regularly evaluating the quality of each<br \/>\neducational experience and for reviewing each other.<br \/>\nIn addition to competent faculty, the institution must require that library resources, re-<br \/>\nsearch laboratories, clinical facilities, and study areas be available in sufficient quantity to<br \/>\nmeet the needs of all learners. Moreover, a proper administrative structure, including but<br \/>\nnot limited to academic records, must be maintained in order to provide the most com-<br \/>\nprehensive education.<br \/>\nCONTENT<br \/>\n \u00a0OF<br \/>\n \u00a0BASIC<br \/>\n \u00a0MEDICAL<br \/>\n \u00a0EDUCATION<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nThe educational content should equip the student with a broad base of general knowledge<br \/>\nin the whole field of medicine. This includes a study of the biological and behavioural<br \/>\nsciences as well as the socio-economics of health care. These sciences are basic to an<br \/>\nunderstanding of clinical medicine. Critical thinking and self-directed learning should also<br \/>\nbe required, as should firm grounding in the ethical principles upon which the physicians<br \/>\nwill function and in the principles of human rights. The student should also be introduced<br \/>\nto medical research and its methodology at this stage.<br \/>\nCLINICAL<br \/>\n \u00a0EDUCATION<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nThe clinical component of medical education must be centered on the supervised study of<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20102006-\u00ad\u201004-\u00ad\u20102006<br \/>\n \u00a0<br \/>\npatients and must involve direct experiences in the diagnosis and treatment of disease. The<br \/>\nclinical component should include personal diagnostic and therapeutic experiences with a<br \/>\ngradual increase in responsibilities. An appropriate balance among the patient base,<br \/>\ntrainees and teachers must be observed.<br \/>\nBefore beginning independent practice, every physician should complete a formal pro-<br \/>\ngram of supervised clinical education. This clinical experience should range from primary<br \/>\nto tertiary care in a variety of inpatient and outpatient settings, such as university hospitals,<br \/>\ncommunity hospitals and other health care facilities.<br \/>\nThe faculty and medical schools have the responsibility to ensure that students who have<br \/>\ngraduated and received the first professional degree have acquired a basic understanding<br \/>\nof clinical medicine and the basic skills needed to evaluate clinical problems and take<br \/>\nappropriate action independently, and exhibit the attitude and character to be an ethical<br \/>\nphysician.<br \/>\nPOSTGRADUATE<br \/>\n \u00a0MEDICAL<br \/>\n \u00a0EDUCATION<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nIt is highly desirable, and in many jurisdictions it is already a requirement, that a graduate<br \/>\nfrom a basic medical education institution participate in a postgraduate training program<br \/>\nprior to obtaining a license. Postgraduate medical education, the second phase of medical<br \/>\neducation, prepares physicians for practice in a medical specialty. Postgraduate medical<br \/>\neducation focuses on the development of clinical skills and general and professional<br \/>\ncompetencies and on the acquisition of detailed factual knowledge in a medical specialty.<br \/>\nThis learning process prepares the physician for the independent practice of medicine in<br \/>\nthat specialty.<br \/>\nThe programs are based in communities, clinics, hospitals or other health care institutions<br \/>\nand should, in most specialties, utilize both inpatient and ambulatory settings, reflecting<br \/>\nthe importance of care for adequate numbers of patients in the postgraduate medical edu-<br \/>\ncation experience. Postgraduate medical education programs, including Transitional Year<br \/>\nprograms, are usually called residency programs, and the physicians being educated in<br \/>\nthem, residents. A resident takes on progressively greater responsibility throughout the<br \/>\ncourse of a residency, consistent with individual growth in clinical experience, knowledge,<br \/>\nand skill.<br \/>\nThe education of resident physicians relies on an integration of didactic activity in a<br \/>\nstructured curriculum with diagnosis and management of patients under appropriate levels<br \/>\nof supervision and scholarly activity aimed at developing and maintaining life-long learning<br \/>\nskills. The quality of this experience is directly related to the quality of patient care, which<br \/>\nis always the highest priority. Educational quality and patient care quality are interdepen-<br \/>\ndent and must be pursued in such a manner that they enhance one another. A proper balance<br \/>\nmust be maintained so that a program of postgraduate medical education does not rely on<br \/>\nresidents to meet service needs at the expense of educational objectives. A resident is pre-<br \/>\npared to undertake independent medical practice within a chosen specialty on the satisfac-<br \/>\ntory completion of a residency.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20102006-\u00ad\u201004-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Pilanesberg<br \/>\n \u00a0<br \/>\nMedical<br \/>\n \u00a0Education<br \/>\n \u00a0<br \/>\nPROFESSIONAL<br \/>\n \u00a0DEVELOPMENT<br \/>\n \u00a0OF<br \/>\n \u00a0PHYSICIANS<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nContinuing professional development* is defined as the educational activities that serve to<br \/>\nmaintain, develop, or increase the knowledge, skills, and professional performance and<br \/>\nrelationships a physician uses to provide services for patients, the public, or the profession.<br \/>\nPhysicians should strive to further their medical education throughout their careers. These<br \/>\neducational experiences are essential to the physician&#8217;s continuing professional develop-<br \/>\nment: to keep abreast of developments in clinical medicine and the health care delivery<br \/>\nenvironment, and to maintain the knowledge and skills necessary to provide high quality<br \/>\ncare. The goal of continuing professional development is to sustain and enhance the com-<br \/>\npetent physician. Medical schools, hospitals and professional societies all share a responsi-<br \/>\nbility for developing and making available to all physicians effective opportunities for<br \/>\ncontinuing professional development.<br \/>\nThe demand for physicians to provide medical care, prevent disease, and give advice in<br \/>\nhealth matters calls for the highest standards of basic, postgraduate, and continuing pro-<br \/>\nfessional development.<br \/>\n* Note on terminology<br \/>\nThere are different uses of the term &#8216;Continuing Professional Development&#8217; (CPD). One way to<br \/>\ndescribe it is all those activities that contribute to the professional development of a physician<br \/>\nincluding involvement in organized medicine, committee work in hospitals or group practices,<br \/>\nteaching, mentoring and reading, to name just a few. One of the components of CPD should be<br \/>\nContinuing Medical Education, which in many jurisdictions is specially defined and possibly<br \/>\nrequired for licensure.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20102006-\u00ad\u201005-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nTHE<br \/>\n \u00a0PHYSICIAN&#8217;S<br \/>\n \u00a0ROLE<br \/>\n \u00a0IN<br \/>\n \u00a0OBESITY<br \/>\n \u00a0<br \/>\nAdopted by the 57th<br \/>\nWMA General Assembly, Pilanesberg, South Africa, October 2006<br \/>\nPREAMBLE<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. Obesity is one of the single most important health issues facing the world in the<br \/>\ntwenty-first century, affecting all countries and socio-economic groups and repre-<br \/>\nsenting a serious drain on health care resources.<br \/>\n2. Obesity has complex origins linked to economic and social changes in society in-<br \/>\ncluding the obesogenic environment within which much of the population lives.<br \/>\n3. Therefore the WMA urges physicians to use their roles as leaders to advocate for recog-<br \/>\nnition by national health authorities that reduction in obesity should be a priority, with<br \/>\nculturally appropriate policies involving physicians and other key stakeholders.<br \/>\nTHE<br \/>\n \u00a0WMA<br \/>\n \u00a0RECOMMENDS<br \/>\n \u00a0THAT<br \/>\n \u00a0PHYSICIANS:<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. Lead the development of societal changes that emphasize environments which support<br \/>\nhealthy food choices and regular exercise or physical activity for all people;<br \/>\n2. Individually and through medical associations, express concern that excessive tele-<br \/>\nvision viewing and video game playing are impediments to physical activity among<br \/>\nchildren and adolescents in many countries;<br \/>\n3. Encourage individuals to make healthy choices;<br \/>\n4. Recognise the role of personal decision making and the adverse influences exerted by<br \/>\ncurrent environments;<br \/>\n5. Recognise that collection and evaluation of data can contribute to evidence based<br \/>\nmanagement, and should be part of routine medical screening and evaluation through-<br \/>\nout life;<br \/>\n6. Encourage the development of life skills that contribute to a healthy lifestyle in all<br \/>\npersons and to better public knowledge of healthy diets, exercise and the dangers of<br \/>\nsmoking and excess alcohol consumption;<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20102006-\u00ad\u201005-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Pilanesberg<br \/>\n \u00a0<br \/>\nObesity<br \/>\n \u00a0<br \/>\n7. Contribute to the development of better assessment tools and databases to enable<br \/>\nbetter targeted and evaluated interventions;<br \/>\n8. Ensure that obesity, its causes and management remain part of continuing professional<br \/>\ndevelopment programmes for health care workers, including physicians;<br \/>\n9. Use pharmacotherapy and bariatric surgery consistent with evidence-based guidelines<br \/>\nand an assessment of the risks and benefits associated with such therapies.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20102006-\u00ad\u201006-\u00ad\u20102006<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nTHE<br \/>\n \u00a0RESPONSIBILITIES<br \/>\n \u00a0OF<br \/>\n \u00a0PHYSICIANS<br \/>\n \u00a0IN<br \/>\n \u00a0PREVENTING<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nAND<br \/>\n \u00a0TREATING<br \/>\n \u00a0OPIATE<br \/>\n \u00a0AND<br \/>\n \u00a0PSYCHOTROPIC<br \/>\n \u00a0DRUG<br \/>\n \u00a0ABUSE<br \/>\n \u00a0<br \/>\nAdopted by the 57th<br \/>\nWMA General Assembly, Pilanesberg, South Africa, October 2006<br \/>\nPREAMBLE<br \/>\n \u00a0<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. Opiate and psychotropic drugs are valuable therapeutic tools when used appropriately,<br \/>\nas medically indicated, for a variety of symptoms and conditions. Unfortunately, non-<br \/>\nclinical misuse of these addictive substances is an enormous problem worldwide. Drug<br \/>\naddiction is a complex social, economic and legal issue as well as a threat to public<br \/>\nhealth and safety globally. It affects people from all demographic and social groups<br \/>\nand economic spheres. In addition to exposing themselves to the direct health risks<br \/>\nrelated to the inappropriate use of these substances, persons addicted to drugs may en-<br \/>\ngage in high risk behaviour, such as needle-sharing and unprotected sex, and many<br \/>\nresort to criminal activity to finance their expensive addiction. These factors increase<br \/>\ntransmission of viral infections, such as Hepatitis B and C and HIV\/AIDS, among<br \/>\nboth users and non-users alike. Other results of addiction include failure to maintain<br \/>\nemployment or to function in social and family life.<br \/>\n2. The legal ramifications of non-medical drug use, which is illegal in most countries,<br \/>\ngenerally do little to assist users in breaking free from their addiction. Despite drug<br \/>\nprograms in many correctional facilities, the availability of illegal substances is often<br \/>\nprevalent among inmates and, in fact, some users begin their addiction in these insti-<br \/>\ntutions. Addressing addiction therefore falls largely to society and the health profes-<br \/>\nsion.<br \/>\n3. The World Medical Association, concerned by the widespread misuse of psychotropic<br \/>\nand opiate drugs, urges physicians to prioritize this problem in the practice of medi-<br \/>\ncine and to adhere to the following guidelines.<br \/>\nPRINCIPLES<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. Responsible prescribing practices<br \/>\na. Physicians should be aware of the addictive properties of certain psychotropic<br \/>\nand opiate drugs. Such drugs should be prescribed with the greatest restraint,<br \/>\nobserving the strictest possible generally accepted medical indications. Physi-<br \/>\ncians must take all necessary measures to ensure that they are fully informed of<br \/>\nthe effects of these drugs. This includes reviewing up-to-date research regard-<br \/>\ning dosage, potential effectiveness for the specific condition, potential side affects<br \/>\nand interactions and prevalence of misuse.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0S-\u00ad\u20102006-\u00ad\u201006-\u00ad\u20102006<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0Pilanesberg<br \/>\n \u00a0<br \/>\nOpiate<br \/>\n \u00a0and<br \/>\n \u00a0Psychotropic<br \/>\n \u00a0Drug<br \/>\n \u00a0Abuse<br \/>\n \u00a0<br \/>\nb. When such drugs are medically indicated, their use must be carefully monitored<br \/>\nto ensure that the patient is following strict instructions regarding dosage, timing<br \/>\nand any other factors associated with the safe use of the particular drug. All ap-<br \/>\npropriate measures must be taken to prevent the stockpiling, resale or other il-<br \/>\nlicit usage of the drug.<br \/>\nc. Patients must be fully informed of all potential therapeutic and non-therapeutic<br \/>\neffects of psychotropic and opiate drugs, including potential for addiction, and be<br \/>\nfully involved in the decision to take them. No competent patient should be<br \/>\nforced to take any psychotropic drug against his or her will.<br \/>\nd. Physicians should be aware of non-medical factors that may predispose patients<br \/>\nto addiction. These may include, among others, family history, past addiction,<br \/>\nemotional trauma, depression or other mental health conditions and peer pres-<br \/>\nsure, especially among young persons.<br \/>\ne. Physicians should learn to recognize &#8216;drug seekers&#8217;, addicted patients who attempt<br \/>\nto obtain psychotropic and opiate drugs under false medical pretences. Drug<br \/>\nseekers often consult more than one physician in an effort to obtain multiple pre-<br \/>\nscriptions. In extreme cases, drug seekers may harm themselves to create symp-<br \/>\ntoms to obtain a prescription. All patient conditions and symptoms should be cli-<br \/>\nnically verified, to the extent possible, and meticulous records maintained regard-<br \/>\ning the patient&#8217;s drug history. If databases containing patient drug records and<br \/>\nprescribing histories are available, they should be consulted.<br \/>\nf. When prescribing any psychotropic or opiate substance to minors, physicians<br \/>\nmust ensure that the parents or guardians of the patient are fully informed of the<br \/>\npotential misuse of the drug and encouraged to monitor the child carefully to en-<br \/>\nsure adherence to the physician&#8217;s instructions. Parents or guardians should be in-<br \/>\nformed that, in some countries, it is increasingly common for children to sell pre-<br \/>\nscription drugs to their peers.<br \/>\n2. Non-drug therapy for addicts to opiate and psychotropic drugs<br \/>\na. Physicians should be aware of all non-drug treatment options for addicts to opiate<br \/>\nand psychotropic drugs, including inpatient and outpatient programs and thera-<br \/>\npeutic communities, in which recovering addicts live in a supportive, drug-free<br \/>\nenvironment. Most treatment programs are focused on breaking the cycle of drug<br \/>\ndependence through detoxification, counselling &#8211; including ongoing peer support &#8211;<br \/>\nand permanent abstinence from the use of any addictive opiate or psychotropic<br \/>\nsubstance, including alcohol. Some offer educational and\/or vocational programs<br \/>\nto facilitate successful reintegration into community life.<br \/>\nb. Physicians should encourage their patients to participate in drug treatment pro-<br \/>\ngrams at the earliest possible stage of addiction.<br \/>\nc. All efforts should be made to respect the dignity and autonomy of addicted<br \/>\npatients. Involuntary inpatient treatment of addicted persons should be a last<br \/>\nresort, according to established guidelines and, where applicable, legal require-<br \/>\nments.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nWorld<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20102006-\u00ad\u201006-\u00ad\u20102006<br \/>\n \u00a0<br \/>\n3. Drug therapy for addicts to opiate drugs<br \/>\na. In some cases, persons addicted to opiate drugs may be treated using medications<br \/>\nthat relieve withdrawal symptoms and cravings for the addictive substance without<br \/>\nproducing the &#8216;high&#8217; associated with opiates. These medications also provide cross<br \/>\ntolerance to other opioids. The objective of drug treatment is the immediate<br \/>\ncessation of the use of opiate drugs.<br \/>\nb. Drug therapy can assist the opiate-dependent patient to function in his or her<br \/>\nnormal environment and activities while working to overcome the opiate addic-<br \/>\ntion. However, it should always be part of a multi-disciplinary approach that in-<br \/>\ncludes proven non-drug treatment elements, such as counselling and peer support.<br \/>\nc. Drug therapy should be administered according to established evidence-based<br \/>\nguidelines and supervised by specially trained physicians with an appropriate<br \/>\nsupport team.<br \/>\n4. Awareness raising and policy development<br \/>\na. National Medical Associations (NMAs) should engage in cross-sectoral national<br \/>\nefforts to raise awareness of the risks associated with the abuse of opiate and<br \/>\npsychotropic drugs and to ensure the availability of appropriate treatment options<br \/>\nfor addicted persons. NMAs should encourage their members to participate in<br \/>\nsimilar programs at the community level.<br \/>\nb. NMAs should promote appropriate drug prevention programming at all levels of<br \/>\nthe educational system, recognizing that experimentation with drugs is increas-<br \/>\ningly prevalent among younger age groups.<br \/>\nc. NMAs and physicians should participate in the development of evidence-based<br \/>\nguidelines that support a multi-disciplinary approach to the treatment of drug ad-<br \/>\ndiction, including harm reduction strategies such as needle exchange programmes.<br \/>\nd. NMAs should participate in the development of legal procedures relating to ille-<br \/>\ngal drug use to ensure that addicted persons are recognized as entitled to receive<br \/>\nappropriate medical and rehabilitative care, including in correctional institutions.<br \/>\nCONCLUSION<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\n1. Physicians have an important role to play in the treatment of drug addiction, both as<br \/>\nclinicians and as advocates for the treatment, rights and dignity of persons addicted to<br \/>\nthese harmful substances. Treatment of addiction, like treatment for any disease or<br \/>\ncondition, should be undertaken in the best interests of the patient and according to<br \/>\nestablished principles of medical ethics.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102007-\u00ad\u201001-\u00ad\u20102007<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nHUMAN<br \/>\n \u00a0TISSUE<br \/>\n \u00a0FOR<br \/>\n \u00a0TRANSPLANTATION<br \/>\n \u00a0<br \/>\nAdopted by the 58th<br \/>\nWMA General Assembly, Copenhagen, Denmark, October 2007<br \/>\nINTRODUCTION<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nThe use of human cells and tissue for therapeutic purposes in medicine covers a broad<br \/>\nspectrum. A differentiated examination is necessary in order to do justice to the different<br \/>\nrequirements of the various sectors of tissue medicine.<br \/>\nThe use of so-called \u00abtissue transplants\u00bb, such as corneas, bone, blood vessels and cardiac<br \/>\nvalves, is an established treatment method in medicine. Tissues are removed, conserved,<br \/>\nstored and then implanted in patients after varying periods of time. In principle, they<br \/>\nshould therefore be treated in the same way as organs that are used for transplantation (cf.<br \/>\nWMA Statement on Human Organ and Tissue Donation and Transplantation, Edinburgh<br \/>\n2000).<br \/>\nIn contrast, so-called \u00abadvanced therapies\u00bb, such as tissue engineering and other techni-<br \/>\nques of regenerative medicine, involve the use of human tissue as starting material for<br \/>\nmanufacturing a processed end product. Even though established therapeutic options<br \/>\nalready exist, it can be expected that the therapeutic importance of these methods may<br \/>\ncontinue to increase, and that there may be many developments in this field in the future.<br \/>\nIn view of the further processing of the tissue involved, the frequently industrial nature of<br \/>\nthe manufacturing organizations and the possibility of tissue being pooled, different regula-<br \/>\ntions are necessary for this sector of tissue medicine than for tissue transplantation.<br \/>\nThe WMA limits this Statement to tissue in the sense of tissue transplants, and gives the<br \/>\nfollowing Recommendations for this sector of tissue medicine:<br \/>\n1. Physicians are fundamentally obliged to treat patients according to the best of their<br \/>\nknowledge and expertise. However, this obligation must not be taken to the point<br \/>\nwhere, for example, the human tissue necessary for therapy is procured in an unethi-<br \/>\ncal or illegal manner. Tissue must always be procured with due consideration for<br \/>\nhuman rights and the principles of medical ethics.<br \/>\n2. To secure the provision of tissue for transplantation, physicians should inform po-<br \/>\ntential donors and\/or their family members about the possibility of tissue donation. In<br \/>\nthe event of combined organ and tissue donation, information should be provided, and<br \/>\nconsent obtained, in one step.<br \/>\n3. The voluntariness of tissue donation must be ensured. The informed and non-coerced<br \/>\nconsent of the donor or his\/her family members is required for any use of human tis-<br \/>\nsue for transplantation. Free and informed decision-making is a process requiring the<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0Copenhagen<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20102007-\u00ad\u201001-\u00ad\u20102007<br \/>\n \u00a0<br \/>\nHuman<br \/>\n \u00a0Tissue<br \/>\n \u00a0for<br \/>\n \u00a0Transplantation<br \/>\n \u00a0<br \/>\nexchange and understanding of information and the absence of coercion. Because<br \/>\nprisoners and other individuals in custody are not in a position to give consent freely<br \/>\nand can be subject to coercion, their tissues must not be used for transplantation<br \/>\nexcept for members of their immediate family.<br \/>\n4. Financial incentives such as direct payments for donating tissue for transplantation are<br \/>\nto be rejected \u2013 in the same what that they are in connection with organ transplants.<br \/>\nAll other steps, such as the procurement, testing, processing, conservation, storage<br \/>\nand allocation of tissue transplants, should likewise not be commercialised.<br \/>\n5. If both organs and tissue can be removed from a potential donor for transplantation,<br \/>\norgan donation must be given priority over tissue donation.<br \/>\n6. Posthumous donation of tissue to a specific recipient (directed donation beyond the<br \/>\nimmediate family) is to be avoided. Living directed donation requires both: a) proof<br \/>\nof direct personal ties between donor and recipient (e.g. blood relations, spouses), and<br \/>\nb) exclusion of potentially coercive material interests.<br \/>\n7. For posthumous tissue donation, the WMA calls for the determination of death to be<br \/>\nconducted in accordance with its Declaration of Sydney on the Determination of<br \/>\nDeath.<br \/>\n8. The risk of diseases (e.g. infections, malignant tumors) being transmitted by trans-<br \/>\nplanted tissue must be minimized through appropriate testing that does not merely<br \/>\ncomply with sufficient standards, but additionally reflects the respective, nationally<br \/>\nimplemented state of medical science and technology.<br \/>\n9. In the case of a delayed diagnosis for infectious disease or malignancy of the donor,<br \/>\nan alert should immediately be reported to all tissue recipients in order to institute the<br \/>\nappropriate precautionary steps.<br \/>\n10. Contamination must be avoided when removing, storing, processing and transplanting<br \/>\ntissue.<br \/>\n11. Unethical allocation formulas for tissue transplants are to be rejected. Allocation<br \/>\nshould be based on the medical indication, urgency and prospects of success.<br \/>\n12. Experimental and clinical studies, as well as open discussions on ethical and moral<br \/>\nprinciples in society, are important for establishing new therapeutic methods. All<br \/>\nexperimental and clinical studies are to be conducted in accordance with the WMA<br \/>\nDeclaration of Helsinki. Scientists and physicians should continuously inform the<br \/>\npublic about developments in tissue medicine and its therapeutic options.<br \/>\n13. International exchange of tissue for transplantation should be properly regulated ac-<br \/>\ncording to agreed upon standards.<br \/>\n14. Information on tissue donors should be stored and maintained by national transplant<br \/>\norganizations and should be provided only if the living donor or family of the de-<br \/>\nceased donor provides free and informed consent.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102007-\u00ad\u201002-\u00ad\u20102007<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nTHE<br \/>\n \u00a0ETHICS<br \/>\n \u00a0OF<br \/>\n \u00a0TELEMEDICINE<br \/>\n \u00a0<br \/>\nAdopted by the 58th<br \/>\nWMA General Assembly, Copenhagen, Denmark, October 2007<br \/>\nDEFINITION<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nTelemedicine is the practice of medicine over a distance, in which interventions, diagno-<br \/>\nstic and treatment decisions and recommendations are based on data, documents and other<br \/>\ninformation transmitted through telecommunication systems.<br \/>\nPREAMBLE<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nThe development and implementation of information and communication technology are<br \/>\ncreating new modalities for providing care for patients. These enabling tools offer dif-<br \/>\nferent ways of practising medicine. The adoption of telemedicine is justified because of its<br \/>\nspeed and its capacity to reach patients with limited access to medical assistance, in ad-<br \/>\ndition to its power to improve health care.<br \/>\nPhysicians must respect the following ethical guidelines when practising telemedicine.<br \/>\nPRINCIPLES<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nPatient-\u00ad\u2010physician<br \/>\n \u00a0relationship<br \/>\n \u00a0and<br \/>\n \u00a0confidentiality<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nThe patient-physician relationship should be based on a personal encounter and sufficient<br \/>\nknowledge of the patient&#8217;s personal history. Telemedicine should be employed primarily<br \/>\nin situations in which a physician cannot be physically present within a safe and accepta-<br \/>\nble time period.<br \/>\nThe patient-physician relationship must be based on mutual trust and respect. It is there-<br \/>\nfore essential that the physician and patient be able to identify each other reliably when<br \/>\ntelemedicine is employed.<br \/>\nIdeally, telemedicine should be employed only in cases in which a prior in-person relation-<br \/>\nship exists between the patient and the physician involved in arranging or providing the<br \/>\ntelemedicine service.<br \/>\nThe physician must aim to ensure that patient confidentiality and data integrity are not<br \/>\ncompromised. Data obtained during a telemedical consultation must be secured through<br \/>\nencryption and other security precautions must be taken to prevent access by unauthorized<br \/>\npersons.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0Copenhagen<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0S-\u00ad\u20102007-\u00ad\u201002-\u00ad\u20102007<br \/>\n \u00a0<br \/>\nTelemedicine<br \/>\n \u00a0<br \/>\nResponsibilities<br \/>\n \u00a0of<br \/>\n \u00a0the<br \/>\n \u00a0physician<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nA physician whose advice is sought through the use of telemedicine should keep a detailed<br \/>\nrecord of the advice he\/she delivers as well as the information he\/she received and on<br \/>\nwhich the advice was based.<br \/>\nIt is the obligation of the physician to ensure that the patient and the health professionals<br \/>\nor family members caring for the patient are able to use the necessary telecommunication<br \/>\nsystem and necessary instruments. The physician must seek to ensure that the patient has<br \/>\nunderstood the advice and treatment suggestions given and that the continuity of care is<br \/>\nguaranteed.<br \/>\nThe physician asking for another physician&#8217;s advice or second opinion remains responsible<br \/>\nfor treatment and other decisions and recommendations given to the patient.<br \/>\nA physician should be aware of and respect the special difficulties and uncertainties that<br \/>\nmay arise when he\/she is in contact with the patient through means of tele-communication.<br \/>\nA physician must be prepared to recommend direct patient-doctor contact when he\/she feels<br \/>\nthat the situation calls for it.<br \/>\nQuality<br \/>\n \u00a0of<br \/>\n \u00a0care<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nQuality assessment measures must be used regularly to ensure the best possible diagnostic<br \/>\nand treatment practices in telemedicine.<br \/>\nThe possibilities and weaknesses of telemedicine in emergencies must be acknowledged.<br \/>\nIf it is necessary to use telemedicine in an emergency situation, the advice and treatment<br \/>\nsuggestions are influenced by the level of threat to the patient and the know-how and ca-<br \/>\npacity of the persons who are with the patient.<br \/>\nRECOMMENDATION<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nThe WMA and National Medical Associations should encourage the development of na-<br \/>\ntional legislation and international agreements on subjects related to the practise of tele-<br \/>\nmedicine, such as e-prescribing, physician registration, liability and the legal status of<br \/>\nelectronic medical records.<\/p>\n<p> \u00a0<\/p>\n<p> \u00a0<br \/>\nHandbook<br \/>\n \u00a0of<br \/>\n \u00a0WMA<br \/>\n \u00a0Policies<br \/>\n \u00a0<br \/>\nS-\u00ad\u20102008-\u00ad\u201001-\u00ad\u20102008<br \/>\n \u00a0\u23d0\uf8e6<br \/>\n \u00a0World<br \/>\n \u00a0Medical<br \/>\n \u00a0Association<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nWMA<br \/>\n \u00a0STATEMENT<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nON<br \/>\n \u00a0<br \/>\n \u00a0<br \/>\nREDUCING<br \/>\n \u00a0DIETARY<br \/>\n \u00a0SODIUM<br \/>\n \u00a0INTAKE<br \/>\n \u00a0<br \/>\nAdopted by the 59th<br \/>\nWMA General Assembly, Seoul, Korea, October 2008<br \/>\nINTRODUCTION<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nCardiovascular diseases (CVD) remain a leading cause of mortality throughout the world.<br \/>\nRisk factors include high blood cholesterol, hypertension, cigarette smoking, physical<br \/>\ninactivity, obesity, and diabetes. These risk factors are largely preventable and modifiable.<br \/>\nGlobally, about 25% of all deaths from cardiovascular diseases are due to hypertension.<br \/>\nThis figure may underestimate the true impact of elevated blood pressure since the blood<br \/>\npressure cardiovascular risk continuum begins at 115\/75 mm Hg. There is overwhelming<br \/>\nevidence that excessive sodium intake is a risk factor for the development, or worsening of<br \/>\nhypertension, and it may also be an independent risk factor for cardiovascular diseases as<br \/>\nwell as all-cause mortality.<br \/>\nSubstantial overall benefits can accrue from even small reductions in the population&#8217;s<br \/>\nblood pressure. Depending upon an individual&#8217;s salt sensitivity, sodium may cause great<br \/>\ndamage to both normotensive and hypertensive populations. Therefore, population-wide<br \/>\nefforts to reduce dietary sodium intake are a cost-effective way to reduce overall hyper-<br \/>\ntension levels and subsequent cardiovascular disease.<br \/>\nBACKGROUND<br \/>\n \u00a0<\/p>\n<p> \u00a0<br \/>\nIn acculturated populations, the level of blood pressure, the incremental rise in blood pres-<br \/>\nsure with age, and the prevalence of hypertension are related to salt intake. Observational<br \/>\nstudies and randomized controlled trials document a clear and consistent effect of salt con-<br \/>\nsumption on increased blood pressure. Blood pressure is also affected by other foods and<br \/>\nnutrients, and a reduced salt intake should be only one component of a comprehensive<br \/>\nstrategy to lower blood pressure. Increasing physical activity, consuming a diet high in<br \/>\nfruits and vegetables and low in saturated and total fats, maintenance of optimal body<br \/>\nweight, and moderation in alcohol intake are also recommended lifestyle approaches to<br \/>\npreventing and managing hypertension and reducing its impact on cardiovascular disease.<br \/>\nThe World Health Organization recommends that average daily sodium consumption in<br \/>\nadults should be less than 2000 mg (5 g salt). Epidemiologic evidence, including the<br \/>\nmarked reduction of either hypertension or of a progressive rise in blood pressure with<br \/>\nadvancing age in populations with an average sodium ingestion <1500 mg (3.8 g salt) per\nday, supports the concept of such a threshold, above which the risk for harmful cardio-\nvascular disease consequences begins to increase.\n\t\n \u00a0\n\t\n \u00a0Seoul\t\n \u00a0\u23d0\uf8e6\t\n \u00a0S-\u00ad\u20102008-\u00ad\u201001-\u00ad\u20102008\t\n \u00a0\nDietary\t\n \u00a0Sodium\t\n \u00a0Intake\t\n \u00a0\nThe world's population consumes 2300-4600 mg of sodium (5.8 - 11.5 g salt) per day per\n2000 calories. In developed countries, it is estimated that 75% to 80% of the daily intake\nof sodium comes from processed foods and foods that are prepared outside of the home\n(e.g., fast food or restaurant meals). Therefore, any meaningful strategy to reduce popula-\ntion salt intake must rely on food manufacturers and preparers to reduce the amount added\nduring preparation as well as on nutritional education programs. The largest impact on\nsodium in the food supply of developed countries may derive from the stepwise lowering\nof sodium in foods that are most commonly eaten and are large contributors to sodium\nintake. In less developed countries, reductions in sodium are more likely to be achieved by\nadding less salt during cooking inside the home.\nRECOMMENDATIONS\t\n \u00a0\n\t\n \u00a0\nNational Medical Associations should:\n\u2022 In cooperation with national and international health organizations, work to\neducate consumers about the effects of sodium intake on hypertension and cardio-\nvascular disease, the benefits of long-term reductions in sodium intake, and about\nthe dietary sources of salt\/sodium and how these can be reduced.\n\u2022 Call for a stepwise 50% reduction in the sodium content of processed foods, \"fast\"\nfood products, and restaurant meals over the next decade.\n\u2022 Urge physicians to counsel patients about the major sources of sodium in their\ndiets and how to reduce sodium intake, including reducing the amount of salt used\nin cooking at home.\n\u2022 In cooperation with the food industry and government regulators, discuss ways to\nimprove labeling of food products and develop label markings and warnings for\nfoods high in sodium.\n\u2022 Encourage government authorities to create national laws and regulations that\nenforce the reduction of sodium in processed foods to acceptable levels. Establish\na deadline for industries to comply with new laws and regulations.\n\u2022 Stimulate debate on the issue at conferences, symposia, and teleconferences in an\neffort to promote awareness among the medical profession regarding sodium in\nfood and its consequences. Doctors who are well-informed will transmit the infor-\nmation to their patients and may be able to prescribe fewer antihypertensive medi-\ncations.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nS-\u00ad\u20102008-\u00ad\u201002-\u00ad\u20102008\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0STATEMENT\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nREDUCING\t\n \u00a0THE\t\n \u00a0GLOBAL\t\n \u00a0BURDEN\t\n \u00a0OF\t\n \u00a0MERCURY\t\n \u00a0\n\t\n \u00a0\nAdopted by the 59th\nWMA General Assembly, Seoul, Korea, October 2008\nMercury is a naturally occurring heavy metal that is a potent neurotoxin. The most likely\nroutes of human exposure on a population basis are ingestion of methylmercury from con-\ntaminated fish. Less commonly, individuals are exposed via inhalation of inorganic mer-\ncury vapor after a spill or during a manufacturing process.\nMercury has been the ideal choice for use in medical devices that measure temperature\nand pressure. Therefore, a typical large hospital may have more than a hundred pounds of\nmercury onsite incorporated into various devices in separate locations.\nHospitals and clinics can avoid the occupational or environmental risk of mercury by\nusing products that don't rely on mercury-based technology. Major healthcare institutions\naround the world have demonstrated that safe, effective alternative products exist, and can\nbe safely used for most situations.\nAlthough the rationale for instituting voluntary mercury replacement initiatives is com-\npelling from both occupational and environmental perspectives, financial considera-tions\nmay ultimately motivate hospitals to undertake a mercury replacement program. Haz-\nardous waste clean-up costs, reporting requirements for spills, disruptions in services, and\nstaff training are costly. The cost of cleaning up one significant contamination can be sub-\nstantially higher than the cost of converting to mercury-free alternatives.\nBy implementing a \"best practices\" management method for mercury use, the need for\nincreased government regulations in the future, may be avoided. Such regulations may\ncreate costly burdens that some facilities may not be able to meet.\nRECOMMENDATIONS\t\n \u00a0\n\t\n \u00a0\nThe following recommendations are based on the urgent need to reduce both the supply\nand demand of mercury in the health care sector:\nGlobal\t\n \u00a0\n\t\n \u00a0\nThe World Medical Association and its member national medical associations should:\n\u2022 Advocate for the United Nations and individual governments to voluntarily co-\noperate to implement key features of the United Nations Environment Programme\n(UNEP) Mercury Programme, which provides a framework for reducing the use,\nrelease, trade and risk related to mercury.\n\u2022 Enhance the activity of existing partnerships.\n\t\n \u00a0\n\t\n \u00a0Seoul\t\n \u00a0\u23d0\uf8e6\t\n \u00a0S-\u00ad\u20102008-\u00ad\u201002-\u00ad\u20102008\t\n \u00a0\nMercury\t\n \u00a0\nRegional\/National\t\n \u00a0\n\t\n \u00a0\nNational medical associations should advocate that their governments work to reduce risks\nrelated to mercury in the environment by:\n\u2022 reducing reliance on mercury mining in favor of environmentally-friendly sources\nof mercury, such as recycled mercury.\n\u2022 developing options and scientifically sound plans for the long term safe storage of\nexcess mercury supplies.\n\u2022 urging governments and other stakeholders to continue to enhance their support of\nthe UNEP Mercury Programme partnerships, through the provision of technical\nand financial resources.\n\u2022 encouraging a phase-out of mercury use in the health care sector\n\u2022 designing and implementing regulations and\/or requirements designed to signifi-\ncantly reduce mercury emissions from coal combustion and cement production by\nusing specific mercury emission controls.\nLocal\t\n \u00a0\n\t\n \u00a0\nPhysicians should:\n\u2022 Explore eliminating mercury-containing products in their offices and clinical\npractices, including thermometers, sphygmomanometers, gastrointestinal tubes, bat-\nteries, lamps, electrical supplies, thermostats, pressure gauges, and other laboratory\nreagents and devices.\n\u2022 Ensure that local hospitals and medical facilities have a plan to identify sources of\nmercury in their workplace, a commitment to mercury reduction, and a mercury\nmanagement policy regarding recycling, disposal and education.\n\u2022 Encourage local hospitals and medical facilities to phase out mercury-containing\nproducts and switch to non-mercury equivalents.\n\u2022 Counsel patients about local and national advisories related to fish consumption\ndesigned to limit exposure to mercury in children and women of childbearing age.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nS-\u00ad\u20102009-\u00ad\u201001-\u00ad\u20102009\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0STATEMENT\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nCONFLICT\t\n \u00a0OF\t\n \u00a0INTEREST\t\n \u00a0\nAdopted by the 60th\nWMA General Assembly, New Delhi, India, October 2009\nPREAMBLE\t\n \u00a0\n\t\n \u00a0\nThis policy is intended to identify areas where a conflict of interest might occur during the\nday-to-day practice of medicine, and to assist physicians in resolving such conflicts in the\nbest interests of their patients. A conflict of interest is understood to exist when profes-\nsional judgement concerning direct patient care might be unduly influenced by a second-\nary interest.\nIn some cases, it may be enough to acknowledge that a potential or perceived conflict\nexists. In others, specific steps to resolve the conflict may be required. Some conflicts of\ninterest are inevitable and there is nothing inherently unethical in the occurrence of con-\nflicts of interest in medicine but it is the manner in which they are addressed that is cru-\ncial.\nIn addition to the clinical practice of medicine and direct patient care, physicians have\ntraditionally served in several different roles and pursued various other interests, such as\nparticipation in research, the education of future physicians and physicians in training and\nthe occupation of administrative or managerial positions. As private interests within medi-\ncine have expanded in many locales, physicians have occasionally provided their expertise\nto these endeavours as well, acting as consultants (and sometimes employees) for private\nenterprise.\nAlthough the participation of physicians in many of these activities will ultimately serve\nthe greater public good, the primary obligation of the individual physician continues to be\nthe health and well-being of his or her patients. Other interests must not be allowed to\ninfluence clinical decision-making (or even have the potential to do so).\nEach doctor has a moral duty to scrutinise his or her own behaviour for potential conflicts\nof interest, even if the conflicts fall outside the kinds of examples or situations addressed\nin this document. If unacknowledged, conflicts of interest can seriously undermine patient\ntrust in the medical profession as well as in the individual practitioner.\nPhysicians may also wish to avail themselves of additional resources such as specialty\nsocieties, national medical associations or regulatory authorities, and should be aware of\napplicable national regulations and laws.\n\t\n \u00a0\n\t\n \u00a0New\t\n \u00a0Delhi\t\n \u00a0\u23d0\uf8e6\t\n \u00a0S-\u00ad\u20102009-\u00ad\u201001-\u00ad\u20102009\t\n \u00a0\nConflict\t\n \u00a0of\t\n \u00a0Interest\t\n \u00a0\nRECOMMENDATION\t\n \u00a0\n\t\n \u00a0\nResearch\t\n \u00a0\n\t\n \u00a0\nThe interests of the clinician and the researcher may not be the same. If the same indivi-\ndual is assuming both roles, as is often the case, the potential conflict should be addressed\nby ensuring that appropriate steps are put in place to protect the patient, including dis-\nclosure of the potential conflict to the patient.\nAs stated in the Declaration of Helsinki:\n\u2022 The Declaration of Geneva of the World Medical Association states that, \"The\nhealth of my patient will be my first consideration,\" and the International Code of\nMedical Ethics declares that, \"A physician shall act only in the patient's interest\nwhen providing medical care which might have the effect of weakening the phy-\nsical and mental condition of the patient.\"\n\u2022 The Declaration of Helsinki states that \u201cIn medical research involving human\nsubjects, the well-being of the individual research subject must take precedence\nover all other interests.\u201d\nResearch should be conducted primarily for the advancement of medical science. A\nphysician should never place his or her financial interests above the welfare of his or her\npatient. Patient interests and scientific integrity must be paramount.\nAll relevant and material physician-researcher relationships and interests must be dis-\nclosed to potential research participants, research ethics boards, appropriate regulatory\noversight bodies, medical journals, conference participants and the medical centre where\nthe research is conducted.\nAll hypothesis-testing research trials should be registered with a publicly-accessible re-\nsearch registry.\nA clear contract should be signed by all parties, including sponsors, investigators and\nprogram participants, clarifying terms relating to, at a minimum:\n\u2022 financial compensation for the physician-researcher (which should approximate\nlost clinical earnings)\n\u2022 ownership of research results (which should rest with the investigator)\n\u2022 the right of the investigator to publish negative results\n\u2022 the right of the investigator to release relevant information to trial participants at\nany point during the study.\nPhysician-researchers should retain control of and should have full access to all trial data,\nand should decline non-disclosure clauses.\nPhysician-researchers should ensure that, regardless of the trial results, the presentation or\npublication of the results of hypothesis-testing trials will not be unduly delayed or other-\nwise obstructed.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nS-\u00ad\u20102009-\u00ad\u201001-\u00ad\u20102009\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nReferral fees should not be accepted for providing the names of potential trial participants,\nand patient information should not be released without the consent of the patient, except\nwhere required by legislation or regulatory authorities.\nAny compensation received from trial sponsors should approximately replace lost clinical\nincome and should be commensurate with the efforts and responsibilities of the physician\nperforming the research. When enrolment is particularly challenging and time-consuming,\nreasonable additional payments may be made to compensate the clinical investigator or\ninstitution specifically for time and effort spent on extra recruiting efforts to enrol appro-\npriate research participants. Escalating bonuses designed to increase trial enrolment should\nnot be accepted.\nPhysician-researchers should decline requests to review grant applications or research\npaper submissions from colleagues or competitors where their relationship would have the\npotential to influence their judgment on the matter.\nPayments or compensation of any sort should not be tied to the outcome of clinical trials.\nPhysician-researchers should not have a financial interest in a company sponsoring a trial\nor a product being studied in a clinical trial if this financial interest could be affected\npositively or negatively by the results of the trial; they should have no direct financial\nstake in the results of the trial. They should not purchase, buy or sell stock (shares) in the\ncompany while the trial is ongoing and until the results have been made public. This\nmight not apply for those physicians who have developed a medication but are not part of\nthe enrolment process.\nPhysician-researchers should only participate in clinical trials when they relate to their\narea of medical expertise and they should have adequate training in the conduct of re-\nsearch and the principles of research ethics.\nAuthorship should be determined prior to the start of the trial and should be based on\nsubstantive scientific contribution.\nEducation\t\n \u00a0\n\t\n \u00a0\nThe educational needs of students and the quality of their training experience must be\nbalanced with the best interests of patients. Where these are in conflict, the interests of\npatients will take precedence.\nWhile recognizing that medical trainees require experience with real patients, physician-\neducators must ensure that these trainees receive supervision commensurate with their\nlevel of training.\nPatients should be made aware that their medical care may be performed in part by stu-\ndents and physicians in training, including the performance of procedures and surgery, and\nwhere possible should give appropriate informed consent to this effect.\nPatients should be made aware of the identity and qualifications of the individuals in-\nvolved in their care.\nRefusal by a patient to involve trainees in their care should not affect the amount or\nquality of care they subsequently receive.\n\t\n \u00a0\n\t\n \u00a0New\t\n \u00a0Delhi\t\n \u00a0\u23d0\uf8e6\t\n \u00a0S-\u00ad\u20102009-\u00ad\u201001-\u00ad\u20102009\t\n \u00a0\nConflict\t\n \u00a0of\t\n \u00a0Interest\t\n \u00a0\nSelf-\u00ad\u2010referrals\t\n \u00a0and\t\n \u00a0fee-\u00ad\u2010splitting\t\n \u00a0\n\t\n \u00a0\nAll referrals and prescriptions (whether for specific goods or services) should be based on\nan objective assessment of the quality of the service or of the physician to whom the pa-\ntient has been referred.\nReferral by physicians to health care facilities (such as laboratories) where they do not\nengage in professional activities but in which they have a financial interest is called self-\nreferral. This practice has the potential to significantly influence clinical decision-making\nand is not generally considered acceptable unless there is a need in that particular com-\nmunity for the facility and other ownership is not a possibility (for example, in small rural\ncommunities). The physician in this situation should receive no more financial interest\nthan would an ordinary investor.\nKickbacks (or fee-splitting) occur when a physician receives financial consideration for\nreferring a patient to a specific practitioner or for a specific service for which a fee is\ncharged. This practice is not acceptable.\nPhysician\t\n \u00a0offices\t\n \u00a0\n\t\n \u00a0\nFor reasons of patient convenience, many physician offices are located in close geographic\nproximity to other medical services such as laboratories, pharmacies and opticians. The\nphysician should not receive any financial compensation or other consideration either for\nreferring a patient to these services, or for being located in close geographical proximity to\nthem. Physician-owned buildings should not charge above-market or below-market rates\nto tenants.\nNon-medical products (those having nothing to do with patient health or the practice of\nmedicine) and scientifically non-validated medical products should not be sold out of the\nphysician\u2019s office. If scientifically validated medical products are sold out of the physi-\ncian\u2019s office charges should be limited to the costs incurred in making them available and\nthe products should be offered in such a way that the patient does not feel pressured to\npurchase them.\nOrganizational\/institutional\t\n \u00a0conflicts\t\n \u00a0\n\t\n \u00a0\nHealth care institutions in particular are increasingly subject to a number of pressures that\nthreaten several of their roles, and many academic medical centres have begun to identify\nalternate sources of revenue. Policies should be in place to ensure that these new sources\nare not in conflict with the values and mission of the institution (for example, tobacco\nfunding in medical schools).\nIndividual medical organizations and institutions (including, but not limited to, medical\nschools, hospitals, national medical associations, official\/state regulators and research in-\nstitutions) should develop and, where possible, enforce conflict of interest guidelines for\ntheir employees and members.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nS-\u00ad\u20102009-\u00ad\u201001-\u00ad\u20102009\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nPhysician-researchers and others will benefit from the development of institutional con-\nflict of interest guidelines to assist them in making appropriate disclosure and clearly\nidentifying situations where a conflict would preclude them from participating in a re-\nsearch study or other activity.\nAcademic health care institutions should have a clear demarcation between investment\ndecision-making committees, technology transfer and the research arm of the institution.\nWritten policies should provide guidelines for disclosure requirements, or for disconti-\nnuing participation in the decision-making process, for those individuals who are con-\nflicted due to sponsored research, consulting agreements, private holdings or licensing\nagreements.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0S-\u00ad\u20102009-\u00ad\u201002-\u00ad\u20102009\t\n \u00a0\nWMA\t\n \u00a0STATEMENT\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nEMBRYONIC\t\n \u00a0STEM\t\n \u00a0CELL\t\n \u00a0RESEARCH\t\n \u00a0\nAdopted by the 60th\nWMA General Assembly, New Delhi, India, October 2009\nPREAMBLE\t\n \u00a0\n\t\n \u00a0\nThe field of stem cell research has been developing during the last decade and is now one\nof the fastest growing areas of biotechnology.\nStem cells can be harvested from an established tissue (adult stem cell) or from the blood\nof the umbilical cord and these sources, for many, create no specific ethical dilemma.\nStem cells can also be obtained from the embryo (embryonic stem cells). Obtaining and\nusing these stem cells raises specific ethical questions and is, for some, problematic.\nSome legislatures have prohibited obtaining and using embryonic stem cells. Others have\nallowed using so-called spare or excess embryos from assisted reproduction cycles for re-\nsearch purposes, but often the production of embryos solely for research purposes is prohi-\nbited. Many jurisdictions have no specific legislative provisions with respect to embryonic\nstem cells.\nThe basis of legal and ethical consideration is that human embryos have a specific and\nspecial ethical status. This has generated debate amongst ethicists, philosophers, clini-\ncians, scientists, health workers, the public and legislators.\nSome assisted reproductive technology, specifically in vitro fertilisation, involves the pro-\nduction of embryos outside of the human body. In many cases not all of these are needed\nto achieve pregnancies. Those not used, so called \u201cspare or excess embryos\u201d, may be do-\nnated for the treatment of others or for research or stored for some time and then des-\ntroyed.\nThe differing legislative approaches to the use of embryos for research, may be reflected\nin law prohibiting the public funding of such research.\nStem cells can be used to conduct research into human disease and basic developmental\nbiology. There are many current research programs investigating the use of stem cells to\ntreat human disease. Although clinical studies have not yet validated the use of stem cells\nin therapy, the potential for therapeutic use in the future has been widely acknowledged by\nmembers of the medical and scientific community.\nIt is too early to assess the likelihood of success in any specific therapy and the place of\nstem cells amongst a variety of forms of treatments.\n\t\n \u00a0\n\t\n \u00a0S-\u00ad\u20102009-\u00ad\u201002-\u00ad\u20102009\t\n \u00a0\u23d0\uf8e6\t\n \u00a0New\t\n \u00a0Delhi\t\n \u00a0\nEmbryonic\t\n \u00a0Stem\t\n \u00a0Cell\t\n \u00a0Research\t\n \u00a0\nPublic views of stem cell research are at least as varied as those of doctors and scientists.\nMuch public debate centres on concerns of abuse of the technology as well as specific\nconcerns about the use of embryos.\nRegulation according to established ethical principles is likely to alleviate concerns for\nmany members of the public, especially if associated with careful and credible policing of\nthe regulations.\nRECOMMENDATION\t\n \u00a0\n\t\n \u00a0\nWhenever possible research should be carried out using stem cells that are not of embryo-\nnic origin. However, there will be circumstances where only embryonic stem cells will be\nsuitable for the research model.\nAll research on stem cells, regardless of their origin, must be carried out according to\nagreed ethical principles. Regulation and legislation must also accord with these principles\nto avoid confusion or conflicts between law and ethics.\nThe ethical principles should, where possible, follow international agreement. Recogni-\nsing that different groups have widely varying views on the use, especially, of embryonic\nstem cells, these principles should be drafted to allow different jurisdictions to limit their\nallowed levels of research as locally appropriate.\nAll and any research using embryos must only occur when written informed consent has\nbeen obtained from both donors of the genetic material that created the embryo.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0S-\u00ad\u20102009-\u00ad\u201003-\u00ad\u20102009\t\n \u00a0\nWMA\t\n \u00a0STATEMENT\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nINEQUALITIES\t\n \u00a0IN\t\n \u00a0HEALTH\t\n \u00a0\nAdopted by the 60th\nWMA General Assembly, New Delhi, India, October 2009\nPREAMBLE\t\n \u00a0\n\t\n \u00a0\nFor over 150 years, the existence of health inequality has been acknowledged worldwide.\nThe recently published Final Report of the WHO Commission on Social Determinants of\nHealth has highlighted the critical importance of health equity to the health, economy and\nsocial cohesiveness of all countries. It is clear that while there are major differences be-\ntween countries, especially between the developing and developed countries, there are also\nsubstantial disparities within countries with respect to various measures of socio-economic\nand cultural diversity. Disparities in health can be defined as either disparities in access to\nhealthcare, disparities in quality of care received, or both. The differences manifest them-\nselves in a wide variety of health measures, such as life expectancy, infant mortality, and\nchildhood mortality. Particularly disturbing is evidence of the gradual and ongoing widen-\ning of specific disparities.\nAt the core of this issue is the healthcare provided by physicians. National medical asso-\nciations should take an active role in combating social and health inequalities in order to\nallow their physician members the ability to provide equal, quality service to all.\nThe Role of the Health Care System:\nWhile the major causes of health disparities lie in the socio-economic and cultural di-\nversity of population groups, there is a very significant role for the health care system in\ntheir prevention and reduction. This role can be summarized as follows:\n\u2022 To prevent the health effects of socio-economic and cultural inequality and in-\nequity \u2013 especially by health promotion and disease prevention activities (Primary\nPrevention)\n\u2022 To Identify, treat and reduce existing health inequality, e.g. early diagnosis of\ndisease, quality management of chronic disease, rehabilitation (Secondary and Ter-\ntiary Prevention).\nRECOMMENDATIONS\t\n \u00a0\n\t\n \u00a0\nThe members of the medical profession, faced with treating the results of this inequity,\nhave a major responsibility and call on their national medical associations to:\n\u2022 Recognize the importance of health inequality and the need to influence national\npolicy and action for its prevention and reduction\n\t\n \u00a0\n\t\n \u00a0S-\u00ad\u20102009-\u00ad\u201003-\u00ad\u20102009\t\n \u00a0\u23d0\uf8e6\t\n \u00a0New\t\n \u00a0Delhi\t\n \u00a0\nInequalities\t\n \u00a0in\t\n \u00a0Health\t\n \u00a0\n\u2022 Identify the social and cultural risk factors to which patients and families are ex-\nposed and to plan clinical activities (diagnostic and treatment) to counter their con-\nsequences.\n\u2022 Advocate for the abolishment of financial barriers to obtaining needed medical\ncare.\n\u2022 Advocate for equal access for all to health care services irrespective of geographic,\nsocial, age, gender, religious, ethnic and economic differences or sexual orienta-\ntion.\n\u2022 Require the inclusion of health inequality studies (including the scope, severity,\ncauses, health, economic and social implications) as well as the provision of cul-\ntural competence tools, at all levels of academic medical training, including further\ntraining for those already in clinical practice.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0S-\u00ad\u20102009-\u00ad\u201004-\u00ad\u20102009\t\n \u00a0\nWMA\t\n \u00a0STATEMENT\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nGUIDING\t\n \u00a0PRINCIPLES\t\n \u00a0FOR\t\n \u00a0THE\t\n \u00a0USE\t\n \u00a0OF\t\n \u00a0TELEHEALTH\t\n \u00a0\t\n \u00a0\nFOR\t\n \u00a0THE\t\n \u00a0PROVISION\t\n \u00a0OF\t\n \u00a0HEALTH\t\n \u00a0CARE\t\n \u00a0\nAdopted by the 60th\nWMA General Assembly, New Delhi, India, October 2009\nDEFINITION\t\n \u00a0\n\t\n \u00a0\nTelehealth is the use of information and communications technology to deliver health and\nhealthcare services and information over large and small distances.\nPREAMBLE\t\n \u00a0\n\t\n \u00a0\nThe prevalence of telemedicine and telehealth in most countries in the world has led the\nWorld Medical Association (WMA) to develop ethical guidelines for physicians who use\nthis modality to provide health care services. The WMA defines telemedicine as \u201cthe prac-\ntice of medicine over a distance, in which interventions, diagnostics and treatment deci-\nsions and recommendations are based on data, including voice and images, documents and\nother information transmitted through telecommunication systems\u201d. This could include\ntelephone and internet.\nA broader telehealth definition brings into play the entire range of activities that support\nthe patient and the public in being healthy: prevention, promotion, diagnostics self-care\nand treatment are all areas where physicians play an important role. It is this broader defi-\nnition that the WMA endorses.\nTelehealth\/telemedicine helps eliminate distance barriers and improve equity of access to\nservices that otherwise often would not be available in remote, rural and increasingly ur-\nban communities. It is about transmitting voice, data, images, and information rather than\nphysically moving patients, health professionals and educators \u2013 thereby improving ac-\ncess, timeliness and convenience and reducing travel costs. It also has the added benefit\nthat the patients more easily can become active participants in their own health and well-\nbeing and are able to engage in educational programs aimed at fostering wellness from the\ncomfort, convenience and safety of their own homes. While this statement focuses mainly\non telehealth encounters between patients and health professionals, it should be noted that\nanother important aspect of telehealth is the use of tele-communication between health\nprofessionals when providing health care.\nThe telemedicine\/telehealth agenda will become an integral part of the larger eHealth\nprograms that most countries in the developed world are pursuing, as are many countries\nin the developing world. More and more solutions are being introduced that provide the\nability to deliver care through an e-channel and therefore more physicians will have access\nto this capability to provide care to their patients.\n\t\n \u00a0\n\t\n \u00a0S-\u00ad\u20102009-\u00ad\u201004-\u00ad\u20102009\t\n \u00a0\u23d0\uf8e6\t\n \u00a0New\t\n \u00a0Delhi\t\n \u00a0\nTelehealth\t\n \u00a0\nGUIDING\t\n \u00a0PRINCIPLES\t\n \u00a0\n\t\n \u00a0\nDuty\t\n \u00a0of\t\n \u00a0Care\t\n \u00a0\n\t\n \u00a0\nWhile the practice of telehealth challenges the conventional perception of the physician-\npatient relationship, there is a \u201cduty of care\u201d established in all telehealth encounters be-\ntween the physician and the patient as in any healthcare encounter.\nThe physician needs to give clear and explicit direction to the patient during the telehealth\nencounter as to who has ongoing responsibility for any required follow-up and ongoing\nhealth care. Physician supervision regarding protocols, conferencing and medical record\nreview is required in all settings and circumstances. Physicians should have the capability\nto immediately contact nonphysician providers and technicians as well as patients.\nThe physician needs to clarify ongoing responsibility for the patient with any other health\ncare providers who are involved in the patient\u2019s care.\nThe legal responsibility of health professionals providing health care through means of\ntelehealth must be clearly defined by the appropriate jurisdiction.\nCommunication\t\n \u00a0with\t\n \u00a0Patients\t\n \u00a0\n\t\n \u00a0\nThe physician will take steps to ensure that quality of communication during a telehealth\nencounter is maximized. Any significant technical deficiencies should be noted in the\ndocumentation of the consultation.\nThe physician providing telehealth services should be familiar with the technology.\nThe physician should be aware of and accommodate the limitations of video\/audio in the\nprovision of telehealth health care services.\nThe physician should receive education\/orientation in telehealth communication skills prior\nto the initial telehealth encounter.\nThe physician needs to determine to the best of his or her ability each patient\u2019s appropria-\nteness for, and level of comfort with, telehealth prior to or at the encounter, while recog-\nnizing that this will not be possible in all situations.\nThe physician, to the extent possible, should ensure that the patient receives sufficient\neducation\/orientation to the telehealth process and communication issues prior to their ini-\ntial telehealth encounter.\nStandards\t\n \u00a0of\t\n \u00a0Practice\/Quality\t\n \u00a0of\t\n \u00a0Clinical\t\n \u00a0Care\t\n \u00a0\n\t\n \u00a0\nThe physician must be satisfied that the standard of care delivered via telehealth is\n\u201creasonable\u201d and at least equivalent to any other type of care that can be delivered to the\npatient\/client, considering the specific context, location and timing, and relative avail-\nability of traditional care. If the \u201creasonable\u201d standard cannot be satisfied via telehealth,\nthe physician should inform the patient and suggest an alternative type of health care\ndelivery\/service.\nThe physician should use existing clinical practice guidelines, whenever possible, to guide\nthe delivery of care in the telehealth setting, recognizing that certain modifications may\nneed to be made to accommodate specific circumstances.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0S-\u00ad\u20102009-\u00ad\u201004-\u00ad\u20102009\t\n \u00a0\nThe physician should ensure that any modifications to clinical practice guidelines for the\ntelehealth setting are approved by the discipline's clinical governing body or association.\nThe physician providing telehealth services should follow all relevant protocols and pro-\ncedures related to: informed consent (verbal, written, and recorded); privacy and confi-\ndentiality; documentation; ownership of patient\/client record; and appropriate video\/tele-\nphone behaviours.\nThe physician providing telehealth services ensures compliance with the relevant legisla-\ntion and professional guidelines of the jurisdiction from which the services are provided as\nwell as the jurisdiction from which the service is administered.\nThe physician providing telehealth services should possess the following: required skills\nexpected in the professional's field of practice; competent communication skills; an under-\nstanding of the scope of service being provided via telehealth; orientation to and ability to\nnavigate the technology system and environment; an understanding of the telehealth\noperational protocols and procedures; and an understanding of any limitations of the tech-\nnology being used.\nClinical\t\n \u00a0Outcomes\t\n \u00a0\n\t\n \u00a0\nOrganizations providing telehealth programs should monitor and continuously strive to\nimprove the quality of services in order to achieve the best possible outcomes.\nOrganizations providing telehealth programs should have in place a systematic method of\ncollecting, evaluating and reporting meaningful health care outcome data and clinical ef-\nfectiveness. Quality indicators should be identified and utilized.\nPatient\t\n \u00a0Confidentiality\t\n \u00a0\n\t\n \u00a0\nThe confidentiality of patient information should be protected.\nThe health care organization and physician providing telehealth services should be aware\nof, and ensure compliance with, relevant legislation and regulations designed to protect the\nconfidentiality of patient\/client information and have its own confidentiality guidelines.\nThe health care organizations and the physician are encouraged to consult with legal\ncounsel and relevant professional licensing\/regulatory bodies when determining confi-\ndentiality policy.\nInformed\t\n \u00a0Consent\t\n \u00a0\n\t\n \u00a0\nRelevant legislation and regulations that relate to patient decision-making and consent\nshould be applied.\nTo the extent possible, informed consent shall be obtained by the physician before starting\nany service or intervention. Where appropriate the patient\u2019s consent should be noted in the\ndocumentation of the consultation.\nConsent for telehealth should follow similar principles and processes as those used for\nother health services.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nS-\u00ad\u20102010-\u00ad\u201001-\u00ad\u20102010\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0STATEMENT\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nENVIRONMENTAL\t\n \u00a0DEGRADATION\t\n \u00a0\t\n \u00a0\nAND\t\n \u00a0SOUND\t\n \u00a0MANAGEMENT\t\n \u00a0OF\t\n \u00a0CHEMICALS\t\n \u00a0\nAdopted by the 61st\nWMA General Assembly, Vancouver, Canada, October 2010\nPREAMBLE\t\n \u00a0\n\t\n \u00a0\nThis Statement focuses on one important aspect of environmental degradation, which is\nenvironmental contamination by harmful domestic and industrial substances. It empha-\nsizes the harmful chemical contribution to environmental degradation and physicians\u2019 role\nin promoting sound management of chemicals as part of sustainable development, es-\npecially in the healthcare environment.\nMost chemicals to which humans are exposed come from industrial sources and include,\nfood additives, household consumer and cosmetic products, agrochemicals, and other sub-\nstances (drugs; dietary supplements) used for therapeutic purposes. Recently, attention has\nbeen concentrated on the effects of human engineered (or synthetic) chemicals on the\nenvironment, including specific industrial or agrochemicals and on new patterns of distri-\nbution of natural substances due to human activity. As the number of such compounds has\nmultiplied, governments and international organizations have begun to develop a more\ncomprehensive approach to their safe regulation.\nWhile governments have the primary responsibility for establishing a framework to pro-\ntect the public\u2019s health from chemical hazards, the World Medical Association, on behalf\nof its members, emphasizes the need to highlight the human health risks and make recom-\nmendations for further action.\nBACKGROUND\t\n \u00a0\n\t\n \u00a0\nChemicals\t\n \u00a0of\t\n \u00a0Concern\t\n \u00a0\n\t\n \u00a0\nDuring the last half-century, the use of chemical pesticides and fertilizers dominated agri-\ncultural practice and manufacturing industries rapidly expanded their use of synthetic che-\nmicals in the production of consumer and industrial goods1\n. The greatest concern relates to\nchemicals, which persist in the environment, have low rates of degradation, bioaccumu-\nlate in human and animal tissue (concentrating as they move up the food chain), and which\nhave significant harmful impacts on human health and the environment (particularly at\nlow concentrations)2\n. Some naturally occurring metals including lead, mercury, and cad-\nmium have industrial sources and are also of concern. Advances in environmental health\nresearch including environmental and human sampling and measuring techniques, and\nbetter information about the potential of low dose human health effects have helped to\nunderscore emerging concerns.\n\t\n \u00a0\n\t\n \u00a0Vancouver\t\n \u00a0\u23d0\uf8e6\t\n \u00a0S-\u00ad\u20102010-\u00ad\u201001-\u00ad\u20102010\t\n \u00a0\nEnvironmental\t\n \u00a0Degradation\t\n \u00a0\nHealth effects from chemical emissions can be direct (occurring as an immediate effect of\nthe emission) or indirect. Indirect health effects are caused by the emissions' effects on\nwater, air and food quality as well as the alterations in regional and global systems, such\nas red tide in many oceans, and the ozone layer and the climate, to which the emissions\nmay contribute.\nNational\t\n \u00a0and\t\n \u00a0International\t\n \u00a0Actions\t\n \u00a0\n\t\n \u00a0\nThe model of regulation of chemicals varies widely both within and between countries,\nfrom voluntary controls to statutory legislation. It is important that all countries move to a\ncoherent, standardized national legislated approach to regulatory control. Furthermore,\ninternational regulations must be coherent such that developing countries will not be\nforced by economic circumstances to circumvent potentially weak national regulations.\nAn example of a legislative framework can be found at http:\/\/ec.europa.eu\/environment\/\nchemicals\/index.htm.\nSynthetic chemicals include all substances that are produced by, or result from, human\nactivities including industrial and household chemicals, fertilizers, pesticides, chemicals\ncontained in products and in wastes, prescription and over-the-counter drug products and\ndietary supplements, and unintentionally produced byproducts of industrial processes or\nincineration, like dioxins. Furthermore, nanomaterials, in some circumstances, can be re-\ngulated by synthetic chemicals regulations but in other cases, may need explicit regulation.\nNotable\t\n \u00a0International\t\n \u00a0Agreements\t\n \u00a0on\t\n \u00a0Chemicals\t\n \u00a0\n\t\n \u00a0\nSeveral notable agreements on chemicals exist. These were prompted by the first United\nNations Conference on the Human Environment declaration in 1972 (Stockholm) on the\ndischarge of toxic substances into the environment3\n. These agreements include the 1989\nBasel Convention to control\/prevent trans-boundary movements of hazardous wastes, the\n1992 Rio Declaration on Environment and Development, the 1998 Rotterdam Convention\non informed consent and shipment of hazardous substances, and the 2001 Stockholm\nConvention on Persistent Organic Pollutants4 5 6.\nIt should be noted that little information\nis available on the efficacy of the controls.\nSTRATEGIC\t\n \u00a0APPROACH\t\n \u00a0TO\t\n \u00a0INTERNATIONAL\t\n \u00a0CHEMICALS\t\n \u00a0MANAGEMENT\t\n \u00a0\n\t\n \u00a0\nWorldwide hazardous environmental contamination persists despite these agreements,\nmaking a more comprehensive approach to chemicals essential. Reasons for ongoing con-\ntamination include persistence of companies, absolute lack of controls in some countries,\nlack of awareness of the potential hazards, inability to apply the precautionary principle,\nnon-adherence to the various conventions and treaties and lack of political will. The Stra-\ntegic Approach to International Chemicals Management (SAICM) was adopted in Dubai,\non February 6, 2006 by delegates from over 100 governments and representatives of civil\nsociety. This is a voluntary global plan of action designed to assure the sound management\nof chemicals throughout their life cycle so that, by 2020, chemicals are used and produced\nin ways that minimize significant adverse effects on human health and the environment.\nThe SAICM addresses both agricultural and industrial chemicals, covers all stages of the\nchemical life cycle of manufacture, use and disposal, and includes chemicals in products\nand in wastes7\n.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nS-\u00ad\u20102010-\u00ad\u201001-\u00ad\u20102010\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWORLD\t\n \u00a0MEDICAL\t\n \u00a0ASSOCIATION\t\n \u00a0(WMA)\t\n \u00a0RECOMMENDATIONS\t\n \u00a0\n\t\n \u00a0\nDespite these national and international initiatives, chemical contamination of the environ-\nment due to inadequately controlled chemical production and usage continues to exert\nharmful effects on global public health. Evidence linking some chemicals to some health\nissues is strong, but there is not evidence for all chemicals, especially newer or nano ma-\nterials, particularly at low doses over long periods of time. Physicians and the healthcare\nsector are frequently required to make decisions concerning individual patient and the pu-\nblic as a whole based on existing data. Physicians therefore caution that they, too, have a\nsignificant role to play in closing the gap between policy formation and chemicals manage-\nment and in reducing risks to human health.\nThe\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0Recommends\t\n \u00a0That:\t\n \u00a0\n\t\n \u00a0\nADVOCACY\t\n \u00a0\n\t\n \u00a0\n\u2022 National Medical Associations (NMAs) advocate for legislation that reduces che-\nmical pollution, reduces human exposure to chemicals, detects and monitors harm-\nful chemicals in both humans and the environment, and mitigates the health effects\nof toxic exposures with special attention to vulnerability during pregnancy and\nearly childhood.\n\u2022 NMAs urge their governments to support international efforts to restrict chemical\npollution through safe management, or phase out and safer substitution when un-\nmanageable (e.g. asbestos), with particular attention to developed countries aiding\ndeveloping countries to achieve a safe environment and good health for all.\n\u2022 NMAs facilitate better communication between government ministries\/depart-\nments responsible for the environment and public health.\n\u2022 Physicians and their medical associations advocate for environmental protection,\ndisclosure of product constituents, sustainable development, and green chemistry\nwithin their communities, countries and regions.\n\u2022 Physicians and their medical associations should support the phase out of mercury\nand persistent bioaccumulative and toxic chemicals in health care devices and pro-\nducts.\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\nchemical or a new industrial facility.\n\u2022 Physicians should encourage the publication of evidence of the effects of different\nchemicals and dosages on human health and the environment. These publications\nshould be accessible internationally and readily available to media, non-govern-\nmental organizations (NGOs) and concerned citizens locally.\n\u2022 Physicians and their medical associations advocate for the development of effec-\ntive and safe systems to collect and dispose of pharmaceuticals that are not con-\nsumed.\n\u2022 Physicians and their medical associations should support efforts to rehabilitate or\nclean areas of environmental degradation based on a \u201cpolluter pays\u201d and pre-\ncautionary principles and ensure that moving forward, such principles are built into\nlegislation.\n\u2022 The WMA, NMAs and physicians should urge governments to collaborate within\nand between departments to ensure coherent regulations are developed.\n\t\n \u00a0\n\t\n \u00a0Vancouver\t\n \u00a0\u23d0\uf8e6\t\n \u00a0S-\u00ad\u20102010-\u00ad\u201001-\u00ad\u20102010\t\n \u00a0\nEnvironmental\t\n \u00a0Degradation\t\n \u00a0\nLEADERSHIP\t\n \u00a0\n\t\n \u00a0\nThe\t\n \u00a0WMA:\t\n \u00a0\n\t\n \u00a0\n\u2022 Supports the goals of the Strategic Approach to International Chemicals Manage-\nment (SAICM), which promotes best practices in the handling of chemicals by\nutilizing safer substitution, waste reduction, sustainable non-toxic building, recy-\ncling, as well as safe and sustainable waste handling in the health care sector.\n\u2022 Cautions that these chemical practices must be coordinated with efforts to reduce\ngreen house gas emissions from health care to mitigate its contribution to global\nwarming.\n\u2022 Urges physicians, medical associations and countries to work collaboratively to\ndevelop systems for event alerts to ensure that health care systems and physicians\nare aware of high-risk industrial accidents as they occur, and receive timely accu-\nrate information regarding the management of these emergencies.\n\u2022 Urges local, national and international organizations to focus on sustainable pro-\nduction, safer substitution, green safe jobs, and consultation with the health care\ncommunity to ensure that damaging health impacts of development are anticipated\nand minimized.\n\u2022 Emphasizes the importance of the safe disposal of pharmaceuticals as one aspect of\nhealth care\u2019s responsibility and the need for collaborative work in developing best\npractice models to reduce this part of the chemical waste problem.\n\u2022 Encourages environmental classification of pharmaceuticals in order to stimulate\nprescription of environmentally less harmful pharmaceuticals.\n\u2022 Encourages ongoing outcomes research on the impact of regulations and moni-\ntoring of chemicals on human health and the environment.\nThe\t\n \u00a0WMA\t\n \u00a0recommends\t\n \u00a0that\t\n \u00a0Physicians;\t\n \u00a0\n\t\n \u00a0\n\u2022 Work to reduce toxic medical waste and exposures within their professional set-\ntings as part of the World Health Professional Alliance\u2019s campaign for Positive\nPractice Environments.\n\u2022 Work to provide information on the health impacts associated with exposure to\ntoxic chemicals, how to reduce patient exposure to specific agents and encourage\nbehaviors that improve overall health.\n\u2022 Inform patients about the importance of safe disposal of pharmaceuticals that are\nnot consumed.\n\u2022 Work with others to help address the gaps in research regarding the environment\nand health (i.e., patterns and burden of disease attributed to environmental degra-\ndation; community and household impacts of industrial chemicals; the most vul-\nnerable populations and protections for such populations).\nPROFESSIONAL\t\n \u00a0EDUCATION\t\n \u00a0&#038;\t\n \u00a0CAPACITY\t\n \u00a0BUILDING\t\n \u00a0\n\t\n \u00a0\nThe\t\n \u00a0WMA\t\n \u00a0recommends\t\n \u00a0that:\t\n \u00a0\n\t\n \u00a0\n\u2022 Physicians and their professional associations assist in building professional and\npublic awareness of the importance of the environment and global chemical pol-\nlutants on personal health.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nS-\u00ad\u20102010-\u00ad\u201001-\u00ad\u20102010\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\n\u2022 National Medical Associations (NMAs) and physician professional associations\ndevelop tools for physicians to help assess their patients\u2019 risk from chemical ex-\nposures.\n\u2022 Physicians and their professional associations develop locally appropriate conti-\nnuing medical education on the clinical signs, diagnosis and treatment of diseases\nthat are introduced into communities as a result of chemical pollution and exacer-\nbated by climate change.\n\u2022 Environmental health and occupational medicine should become a core theme in\nmedical education. Medical schools should encourage in the training of sufficient\nspecialists in environmental health and occupational medicine.\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\n1\nWiser G, Center for International Environmental Law, UNEP Forum, Sept. 2005\n2\nhttp:\/\/www.unep.org\/hazardoussubstances\/Introduction\/tabid\/258\/language\/en-US\/Default.aspx\n3\nhttp:\/\/www.unep.org\/Documents.Multilingual\/Default.asp?DocumentID=97&#038;ArticleID=1503&#038;l=en\n4\nhttp:\/\/www.unep.org\/Documents.Multilingual\/Default.asp?DocumentID=78&#038;ArticleID=1163\n5\nWiser G, Center for International Environmental Law, UNEP Forum, Sept. 2005\n6\nhttp:\/\/chm.pops.int\/Convention\/tabid\/54\/language\/en-US\/Default.aspx\n7\nhttp:\/\/www.chem.unep.ch\/saicm\/SAICM%20texts\/SAICM%20documents.htm\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0S-\u00ad\u20102011-\u00ad\u201001-\u00ad\u20102011\t\n \u00a0\nWMA\t\n \u00a0STATEMENT\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nTHE\t\n \u00a0GLOBAL\t\n \u00a0BURDEN\t\n \u00a0OF\t\n \u00a0CHRONIC\t\n \u00a0DISEASE\t\n \u00a0\nAdopted by the 62nd\nWMA General Assembly, Montevideo, Uruguay, October 2011\nINTRODUCTION\t\n \u00a0\n\t\n \u00a0\nChronic diseases, including cardiovascular and circulatory diseases, diabetes, cancer, and\nchronic lung disease are the leading cause of death and disability in both the developed\nand developing world. Chronic diseases are not replacing existing causes of disease and\ndisability (infectious disease and trauma), but are adding to the disease burden. Develop-\ning countries now face the triple burden of infectious disease, trauma and chronic disease.\nThis increased burden is straining the capacity of many countries to provide adequate\nhealth care services. This burden is also undermining these nations' efforts to increase life\nexpectancy and spur economic growth.\nOngoing and anticipated global trends that will lead to more chronic disease problems in\nthe future include an aging population, urbanization and community planning, increasingly\nsedentary lifestyles, climate change and the rapidly increasing cost of medical technology\nto treat chronic disease. Chronic disease prevalence is closely linked to global social and\neconomic development, globalization and mass marketing of unhealthy foods and other\nproducts. The prevalence and cost of addressing the chronic disease burden is expected to\nrise in coming years.\nPOSSIBLE\t\n \u00a0SOLUTIONS\t\n \u00a0\n\t\n \u00a0\nThe primary solution is disease prevention. National policies that help people achieve\nhealthy lifestyles and behaviors are the foundation for all possible solutions.\nIncreased access to primary care combined with well designed and affordable disease -\ncontrol programs can greatly improve health care. Partnerships of national ministries of\nhealth with institutions in developed countries may overcome many barriers in the poorest\nsettings. Effective partnerships currently exist in rural Malawi, Rwanda and Haiti. In these\nsettings where no oncologists are available, care is provided by local physicians and nurse\nteams. These teams deliver chemotherapy to patients with a variety of treatable malig-\nnancies.\nMedical education systems should become more socially accountable. The World Health\nOrganization (WHO) defines social accountability of medical schools as the obligation to\ndirect their education, research and service activities towards addressing the priority health\nconcerns of the community, region, or nation they have a mandate to serve. The priority\nhealth concerns are to be identified jointly by governments, health care organizations,\n\t\n \u00a0\n\t\n \u00a0S-\u00ad\u20102011-\u00ad\u201001-\u00ad\u20102011\t\n \u00a0\u23d0\uf8e6\t\n \u00a0Montevideo\t\n \u00a0\nChronic\t\n \u00a0Disease\t\n \u00a0\nhealth professionals and the public. There is an urgent need to adopt accreditation stand-\nards and norms that support social accountability. Educating physicians and other health\ncare professionals to deliver health care that is concordant with the resources of the coun-\ntry must be a primary consideration. Led by primary care physicians, teams of physicians,\nnurses and community health workers will provide care that is driven by the princi-ples of\nquality, equity, relevance and effectiveness. [see WMA Resolution on Medical Work-\nforce]\nStrengthening the health care infrastructure is important in caring for the increasing num-\nbers of people with chronic disease. Components of this infrastructure include training the\nprimary health care team, improved facilities, chronic disease surveillance, public health\npromotion campaigns, quality assurance and establishment of national and local standards\nof care. One of the most important components of health care infrastructure is human re-\nsources; well-trained and motivated health care professionals led by primary care physi-\ncians are crucial to success. International aid and development programs need to move\nfrom \"vertical focus\" on single diseases or objectives to a more sustainable and effective\nprimary care health infrastructure development.\nFor\t\n \u00a0World\t\n \u00a0Governments:\t\n \u00a0\n\t\n \u00a0\n1. Support global immunization strategies;\n2. Support global tobacco and alcohol control strategies;\n3. Promote healthy living and implement policies that support prevention and healthy\nlifestyle behaviors;\n4. Set aside a fixed percentage of national budget for health infrastructure develop-\nment and promotion of healthy lifestyles.\n5. Promote trade policy that protects public health;\n6. Promote research for prevention and treatment of chronic disease;\n7. Develop global strategies for the prevention of obesity.\nFor\t\n \u00a0National\t\n \u00a0Medical\t\n \u00a0Associations:\t\n \u00a0\n\t\n \u00a0\n1. Work to create communities that promote healthy lifestyles and prevention beha-\nviors and to increase physician awareness of optimal disease prevention behaviors;\n2. Offer patients smoking cessation, weight control strategies, substance abuse coun-\nseling, self-management education and support, and nutritional counseling;\n3. Promote a team-based approach to chronic disease management;\n4. Advocate for integration of chronic disease prevention and control strategies in\ngovernment-wide policies;\n5. Invest in high quality training for more primary care physicians and an equitable\ndistribution of them among populations;\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0S-\u00ad\u20102011-\u00ad\u201001-\u00ad\u20102011\t\n \u00a0\n6. Provide high quality accessible resources for continuing medical education;\n7. Support establishing evidence-based standards of care for chronic disease;\n8. Establish, support and strengthen professional associations for primary care physi-\ncians\n9. Promote medical education that is responsive to societal needs;\n10. Promote an environment of support for continuity of care for chronic disease, in-\ncluding patient education and self-management;\n11. Advocate for policies and regulations to reduce factors that promote chronic dis-\nease such as smoking cessation and blood pressure control;\n12. Support strong public health infrastructure; and\n13. Support the concept that social determinants are part of prevention and health care.\nFor\t\n \u00a0Medical\t\n \u00a0Schools:\t\n \u00a0\n\t\n \u00a0\n1. Develop curriculum objectives that meet societal needs; e.g., social accountability;\n2. Focus on providing primary care training opportunities that highlight the integra-\ntive and continuity elements of the primary care specialties including family medi-\ncine;\n3. Provide community-oriented and community-based primary care educational ve-\nnues so that students become acquainted with the basic elements of chronic care\ninfrastructure and continuity care provision;\n4. Create departments of family medicine that are of equal academic standing in the\nuniversity; and\n5. Promote the use of interdisciplinary and other collaborative training methodologies\nwithin primary and continuing education programs.\n6. Include instruction in prevention of chronic diseases in the general curriculum.\nFor\t\n \u00a0Individual\t\n \u00a0Physicians:\t\n \u00a0\n\t\n \u00a0\n1. Work to create communities that promote healthy lifestyles and prevention beha-\nviors;\n2. Offer patients smoking cessation, weight control strategies, substance abuse coun-\nseling, self-management education and support, and nutritional counseling;\n3. Promote a team-based approach to chronic disease management;\n4. Ensure continuity of care for patients with chronic disease;\n\t\n \u00a0\n\t\n \u00a0S-\u00ad\u20102011-\u00ad\u201001-\u00ad\u20102011\t\n \u00a0\u23d0\uf8e6\t\n \u00a0Montevideo\t\n \u00a0\nChronic\t\n \u00a0Disease\t\n \u00a0\n5. Model prevention behaviors to patients by maintaining personal health;\n6. Become community advocates for positive social determinants of health and for\nbest prevention methods;\n7. Work with parents and the community to ensure that the parents have the best\nadvice on maintaining the health of their children.\n8. Physicians should collaborate with patients' associations in designing and deliver-\ning prevention education.\nNote: Depending on the country, different stakeholders will assume greater or lesser responsibility\nfor change.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0S-\u00ad\u20102011-\u00ad\u201002-\u00ad\u20102011\t\n \u00a0\nWMA\t\n \u00a0RECOMMENDATION\t\n \u00a0\nON\t\n \u00a0\nTHE\t\n \u00a0DEVELOPMENT\t\n \u00a0OF\t\n \u00a0A\t\n \u00a0MONITORING\t\n \u00a0AND\t\n \u00a0\t\n \u00a0\nREPORTING\t\n \u00a0MECHANISM\t\n \u00a0TO\t\n \u00a0PERMIT\t\n \u00a0AUDIT\t\n \u00a0OF\t\n \u00a0\t\n \u00a0\nADHERENCE\t\n \u00a0OF\t\n \u00a0STATES\t\n \u00a0TO\t\n \u00a0THE\t\n \u00a0DECLARATION\t\n \u00a0OF\t\n \u00a0TOKYO\t\n \u00a0\nAdopted by the 62nd\nWMA General Assembly, Montevideo, Uruguay, October 2011\nThe\t\n \u00a0WMA\t\n \u00a0recommends\t\n \u00a0that\t\n \u00a0\n1.\n1. Where physicians are working in situations of dual loyalties, support must be\noffered to ensure they are not put in positions that might lead to violations of\nfundamental professional ethics, whether by active breaches of medical ethics or\nomission of ethical conduct, and\/or of human rights, as laid out in the Declaration\nof Tokyo.\n2. National Medical Associations (NMA's) should offer support for physicians in\ndifficult situations, including, as feasible and without endangering either patients\nor doctors, helping individuals to report violations of patients' health rights and\nphysicians' professional ethics in custodial settings.\n3. The WMA should review the evidence available, in cases brought to it by its mem-\nbers, of the violation of human rights codes by states and\/or the forcing of physi-\ncians to violate the Declaration of Tokyo, and refer as appropriate such cases to the\nrelevant national and international authorities.\n4. The WMA should contact member associations and encourage them to investigate\naccusations of physician involvement in torture and similar abuses of human rights\nreported to it from reputable sources, and to report back in particular on whether\nphysicians are at risk and in need of support. The WMA should provide support to\nthe NMAs and their members to resist such violations, and as far as realistically\npossible, stand firm in their ethical convictions.\n5. The WMA shall encourage and support NMAs in their calls for investigations by\nthe relevant special rapporteur (or other individual or organization) when NMAs\nand their members raise valid concerns.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nS-\u00ad\u20102011-\u00ad\u201003-\u00ad\u20102011\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0STATEMENT\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nTHE\t\n \u00a0PROTECTION\t\n \u00a0AND\t\n \u00a0INTEGRITY\t\n \u00a0OF\t\n \u00a0MEDICAL\t\n \u00a0PERSONNEL\t\n \u00a0\t\n \u00a0\nIN\t\n \u00a0ARMED\t\n \u00a0CONFLICTS\t\n \u00a0AND\t\n \u00a0OTHER\t\n \u00a0SITUATIONS\t\n \u00a0OF\t\n \u00a0VIOLENCE\t\n \u00a0\nAdopted by the 62nd\nWMA General Assembly, Montevideo, Uruguay, October 2011\nPREAMBLE\t\n \u00a0\n\t\n \u00a0\nDuring wars and armed conflicts hospitals and other medical facilities have often been\nattacked and misused and patients and medical personnel have been killed or wounded.\nSuch attacks are a violation of the Geneva Conventions (1949), Additional Protocols to the\nGeneva Conventions (1977) and WMA regulations in times of war (2006).\nThe World Medical Association (WMA) has been active in condemning documented at-\ntacks on medical personnel and facilities in armed conflicts. The International Committee\nof the Red Cross (ICRC) Geneva Conventions and their Additional Protocols shall protect\nmedical personnel in international and non-international armed conflicts. The warring\nparties have duty not to interfere with medical care for wounded or sick combatants and\ncivilians, and not attack, threaten or impede medical functions. Physicians and other health\ncare personnel must be considered as neutral and must not be prevented from fulfilling\ntheir duties.\nThe lack of systematic reporting and documentation of violence against medical personnel\nand facilities creates threats to both civilians and military personnel. The development of\nstrategies for protection and efforts to improve compliance with the laws of war are im-\npeded as long as such information is not available.\nSTATEMENT\t\n \u00a0\n\t\n \u00a0\nThe World Medical Association condemns all attacks on and misuse of medical personnel,\nfacilities and vehicles in armed conflicts. These attacks put people in need of help in great\ndanger and can lead to the flight of physicians and other health personnel from the conflict\nareas with a lack of available medical personnel as a result.\nCurrently no party is responsible for collecting data regarding assaults on medical person-\nnel and facilities. Data collection after attacks is vital to identify the reasons why medical\npersonnel and facilities are attacked. Such data are important in order to understand the\nnature of the attacks and to take necessary steps to prevent attacks in the future. All attacks\nmust also be properly investigated and those responsible for the violations of the Geneva\nConventions and Protocols must be brought to justice.\n\t\n \u00a0\n\t\n \u00a0Montevideo\t\n \u00a0\u23d0\uf8e6\t\n \u00a0S-\u00ad\u20102011-\u00ad\u201003-\u00ad\u20102011\t\n \u00a0\nProtection\t\n \u00a0and\t\n \u00a0Integrity\t\n \u00a0of\t\n \u00a0Medical\t\n \u00a0Personnel\t\n \u00a0\nThe WMA requests that appropriate international bodies establish mechanisms with the\nnecessary resources to collect and disseminate data regarding assaults on physicians, other\nhealth care personnel and medical facilities in armed conflicts. Such mechanisms could in-\nclude the establishment of a new United Nations post of Rapporteur on the independence\nand integrity of health professionals. As stated in the WMA proposal for a United Nations\nRapporteur on the Independence and Integrity of Health Professionals (1997), \"The new\nrapporteur would be charged with the task of monitoring that doctors are allowed to move\nfreely and that patients have access to medical treatment, without discrimination as to na-\ntionality or ethnic origin, in war zones or in situations of political tension\".\nWhen a reporting system is established the WMA will recommend to their member or-\nganisations reporting armed conflicts which they become aware of.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nS-\u00ad\u20102011-\u00ad\u201004-\u00ad\u20102011\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0STATEMENT\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nSOCIAL\t\n \u00a0DETERMINANTS\t\n \u00a0OF\t\n \u00a0HEALTH\t\n \u00a0\nAdopted by the 62nd\nWMA General Assembly, Montevideo, Uruguay, October 2011\nThe social determinants of health are: the conditions in which people are born, grow, live,\nwork and age; and the societal influences on these conditions. The social determinants of\nhealth are major influences on both quality of life, including good health, and length of\ndisability-free life expectancy. While health care will attempt to pick up the pieces and\nrepair the damage caused by premature ill health, it is these social, cultural, environ-\nmental, economic and other factors that are the major causes of rates of illness and, in\nparticular, the magnitude of health inequalities.\nHistorically, the primary role of doctors and other health care professionals has been to\ntreat the sick - a vital and much cherished role in all societies. To a lesser extent, health\ncare professionals have dealt with individual exposures to the causes of disease - smoking,\nobesity, and alcohol in chronic disease, for example. These familiar aspects of life style\ncan be thought of as \u2018proximate' causes of disease.\nThe work on social determinants goes far beyond this focus on proximate causes and\nconsiders the \"causes of the causes\". For example, smoking, obesity, alcohol, sedentary\nlife style are all causes of illness. A social determinants approach addresses the causes of\nthese causes; and in particular how they contribute to social inequalities in health. It\nfocuses not only on individual behaviours but seeks to address the social and economic\ncircumstances that give rise to premature ill health, throughout the life course: early child\ndevelopment, education, work and living conditions, and the structural causes that give\nrise to these living and working conditions. In many societies, unhealthy behaviours fol-\nlow the social gradient: the lower people are in the socioeconomic hierarchy, the more\nthey smoke, the worse their diet, and the less physical activity they engage in. A major,\nbut not the only, cause of the social distribution of these causes is level of education. Other\nspecific examples of addressing the causes of the causes: price and availability, which are\nkey drivers of alcohol consumption; taxation, package labeling, bans on advertising, and\nsmoking in public places, which have had demonstrable effects on tobacco consumption.\nThe voice of the medical profession has been most important in these examples of tackling\nthe causes of the causes.\nThere is a growing movement, globally, that seeks to address gross inequalities in health\nand length of life through action on the social determinants of health. This movement has\ninvolved the World Health Organisation, several national governments, civil society organi-\nzation, and academics. Solutions are being sought and learning shared. Doctors should be\nwell informed participants in this debate. There is much that can happen within the prac-\ntice of medicine that can contribute directly and through working with other sectors. The\n\t\n \u00a0\n\t\n \u00a0Montevideo\t\n \u00a0\u23d0\uf8e6\t\n \u00a0S-\u00ad\u20102011-\u00ad\u201004-\u00ad\u20102011\t\n \u00a0\nSocial\t\n \u00a0Determinants\t\n \u00a0of\t\n \u00a0Health\t\n \u00a0\nmedical profession can be advocates for action on those social conditions that have im-\nportant effects on health.\nThe WMA could add significant value to the global efforts to address these social deter-\nminants by helping doctors, other health professionals and National Medical Associations\nunderstand what the emerging evidence shows and what works, in different circumstances.\nIt could help doctors to lobby more effectively within their countries and across interna-\ntional borders, and ensure that medical knowledge and skills are shared.\nThe WMA should help to gather data of examples that are working, and help to engage\ndoctors and other health professionals in trying new and innovative solutions. It should\nwork with national associations to educate and inform their members and put pressure on\nnational governments to take the appropriate steps to try to minimise these root causes of\npremature ill health. In Britain, for example, the national government has issued a public\nhealth white paper that has at its heart reduction of health inequalities through action on\nthe social determinants of health; several local areas have drawn up plans of action; there\nare good examples of general practice that work across sectors improve the quality of\npeople's lives and hence reduce health inequalities. The WMA should gather examples of\ngood practice from its members and promote further work in this area.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nS-\u00ad\u20102011-\u00ad\u201005-\u00ad\u20102011\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0STATEMENT\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nTHE\t\n \u00a0PROFESSIONAL\t\n \u00a0AND\t\n \u00a0ETHICAL\t\n \u00a0USE\t\n \u00a0OF\t\n \u00a0SOCIAL\t\n \u00a0MEDIA\t\n \u00a0\nAdopted by the 62nd\nWMA General Assembly, Montevideo, Urugay, October 2011\nDEFINITION\t\n \u00a0\n\t\n \u00a0\nSocial Media is generally understood to be a collective term for the different platforms and\napplications that allow user-generated content to be created and shared electronically.\nPREAMBLE\t\n \u00a0\n\t\n \u00a0\nThe objectives of the proposed policy are to:\n\u2022 Examine the professional and ethical challenges related to the increasing usage of\nsocial media by physicians, medical students and patients.\n\u2022 Establish a framework that protects their respective interests.\n\u2022 Ensure trust and reputation by maintaining high professional and ethical standards.\nThe use of social media has become a fact of life for many millions of people world wide\nincluding physicians, medical students and patients.\nInteractive, collaborative tools such as wikis, social networks, chat rooms and blogs have\ntransformed passive Internet users into active participants. They are means for gathering,\nsharing and disseminating personal information, including health information, socializing\nand connecting with friends, relatives, professionals etc. They can be used to seek medical\nadvice, and patients with chronic diseases can share their experiences with each other.\nThey can also been used in research, public health, education and direct or indirect pro-\nfessional promotion.\nThe positive aspects of social media should be recognized such as in promoting healthy\nlife style, in empowering patients and in reducing patients' isolation.\nAreas, which may require special attention:\n\u2022 Sensitive content, photographs, other personal materials posted on online social\nforums often exists in the public domain and have the capacity to remain on the\ninternet permanently. Individuals may not have control over the ultimate distribu-\ntion of material they post on-line.\n\u2022 Patient portal, blogs and tweets are not a substitute for one on one consultation\nwith physicians but may widen engagement with health services amongst certain\n\t\n \u00a0\n\t\n \u00a0Montevideo\t\n \u00a0\u23d0\uf8e6\t\n \u00a0S-\u00ad\u20102011-\u00ad\u201005-\u00ad\u20102011\t\n \u00a0\nSocial\t\n \u00a0Media\t\n \u00a0\ngroups. Online \"friendships\" with patients may also alter the patient-physician\nrelationship, and may result in unnecessary, possibly problematic physician and\npatient self-disclosure.\n\u2022 Each party's privacy may be compromised in the absence of adequate and con-\nservative privacy settings or by their inappropriate use. Privacy settings are not\nabsolute; social media sites may change default privacy settings unilaterally, without\nthe user's knowledge. Social media sites may also make communications available\nto third parties.\n\u2022\nInterested stakeholders such as current\/prospective employers, insurance companies and\ncommercial entities may monitor these Internet web sites for various purposes such as to\nbetter understand their customer's needs and expectations, to profile job candidates or to\nimprove a product or a service.\nRECOMMENDATIONS\t\n \u00a0\n\t\n \u00a0\nThe WMA urges their NMA\u00b4s to establish guidelines for their physicians addressing the\nfollowing issues:\n1.\n1. To maintain appropriate boundaries of the patient-physician relationship in accor-\ndance with professional ethical guidelines just as they would in any other context.\n2. To study carefully and understand the privacy provisions of social networking\nsites, bearing in mind their limitations.\n3. For physicians to routinely monitor their own Internet presence to ensure that the\npersonal and professional information on their own sites and, to the extent possi-\nble, content posted about them by others is accurate and appropriate.\n4. To consider the intended audience and assess whether it is technically feasible to\nrestrict access to the content to pre-defined individuals or groups.\n5. To adopt a conservative approach when disclosing personal information as patients\ncan access the profile. The professional boundaries that should exist between the\nphysician and the patient can thereby be blurred. Physicians should acknowledge\nthe potential associated risks of social media and accept them, and carefully select\nthe recipients and privacy settings.\n6. To provide factual and concise information, declare any conflicts of interest and\nadopt a sober tone when discussing professional matters.\n7. To ensure that no identifiable patient information be posted in any social media by\ntheir physician. Breaching confidentiality undermines the public's trust in the medi-\ncal profession, impairing the ability to treat patients effectively.\n8. To draw the attention of medical students and physicians to the fact that online\nposting may contribute also to the public perception of the profession.\n\t\n \u00a0\n\t\n \u00a0S-\u00ad\u20102011-\u00ad\u201005-\u00ad\u20102011\t\n \u00a0\u23d0\uf8e6\t\n \u00a0Montevideo\t\n \u00a0\nSocial\t\n \u00a0Media\t\n \u00a0\n9. To consider the inclusion of educational programs with relevant case studies and\nappropriate guidelines in medical curricula and continuing medical education.\n10. To bring their concerns to a colleague when observing his or her clearly inappro-\npriate behavior. If the behaviour significantly violates professional norms and the\nindividual does not take appropriate action to resolve the situation, physicians should\nreport the conduct to appropriate authorities.\n\u2022\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0S-\u00ad\u20102012-\u00ad\u201001-\u00ad\u20102012\t\n \u00a0\nWMA\t\n \u00a0STATEMENT\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nELECTRONIC\t\n \u00a0CIGARETTES\t\n \u00a0AND\t\n \u00a0\t\n \u00a0\nOTHER\t\n \u00a0ELECTRONIC\t\n \u00a0NICOTINE\t\n \u00a0DELIVERY\t\n \u00a0SYSTEMS\t\n \u00a0\nAdopted by the 63rd\nWMA General Assembly, Bangkok, Thailand, October 2012\nINTRODUCTION\t\n \u00a0\nElectronic cigarettes (e-cigarettes) are products designed to deliver nicotine to a user in the\nform of a vapor. They are usually composed of a rechargeable battery-operated heating\nelement, a replaceable cartridge that contains nicotine and\/or other chemicals, and an\natomizer that, when heated, turns the contents of the cartridge into a vapor (not smoke).\nThis vapor is then inhaled by the user. These products are often made to look like other\ntobacco-derived products like cigarettes, cigars, and pipes. They can also be made to look\nlike everyday items such as pens and USB memory sticks.\nNo standard definition of e-cigarettes exists and different manufacturers use different\ndesigns and different ingredients. Quality control processes used to manufacture these\nproducts are substandard or non-existent. Few studies have been done to analyze the level\nof nicotine delivered to the user and the composition of the vapor produced.\nManufacturers and marketers of e-cigarettes often claim that use of their products is a safe\nalternative to smoking, particularly since they do not produce carcinogenic smoke.\nHowever, no studies have been conducted to determine that the vapor is not carcinogenic,\nand there are other potential risks associated with these devices: Appeal to children,\nespecially when flavors like strawberry or chocolate are added to the cartridges. E-\ncigarettes can increase nicotine addiction among young people and their use may lead to\nexperimenting with other tobacco products.\nManufacturers and distributors mislead people into believing these devices are acceptable\nalternatives to scientifically proven cessation techniques, thus delaying actual smoking\ncessation. E-cigarettes are not comparable to scientifically-proven methods of smoking\ncessation. Their dosage, manufacture, and ingredients are not consistent or clearly la-\nbelled. Brand stretching by using known cigarette logos is to be deplored.\nUnknown amounts of nicotine are delivered to the user, and the level of absorption is\nunclear, leading to potentially toxic levels of nicotine in the system. These products may\nalso contain other ingredients toxic to humans.\nHigh potential of toxic exposure to nicotine by children, either by ingestion or dermal\nabsorption, because the nicotine cartridges and refill liquid are readily available over the\nInternet and are not sold in child resistant packaging.\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\nS-\u00ad\u20102012-\u00ad\u201001-\u00ad\u20102012\t\n \u00a0\u23d0\uf8e6\t\n \u00a0Bangkok\t\n \u00a0\nElectronic\t\n \u00a0Cigarettes\t\n \u00a0\nDue to the lack of rigorous chemical and animal studies, as well as clinical trials on com-\nmercially available e-cigarettes, neither their value as therapeutic aids for smoking ces-\nsation nor their safety as cigarette replacements is established. Lack of product testing\ndoes not permit the conclusion that e-cigarettes do not produce any harmful products even\nif they produce fewer dangerous substances than conventional cigarettes.\nClinical testing, large population studies and full analyses of e-cigarette ingredients and\nmanufacturing processes need to be conducted before their safety, viability and impacts\ncan be determined as either clinical tools or as widely available effective alternatives to\ntobacco use.\nRECOMMENDATIONS\t\n \u00a0\nThat the manufacture and sale of e-cigarettes and other electronic nicotine delivery sys-\ntems be subject to national regulatory bodies prior approval based on testing and research\nas either a new form of tobacco product or as a drug delivery device.\nThat the marketing of e-cigarettes and other electronic nicotine delivery systems as a valid\nmethod for smoking cessation must be based on evidence and must be approved by ap-\npropriate regulatory bodies based on safety and efficacy data.\nThat e-cigarettes and other electronic nicotine delivery systems be included in smoke free\nlaws.\nPhysicians should inform their patients of the risks of using e-cigarettes even if regulatory\nauthorities have not taken a position on the efficacy and safety of these products.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0S-\u00ad\u20102012-\u00ad\u201002-\u00ad\u20102012\t\n \u00a0\nWMA\t\n \u00a0STATEMENT\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nTHE\t\n \u00a0ETHICAL\t\n \u00a0IMPLICATIONS\t\n \u00a0OF\t\n \u00a0COLLECTIVE\t\n \u00a0ACTION\t\n \u00a0BY\t\n \u00a0PHYSICIANS\t\n \u00a0\nAdopted by the 63rd\nWMA General Assembly, Bangkok, Thailand, October 2012\nPREAMBLE\t\n \u00a0\nIn recent years, in countries where physicians' satisfaction with their working conditions\nhas decreased, collective action by physicians has become increasingly common.\nPhysicians may carry out protest action and sanctions in order to improve direct and\nindirect working conditions that also may affect patient care. Physicians must consider not\nonly their duty to individual patients, but also their responsibility to improve the system\nsuch that it meets the requirements of accessibility and quality.\nIn addition to their professional obligations, physicians are often also employees. There\nmay be tension between physicians' duty not to cause harm, and their rights as employees.\nTherefore, physicians' strikes or other forms of collective action often give rise to public\ndebate on ethical and moral issues. This statement attempts to address these issues.\nRECOMMENDATIONS\t\n \u00a0\nThe World Medical Association recommends that National Medical Associations (NMAs)\nadopt the following guidelines for physicians with regard to collective action:\nPhysicians who take part in collective action are not exempt from their ethical or pro-\nfessional obligations to patients.\nEven when the action taken is not organized by or associated with the National Medical\nAssociation, the NMA should ensure that the individual physician is aware of and abides\nby his or her ethical obligations.\nWhenever possible, physicians should press for reforms through non-violent public de-\nmonstrations, lobbying and publicity or informational campaigns or negotiation or media-\ntion.\nIf involved in collective action, NMAs should act to minimize the harm to the public and\nensure that essential and emergency health services, and the continuity of care, are pro-\nvided throughout a strike. Further, NMAs should advocate for measures to review excep-\ntional cases.If involved in collective action, NMAs should provide continuous and up-to-\ndate information to their patients and the general public with regard to the demands of the\nconflict and the actions being undertaken. The general public must be kept informed in a\ntimely manner about any strike actions and the restrictions they may have on health care.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nS-\u00ad\u20102012-\u00ad\u201003-\u00ad\u20102012\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0STATEMENT\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nFORCED\t\n \u00a0AND\t\n \u00a0COERCED\t\n \u00a0STERILISATION\t\n \u00a0\nAdopted by the 63rd\nWMA General Assembly, Bangkok, Thailand, October 2012\nThe WMA recognises that no person, regardless of gender, ethnicity, socio-economic\nstatus, medical condition or disability, should be subjected to forced or coerced permanent\nsterilisation.\nA full range of contraceptive services, including sterilisation, should be accessible and\naffordable to every individual. The state may have a role to play in ensuring that such ser-\nvices are available, along with private, charitable and third sector organisations. The\ndecision to undergo contraception, including sterilisation, must be the sole decision of the\nindividual concerned.\nAs with all other medical treatments, sterilisation should only be performed on a com-\npetent patient after an informed choice has been made and the free and valid consent of the\nindividual has been obtained. Where a patient is incompetent, a valid decision about treat-\nment must be made in accordance with relevant legal requirements and the ethical\nstandards of the WMA before the procedure is carried out. Sterilization of those unable to\ngive consent would be extremely rare and done only with the consent of the surrogate\ndecision maker.\nSuch consent should be obtained when the patient is not facing a medical emergency, or\nother major stressor.\nThe WMA condemns practices where a state or any other actor attempts to bypass ethical\nrequirements necessary for obtaining free and valid consent.\nConsent to sterilisation should be free from material or social incentives which might\ndistort freedom of choice and should not be a condition of other medical care (including\nsafe abortion), social, insurance, institutional or other benefits.\nThe WMA calls on national medical associations to advocate against forced and coerced\nsterilisation in their own countries and globally.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0S-\u00ad\u20102012-\u00ad\u201004-\u00ad\u20102012\t\n \u00a0\nWMA\t\n \u00a0STATEMENT\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nORGAN\t\n \u00a0AND\t\n \u00a0TISSUE\t\n \u00a0DONATION\t\n \u00a0\nAdopted by the 63rd\nWMA General Assembly, Bangkok, Thailand, October 2012\nPREAMBLE\t\n \u00a0\t\n \u00a0\nAdvances in medical sciences, especially surgical techniques, tissue typing and immuno-\nsuppressive drugs, have made possible a significant increase in the rates of successful\ntransplantation of human organs and tissue. Yet, in all countries, a shortage of organ donors\nresults in potentially avoidable loss of life. National medical associations should support\nattempts to maximise the number of donor organs available in their countries and to ensure\nthat the highest ethical standards are maintained. The World Medical Association has\ndeveloped this policy to assist medical associations, physicians, other health care pro-\nviders and policy makers to achieve this.\n\u2022 This policy is based on a number of core principles: altruism, autonomy, benefi-\ncence, equity and justice. These principles should guide those developing local\npolicies and those operating within it, both in relation to organ procurement and to\nthe distribution and transplantation of donor organs. All systems and processes\nshould be transparent and open to scrutiny.\n\u2022 This statement applies to organ and tissue donation from both deceased and living\ndonors. It does not apply to blood donation.\nRAISING\t\n \u00a0PUBLIC\t\n \u00a0AWARENESS\t\n \u00a0\nIt is important that individuals are aware of the option of donation and have the oppor-\ntunity to choose whether or not to donate organs and\/or tissue after their death. Awareness\nand choice should be facilitated in a coordinated multi-faceted approach by a variety of\nstakeholders and means, including media awareness and public campaigns. In designing\nsuch campaigns account needs to be taken of any religious or cultural sensitivities of the\ntarget audience.\nThrough awareness raising campaigns, individuals should be informed of the benefits of\ntransplantation, the impact on the lives of those who are waiting for a transplant and the\nshortage of donors available. They should be encouraged to think about their own wishes\nabout donation, to discuss their wishes with their family and friends and to use established\nmechanisms to formally record them by opting into, or out of, donation.\nThe WMA advocates informed donor choice. National medical associations in countries\n\t\n \u00a0\n\t\n \u00a0S-\u00ad\u20102012-\u00ad\u201004-\u00ad\u20102012\t\n \u00a0\u23d0\uf8e6\t\n \u00a0Bangkok\t\n \u00a0\nOrgan\t\n \u00a0and\t\n \u00a0Tissue\t\n \u00a0Donation\t\n \u00a0\nthat have adopted or are considering a policy of \"presumed consent\" (or opt-out), in which\nthere is an assumption that the individual wishes to donate unless there is evidence to the\ncontrary, or \"mandated choice\", in which all persons would be required to declare whether\nthey wish to donate, should make every effort to ensure that these policies have been\nadequately publicised and do not diminish informed donor choice, including the patient's\nright not to donate.\nConsideration should be given to the establishment of national donor registries to collect\nand maintain a list of citizens who have chosen either to donate or not to donate their\norgans and\/or tissue. Any such registry must protect individual privacy and the indi-\nvidual's ability to control the collection, use, disclosure of, and access to, his or her health\ninformation for other purposes. Provisions must be in place to ensure that the decision to\nsign up to a register is adequately informed and that registrants can withdraw from the\nregistry easily and quickly and without prejudice.\nLiving organ donation is becoming an increasingly important component of transplanta-\ntion programmes in many countries. Most living donation is between related or emo-\ntionally close individuals but small but increasing numbers are donating to people they do\nnot know. Given that there are health risks associated with living organ donation, proper\ncontrols and safeguards are essential. Information aimed at informing people about the\npossibility of donating organs as a living donor should be carefully designed so as not to\nput pressure on them to donate. Potential donors should know where to obtain detailed\ninformation about what is involved, should be informed of the inherent risks and should\nknow that there are safeguard in place to protect those offering to donate.\nPROTOCOLS\t\n \u00a0FOR\t\n \u00a0ORGAN\t\n \u00a0AND\t\n \u00a0TISSUE\t\n \u00a0DONATION\t\n \u00a0FROM\t\n \u00a0DECEASED\t\n \u00a0DONORS\t\n \u00a0\nThe WMA encourages its members to support the development of comprehensive, coordi-\nnated national protocols for deceased (also referred to as cadaveric) organ and tissue\nprocurement in consultation and cooperation with all relevant stakeholders. Ethical, cul-\ntural and societal issues arising in connection with donation and transplantation should be\nresolved, wherever possible, in an open process involving public debate informed by\nsound evidence.\nNational and local protocols should provide detailed information about the identification,\nreferral and management of potential donors as well as communication with those close to\npeople who have died. They should encourage the procurement of organs and tissues con-\nsistent with this statement. Protocols should uphold the following key principles:\n\u2022 Decisions to withhold or withdraw life-prolonging treatment should be based on an\nassessment of whether the treatment is able to benefit the patient. Such decisions\nmust be, and must be seen to be, completely separate from any decisions about do-\nnation\n\u2022 The diagnosis of death should be made according to national guidelines and as\noutlined in the WMA's Declaration of Sydney on the Determination of Death and\nRecovery of Organs.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0S-\u00ad\u20102012-\u00ad\u201004-\u00ad\u20102012\t\n \u00a0\n\u2022 There should be a clear separation between the treating team and the transplant\nteam. In particular, the physician who declares or certifies the death of a potential\ndonor should not be involved in the transplantation procedure. Nor should he\/she be\nresponsible for the care of the organ recipient.\n\u2022 Countries that carry out donation following circulatory death should have specific\nand detailed protocols for this practice.\n\u2022 Where an individual has expressed a clear and voluntary wish to donate organs and\/\nor tissue after death, steps should be taken to facilitate that wish wherever possi-\nble. This is part of the treating team's responsibility to the dying patient.\n\u2022 The WMA considers that the potential donor's wishes are paramount. Relatives and\nthose close to the patient should be strongly encouraged to support a deceased per-\nson's previously expressed wish to donate organs and\/or tissues.\n\u2022 Those charged with approaching the patient, family members or other designated\ndecision maker about organ and tissue donation should possess the appropriate com-\nbination of knowledge, skill and sensitivity for engaging in such discussions. Medi-\ncal students and practising physicians should seek the necessary training for this\ntask, and the appropriate authorities should provide the resources necessary to secure\nthat training.\n\u2022 Donation should be unconditional. In exceptional cases, requests by potential do-\nnors, or their substitute decision makers, for the organ or tissue to be given to a\nparticular recipient may be considered if permitted by national law. Donors seeking\nto apply conditions that could be seen as discriminatory against certain groups, how-\never, should be declined.\nHospitals and other institutions where donation occurs should ensure that donation pro-\ntocols are publicised amongst those likely to use them and that adequate resources are\navailable for their implementation. They should also foster a pro-donation culture within\nthe institution in which consideration of donation is the norm, rather than the exception,\nwhen a patient dies.\nThe role of transplant coordination is critical to organ donation. Those performing coordi-\nnation act as the key point of contact between the bereaved family and the donation team\nand usually also undertake the complex logistical arrangements to make donation happen.\nTheir role should be recognised and supported.\nDeceased organ donation must be based on the notion of a gift, freely and voluntarily\ngiven. It should involve the voluntary and unpressured consent of the individual provided\nbefore death (by opting in or opting out of donation depending upon the jurisdiction) or\nthe voluntary authorisation of those close to the deceased patient if that person's wishes\nare unknown. The WMA is strongly opposed to the commercialisation of donation and\ntransplantation.\nProspective donors or their substitute health care decision makers1\nshould have access to\naccurate and relevant information, including through their general practitioners. Normally,\nthis will include information about:\n\u2022 the procedures and definitions involved in the determination of death,\n\t\n \u00a0\n\t\n \u00a0S-\u00ad\u20102012-\u00ad\u201004-\u00ad\u20102012\t\n \u00a0\u23d0\uf8e6\t\n \u00a0Bangkok\t\n \u00a0\nOrgan\t\n \u00a0and\t\n \u00a0Tissue\t\n \u00a0Donation\t\n \u00a0\n\u2022 the testing that is undertaken to determine the suitability of the organs and\/or tissue\nfor transplantation and that this may reveal previously unsuspected health risks in\nprospective donors and their families,\n\u2022 measures that may be required to preserve organ function until death is determined\nand transplantation can occur,\n\u2022 what will happen to the body once death has been declared,\n\u2022 what organs and tissues can be donated,\n\u2022 the protocol that will be followed in the event that the family objects to donation,\nand\n\u2022 the possibility of withdrawing consent.\nProspective donors or their substitute health care decision makers should be given the\nopportunity to ask questions about donation and should have their questions answered\nsensitively and intelligibly.\nWhere both organs and tissues are to be donated, information should be provided, and\nconsent obtained, for both together in order to minimise distress and disruption to those\nclose to the deceased.\nIn some parts of the world a contribution towards funeral costs is given to the family of\nthose who donate. This can be viewed either as appropriate recognition of their altruistic\nact or as a payment that compromises the voluntariness of the choice and the altruistic basis\nfor donation. The interpretation may depend, in part, on the way it is set up and managed.\nWhen considering the introduction of such a system, care needs to be taken to ensure that\nthe core principles of altruism, autonomy, beneficence, equity and justice are met.\nFree and informed decision making requires not only the provision of information but also\nthe absence of coercion. Any concerns about pressure or coercion should be resolved\nbefore the decision to donate organs or tissue is made.\nPrisoners and other people who are effectively detained in institutions should be eligible to\ndonate after death only in exceptional circumstances where:\n\u2022 there is evidence that this represents their long-standing and considered wish and\nsafeguards are in place to confirm this; and\n\u2022 their death is from natural causes; and\n\u2022 the organs are donated to a first or second degree relative either directly or through a\nproperly regulated pool.\nIn jurisdictions where the death penalty is practised, executed prisoners must not be con-\nsidered as organ and\/or tissue donors. While there may be individual cases where pri-\nsoners are acting voluntarily and free from pressure, it is impossible to put in place ade-\nquate safeguards to protect against coercion in all cases.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0S-\u00ad\u20102012-\u00ad\u201004-\u00ad\u20102012\t\n \u00a0\nALLOCATION\t\n \u00a0OF\t\n \u00a0ORGANS\t\n \u00a0FROM\t\n \u00a0DECEASED\t\n \u00a0DONORS\t\n \u00a0\nThe WMA considers there should be explicit policies, open to public scrutiny, governing\nall aspects of organ and tissue donation and transplantation, including the management of\nwaiting lists for organs to ensure fair and appropriate access.\nPolicies governing the management of waiting lists should ensure efficiency and fairness.\nCriteria that should be considered in allocating organs or tissue include:\n\u2022 severity and urgency of medical need\n\u2022 length of time on the waiting list\n\u2022 medical probability of success measured by such factors as age, type of disease,\nlikely improvements in quality of life, other complications, and histocompatibility.\nThere should be no discrimination based on social status, lifestyle or behaviour. Non-\nmedical criteria should not be considered.\nLiving donation is becoming increasingly common as a way to overcome the shortage of\norgans from deceased donors. In most cases donors provide organs to relatives or people\nto whom they are emotionally close. A small number of individuals choose to donate an\norgan altruistically to a stranger. Another scenario is where one or more donor and re-\ncipient pairs are incompatible with each other but donate in the form of a cross-over or\npooled donation system (for example, donor A donates to recipient B, donor B donates to\nrecipient C and donor C donates to recipient A).\nAll potential donors should be given accurate and up to date information about the pro-\ncedure and the risks of donation and have the opportunity to discuss the issue privately\nwith a member of the healthcare team or a counsellor. Normally this information will\ninclude:\n\u2022 the risks of becoming a living donor,\n\u2022 the tests that are undertaken to assess suitability for donation and that this may\nreveal previously unsuspected health problems,\n\u2022 what will happen before, during and after donation takes place, and\n\u2022 in the case of solid organs, the long-term implications of living without the donated\norgan.\nProspective donors should be given the opportunity to ask questions about donation and\nshould have their questions answered sensitively and intelligibly.\nProcedures should be in place to ensure that living donors are acting voluntarily and free\nfrom pressure or coercion. In order to avoid donors being paid and then posing as a known\ndonor, independent checks should also be undertaken to verify the claimed relationship\nand, where this cannot be proven, the donation should not proceed. Such checks should be\nindependent of the transplant team and those who are caring for the potential recipient.\nAdditional safeguards should be in place for vulnerable donors, including but not only,\npeople who are dependent in some way (such as competent minors donating to a parent or\nsibling).\n\t\n \u00a0\n\t\n \u00a0S-\u00ad\u20102012-\u00ad\u201004-\u00ad\u20102012\t\n \u00a0\u23d0\uf8e6\t\n \u00a0Bangkok\t\n \u00a0\nOrgan\t\n \u00a0and\t\n \u00a0Tissue\t\n \u00a0Donation\t\n \u00a0\nPrisoners should be eligible to be living donors only in exceptional circumstances, to first\nor second degree family members; evidence should be provided of any claimed rela-\ntionship before the donation may proceed. Where prisoners are to be considered as living\ndonors, extra safeguards are required to ensure they are acting voluntarily and are not\nsubject to coercion.\nThose who lack the capacity to consent should not be considered as living organ donors\nbecause of their inability to understand and decide voluntarily. Exceptions may be made in\nvery limited circumstances, following legal and ethical review.\nDonors should not lose out financially as a result of their donation and so should be\nreimbursed for general and medical expenses and any loss of earnings incurred.\nIn some parts of the world individuals are paid for donating a kidney, although in virtually\nall countries the sale of organs is unlawful. The WMA is opposed to a market in organs.\nProtocols for free and informed decision making should be followed in the case of re-\ncipients of organs or tissue. Normally, this will include providing information about:\n\u2022 the risks of the procedure,\n\u2022 the likely short, medium and long-term survival, morbidity, and quality-of-life\nprospects,\n\u2022 alternatives to transplantation, and\n\u2022 how organs and tissues are obtained.\nOrgans or tissue suspected to have been obtained through unlawful means must not be\naccepted for transplantation\nOrgans and tissues must not be sold for profit. In calculating the cost of transplantation,\ncharges related to the organ or tissue itself should be restricted to those costs directly\nassociated with its retrieval, storage, allocation and transplantation.\nTransplant surgeons should seek to ensure that the organs and tissues they transplant have\nbeen obtained in accordance with the provisions of this policy and should refrain from\ntransplanting organs and tissues that they know, or suspect, have not been procured in a\nlegal and ethical manner.\nIn the case of a delayed diagnosis for infection, disease or malignancy in the donor, there\nshould be a strong presumption that the recipient will be informed of any risk to which\nthey may have been exposed. Individual decisions about disclosure need to take account of\nthe particular circumstances, including the level and severity of risk. In most cases dis-\nclosure will be appropriate and should be managed carefully and sensitively.\nFUTURE\t\n \u00a0OPTIONS\t\n \u00a0\nPublic health measures to reduce the demand for donated organs should be seen as a\npriority, alongside moves to increase the effectiveness and success of organ donation\nsystems.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0S-\u00ad\u20102012-\u00ad\u201004-\u00ad\u20102012\t\n \u00a0\nNew developments and possibilities, such as xenotransplantation and the use of stem cell\ntechnology to repair damaged organs, should be monitored. Before their introduction into\nclinical practice such technologies should be subject to scientific review and robust safety\nchecks as well as ethical review. Where, as with xenotransplantation, there are potential\nrisks that go beyond individual recipients, this process should also involve public debate.\n1\nThe term \"substitute health care decision maker\" is intended to refer to any person properly\ndesignated to make health care related decisions on behalf of the patient.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nS-\u00ad\u20102012-\u00ad\u201005-\u00ad\u20102012\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0STATEMENT\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nTHE\t\n \u00a0PRIORITISATION\t\n \u00a0OF\t\n \u00a0IMMUNISATION\t\n \u00a0\nAdopted by the 63rd\nWMA General Assembly, Bangkok, Thailand, October 2012\nPREAMBLE\t\n \u00a0\nVaccination use to prevent against disease was first done successfully by Jenner in 1796\nwhen he used cowpox material for vaccination against smallpox. Since then, vaccination\nand immunisation have been acknowledged as an effective preventive strategy for several\ncommunicable diseases and are now being developed for the control of some non-\ncommunicable diseases.\nVaccine development and administration are some of the most significant interventions to\ninfluence global health in modern times. It is estimated that immunisation currently pre-\nvents approximately 2.5 million deaths every year, saving lives from diseases such as\ndiphtheria, tetanus, whooping cough (pertussis) and measles. Approximately 109 million\nchildren under the age of one are fully vaccinated with the diphtheria-tetanus-pertussis\n(DTP3) vaccine alone.\nMostly the ultimate goal of immunisation is the total eradication of a communicable\ndisease. This was achieved for smallpox in 1980 and there is a realistic goal for the eradi-\ncation of polio within the next few years.\nThe Global Immunisation Vision Strategy (GIVS) 2006-2015 was developed by the WHO\nand UNICEF in the hope of reaching target populations who currently do not have im-\nmunisation services or who do not have an adequate level of coverage.\nThe four strategies promoted in this vision are:\n\u2022 Protecting more people in a changing world\n\u2022 Introducing new vaccines and technologies\n\u2022 Integrating immunisation, other linked health interventions and\n\u2022 Surveillance in the health systems context\n\u2022 Immunizing in the context of global interdependence1\nVaccine research is constantly revealing new possibilities to protect populations from\nserious health threats. Additionally, new strains of diseases emerge requiring the adapta-\ntion of vaccines in order to offer protection.\nThe process of immunisation requires an environment that is resourced with appropriate\nmaterials and health workers to ensure the safe and effective administration of vaccines.\n\t\n \u00a0\n\t\n \u00a0Bangkok\t\n \u00a0\u23d0\uf8e6\t\n \u00a0S-\u00ad\u20102012-\u00ad\u201005-\u00ad\u20102012\t\n \u00a0\nPrioritisation\t\n \u00a0of\t\n \u00a0Immunisation\t\n \u00a0\nAdministration of vaccines often requires injections, and safety procedures for injections\nmust always be followed.\nImmunisation schedules can vary according to the type of vaccine, with some requiring\nmultiple administrations to be effective. It is vitally important that the full schedule is\nfollowed otherwise the effectiveness of the vaccine may be compromised.\nThe benefits of immunisation have had a profound effect on populations, not only in terms\nof preventing ill health but also in permitting resources previously required to treat the\ndiseases to be redirected to other health priorities. Healthier populations are economically\nbeneficial and can contribute more to society.\nReducing child mortality is the fourth of the United Nation's Millennium Development\nGoals, with immunisation of children having a significant impact on mortality rates on\nchildren aged under five. According to the WHO, there are still more than 19 million\nchildren who have not received the DTP3 vaccine. In addition, basic health care services\nfor maternal health with qualified health care personnel must be established.\nImmunisation of adults for diseases such as influenza and pneumococcal infections has\nbeen shown to be effective, not only in decreasing the number of cases amongst those that\nhave received immunisation but also in decreasing the disease burden in society.\nThe medical profession denounce any claims that are unfounded and inaccurate with res-\npect to the possible dangers of vaccine administration. Claims such as these have resulted\nin diminished immunisation rates in some countries. The result is that the incidences of the\ndiseases to be prevented have increased with serious consequences for a number of\npersons.\nCountries differ in immunisation priorities, with the prevalence and risk of diseases\nvarying among populations. Not all countries have the same coverage rates, nor do they\nhave the resources to acquire, coordinate, distribute or effectively administer vaccines to\ntheir populations, often relying on non-governmental organizations to support immuni-\nsation programmes. These organizations in turn often rely on external funding that may\nnot be secure. In times of global financial crisis, funding for such programmes is under\nconsiderable pressure.\nThe risk of health complications from vaccine-preventable diseases is greatest in those\nwho experience barriers in accessing immunisation services. These barriers could be cost,\nlocation, lack of awareness of immunisation services and their health benefits or other\nlimiting factors.\nThose with chronic diseases, underlying health issues or other risk factors such as age are\nat particular risk of major complications due to vaccine-preventable diseases and therefore\nshould be targeted to ensure adequate immunisation.\nSupply chains can be difficult to secure, particularly in countries that lack coordination or\nsupport of their immunisation programmes. Securing the appropriate resources, such as\nqualified health professionals, equipment and administrative support can present signifi-\ncant challenges.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nS-\u00ad\u20102012-\u00ad\u201005-\u00ad\u20102012\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nData collection on vaccine administration rates, side effects of vaccines and disease sur-\nveillance can often be difficult to achieve, particularly in isolated and under-resourced\nareas. Nevertheless, reporting incidents and monitoring disease spread are vital tools in\ncombating global health threats.\nRECOMMENDATIONS\t\n \u00a0\nThe WMA supports the recommendations of the Global Immunisation Vision Strategy\n(GIVS) 2006-2015, and calls on the international community to:\n\u2022 Encourage governments to commit resources to immunisation programmes targeted\nto meet country specific needs.\n\u2022 Recognise the importance of vaccination\/immunisation through the continued sup-\nport and adoption of measures to achieve global vaccination targets and to meet the\nMillennium Development Goals, especially four (reduce child mortality), five (im-\nprove maternal health) and six (combat HIV\/AIDS, malaria and other diseases).\n\u2022 Recognise the global responsibility of immunisation against preventable diseases\nand support work in countries that have difficulties in meeting the 2012 targets in\nthe Global Polio Eradication Initiative2\n.\n\u2022 Support national governments with vulnerable populations at risk of vaccine-pre-\nventable diseases, and the local agencies that work to deliver immunisation services\nand to work with them to alleviate retrictions in accessing services.\n\u2022 Support vaccine research and development and ensure commitment through the ade-\nquate funding of vital vaccine research.\n\u2022 Promote vaccination and the benefits of immunisation, particularly targeting those\nat-risk and those who are difficult to reach. Comply with monitoring activities\nundertaken by WHO and other health authorities. Promote high standards in the\nresearch, development and administration of vaccines to ensure patient safety. Vac-\ncines need to be thoroughly tested before implemented on a large scale and subse-\nquently monitored in order to identify possible complications and untoward side\neffects. In order to be successful, immunisation programmes need public trust which\ndepends on safety.\nIn delivering vaccination programmes, the WMA recommends that:\n\u2022 The full immunisation schedule is delivered to provide optimum coverage. Where\npossible, the schedule should be managed and monitored by suitably trained indi-\nviduals to ensure consistent delivery and prompt appropriate management of adverse\nreactions to vaccines.\n\u2022 Strategies are employed to reach populations that may be isolated because of loca-\ntion, race, religion, economic status, social marginalization, gender and\/or age.\n\u2022 Ensure that qualified health professionals receive comprehensive training to safely\ndeliver vaccinations and immunisations, and that vaccination\/immunisations are tar-\ngeted to those whose need is greatest.\n\u2022 Educate people on the benefits of immunisation and how to access immunisation\nservices.\n\t\n \u00a0\n\t\n \u00a0Bangkok\t\n \u00a0\u23d0\uf8e6\t\n \u00a0S-\u00ad\u20102012-\u00ad\u201005-\u00ad\u20102012\t\n \u00a0\nPrioritisation\t\n \u00a0of\t\n \u00a0Immunisation\t\n \u00a0\n\u2022 Maintain accurate medical records to ensure that valid data on vaccine admin-\nistration and coverage rates are available, enabling immunisation policies to be\nbased upon sound and reliable evidence.\n\u2022 Healthcare professionals should be seen as a priority population for the receipt of\nimmunisation services due to their exposure to patients and to diseases.\nThe WMA calls upon its members to advocate the following:\n\u2022 To increase awareness of national immunisation schedules and of their own (and\ntheir dependents) personal immunisation history.\n\u2022 To work with national and local governments to ensure that immunisation pro-\ngrammes are resourced and implemented.\n\u2022 To ensure that health personnel delivering vaccines and immunisation services re-\nceive proper education and training.\n\u2022 To promote the evidence base and increase awareness about the benefits of im-\nmunisation amongst physicians and the public.\n1\nWorld Health Organization and United Nations Children's Fund. Global Immunisation Vision and\nStrategy, 2006-2015. Geneva, Switzerland: World Health Organization and United Nations Child-\nren's Fund; 2005. Available at: http:\/\/www.who.int\/immunisation\/givs\/related_docs\/en\/index.html\n2\nWorld Health Organization. Global Polio Eradication Initiative: Strategic Plan 2010-2012.\nGeneva, Switzerland: World Health Organization; 2010. Available at:\nhttp:\/\/www.polioeradication.org\/Portals\/0\/Document\/StrategicPlan\/StratPlan2010_2012_ENG.pdf\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nS-\u00ad\u20102012-\u00ad\u201006-\u00ad\u20102012\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0STATEMENT\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\n\t\n \u00a0VIOLENCE\t\n \u00a0IN\t\n \u00a0THE\t\n \u00a0HEALTH\t\n \u00a0SECTOR\t\n \u00a0BY\t\n \u00a0PATIENTS\t\n \u00a0AND\t\n \u00a0\t\n \u00a0\nTHOSE\t\n \u00a0CLOSE\t\n \u00a0TO\t\n \u00a0THEM\t\n \u00a0\nAdopted by the 63rd\nWMA General Assembly, Bangkok, Thailand, October 2012\nPREAMBLE\t\n \u00a0\nAll persons have the right to work in a safe environment without the threat of violence.\nWorkplace violence includes both physical and non-physical (psychological) violence.\nGiven that non-physical abuse, such as harassment and threats, can have severe psy-\nchological consequences, a broad definition of workplace violence should be used. For\nthe purposes of this statement we will use the widely accepted definition of workplace\nviolence, as used by the WHO: \"The intentional use of power, threatened or actual, against\nanother person or against a group, in work-related circumstances, that either results in or\nhas a high degree of likelihood of resulting in injury, death, psychological harm, mal-\ndevelopment, or deprivation\".\nViolence, apart from the numerous health effects it can have on its victims, also has\npotentially destructive social effects. Violence against health workers, including physi-\ncians, not only affects the individuals directly involved, but also impacts the entire health-\ncare system and its delivery. Such acts of violence affect the quality of the working\nenvironment, which has the potential to detrimentally impact the quality of patient care.\nFurther, violence can affect the availability of care, particularly in impoverished areas.\nWhile workplace violence is indisputably a global issue, various cultural differences\namong countries must be taken into consideration in order to accurately understand the\nconcept of violence on a universal level. Significant differences exist in terms of what\nconstitutes violence and what specific forms of workplace violence are most likely to\noccur. Threats and other forms of psychological violence are widely recognized to be\nmore prevalent than physical violence. Reasons and causes of violence in the healthcare\nsetting are extremely complex.\nSeveral studies have identified common triggers for acts of violence in the health sector to\nbe delays in receiving treatment and dissatisfaction with the treatment provided1\n.\nMoreover, patients may act aggressively as a result of their medical condition, the medi-\ncation they take or the use of alcohol and other drugs. Another important example is that\nindividuals may threaten or perpetrate physical violence against healthcare workers\nbecause they oppose, on the basis of their social, political or religious beliefs, a specific\narea of medical practice.\nA multi-faceted approach encompassing the areas of legislation, security, data collection,\ntraining, environmental factors, public awareness and financial incentives is required in\norder to successfully address the issue of violence in the health sector.\n\t\n \u00a0\n\t\n \u00a0Bangkok\t\n \u00a0\u23d0\uf8e6\t\n \u00a0S-\u00ad\u20102012-\u00ad\u201006-\u00ad\u20102012\t\n \u00a0\nViolence\t\n \u00a0in\t\n \u00a0the\t\n \u00a0Health\t\n \u00a0Sector\t\n \u00a0\nIn addition, collaboration among various stakeholders (including governments, National\nMedical Associations (NMAs), hospitals, general health services, management, insurance\ncompanies, trainers, preceptors, researchers, police and legal authorities) is more effective\nthan the individual efforts of any one party. As the representatives of physicians, NMAs\nshould take an active role in combating violence in the health sector and also encourage\nother key stakeholders to act, thus further protecting the quality of the working environ-\nment for healthcare employees and the quality of patient care.\nThis collaborative approach to addressing violence in the health sector must be promoted\nthroughout the world.\nRECOMMENDATIONS\t\n \u00a0\nThe WMA encourages National Medical Associations (NMAs) to act in the following areas:\nStrategy - NMAs should encourage healthcare institutions to develop and implement a\nprotocol to deal with acts of violence. The protocol should include the following:\n\u2022 A zero-tolerance policy towards workplace violence.\n\u2022 A universal definition of workplace violence.\n\u2022 A predetermined plan for maintaining security in the workplace.\n\u2022 A designated plan of action for healthcare professionals to take when violence takes\nplace.\n\u2022 A system for reporting and recording acts of violence, which may include reporting\nto legal and\/or police authorities.\n\u2022 A means to ensure that employees who report violence do not face reprisals.\nIn order for this protocol to be effective, it is necessary for the management and admin-\nistration of healthcare institutions to communicate and take the necessary steps to ensure\nthat all staff are aware of the strategy.\nPolicymaking - In order to help increase patient satisfaction, national priorities and limita-\ntions on medical care should be clearly addressed by government institutions.\nThe state has obligations to ensure the safety and security of patients, physicians, and\nother healthcare workers. This includes providing an appropriate physical environment.\nHence, healthcare systems should be designed to promote the safety of healthcare staff and\npatients. An institution which has experienced an act of violence by a patient may require\nthe provision of extra security, as all healthcare workers have the right to be protected in\ntheir work place.\nIn some jurisdictions, physicians might have the right to refuse to treat a violent patient.\nIn such cases, they must ensure that adequate alternative arrangements are made by the\nrelevant authorities in order to safeguard the patient's health and treatment.\nPatients with acute, chronic or illness-induced mental health disturbances may act\nviolently toward caregivers; those offering care to these patients must be adequately pro-\ntected.\nTraining - A well-trained and vigilant staff supported by management can be a key\ndeterrent of violent acts. NMAs should work with undergraduate and postgraduate edu-\ncation providers to ensure that healthcare professionals are trained in the following: com-\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nS-\u00ad\u20102012-\u00ad\u201006-\u00ad\u20102012\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nmunication skills and recognising and handling potentially violent persons and high risk\nsituations in order to prevent incidents of violence. The cultivation of physician-patient\nrelationships based on respect and mutual trust will not only improve the quality of patient\ncare, but will also foster feelings of security resulting in a reduced risk of violence.\nCommunication - NMAs should work with other key stakeholders to increase awareness\nof violence in the health sector. When appropriate, they should inform healthcare workers\nand the public when acts of violence occur and encourage physicians to report acts of\nviolence through the appropriate channels.\nFurther, once an act of violence has taken place, the victim should be informed about the\nprocedures undertaken thereafter.\nSupport to victims - Medical, psychological and legal counselling and support should be\nprovided to staff members who have been the victims of threats and\/or acts of violence\nwhile at work.\nData Collection - NMAs should lobby their governments and\/or hospital boards to\nestablish appropriate reporting systems enabling all healthcare workers to report anony-\nmously and without reprisal, any threats or incidents of violence. Such a system should\nassess in terms of number, type and severity, incidents of violence within an institution\nand resulting injuries. The system should be used to analyse the effectiveness of pre-\nventative strategies. Aggregated data and analyses should be made available to NMAs.\nInvestigation - In all cases of violence there should be some form of investigation to\nbetter understand the causes and to aid in prevention of future violence. In some cases, the\ninvestigation may lead to prosecution under civil or criminal codes. The procedure should\nbe, as much as possible, authoritative-led and uncomplicated for the victim.\nSecurity - NMAs should work to ensure that appropriate security measures are in place in\nall healthcare institutions and that acts of violence in the healthcare sector are given a high\npriority by law-enforcement institutions. A routine violence risk audit should be imple-\nmented in order to identify which jobs and locations are at highest risk for violence.\nExamples of high risk areas include general practice premises, mental health treatment\nfacilities and high traffic areas of hospitals including the emergency department.\nThe risk of violence may be ameliorated by a variety of means which could include\nplacing security guards in these high risk areas and at the entrance of buildings, by the\ninstallation of security cameras and alarm devices for use by health professionals, and by\nmaintaining sufficient lighting in work areas, contributing to an environment conducive to\nvigilance and safety.\nFinancial - NMAs should encourage their governments to allocate appropriate funds in\norder to effectively tackle violence in the health sector.\n1\nCarmi-Iluz T, Peleg R, Freud T, Shvartzman P. Verbal and physical violence towards hospital-\nand community- based physicians in the Negev: an observational study BMC Health Service\nResearch 2005; 5: 54\nDerazon H, Nissimian S, Yosefy C, Peled R, Hay E. Violence in the emergency department\n(Article in Hebrew) Harefuah. 1999 Aug; 137(3-4): 95-101, 175\nLandua SF. Violence against medical and non-medical personnel in hospital emergency wards\nin Israel Research Report, Submitted to the Israel National Institute for Health Policyand Health\nServices Research, December 2004\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0S-\u00ad\u20102013-\u00ad\u201001-\u00ad\u20102013\t\n \u00a0\nWMA\t\n \u00a0STATEMENT\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nFUNGAL\t\n \u00a0DISEASE\t\n \u00a0DIAGNOSIS\t\n \u00a0AND\t\n \u00a0MANAGEMENT\t\n \u00a0\nAdopted by the 64th\nWMA General Assembly, Fortaleza, Brazil, October 2013\nAnnual WHO Global Burden of Disease estimates recognize that fungal diseases account\nfor a significant proportion of health problems worldwide. These include cutaneous fungal\ninfections which affect up to a billion persons and vulvovaginal candidiasis which affects\ntens of millions of women, often multiple times annually.\nEven more serious are invasive and chronic fungal diseases that lead to estimated annual\nmorbidity rates that are similar to those caused by commonly recognized global health\nconcerns such as malaria and tuberculosis. In addition to death, these fungal diseases\ncommonly lead to chronic ill health, including blindness with keratitis, respiratory distress\nwith allergic bronchopulmonary aspergillosis (ABPA), severe asthma with fungal sensiti-\nsation (SAFS) and chronic pulmunary aspergillosis (CPA), weight loss and nutritional\ndeficiency with oesophageal candidiasis and CPA, and inability to engage in healthy\nsexual activity with vulvovaginal candidiasis.\nSerious fungal diseases are often opportunistic, occurring as a consequence of other condi-\ntions that suppress the immune system, such as asthma, AIDS, cancer, post-transplant im-\nmunosuppressive drugs and corticosteroid therapies. Some occur in critically ill patients.\nDespite the fact that many fungal diseases can be treated relatively simply, in many cases,\nthese diseases go untreated. Fungal infections alone are often not distinctive enough to\nallow a clinical diagnosis, and as cultures are frequently falsely negative, missed diagnosis\nis common. In addition, a relatively narrow diagnostic window to cure the patient is fre-\nquently missed, resulting in prolonged expensive hospital stays, often with a fatal out-\ncome. Despite the existence of effective medicine to treat fungal infections, these are often\nnot available when and where they are needed.\nSTATEMENT\t\n \u00a0\t\n \u00a0\nThe WMA stresses the need to support the diagnosis and management of fungal diseases\nand urges national governments to ensure that both diagnostic tests and antifungal ther-\napies are available for their populations. Depending on the prevalence of fungal diseases\nand their underlying conditions, specific antigen testing or microscopy and culture are\nessential. These tests, and personnel trained to administer and interpret the tests, should be\navailable in all countries where systemic fungal infections occur. This will likely include\ndeveloping at least one diagnostic centre of excellence with a sufficient staff of trained\ndiagnostic personnel. Monitoring for antifungal toxicities should be available.\n\t\n \u00a0\n\t\n \u00a0S-\u00ad\u20102013-\u00ad\u201001-\u00ad\u20102013\t\n \u00a0\u23d0\uf8e6\t\n \u00a0Fortaleza\t\n \u00a0\nFungal\t\n \u00a0Disease\t\n \u00a0\nPhysicians will be the first point of contact for most patients with a fungal infection and\nshould be sufficiently educated about the topic in order to ensure an effective diagnostic\napproach.\nThe WMA encourages its members to undertake and support epidemiologic studies on the\nburden of fungal disease in their country and to inform the national government of the\nresults.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0S-\u00ad\u20102013-\u00ad\u201002-\u00ad\u20102013\t\n \u00a0\nWMA\t\n \u00a0STATEMENT\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nHUMAN\t\n \u00a0PAPILLOMAVIRUS\t\n \u00a0VACCINATION\t\n \u00a0\nAdopted by the 64th\nWMA General Assembly, Fortaleza, Brazil, October 2013\nPREAMBLE\t\n \u00a0\nHuman papillomavirus (HPV) vaccination presents a unique and valuable opportunity for\nphysicians to substantially prevent morbidity and mortality from certain cancers in all\npopulations, and to improve maternal health. The HPV vaccine therefore merits considera-\ntion by the World Medical Association (WMA) separately from other vaccines.\nHPV is a sexually transmitted virus and is so common that most sexually active adults\nbecome infected at some point in their lives. Most infections are asymptomatic and resolve\nwithout medical intervention. However, some of the 40 types of HPV can cause cervical\ncancer. HPV is the cause of nearly 100% of cervical cancer cases and may also cause\ncancer of the vagina, vulva, anus, penis and the head and neck. Cervical cancer accounts\nfor more than 10% of all female cancers, and the majority of cervical cancer deaths are in\ndeveloping countries.\nVaccines can protect against infection by the most common HPV types and afford pro-\ntection against cancer. The U.S. Advisory Committee on Immunization Practices recom-\nmends HPV vaccination for both females and males starting at age 11 years up to age 26\nyears. Benefits of vaccinating young men include protection against genital warts and\ncancer in addition to preventing transmission of HPV to sexual partners. The additional\nprotection afforded by the quadrivalent vaccine against genital warts as well as cervical\nand other cancers should be taken into consideration when developing HPV vaccination\nprogrammes. The HPV vaccines are effective; post-marketing studies have shown decreases\nin HPV prevalence and HPV related disorders such as genital warts and abnormal cervical\ncytology. Studies concerning the safety of HPV vaccines have been reassuring.\nThese vaccines should be made widely available and should be promoted by physicians as\na matter of individual patient wellbeing and public health.\nRECOMMANDATIONS\t\n \u00a0\nThe WMA urges physicians to educate themselves and their patients about HPV and\nassociated diseases, HPV vaccination and routine cervical cancer screening; and encourages\nthe development and funding of programs to make HPV vaccine available and to provide\ncervical cancer screening in countries without organized cervical cancer screening pro-\ngrams.\n\t\n \u00a0\n\t\n \u00a0S-\u00ad\u20102013-\u00ad\u201002-\u00ad\u20102013\t\n \u00a0\u23d0\uf8e6\t\n \u00a0Fortaleza\t\n \u00a0\nHuman\t\n \u00a0Papillomavirus\t\n \u00a0Vaccination\t\n \u00a0\nNational medical associations (NMAs) are encouraged to carry out intensive education of\nand advocacy efforts toward their members to:\n\u2022 Improve awareness and understanding of HPV and associated diseases;\n\u2022 Understand the availability and efficacy of HPV vaccines;\n\u2022 Understand the desirability of including HPV vaccines in national immunization\nprograms;\n\u2022 Understand the need for routine cervical cancer screening; and\n\u2022 Integrate HPV cancer prevention methods, early detection and screening, diagnosis,\ntreatment and palliative care into existing continuing professional development pro-\ngrams and pre-service training. Such training will leverage existing support for HPV\nprograms and help in capacity building and quality assurance efforts.\nNMAs are also encouraged to:\n\u2022 Integrate HPV vaccination for all adolescents and routine cervical cancer screening\nfor young women into all appropriate health care settings and visits;\n\u2022 Support the availability of the HPV vaccine and routine cervical cancer screening\nfor appropriate populations that benefit most from preventive measures, including\nbut not limited to at-risk patients such as low-income, disadvantaged and popula-\ntions that are not yet sexually active;\n\u2022 Recommend HPV vaccination for all appropriate populations;\n\u2022 Promote member advocacy for HPV prevention, care and treatment; and\n\u2022 Create a network of physicians and practitioners who are willing and able to mentor\nand support one another and establish linkages to existing HPV vaccine and cancer\nprevention networks.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0S-\u00ad\u20102013-\u00ad\u201003-\u00ad\u20102013\t\n \u00a0\nWMA\t\n \u00a0STATEMENT\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nNATURAL\t\n \u00a0VARIATIONS\t\n \u00a0OF\t\n \u00a0HUMAN\t\n \u00a0SEXUALITY\t\n \u00a0\nAdopted by the 64th\nWMA General Assembly, Fortaleza, Brazil, October 2013\nPREAMBLE\t\n \u00a0\t\n \u00a0\nHealthcare professionals encounter many aspects of human diversity when providing care,\nincluding different variations of human sexuality.\nA large body of scientific research indicates that homosexuality is a natural variation of\nhuman sexuality without any intrinsically harmful health effects.\nAs a consequence homosexuality was removed from the American Psychiatric Associa-\ntion\u2019s official diagnostic manual in 1973. The World Health Organisation (WHO) removed\nit from the ICD in 1990 following a similar process of scientific review. The Pan\nAmerican Health Organization (WHO) states: \u201cIn none of its individual manifestations\ndoes homosexuality constitute a disorder or an illness, and therefore it requires no cure.\u201d\nDirect and indirect discrimination, stigmatisation, peer rejection, and bullying continue to\nhave a serious impact upon the psychological and physical health of people with a homo-\nsexual or bisexual orientation. These negative experiences lead to higher prevalence rates\nof depression, anxiety disorders, substance misuse, and suicidal ideations and attempts.\nThe suicide rate among adolescents and young adults with a homosexual or bisexual\norientation is, consequently, three times higher than that of their peers.\nThis can be exacerbated by so-called \u201cconversion\u201d or \u201creparative\u201d procedures, which\nclaim to be able to convert homosexuality into asexual or heterosexual behaviour and give\nthe impression that homosexuality is a disease. These methods have been rejected by\nmany professional organisations due to a lack of evidence of their effectiveness. They\nhave no medical indication and represent a serious threat to the health and human rights of\nthose so treated.\nRECOMMENDATIONS\t\n \u00a0\nThe WMA strongly asserts that homosexuality does not represent a disease, but rather a\nnatural variation within the range of human sexuality.\nThe WMA condemns all forms of stigmatisation, criminalisation and discrimination of\npeople based on their sexual orientation.\n\t\n \u00a0\n\t\n \u00a0S-\u00ad\u20102013-\u00ad\u201003-\u00ad\u20102013\t\n \u00a0\u23d0\uf8e6\t\n \u00a0Fortaleza\t\n \u00a0\nNatural\t\n \u00a0Variations\t\n \u00a0of\t\n \u00a0Human\t\n \u00a0Sexuality\t\n \u00a0\nThe WMA calls upon all physicians to classify physical and psychological diseases on the\nbasis of clinically relevant symptoms according to ICD-10 criteria regardless of sexual\norientation, and to provide therapy in accordance with internationally recognised treat-\nments and protocols.\nThe WMA asserts that psychiatric or psychotherapeutic approaches to treatment must not\nfocus upon homosexuality itself, but rather upon conflicts, which arise between homo-\nsexuality, and religious, social and internalised norms and prejudices.\nThe WMA condemns so-called \u201cconversion\u201d or \u201creparative\u201d methods. These constitute\nviolations of human rights and are unjustifiable practices that should be denounced and\nsubject to sanctions and penalties. It is unethical for physicians to participate during any\nstep of such procedures.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0S-\u00ad\u20102013-\u00ad\u201004-\u00ad\u20102013\t\n \u00a0\nWMA\t\n \u00a0STATEMENT\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nTHE\t\n \u00a0RIGHT\t\n \u00a0OF\t\n \u00a0REHABILITATION\t\n \u00a0OF\t\n \u00a0VICTIMS\t\n \u00a0OF\t\n \u00a0TORTURE\t\n \u00a0\nAdopted by the 64th\nWMA General Assembly, Fortaleza, Brazil, October 2013\nPREAMBLE\t\n \u00a0\nThe World Medical Association notes with grave concern the continued use of torture in\nmany countries throughout the world.\nThe WMA reaffirms its total condemnation of all form of torture, and other cruel, in-\nhuman or degrading treatment or punishment, as defined by the UN Convention Against\nTorture (CAT, 1984). Torture is one of the gravest violations of international human rights\nlaw and has devastating consequences for victims, their families and society as a whole.\nTorture causes severe physical and mental injuries and is a crime absolutely prohibited\nunder international law.\nThe WMA reaffirms its policies adopted previously, namely:\n\u2022 The Declaration of Tokyo laying down Guidelines for Physicians Concerning Tor-\nture and other Cruel, Inhuman or Degrading Treatment or Punishment in Relation to\nDetention and Imprisonment (1975)\n\u2022 The Declaration of Hamburg concerning Support for Medical Doctors Refusing to\nParticipate in, or to Condone, the Use of Torture or Other Forms of Cruel, Inhuman\nor Degrading Treatment (1997)\n\u2022 The Resolution on the Responsibility of Physicians in the Documentation and De-\nnunciation of Acts of Torture or Cruel or Inhuman or Degrading Treatment (2003).\nThe medical evaluation is an essential factor in pursuing the documentation of torture and\nthe reparation of victims of torture. Physicians have a critical role to play in gathering\ninformation about torture, documenting evidence of torture for legal purposes, as well as\nsupporting and rehabilitating victims.\nThe WMA recognizes the adoption, in December 2012, by the UN Committee Against\nTorture of the General Comment on the Implementation of article 14 of Convention\nagainst Torture relating to the right to reparation of victims of torture.\nThe General Comment outlines the right of rehabilitation as an obligation on States and\nspecifies the scope of these services. The WMA welcomes in particular:\n\u2022 The obligation of State parties to adopt a \u201clong-term and integrated approach and\n\t\n \u00a0\n\t\n \u00a0S-\u00ad\u20102013-\u00ad\u201004-\u00ad\u20102013\t\n \u00a0\u23d0\uf8e6\t\n \u00a0Fortaleza\t\n \u00a0\nVictims\t\n \u00a0of\t\n \u00a0Torture\t\n \u00a0\nensure that specialized services for the victim of torture or ill treatment are available,\nappropriate and promptly accessible\u201d (paragraph 13), without making access to these\nservices dependent on the victim pursuing judicial remedies.\n\u2022 The recognition of the right of victims to choose a rehabilitation service provider, be\nit a State institution, or a non-State service provider, which is funded by the State.\n\u2022 The recognition that State parties should provide torture victims with access to\nrehabilitation programs as soon as possible following an assessment by qualified\nindependent healthcare professionals.\n\u2022 The references in paragraph 18 to measures aimed at protecting health and legal\nprofessionals who assist torture victims, developing specific training on the Istanbul\nProtocol for health professionals, and promoting the observance of international\nstandards and codes of conduct by public servants, including medical, psychological\nand social service personnel.\nRECOMMENDATIONS\t\n \u00a0\nThe WMA emphasizes the vital function of reparation for victims of torture and their\nfamilies in rebuilding their lives and achieve redress and the important role of physicians\nin rehabilitation.\nThe WMA encourages its member associations to work with relevant agencies \u2013 govern-\nmental and non-governmental \u2013 acting for the reparation of victims of torture, in particular\nin the areas of documentation and rehabilitation, as well as prevention.\nThe WMA encourages its members to support agencies that are under threat of \u2013 or\nsubjected to \u2013 reprisals from state parties due to their involvement in the documentation of\ntorture, rehabilitation and reparation of torture victims.\nThe WMA calls on its members to use their medical experience to support torture victims\nin accordance with article 14 of the UN Convention against Torture.\nThe WMA calls on its member associations to support and facilitate data collection at the\nnational level in order to monitor the implementation of the State\u2019s obligation to provide\nrehabilitation services.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0S-\u00ad\u20102013-\u00ad\u201005-\u00ad\u20102013\t\n \u00a0\nWMA\t\n \u00a0STATEMENT\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nTHE\t\n \u00a0UNITED\t\n \u00a0NATIONS\t\n \u00a0RESOLUTION\t\n \u00a0FOR\t\n \u00a0A\t\n \u00a0MORATORIUM\t\n \u00a0ON\t\n \u00a0\nTHE\t\n \u00a0USE\t\n \u00a0OF\t\n \u00a0THE\t\n \u00a0DEATH\t\n \u00a0PENALTY\t\n \u00a0\nAdopted by the 64th\nWMA General Assembly, Fortaleza, Brazil, October 2013\nPREAMBLE\t\n \u00a0\nThe WMA Resolution on Physician Participation in Capital Punishment states that it is\nunethical for physicians to take part in capital punishment, and the WMA Declaration of\nGeneva obliges physicians to maintain the utmost respect for human life.\nThe WMA acknowledges that the views prevalent in the countries of some of its members\nprevent all members unconditionally opposing the death penalty.\nThe WMA therefore supports the suspension of the use of the death penalty through a\nglobal moratorium.\nThe WMA has long recognized that it cannot hold its national medical association mem-\nbers responsible for the actions and policies of their respective governments.\nRECOMMANDATIONS\t\n \u00a0\nThe World Medical Association supports United Nations General Assembly Resolution\n65\/206 calling for a moratorium on the use of the death penalty.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nS-\u00ad\u20102014-\u00ad\u201001-\u00ad\u20102014\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0STATEMENT\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nAESTHETIC\t\n \u00a0TREATMENT\t\n \u00a0\nAdopted by the 65th\nWMA General Assembly, Durban, South Africa, Otober 2014\nPREAMBLE\t\n \u00a0\nAesthetic treatments have become increasingly common in recent years as society appears\nto have become more preoccupied with physical appearance. These treatments are per-\nformed by practitioners with widely differing clinical and educational backgrounds.\nFor the purpose of this statement, aesthetic treatment is defined as an intervention that is\nperformed not to treat an injury, a disease or a deformity, but for non-therapeutic reasons,\nwith the sole purpose of enhancing or changing the physical appearance of the individual\nconcerned. In this statement, the individual undergoing treatment is referred to as the\npatient. The treatments available include a great variety of interventions, ranging from\nsurgical procedures to injections and different kinds of skin treatments. This statement\nfocuses on interventions that are methodologically similar to those performed in con-\nventional health care. Tattooing, scarring and similar interventions are therefore not con-\nsidered in this statement.\nBody image affects a person's self-esteem and mental health and is an integral part of a\nperson's overall health and well-being. However, media images of \u201cperfect bodies\u201d have\nbecome the norm, causing some people, to develop unrealistic and unhealthy body images.\nMany aesthetic treatments involve risks and may potentially harm the health of the patient.\nMinors1\nare particularly vulnerable, as their bodies are often not fully developed. In order\nto protect persons considering or undergoing aesthetic treatment the WMA has developed\nthe following basic principles regarding aesthetic treatments.\nReaffirming the medical ethics principles laid out in the WMA Declaration of Geneva, the\nWMA Declaration of Lisbon on the Rights of the Patient and the WMA International\nCode of Medical Ethics, and consistent with the mandate of the WMA, this statement is\naddressed primarily to physicians. However, the WMA encourages other practitioners per-\nforming aesthetic treatments to adopt these principles.\nPRINCIPLES\t\n \u00a0\n1. The patient\u00b4s dignity, integrity and confidentiality must always be respected.\n2. Physicians have a role in helping to identify unhealthy body images and to address\nand treat disorders when these exist.\n\t\n \u00a0\n\t\n \u00a0Durban\t\n \u00a0\u23d0\uf8e6\t\n \u00a0S-\u00ad\u20102014-\u00ad\u201001-\u00ad\u20102014\t\n \u00a0\nAesthetic\t\n \u00a0Treatment\t\n \u00a0\n3. Aesthetic treatments must only be performed by practitioners with sufficient knowl-\nedge, skills and experience of the interventions performed.\n4. All practitioners providing aesthetic treatments must be registered with and\/or li-\ncensed by the appropriate regulatory authority. Ideally, the practitioner should also\nbe authorized by this authority to provide these specific aesthetic treatments.\n5. All aesthetic treatments must be preceded by a thorough examination of the patient.\nThe practitioner should consider all circumstances, physical and psychological,\nthat may cause an increased risk of harm for the individual patient and should\nrefuse to perform the treatment if the risk is unacceptable. This is especially true in\nthe case of minors. Practitioners should always choose the most appropriate treat-\nment option, rather than the most lucrative one.\n6. Minors may need or benefit from plastic medical treatments but pure aesthetic\nprocedures should not be performed on minors. If, in exceptional cases, aesthetic\ntreatment is performed on a minors, it should only be done with special care and\nconsideration and only if the aim of the treatment is to avoid negative attention\nrather than gain positive attention. All relevant medical factors, such as whether\nthe minor is still growing or whether the treatment will need to be repeated at a\nlater date, must be considered.\n7. The patient must consent explicitly to any aesthetic treatment, preferably in writing.\nBefore seeking consent the practitioner should inform the patient of all relevant\naspects of the treatment, including how the procedure is performed, possible risks\nand the fact that many of these treatments may be irreversible. The patient should\nbe given sufficient time to consider the information before the treatment starts.\nWhere the patient requesting the treatment is a minor, the informed consent of his\nor her parents or legally authorized representative should be obtained.\n8. All aesthetic treatments performed should be carefully documented by the practi-\ntioner. The documentation should include a detailed description of the treatment\nperformed, information on medications used, if any, and all other relevant aspects\nof the treatment.\n9. Aesthetic treatments must only be performed under strictly hygienic and medically\nsafe conditions on premises that are adequately staffed and equipped. This must\ninclude equipment for treating life-threatening allergic reactions and other poten-\ntial complications.\n10. Advertising and marketing of aesthetic treatments should be responsible and should\nnot foster unrealistic expectations of treatment results. Unrealistic or altered pho-\ntographs showing patients before and after treatments must not be used in adver-\ntising.\n11. Advertising and marketing of aesthetic treatments should never be targeted to\nminors.\n12. Practitioners should never offer or promote financial loans as a means of paying\nfor aesthetic treatment.\n1\nFor the purpose of this statement minor is defined as a person who, according to applicable\nnational legislation, is not an adult.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nS-\u00ad\u20102014-\u00ad\u201002-\u00ad\u20102014\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0STATEMENT\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nTHE\t\n \u00a0PREVENTION\t\n \u00a0OF\t\n \u00a0AIR\t\n \u00a0POLLUTION\t\n \u00a0DUE\t\n \u00a0TO\t\n \u00a0VEHICLE\t\n \u00a0EMISSIONS\t\n \u00a0\nAdopted by the 65th\nWMA General Assembly, Durban, South Africa, October 2014\nPREAMBLE\t\n \u00a0\nThere are a number of ways in which the volume of harmful emissions can be reduced.\nThese include encouraging fewer road traffic journeys, active transport for individuals\nundertaking relatively short journeys, the use of mass public transit in preference to\nindividual vehicles, and alternative energy sources for vehicles, including electric and\nhybrid technologies. Where vehicle use is essential, means of reducing harmful emissions\nshould be used.\nPhysicians around the world are aware of air pollution. It impacts the quality of life for\nhundreds of millions of people worldwide, causing both, a large burden of disease as well\nas economic losses and increased health care costs. According to WHO estimates, in 2012,\nurban outdoor air pollution was responsible for 3.7 million annual deaths, representing\n6.7% of the total deaths (WHO, 2014).\nEspecially, diesel soot is acknowledged as a proven carcinogen (IARC, 07\/2012). Further-\nmore, it has many other toxic effects, most prominently in the cardiovascular (Brook et al.,\n2010) and respiratory systems (ERS, 2010). Moreover, in the context of global warming,\nsoot, along with methane, is identified as the second most important greenhouse driving\nforce substance after CO2 (Kerr, 2013).\nDespite the fact that new vehicles will have to comply with stricter emission standards\nwhich take into account most harmful ultra fine particles too, a high-polluting in-use fleet,\nincluding off-road vehicles such as construction engines and ships, will continue polluting\nfor many more years.\nBACKGROUND\t\n \u00a0\nIn many densely populated cities around the world, fine dust concentrations measurable as\naerosols exceed up to 50 times the maximum WHO recommendation. High volumes of\ntransport, power generated from coal, and pollution caused by construction machinery are\namong the contributing factors. People living and working near major (high density\nvolume traffic) streets are most affected by pollutants. For fighting the health risks men-\ntioned above, there exist a variety of highly efficient and reliable filter systems on the\nmarket (Best Available Technology (BAT) filters1\n). They are applicable to all internal\ncombustion engines and they reduce even most harmful ultra-fine particles by a factor of\n\t\n \u00a0\n\t\n \u00a0Durban\t\n \u00a0\u23d0\uf8e6\t\n \u00a0S-\u00ad\u20102014-\u00ad\u201002-\u00ad\u20102014\t\n \u00a0\nAir\t\n \u00a0Pollution\t\n \u00a0\nover one hundred. As soon as 90% of heavy duty vehicles, both, new and upgraded ones,\nsatisfy this standard, health problems attributable to emissions of heavy duty traffic will be\ngreatly reduced, and no further tightening of emission standards will be possible or even\nneeded at all because of an almost total elimination of the pollutant as such.\nIn a variety of countries on different continents and under varying conditions retrofit or\nupgrading programs have been successfully performed. The UN\u2019s Working Party on Pol-\nlution Prevention and Energy in Geneva has just proposed a technical standard for\nregulation in their member states, which will be applicable worldwide.\nThe WMA supports these efforts and calls on policy makers in all countries, especially in\nurban regions, to introduce regulatory restrictions of access for vehicles without filter,\nand\/or to provide financial assistance to support the retrofitting of in-use vehicles.\nRECOMMENDATIONS\t\n \u00a0\nThe WMA therefore recommends that all NMAs should encourage their respective govern-\nments to:\n1. Introduce BAT standards for all new diesel vehicles (on road and off-road)\n2. Incentivise retrofitting with BAT filters for all in-use engines\n3. Monitor and limit the concentration of nanosize soot particles in the urban breathing\nair\n4. Conduct epidemiological studies detecting and differentiating the health effects of\nultrafine particles\n5. Build professional and public awareness of the importance of diesel soot and the\nexisting methods of eliminating the particles\n6. Contribute to developing strategies to protect people from soot particles in aircraft\npassenger cabins, trains, homes and in the general environment. These strategies\nshould include plans to develop and increase use of public transportation systems.\nABBREVIATIONS:\t\n \u00a0\nEPA: Environmental Protection Agency (US)\nERS: European Respiratory Society\nIARC: International Agency for Research of Cancer\nBAT Standards: Emission standards for passenger cars, heavy-duty vehicles and off-road\nmachinery, based on count of ultrafine particles rather than mass and aimed at the\nprotection of human health from the most hazardous soot particles, the lung and even cell\nmembrane penetrating ultra-fines.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nS-\u00ad\u20102014-\u00ad\u201002-\u00ad\u20102014\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nREFERENCES:\t\n \u00a0\n\u2022 Brook, Robert D. et al. (2010): AHA Scientific Statement: Particulate Matter Air\nPollution and Cardiovascular Disease. An Update to the Scientific Statement from\nthe American Heart Association. Circulation 121: 2331-2378.\n\u2022 ERS (2010): The ERS report on air pollution and public health. European\nRespiratory Society, Lausanne, Switzerland. ISBN: 978-1-84984-008-8\n\u2022 IARC (2012): \u201cIARC: Diesel Engine Exhaust Carcinogenic\u201d. Press Release No.\n213.http:\/\/www.iarc.fr\/en\/media-centre\/pr\/2012\/pdfs\/pr213_E.pdf. (access: 14\/02\/14)\n\u2022 Kerr, Richard R. (2013): \u201cSoot is Warming the World Even More Than Thought\u201d.\nIn: Science 339(6118), p. 382.\n\u2022 WHO (2014): \u201cBurden of disease from Ambient Air Pollution for 2012.\u201d http:\/\/\nwww.who.int\/phe\/health_topics\/outdoorair\/databases\/AAP_BoD_results_March20\n14.pdf?ua=1 (access: 26\/08\/14)\n1\nEuro 6\/VI, US\/EPA\/CARB, Chinese and equivalent standards.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0S-\u00ad\u20102014-\u00ad\u201003-\u00ad\u20102014\t\n \u00a0\nWMA\t\n \u00a0STATEMENT\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nSOLITARY\t\n \u00a0CONFINEMENT\t\n \u00a0\nAdopted by the 65th\nWMA General Assembly, Durban, South Africa, October 2014\nPREAMBLE\t\n \u00a0\nIn many countries substantial numbers of prisoners are held at times in solitary confine-\nment. Prisoners are typically kept in isolation for most of the day, and are allowed out of\ntheir cells only a short period of time of solitary exercise. Meaningful contact with other\npeople (prisoners, prison staff, outside world) is kept to a minimum. Some countries have\nstrict provisions on how long and how often prisoners can be kept in solitary confinement,\nbut many countries lack clear rules on this.\nThe reasons for the use of solitary confinement vary in different jurisdictions. It may be\nused as a disciplinary measure when a prisoner does not respond to other sanctions in-\ntended to address his or her behaviour, for example, in response to seriously disruptive\nbehaviour, threats of violence or suspected acts of violence.\nThe legal authorities in some nations allow individuals to be held in solitary confinement\nduring an on-going criminal investigation or to be sentenced to solitary confinement, even\nwhen the individual poses no threat to others. Individuals with mental illness may be\nkept in high-security or super-maximum security (supermax) units or prisons. Solitary con-\nfinement can be imposed for hours to days or even years.\nReliable data on the use of solitary confinement are lacking. Various studies estimate that\ntens of thousands or even hundreds of thousands of prisoners are currently held in soli-\ntary confinement worldwide.\nPeople react to isolation in different ways. For a significant number of prisoners, solitary\nconfinement has been documented to cause serious psychological, psychiatric, and some-\ntimes physiological effects, including insomnia, confusion, hallucinations and psycho-\nsis. Solitary confinement is also associated with a high rate of suicidal behaviour. Nega-\ntive health effects can occur after only a few days, and may in some cases persist when\nisolation ends.\nCertain populations are particularly vulnerable to the negative health effects of solitary\nconfinement. For example, persons with psychotic disorders, major depression, or post-\ntraumatic stress disorder or people with severe personality disorders may find isolation\nunbearable and suffer health harms. Solitary confinement may complicate treating such\nindividuals and their associated health problems successfully later in the prison environ-\nment or when they are released back into the community.\n\t\n \u00a0\n\t\n \u00a0S-\u00ad\u20102014-\u00ad\u201003-\u00ad\u20102014\t\n \u00a0\u23d0\uf8e6\t\n \u00a0Durban\t\n \u00a0\nSolitary\t\n \u00a0Confinement\t\n \u00a0\nHuman rights conventions prohibit the use of torture, cruel, inhuman or degrading treat-\nment or punishment. The use of pronged solitary confinement against a prisoner\u00b4s own\nwill or the use of solitary confinement during pre-trial detention or against minors can\nbe regarded as a breach of international human rights law, and must be avoided.\nRECOMMENDATIONS\t\n \u00a0\nThe WMA urges National Medical Associations and governments to promote the follow-\ning principles:\n1. Solitary confinement should be imposed only as a last resort whether to protect\nothers or the individual prisoner, and only for the shortest period of time pos-\nsible. The human dignity of prisoners confined in isolation must always be res-\npected.\n2. Authorities responsible for overseeing solitary confinement should take account of\nthe individual\u2019s health and medical condition and regularly re-evaluate and docu-\nment the individual\u2019s status. Adverse health consequences should lead to the im-\nmediate cessation of solitary confinement.\n3. All decisions on solitary confinement must be transparent and regulated by law.\nThe use of solitary confinement should be time-limited by law. Prisoners sub-\nject to solitary confinement should have a right of appeal.\n4. Prolonged solitary confinement, against the will of the prisoner, must be avoided.\nWhere prisoners seek prolonged solitary confinement, for whatever reason, they\nshould be medically and psychologically assessed to ensure it is unlikely to lead to\nharm.\n5. Solitary confinement should not be imposed when it would adversely affect the\nmedical condition of prisoners with a mental illness. If it is essential to provide\nsafety for the prisoner or other prisoners then especially careful and frequent\nmonitoring must occur, and an alternative found as soon as possible.\n6. Prisoners in isolation should be allowed a reasonable amount of regular human\ncontact. As with all prisoners, they must not be subjected to extreme physical\nand mentally taxing conditions.\n7. The health of prisoners in solitary confinement must be monitored regularly by a\nqualified physician. For this purpose, a physician should be allowed to check both\nthe documentation of solitary confinement decisions in the institution and the\nactual health of the confined prisoners on a regular basis.\n8. Prisoners who have been in solitary confinement should have an adjustment period\nbefore they are released from prison. This must never extend their period of in-\ncarceration.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0S-\u00ad\u20102014-\u00ad\u201003-\u00ad\u20102014\t\n \u00a0\n9. Physician\u00b4s role is to protect, advocate for, and improve prisoners\u00b4 physical and\nmental health, not to inflict punishment. Therefore, physicians should never parti-\ncipate in any part of the decision-making process resulting in solitary confine-\nment.\n10. Doctors have a duty to consider the conditions in solitary confinement and to pro-\ntest to the authorities if they believe that they are unacceptable or might amount to\ninhumane or degrading treatment.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nR-\u00ad\u20101981-\u00ad\u201001-\u00ad\u20102008\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nPHYSICIAN\t\n \u00a0PARTICIPATION\t\n \u00a0IN\t\n \u00a0CAPITAL\t\n \u00a0PUNISHMENT\t\n \u00a0\nAdopted by the 34th\nWorld Medical Assembly, Lisbon, Portugal, September\/October 1981\nand amended by the 52nd\nWMA General Assembly, Edinburgh, Scotland, October 2000\nand the 59th\nWMA General Assembly, Seoul, Korea, October 2008\nRESOLVED, that it is unethical for physicians to participate in capital punishment, in any\nway, or during any step of the execution process, including its planning and the instruction\nand\/or training of persons to perform executions.\nThe World Medical Association\nREQUESTS firmly its constituent members to advise all physicians that any participation\nin capital punishment as stated above is unethical.\nURGES its constituent members to lobby actively national governments and legislators\nagainst any participation of physicians in capital punishment.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0R-\u00ad\u20101988-\u00ad\u201001-\u00ad\u20102015\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nACADEMIC\t\n \u00a0SANCTIONS\t\n \u00a0OR\t\n \u00a0BOYCOTTS\t\n \u00a0\nAdopted by the 40th\nWorld Medical Assembly, Vienna, Austria, September 1988\nand editorially revised by the 170th\nWMA Council Session, Divonne-les-Bains, France,\nMay 2005\nand reaffirmed by the 200th\nWMA Council Session, Oslo, Norway, April 2015\nWHEREAS\nacademic sanctions or boycotts are discriminatory restrictions on academic, professional\nand scientific freedoms that deny or exclude physicians and others from educational, cul-\ntural and scientific meetings and other opportunities for the exchange of information and\nknowledge, the purpose of such restrictions being to protest the social and political poli-\ncies of governments, and\nWHEREAS\nsuch restrictions are in direct conflict with the major objectives of the WMA, viz., to\nachieve the highest international standards in medical education, medical science, medical\nart and medical ethics, and\nWHEREAS\nsuch restrictions adversely affect health care, particularly of the disadvantaged, and there-\nfore thwart the WMA's objective of obtaining the best possible health care for all people\nof the world, and\nWHEREAS\nsuch restrictions discriminate against physicians and patients on grounds of political per-\nsuasion or of political decisions taken by governments and are therefore in conflict with\nthe WMA's Declaration of Geneva, Statement on Non-Discrimination in Professional Mem-\nbership and Activities of Physicians and Statement on Freedom to Attend Medical Meet-\nings, and\nWHEREAS\na basic rule of medical practice is \"primum non nocere\", i.e. first, do no harm,\nTHEREFORE BE IT RESOLVED,\nthat the WMA regards the application of such restrictions as arbitrary political decisions\ndesigned to deny international scholarly exchange and to blacklist particular physicians or\n\t\n \u00a0\n\t\n \u00a0R-\u00ad\u20101988-\u00ad\u201001-\u00ad\u20102015\t\n \u00a0\u23d0\uf8e6Oslo\t\n \u00a0\nAcademic\t\n \u00a0Sanctions\t\n \u00a0Boycotts\t\n \u00a0\nbodies of physicians because of their nationality or because of the political policies of their\ngovernments. The WMA is unalterably opposed to such restrictions and calls on all Na-\ntional Medical Associations to resist the imposition of such restrictions by every means at\ntheir disposal and to heed the WMA's Statement on Non-Discrimination in Professional\nMembership and Activities of Physicians and the WMA Statement on Freedom to Attend\nMedical Meetings.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0R-\u00ad\u20101997-\u00ad\u201002-\u00ad\u20102007\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nECONOMIC\t\n \u00a0EMBARGOES\t\n \u00a0AND\t\n \u00a0HEALTH\t\n \u00a0\nAdopted by the 49th WMA General Assembly, Hamburg, Germany, November 1997\nand reaffirmed by the 58th\nWMA General Assembly, Copenhagen, Denmark, October 2007\nRECOGNISING\t\n \u00a0THAT:\t\n \u00a0\n\t\n \u00a0\nall people have the right to the preservation of health; and,\nthe Geneva Convention (Article 23, Number IV, 1949) requires the free passage of medi-\ncal supplies intended for civilians;\nTHE WMA URGES national medical associations to ensure that Governments employing\neconomic sanctions against other States respect the agreed exemptions for medicines, me-\ndical supplies and basic food items.\n\t\n \u00a0\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nR-\u00ad\u20101997-\u00ad\u201003-\u00ad\u20102008\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nACCESS\t\n \u00a0OF\t\n \u00a0WOMEN\t\n \u00a0AND\t\n \u00a0CHILDREN\t\n \u00a0TO\t\n \u00a0HEALTH\t\n \u00a0CARE\t\n \u00a0\t\n \u00a0\nAND\t\n \u00a0THE\t\n \u00a0ROLE\t\n \u00a0OF\t\n \u00a0WOMEN\t\n \u00a0IN\t\n \u00a0THE\t\n \u00a0MEDICAL\t\n \u00a0PROFESSION\t\n \u00a0\nAdopted by the 49th\nWMA General Assembly, Hamburg, Germany, November 1997\nand amended by the 59th\nWMA General Assembly, Seoul, Korea, October 2008\nPREAMBLE\t\n \u00a0\n\t\n \u00a0\nFor years women and girls worldwide have been suffering increasing violations of their\nhuman rights. These violations often arise from historically based gender bias where\nwomen and girls are restricted in their access to, inter alia, employment, education and\nhealth care.\nIn many countries, due to, inter alia, religious and cultural convictions, female doctors and\nnurses have been prevented from exercising their profession, which may lead to female\npatients and their children not having access to health care.\nGirls have the same rights as boys, and women have the same rights as men. Discrimina-\nting against girls and women damages their health expectation. Education of girl children\nis a major factor affecting their likelihood of experiencing health and well-being as adults.\nIt also improves the chances of their children surviving infancy. Secondary discrimination\ndue to social, religious and cultural practices - which diminishes women's freedom to\nmake decisions for themselves and to access work and healthcare - should be condemned.\nRECOMMANDATIONS:\t\n \u00a0\n\t\n \u00a0\nTherefore, the World Medical Association urges its constituent members to:\n\u2022 Categorically condemn violations of the basic human rights of women and child-\nren, including violations stemming from social, religious and cultural practices;\n\u2022 Insist on the rights of women and children to full and adequate medical care, espe-\ncially where religious and cultural restrictions hinder access to such medical care;\n\u2022 Promote women's and children's health rights as human rights;\n\u2022 Sensitize their membership on issues of gender equality and on participation of\nwomen in decision-making and health related activities;\n\u2022 Increase broad-based representation and effective participation of women in the\nmedical profession, especially in light of the increased enrolment of women in\nmedical schools;\n\t\n \u00a0\n\t\n \u00a0New\t\n \u00a0Delhi\t\n \u00a0\u23d0\uf8e6\t\n \u00a0R-\u00ad\u20101997-\u00ad\u201003-\u00ad\u20102008\t\n \u00a0\nWoman\t\n \u00a0and\t\n \u00a0Children\t\n \u00a0to\t\n \u00a0Health\t\n \u00a0Care\t\n \u00a0\t\n \u00a0\n\u2022 Promote the achievement of the human right to equality of opportunity, equality of\ntreatment and non-sexism;\n\u2022 Promote a higher growth rate of membership in National Medical Associations\namongst women through empowerment, career development, appropriate training to\nimprove knowledge and skills, and other strategic initiatives.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nR-\u00ad\u20101998-\u00ad\u201003-\u00ad\u20102009\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nIMPROVED\t\n \u00a0INVESTMENT\t\n \u00a0IN\t\n \u00a0PUBLIC\t\n \u00a0HEALTH\t\n \u00a0\nAdopted by the 50th\nWorld Medical Assembly, Ottawa, Canada, October 1998\nand amended by the 60th\nWMA General Assembly, New Delhi, India, October 2009\nINTRODUCTION\t\n \u00a0\n\t\n \u00a0\nEach country should have a health system with enough resources to attend to the needs of\nits population. However today, many countries across the world are suffering wide in-\nequities and inequalities in health care and this is causing problems of access to health ser-\nvices for the poorer segments of society [the weak or underprivileged]. The situation is\nespecially serious in low-income countries.\nThe international community has attempted to improve the situation. The 20\/20 initiative\nof 1995, the 1996 Initiative for Heavily Indebted Poor Countries (HIPC), and Objectives\nfor Millennium 2000 Development (MDGs) are all initiatives aimed at reducing poverty\nand dealing with poor health, inequities and inequalities between the sexes, education,\ninsufficient access to drinking water and environmental contamination.\nThe objectives are formed as an agreement with acknowledgement of the contributions\nwhich developed countries can make, in the shape of trade relations, development assis-\ntance, reduction of the burden of debt, improving access to essential medication and the\ntransfer of technology. Three of the eight objectives are directly related to health, which\nhas a considerable influence on various other objectives that interact to support each of the\nothers within a structural framework, these are designed to increase human development\nglobally. The eight Millennium Development Objectives (MDO) foresee a development\nvision based on health and education, thus affirming that development does not only refer\n(allude) to economic growth.\nVarious reports from the World Health Organization have underlined the opportunities\nand skills [or techniques] which are currently involved in bringing about significant im-\nprovements in health, as well as helping to reduce poverty and encourage growth. Addi-\ntionally, the reports highlight the fact that it is of fundamental importance to reduce limita-\ntions on human resources, in order to increase the achievements of the public health sys-\ntem, a situation which requires urgent attention. These limitations are related to work, train-\ning and payment conditions, and play a substantial role in determining capacity for sus-\ntained growth of access to health services.\nRECOMMENDATIONS\t\n \u00a0\n\t\n \u00a0\nThe World Medical Association urges National Medical Associations to:\n\t\n \u00a0\n\t\n \u00a0New\t\n \u00a0Delhi\t\n \u00a0\u23d0\uf8e6\t\n \u00a0R-\u00ad\u20101998-\u00ad\u201003-\u00ad\u20102009\t\n \u00a0\nInvestment\t\n \u00a0in\t\n \u00a0Public\t\n \u00a0Health\t\n \u00a0\n1. Advocate that their governments should adhere to and promote the proposals to in-\ncrease investment in the health sector; and to adhere to and promote initiatives to re-\nduce the debt burden for the poorest countries on the planet.\n2. Advocate [defend] the inclusion of public health factors in all fields of policy pro-\nvision, since health is mostly determined by factors that are external to the area of\nhealthcare, for example, housing and education. [Health is not only medicine, it also\ndepends on living standards].\n3. Encourage and support countries in the planning and implementation of investment\nplans, which invest in health for the poor; guarantee that more resources be used for\nhealth in general, with greater efficiency and impact; and reduce limitations for the\nmost effective use of the additional investments.\n4. Maintain vigilance to ensure that the investment plans focus maximum attention on\ngenerating capacity, that they promote leadership skills and promote incentives to\nretain and place qualified personnel, whilst it is taken into consideration that the limi-\ntations in relation to the previous matter currently constitute the greatest obstacle for\nprogress.\n5. Urge international financial institutions and other important donors to: i) Adopt the\nnecessary measures to help the countries that have already organised mechanisms to\nprepare their investment plans, and provide assistance to those countries that have be-\ngun to take the necessary steps, with the support and participation of the international\ncommunity; ii) Help countries to obtain funds to develop and implement their invest-\nment plans; iii) Continue providing technical assistance to the countries for their plans.\n6. Exchange information in order to coordinate efforts to change policies in these areas.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nR-\u00ad\u20101998-\u00ad\u201004-\u00ad\u20102009\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nMEDICAL\t\n \u00a0WORKFORCE\t\n \u00a0\nAdopted by the 50th\nWorld Medical Assembly, Ottawa, Canada, October 1998\nand amended by the 60th\nWMA General Assembly, New Delhi, India, October 2009\nPREAMBLE\t\n \u00a0\n\t\n \u00a0\nThe health of our countries depends upon keeping the population healthy. Health care is a\nkey right of individuals. This care is dependent upon access to highly-trained medical and\nother healthcare professionals. Well-functioning health care systems depend upon these\nsufficient human resources. Comprehensive and extensive planning on a national level is\nrequired in order to ensure that a country has a medical workforce in all fields of medicine\nthat meets the present and future health needs of the entire population of that country.\nThere are currently significant shortages in the area of health human resources. These\nshortages are present in all countries but are especially pronounced in developing coun-\ntries where health human resources are more limited.\nThe problem is made more severe by the fact that many countries have not invested ade-\nquately in the education, training, recruitment and retention of their medical workforce.\nThe ageing population in developed countries has also been reflected by an ageing medi-\ncal workforce. Many developed countries address their medical workforce shortages by\nemploying health care professionals from developing countries to bolster their own health\ncare systems.\nThe migration of health care professionals from developing countries to developed coun-\ntries has, over the past ten years, impaired the performance of health systems in develop-\ning countries. Economic realities of insufficient investments in health care and inadequate\nfacilities and support for health care professionals have continued to be responsible for\nthis migration.\nThe World Health Organization has recognized that the crisis of health workforce short-\nages is impeding the provision of essential, life-saving interventions. It has therefore esta-\nblished structures such as the Global Health Workforce Alliance, a partnership dedicated\nto identifying and implementing solutions to the health workforce problems. The WHO is\npromoting the development of a cadre of medical\/clinical assistants who propose to join\nthe medical workforce to partially address these shortages.\nRECOMMENDATIONS\t\n \u00a0\n\t\n \u00a0\nRecognizing that health care systems require adequate numbers of qualified and com-\npetent health care professionals, the World Medical Association asks all National Medical\nAssociations to participate and be active in addressing these requirements and to:\n\t\n \u00a0\n\t\n \u00a0New\t\n \u00a0Delhi\t\n \u00a0\u23d0\uf8e6\t\n \u00a0R-\u00ad\u20101998-\u00ad\u201004-\u00ad\u20102009\t\n \u00a0\nMedical\t\n \u00a0Workforce\t\n \u00a0\n1. Call on their respective governments to allocate sufficient financial resources for the\neducation, training, development, recruitment and retention of physicians to meet the\nmedical needs of the entire population in their countries.\n2. Call on their respective governments to ensure that the education, training and develop-\nment of healthcare professionals meets the highest possible standards including:\n\u2022 The training and development of medical\/clinical assistants where this is applica-\nble and appropriate and\n\u2022 Ensuring clear definitions of scope of practice and conditions for adequate support\nand supervision;\n3. Call on governments to ensure that appropriate ratios are maintained between popula-\ntion and the medical workforce at all levels, including mechanisms to address reduced\naccess to care in rural and remote areas, based on accepted international norms and\nstandards where these are available;\n4. Take measures to attract and support individuals within their countries to enter the\nmedical profession and also call on their respective governments to take such action;\n5. Actively advocate for programs that will ensure the retention of physicians within\ntheir respective countries and ensure governments\u2019 recognition of this need;\n6. Call on governments to improve the health care working environment (including ac-\ncess to appropriate facilities, equipment, treatment modalities and professional sup-\nport), physician remuneration, physician living environment and career development\nof the medical workforce at all levels;\n7. Advocate for the development of transparent memoranda of understanding between\ncountries where migration of trained health care professionals is an issue of concern\nand enlist where possible the NMA of origin and receiving NMA\u2019s to support these\nphysicians.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nR-\u00ad\u20101998-\u00ad\u201005-\u00ad\u20102008\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nSUPPORTING\t\n \u00a0THE\t\n \u00a0OTTAWA\t\n \u00a0CONVENTION\t\n \u00a0\n(Convention on the prohibition of the use, stockpiling, production\nand transfer of anti-personnel mines and on their destruction)\nAdopted by the 50th\nWorld Medical Assembly, Ottawa, Canada, October 1998\nand amended by the 59th\nWMA General Assembly, Seoul, Korea, October 2008\nThe World Medical Association:\n\u2022 expresses its support for the Ottawa Convention (also known as the landmine ban\nconvention); and\n\u2022 urges its member National Medical Associations to press their governments to sign\nand ratify the Convention.\n\u2022 urges its member National Medical Associations to press their governments to\ncease manufacture, sale, deployment and use of landmines.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0R-\u00ad\u20101999-\u00ad\u201001-\u00ad\u20101999\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nTHE\t\n \u00a0INCLUSION\t\n \u00a0OF\t\n \u00a0MEDICAL\t\n \u00a0ETHICS\t\n \u00a0AND\t\n \u00a0HUMAN\t\n \u00a0RIGHTS\t\n \u00a0\t\n \u00a0\nIN\t\n \u00a0THE\t\n \u00a0CURRICULUM\t\n \u00a0OF\t\n \u00a0MEDICAL\t\n \u00a0SCHOOLS\t\n \u00a0WORLD-\u00ad\u2010WIDE\t\n \u00a0\nAdopted by the 51st\nWorld Medical Assembly, Tel Aviv, Israel, October 1999\n1. Whereas Medical Ethics and Human Rights form an integral part of the work and cul-\nture of the medical profession, and\n2. Whereas Medical Ethics and Human Rights form an integral part of the history, struc-\nture and objectives of the World Medical Association\n3. It is hereby resolved that the WMA strongly recommends to Medical Schools world-\nwide that the teaching of Medical Ethics and Human Rights be included as an obli-\ngatory course in their curricula.\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nR-\u00ad\u20102002-\u00ad\u201001-\u00ad\u20102013\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nEUTHANASIA\t\n \u00a0\nAdopted by the 53rd\nWMA General Assembly, Washington, DC, USA, October 2002\nand reaffirmed with minor revision by the 194th\nWMA Council Session,\nBali, Indonesia, April 2013\nThe World Medical Association's Declaration on Euthanasia, adopted by the 38th\nWorld\nMedical Assembly, Madrid, Spain, October 1987 and reaffirmed by the 170th\nWMA\nCouncil Session, Divonne-les-Bains, France, May 2005 states:\n\"Euthanasia, that is the act of deliberately ending the life of a patient, even at the\npatient's own request or at the request of close relatives, is unethical. This does not\nprevent the physician from respecting the desire of a patient to allow the natural pro-\ncess of death to follow its course in the terminal phase of sickness.\"\nThe WMA Statement on Physician-Assisted Suicide, adopted by the 44th\nWorld Medical\nAssembly, Marbella, Spain, September 1992 and editorially revised by the 170th\nWMA\nCouncil Session, Divonne-les-Bains, France, May 2005 likewise states:\n\"Physicians-assisted suicide, like euthanasia, is unethical and must be condemned by\nthe medical profession. Where the assistance of the physician is intentionally and\ndeliberately directed at enabling an individual to end his or her own life, the physi-\ncian acts unethically. However the right to decline medical treatment is a basic right\nof the patient and the physician does not act unethically even if respecting such a\nwish results in the death of the patient.\"\nThe World Medical Association has noted that the practice of active euthanasia with\nphysician assistance, has been adopted into law in some countries.\nBE\t\n \u00a0IT\t\n \u00a0RESOLVED\t\n \u00a0that:\t\n \u00a0\n\t\n \u00a0\nThe World Medical Association reaffirms its strong belief that euthanasia is in conflict\nwith basic ethical principles of medical practice, and\nThe World Medical Association strongly encourages all National Medical Associations\nand physicians to refrain from participating in euthanasia, even if national law allows it or\ndecriminalizes it under certain conditions.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0R-\u00ad\u20102002-\u00ad\u201002-\u00ad\u20102012\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nFEMALE\t\n \u00a0FOETICIDE\t\n \u00a0\nAdopted by the 53rd\nWMA General Assembly, Washington, DC, USA, October 2002\nand reaffirmed by the 191st\nWMA Council Session, Prague, Czech Republic, April 2012\n1. Whereas there is grave concern that in certain countries female foeticide is commonly\npractised.\n2. The WMA denounces female foeticide as a totally unacceptable example of gender\ndiscrimination.\n3. The World Medical Association calls on National Medical Associations:\n1. To denounce the practice of female foeticide and the use of selective sex\ndetermination for that purpose and;\n2. To advise their governments accordingly.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nR-\u00ad\u20102002-\u00ad\u201005-\u00ad\u20102012\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nTHE\t\n \u00a0ABUSE\t\n \u00a0OF\t\n \u00a0PSYCHIATRY\t\n \u00a0\nAdopted by the 53rd\nWMA General Assembly, Washington, DC, USA, October 2002\nand revised by the 63rd\nWMA General Assembly, Bangkok, Thiland, October 2012\nThe World Medical Association (WMA) notes with concern evidence from a number of\ncountries that political dissidents, practitioners of various religions and social activists\nhave been detained in psychiatric institutions and subjected to unnecessary psychiatric\ntreatment as a punishment and not to treat a substantiated psychiatric illness.\nThe WMA:\n\u2022 Declares that such detention and unwarranted treatment is abusive, unethical and\nunacceptable;\n\u2022 Calls on physicians and psychiatrists to resist involvement in these abusive prac-\ntices;\n\u2022 Calls on member NMAs to support their physician members who resist involve-\nment in these abuses, and\n\u2022 Calls on governments to stop abusing medicine and psychiatry in this manner, and\non non-governmental organizations and the World Health Organization to work to\nend these abuses; and\n\u2022 Calls on governments to uphold the United Nations International Covenant on\nCivil and Political Rights, which states that \"all persons are equal before the law\nand are entitled without any discrimination to the equal protection of the law.\"\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0R-\u00ad\u20102002-\u00ad\u201006-\u00ad\u20102013\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nWOMEN'S\t\n \u00a0RIGHTS\t\n \u00a0TO\t\n \u00a0HEALTH\t\n \u00a0CARE\t\n \u00a0\t\n \u00a0\nAND\t\n \u00a0HOW\t\n \u00a0THAT\t\n \u00a0RELATES\t\n \u00a0TO\t\n \u00a0THE\t\n \u00a0PREVENTION\t\n \u00a0\t\n \u00a0\nOF\t\n \u00a0MOTHER-\u00ad\u2010TO-\u00ad\u2010CHILD\t\n \u00a0HIV\t\n \u00a0INFECTION\t\n \u00a0\nAdopted by the 53rd\nWMA General Assembly, Washington, DC, USA, October 2002\nand amended by the 64th\nWMA General Assembly, Fortaleza, Brazil, October 2013\nPREAMBLE\t\n \u00a0\nIn many parts of the world the prevalence of HIV infection continues to increase. One of\nthe Millennium Development Goals (MDG 6), specifically targets combating HIV\/AIDS,\nmalaria and other diseases, with 2015 being its target year to halt HIV\/AIDS infection and\nto begin reversing the spread of HIV\/AIDS. In addition, it was hoped that by 2010\nuniversal access to treatment for HIV\/AIDS for all those requiring it would be achieved. A\nDecember 2012 UN resolution declared that countries must develop programmes for\nUniversal Health Access after 2015 when the MDGs end.\nHIV\/AIDS is a disease that disproportionately affects people in their reproductive years\nalthough today, due to better management of the condition, there are also many older\npeople who are infected. In addition, many who were infected as infants are now reaching\nreproductive maturity.\nIn developed countries men who have sex with men and injection drug users constitute\nsignificant risk groups for contracting HIV. In many developing countries, women are at\nrisk due to heterosexual contact with HIV infected partners. In 2011 approximately 58\npercent of people living with HIV in sub-Saharan Africa were women, equating to about\n13.6 million women living with HIV and AIDS, compared to about 9.9 million men\n(UNAIDS 'Global Fact Sheet 2012: World AIDS Day 2012).\nIn the absence of HIV, maternal mortality worldwide would be significantly (20% ) lower\n(Murray et al. Maternal mortality for 181 countries, 1980~2008: a systematic analysis of\nprogress towards Millennium Development Goal 5).\nHIV infection increases the risk of invasive cervical cancer 2 to 22 fold. Some evidence\nexists that the use of antiretroviral therapy may decrease this risk. Hence, the appropriate\nmanagement of patients infected with HIV may have a long-term impact on other aspects\nof women\u2019s health.\nThe WMA believes that access to healthcare, including both therapeutic and preventative\nstrategies, is a fundamental human right. This imposes an obligation on government to\n\t\n \u00a0\n\t\n \u00a0R-\u00ad\u20102002-\u00ad\u201006-\u00ad\u20102013\t\n \u00a0\u23d0\uf8e6\t\n \u00a0Fortaleza\t\n \u00a0\nWomen\u2019s\t\n \u00a0Right\t\n \u00a0to\t\n \u00a0Health\t\n \u00a0Care\t\n \u00a0\nensure that these human rights are fully respected and protected. Gender inequalities must\nbe addressed and eradicated. This should impact every aspect of healthcare.\nThe promotion and protection of the reproductive rights of women are critical to the\nultimate success of confronting and resolving the HIV\/AIDS pandemic.\nMany of the MDGs address empowering women and promoting their role in society and\nspecifically in healthcare. MDG 5B, in particular, promotes universal access to repro-\nductive health including contraceptive access, reduction in adolescent birth rate, antenatal\ncare coverage and addressing unmet needs for family planning. In addition, MDG 3\nwhich promotes gender equality and empowers women, and MDGs 1 and 2 will influence\nwomen\u2019s status in society and therefore their access to healthcare and health promotion.\nRECOMMENDATIONS\t\n \u00a0\n\t\n \u00a0\nThe WMA requests all national member associations to encourage their governments to\nundertake and promote the following actions:\n\u2022 Develop empowerment programs for women of all ages to ensure that women are\nfree from discrimination and enjoy universal and free access to reproductive health\neducation and life skills training. It is recommended that campaigns be initiated and\nactivated in the media, including social media and popular programmes on radio and\ntelevision in order to eradicate myths, stigma and stereotypes that might degrade or\ndehumanise women. This must include campaigns against genital mutilation and\nforced adolescent marriages and unwanted pregnancies. In addition, promoting the\navailability and choice of contraception for women, without necessarily having to\nget input from their partners, and promoting the availability of HIV testing and treat-\nment are essential for reproductive health. It is also important to provide for the eco-\nnomic means for the infected populations in terms of prevention, treatment and\nmedical follow-up.\n\u2022 Women must have the same access as men, without discrimination to education,\nemployment, economic independence, information about healthcare and health ser-\nvices.\n\u2022 Laws, policies and practices that facilitate the full recognition and respect of human\nrights and the fundamental freedom of women should be initiated or reviewed and\nrevised where appropriate. It is essential that women are empowered to make deci-\nsions regarding their children, their financial status and their future.\n\u2022 All governments should develop programmes to provide prophylactic treatment in\nthe form of antiretrovirals to women who have been raped or sexually assaulted.\nUniversal and free access to antiretroviral therapy must also be provided to all HIV\ninfected women.\n\u2022 HIV infected women who are pregnant should receive counselling and access to\nanti-retroviral prophylaxis or treatment in order to prevent mother to child trans-\nmission of HIV.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0R-\u00ad\u20102003-\u00ad\u201001-\u00ad\u20102013\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nTHE\t\n \u00a0DESIGNATION\t\n \u00a0OF\t\n \u00a0AN\t\n \u00a0ANNUAL\t\n \u00a0MEDICAL\t\n \u00a0ETHICS\t\n \u00a0DAY\t\n \u00a0\nAdopted by the 54th\nWMA General Assembly, Helsinki, Finland, September 2003\nand reaffirmed by the 194th\nWMA Council Session, Bali, Indonesia, April 2013\nWhereas the World Medical Association has a specific focus and function in the field of\nmedical ethics, and came into being on 18 September 1947 during the first General\nAssembly, it is resolved that NMAs are encouraged to annually observe the 18th\nSeptember as \"Medical Ethics Day\".\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nR-\u00ad\u20102003-\u00ad\u201002-\u00ad\u20102007\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nTHE\t\n \u00a0RESPONSIBILITY\t\n \u00a0OF\t\n \u00a0PHYSICIANS\t\n \u00a0IN\t\n \u00a0THE\t\n \u00a0DOCUMENTATION\t\n \u00a0\t\n \u00a0\nAND\t\n \u00a0DENUNCIATION\t\n \u00a0OF\t\n \u00a0ACTS\t\n \u00a0OF\t\n \u00a0TORTURE\t\n \u00a0OR\t\n \u00a0CRUEL\t\n \u00a0\t\n \u00a0\nOR\t\n \u00a0INHUMAN\t\n \u00a0OR\t\n \u00a0DEGRADING\t\n \u00a0TREATMENT\t\n \u00a0\nAdopted by the 54th\nWMA General Assembly, Helsinki, Finland, September 2003\nand amended by the 58th\nWMA General Assembly, Copenhagen, Denmark, October 2007\nThe World Medical Association,\n1. Considering the Preamble to the United Nations Charter of 26 June 1945 solemnly\nproclaiming the faith of the people of the United Nations in the fundamental human\nrights, the dignity and value of the human person,\n2. Considering the Preamble to the Universal Declaration of Human Rights of 10 De-\ncember 1948 which states that disregard and contempt for human rights have re-\nsulted in barbarous acts which have outraged the conscience of mankind,\n3. Considering Article 5 of that Declaration which proclaims that no one shall be sub-\njected to torture or cruel, inhuman or degrading treatment,\n4. Considering the American Convention on Human Rights, which was adopted by the\nOrganization of American States on 22 November 1969 and entered into force on 18\nJuly 1978, and the Inter-American Convention to Prevent and Punish Torture, which\nentered into force on 28 February 1987,\n5. Considering the Declaration of Tokyo, adopted by the World Medical Association in\n1975, which reaffirms the prohibition of any form of medical involvement or presence\nof a physician during torture or inhuman or degrading treatment,\n6. Considering the Declaration of Hawaii, adopted by the World Psychiatric Association\nin 1977,\n7. Considering the Declaration of Kuwait, adopted by the International Conference of\nIslamic Medical Associations in 1981,\n8. Considering the Principles of Medical Ethics Relevant to the Role of Health Person-\nnel, Particularly Physicians, in the Protection of Prisoners and Detainees Against Tor-\nture and Other Cruel, Inhuman or Degrading Treatment or Punishment, adopted by\nthe United Nations General Assembly on 18 December 1982, and particularly Princi-\nple 2, which states: \"It is a gross contravention of medical ethics\u2026 for health person-\nnel, particularly physicians, to engage, actively or passively, in acts which constitute\nparticipation in, complicity in, incitement to or attempts to commit torture or other\ncruel, inhuman or degrading treatment\u2026\",\n\t\n \u00a0\n\t\n \u00a0Copenhagen\t\n \u00a0\u23d0\uf8e6\t\n \u00a0R-\u00ad\u20102003-\u00ad\u201002-\u00ad\u20102007\t\n \u00a0\nDenunciation\t\n \u00a0of\t\n \u00a0Acts\t\n \u00a0of\t\n \u00a0Torture\t\n \u00a0\n9. Considering the Convention Against Torture and Other Cruel, Inhuman or Degrading\nTreatment or Punishment, which was adopted by the United Nations General Assem-\nbly on December 1984 and entered into force on 26 June, 1987,\n10. Considering the European Convention for the Prevention of Torture and Inhuman or\nDegrading Treatment or Punishment, which was adopted by the Council of Europe on\n26 June 1987 and entered into force on 1 February 1989,\n11. Considering the Resolution on Human Rights adopted by the World Medical Asso-\nciation in Rancho Mirage, in October 1990 during the 42nd\nGeneral Assembly and\namended by the 45th\n, 46th\nand 47th\nGeneral Assemblies,\n12. Considering the Declaration of Hamburg, adopted by the World Medical Association\nin November 1997 during the 49th\nGeneral Assembly, calling on physicians to protest\nindividually against ill-treatment and on national and international medical organiza-\ntions to support physicians in such actions,\n13. Considering the Istanbul Protocol (Manual on the Effective Investigation and Docu-\nmentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punish-\nment), adopted by the United Nations General Assembly on 4 December 2000,\n14. Considering the Convention on the Rights of the Child, which was adopted by the\nUnited Nations on 20 November 1989 and entered into force on 2 September 1990,\nand\n15. Considering the World Medical Association Declaration of Malta on Hunger Strikers,\nadopted by the 43rd\nWorld Medical Assembly Malta, November 1991and amended by\nthe WMA General Assembly, Pilanesberg, South Africa, October, 2006,\nRECOGNIZING\t\n \u00a0\n1. That careful and consistent documentation and denunciation by physicians of cases of\ntorture and of those responsible contributes to the protection of the physical and men-\ntal integrity of victims and in a general way to the struggle against a major affront to\nhuman dignity,\n2. That physicians, by ascertaining the sequelae and treating the victims of torture, either\nearly or late after the event, are privileged witnesses of this violation of human rights,\n3. That the victims, because of the psychological sequelae from which they suffer or the\npressures brought on them, are often unable to formulate by themselves complaints\nagainst those responsible for the ill-treatment they have undergone,\n4. That the absence of documenting and denouncing acts of torture may be considered as\na form of tolerance thereof and of non-assistance to the victims,\n5. That nevertheless there is no consistent and explicit reference in the professional\ncodes of medical ethics and legislative texts of the obligation upon physicians to\ndocument, report or denounce acts of torture or inhuman or degrading treatment of\nwhich they are aware,\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nR-\u00ad\u20102003-\u00ad\u201002-\u00ad\u20102007\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nRECOMMENDS\t\n \u00a0THAT\t\n \u00a0NATIONAL\t\n \u00a0MEDICAL\t\n \u00a0ASSOCIATIONS\t\n \u00a0\n1. Attempt to ensure that detainees or victims of torture or cruelty or mistreatment have\naccess to immediate and independent health care. Attempt to ensure that physicians\ninclude assessment and documentation of symptoms of torture or ill-treatment in the\nmedical records using the necessary procedural safeguards to prevent endangering\ndetainees.\n2. Promote awareness of the Istanbul Protocol and its Principles on the Effective Investi-\ngation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treat-\nment. This should be done at country level using different methods of information dis-\nsemination; including trainings, publications and web documents.\n3. Disseminate to physicians the Istanbul Protocol.\n4. Promote training of physicians on the identification of different modes of torture, in\nrecognizing physical and psychological symptoms following specific forms of torture\nand in using the documentation techniques foreseen in the Istanbul Protocol to create\ndocumentation that can be used as evidence in legal or administrative proceedings.\n5. Promote awareness of the correlation between the examination findings, under-\nstanding torture methods and the patients' allegations of abuse;\n6. Facilitate the production of high-quality medical reports on torture victims for sub-\nmission to judicial and administrative bodies;\n7. Attempt to ensure that physicians observe informed consent and avoid putting indi-\nviduals in danger while assessing or documenting signs of torture and ill-treatment;\n8. Attempt to ensure that physicians include assessment and documentation of symptoms\nof torture or ill-treatment in the medical records using the necessary procedural safe-\nguards to prevent endangering detainees.\n9. Support the adoption in their country of ethical rules and legislative provisions:\n1. aimed at affirming the ethical obligation on physicians to report or denounce acts\nof torture or cruel, inhuman or degrading treatment of which they are aware; de-\npending on the circumstances, the report or denunciation would be addressed to\nmedical, legal, national or international authorities, to non-governmental organiza-\ntions or to the International Criminal Court. Doctors should use their discretion in\nthis matter, bearing in mind paragraph 68 of the Istanbul Protocol.\n2. establishing, to that effect, an ethical and legislative exception to professional con-\nfidentiality that allows the physician to report abuses, where possible with the sub-\nject's consent, but in certain circumstances where the victim is unable to express\nhim\/herself freely, without explicit consent.\n3. cautioning physicians to avoid putting individuals in danger by reporting on a\nnamed basis a victim who is deprived of freedom, subjected to constraint or threat\nor in a compromised psychological situation\n\t\n \u00a0\n\t\n \u00a0Copenhagen\t\n \u00a0\u23d0\uf8e6\t\n \u00a0R-\u00ad\u20102003-\u00ad\u201002-\u00ad\u20102007\t\n \u00a0\nDenunciation\t\n \u00a0of\t\n \u00a0Acts\t\n \u00a0of\t\n \u00a0Torture\t\n \u00a0\n10. Place at their disposal all useful information on reporting procedures, particularly to\nthe national authorities, nongovernmental organizations and the International Crimi-\nnal Court.\nIstanbul Protocol, paragraph 68: \"In some cases, two ethical obligations are in conflict.\nInternational codes and ethical principles require the reporting of information concerning\ntorture or maltreatment to a responsible body. In some jurisdictions, this is also a legal re-\nquirement. In some cases, however, patients may refuse to give consent to being exa-\nmined for such purposes or to having the information gained from examination disclosed\nto others. They may be fearful of the risks of reprisals for themselves or their families. In\nsuch situations, health professionals have dual responsibilities: to the patient and to society\nat large, which has an interest in ensuring that justice is done and perpetrators of abuse are\nbrought to justice. The fundamental principle of avoiding harm must feature prominently\nin consideration of such dilemmas. Health professionals should seek solutions that pro-\nmote justice without breaking the individual's right to confidentiality. Advice should be\nsought from reliable agencies; in some cases this may be the national medical association\nor non-governmental agencies. Alternatively, with supportive encouragement, some reluc-\ntant patients may agree to disclosure within agreed parameters.\"\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nR-\u00ad\u20102003-\u00ad\u201003-\u00ad\u20102014\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nTHE\t\n \u00a0NON-\u00ad\u2010COMMERCIALISATION\t\n \u00a0OF\t\n \u00a0\t\n \u00a0\nHUMAN\t\n \u00a0REPRODUCTIVE\t\n \u00a0MATERIAL\t\n \u00a0\nAdopted by the 54th\nWMA General Assembly, Helsinki, Finland, September 2003\nand revised by 65th\nWMA General Assembly, Durban, South Africa, October 2014\nPREAMBLE\t\n \u00a0\nThe rapid advances in biomedical technologies have led to growth of the reproductive\nassistance industry, which tends to be poorly regulated. Despite the fact that many govern-\nments have laws prohibiting commercial transactions of reproductive material, most have\nnot been successful in universally preventing the sale of human ova, sperm and embryos\non the internet and elsewhere. The market value of human material, including cells, tis-\nsues, and cellular tissue can be lucrative, creating a potential conflict for physicians and\nothers between economic interests and professional ethical obligations.\nFor the purposes of this resolution human reproductive material is defined as human\ngametes and embryos.\nAccording to the WHO, transplant commercialism \u201cis a policy or practice in which cells,\ntissues or organs are treated as a commodity, including by being bought or sold or used for\nmaterial gain.\u201d1\nThe principle that the \u201chuman body and its parts shall not, as such, give rise to financial\ngain\u201d2\nis laid down in numerous international declarations and recommendations.3\nThe\n2006 WMA Statement on Human Organ Donation and Transplantation and the 2012\nWMA Statement on Organ and Tissue Donation call for the prohibition of the sale of or-\ngans and tissues for transplantation. The WMA Statement on Assisted Reproductive\nTechnologies (2006) also states that it is inappropriate to offer financial benefits to en-\ncourage donation of human reproductive material.\nThe same principles should be in place for the use of human reproductive material in the\narea of medical research. The International Bioethics Committee of the United Nations\nEducational, Scientific and Cultural Organization (UNESCO IBC) in its report on the\nethical aspects of human embryonic stem cell research states that the transfer of human\nembryos must not be a commercial transaction and that measures should be taken to\ndiscourage any financial incentive.\nIt is important to distinguish between the sale of clinical assisted reproductive services,\nwhich is legal, and the sale of the human reproductive materials, which is usually illegal.\nDue to the special nature of human embryos, the commercialization of gametes is unlike\nthat of other cells and tissues as sperm and eggs may develop into a child if fertilization is\nsuccessful.\n\t\n \u00a0\n\t\n \u00a0Durban\t\n \u00a0\u23d0\uf8e6\t\n \u00a0R-\u00ad\u20102003-\u00ad\u201003-\u00ad\u20102014\t\n \u00a0\nNon-\u00ad\u2010Commercialization\t\n \u00a0of\t\n \u00a0Human\t\n \u00a0Reproductive\t\n \u00a0Material\t\n \u00a0\nBefore human reproductive material is donated, the donor must give informed consent that\nis free of duress. This requires that the individual donor is deemed fully competent and has\nbeen given all the available information regarding the procedure and its outcome. If re-\nsearch is to be conducted on the material, it is subject to a separate consent process that\nmust be consistent with the provisions in the WMA's Declaration of Helsinki. There must\nnot be any inducement or other undue pressure to donate or offers of compensation.\nMonetary compensation given to individuals for economic losses, expenses or incon-\nveniences associated with the retrieval of donated reproductive materials should be dis-\ntinguished from payment for the purchase of reproductive materials.\nRECOMMENDATIONS\t\n \u00a0\n1.\n1. National Medical Associations (NMAs) should urge their governments to prohibit\ncommercial transactions in human ova, sperm and embryos and any human material\nfor reproductive purpose.\n2. Physicians involved in the procurement and use of human ova, sperm, and em-\nbryos should implement protocol to ensure that materials have been acquired ap-\npropriately with the consent and authorization of the source individuals. In doing\nso, they can uphold the ethical principle of non-commercialization of human repro-\nductive material.\n3. Physicians should consult with potential donors prior to donation in order to ensure\nfree and informed consent.\n4. Physicians should adhere to the WMA Statement on Conflict of Interest when\ntreating patients who seek reproductive services.\n1\nGlobal Glossary of Terms and Definitions on Donation and Transplantation, WHO, November\n2009\n2\nEuropean convention of human rights and biomedicine - Article 21 \u2013 Prohibition of financial\ngain\n3\nDeclaration of Istanbul guiding principle 5\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nR-\u00ad\u20102004-\u00ad\u201001-\u00ad\u20102014\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nWFME\t\n \u00a0GLOBAL\t\n \u00a0STANDARDS\t\n \u00a0FOR\t\n \u00a0QUALITY\t\n \u00a0IMPROVEMENT\t\n \u00a0OF\t\n \u00a0\nMEDICAL\t\n \u00a0EDUCATION\t\n \u00a0\nApproved by the 55th\nWMA General Assembly, Tokyo, Japan, October 2004\nand reaffirmed by the 197th\nWMA Council Session, Tokyo, Japan, April 2014\nWhereas the WMA:\n1. Recognizes the need and importance for sound global standards for quality improve-\nment of medical education;\n2. Acknowledges the WMA's special relationship with the World Federation for Medical\nEducation (WFME) as one of the founders of the Federation;\n3. Recognizes that it is represented in the WFME Executive Council and in this capacity\nis co-responsible for the WFME Project on International Standards in Medical Educa-\ntion, conducted since 1997 1\n;\n4. Acknowledges the recent development of the WFME Trilogy of Documents of Global\nStandards in Medical Education for Quality Improvement, covering Basic Medical\nEducation2\n, Postgraduate Medical Education3\nand the Continuing Professional De-\nvelopment (CPD) of Medical Doctors4\n;\n5. Recognizes the endorsement5\nof the WFME Global Standards at the World Confer-\nence in Medical Education: Global Standards in Medical Education for Better Health\nCare, in Copenhagen, Denmark, March 20036\n;\nIt hereby:\n1. Expresses its encouragement and support of the ongoing work of implementing the\nTrilogy of WFME Documents on Global Standards in Medical Education.\n1\nThe Executive Council, The World Federation for Medical Education: International standards in\nmedical education: assessment and accreditation of medical schools\u00b4 educational programmes. A\nWFME position paper. Med Ed 1998; 32: 549-558.\n2\nWorld Federation for Medical Education: Basic Medical Education. WFME Global Standards for\nQuality Improvement. WFME, Copenhagen 2003. http:\/\/www.wfme.org\n3\nWorld Federation for Medical Education. Postgraduate Medical Education. WFME Global\nStandards for Quality Improvement. WFME, Copenhagen 2003. http:\/\/www.wfme.org\n4\nWorld Federation for Medical Education: Continuing Professional Development (CPD) of Me-\ndical Doctors. WFME Global Standards for Quality Improvement. WFME Copenhagen 2003.\nhttp:\/\/www.wfme.org\n5\nJ.P. de V. van Niekerk. WFME Global Standards receive ringing endorsement. Med Ed, 2003;\n37: 586-587.\n6\nWFME website: http:\/\/www.wfme.org\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0R-\u00ad\u20102006-\u00ad\u201001-\u00ad\u20102006\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nMEDICAL\t\n \u00a0ASSISTANCE\t\n \u00a0IN\t\n \u00a0AIR\t\n \u00a0TRAVEL\t\n \u00a0\nAdopted by the 57th\nWMA General Assembly, Pilanesberg, South Africa, October 2006\n1. Air travel is the preferred mode of long distance transportation for people across the\nworld. The growing convenience and affordability of air travel has led to an increase\nin the number of air passengers, including older passengers and other individuals at\nincreased risk for health emergencies. In addition, long-duration flights are common,\nincreasing the risk of in-flight medical emergencies.\n2. The environment in normal passenger planes is not conducive to the provision of\nquality medical care, especially in the case of medical emergencies. Noise and move-\nment of the plane, a very confined space, the presence of other passengers who may\nbe experiencing stress or fear as a result of the situation, the insufficiency or complete\nlack of diagnostic and therapeutic materials and other factors create extremely diffi-\ncult conditions for diagnosis and treatment. Even the most experienced medical pro-\nfessional is likely to be challenged by these circumstances.\n3. Most airlines require flight personnel to be trained in basic first aid. In addition, many\nprovide some degree of training beyond this minimum level and may also carry cer-\ntain emergency medicines and equipment on board. Some carriers even have the capa-\ncity to provide remote ECG reading and medical counselling services.\n4. Even well-trained flight personnel are limited in their knowledge and experience and\ncannot offer the same assistance as a physician or other certified health professional.\nCurrently, continuing medical education courses are available to physicians to train\nthem specifically for in-flight emergencies.\n5. Physicians are often concerned about providing assistance due to uncertainty re-\ngarding legal liability, especially on international flights or flights within the United\nStates. While numerous airlines provide some kind of liability insurance for medical\nprofessionals and lay persons who will provide voluntary assistance during flight, this\nis not always the case and even where it does exist, the terms of the insurance cannot\nalways be adequately explained and understood in a sudden medical crisis. The finan-\ncial and professional consequences of litigation against physicians who offer assis-\ntance can be very costly.\n6. Some important steps have been taken to protect the life and health of airline pas-\nsengers, yet the situation is far from ideal and needs improvement. Many of the major\nproblems could be mitigated by simple actions taken by both airlines and national le-\ngislatures, ideally in cooperation with one another and with the International Air Trans-\nport Association (IATA) to arrive at coordinated and consensus-based international\npolicies and programs.\n7. National Medical Associations have an important leadership role to play in promoting\nmeasures to improve the availability and efficacy of in-flight medical care.\n\t\n \u00a0\n\t\n \u00a0R-\u00ad\u20102006-\u00ad\u201001-\u00ad\u20102006\t\n \u00a0\u23d0\uf8e6\t\n \u00a0Durban\t\n \u00a0\nAir\t\n \u00a0travel\t\n \u00a0\n8. Therefore the World Medical Association calls on its members to encourage national\nairlines providing medium and long range passenger flights to take the following ac-\ntions:\na. Equip their airplanes with a sufficient and standardised set of medical emergency\nmaterials and drugs that:\n1. are packaged in a standardised and easy to identify manner;\n2. are accompanied by information and instructions in English as well the main\nlanguages of the countries of departure and arrival; and\n3. include Automated External Defibrillators, which are considered essential\nequipment in non-professional settings.\nb. Provide stand-by medical assistance that can be contacted by radio or telephone to\nhelp either the flight attendants or to support a volunteering health professional, if\none is on board and available to assist.\nc. Develop medical emergency plans to guide personnel in responding to the medical\nneeds of passengers.\nd. Provide sufficient medical and organisational instruction to flight personnel, be-\nyond basic first aid training, to enable them to better attend to passenger needs\nand to assist medical professionals who volunteer their services during emer-\ngencies.\ne. Provide insurance for medical professionals and assisting lay personnel to protect\nthem from damages and liabilities (material and non-material) resulting from in-\nflight diagnosis and treatment.\n9. The World Medical Association calls on its members to encourage their national avia-\ntion authorities to provide yearly summarised reports of in-flight medical incidents\nbased on mandatory standardised incident reports for every medical incident requiring\nthe administration of first aid or other medical assistance and\/or causing a change of\nthe flight.\n10. The World Medical Association calls on its members to encourage their legislators to\nenact legislation to provide immunity from legal action to physicians who provide\nemergency assistance in in-flight medical incidents.\n11. In the absence of legal immunity, the airline must accept all legal and financial conse-\nquences of providing assistance by a physician.\n12. The World Medical Association calls on its members to:\na. educate physicians about the problems of in-flight medical emergencies;\nb. inform physicians of training opportunities or provide or promote the develop-\nment of training programs where they do not exist; and\nc. encourage physicians to discuss potential problems with patients at high risk for\nrequiring in-flight medical attention prior to their flight.\n13. The World Medical Association calls on IATA to further develop precise standards in\nthe following areas and, where appropriate, work with governments to implement these\nstandards as legal requirements:\na. medical equipment and drugs on board medium and long range flights;\nb. packaging and information materials standards, including multilingual descrip-\ntions and instructions in appropriate languages;\nc. medical emergency organisation procedures and training programs for medical\npersonal.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0R-\u00ad\u20102006-\u00ad\u201002-\u00ad\u20102006\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nCHILD\t\n \u00a0SAFETY\t\n \u00a0IN\t\n \u00a0AIR\t\n \u00a0TRAVEL\t\n \u00a0\nAdopted by the 57th\nWMA General Assembly, Pilanesberg, South Africa, October 2006\n1. Whereas air travel is a common mode of transportation and is used by people of all\nages every day;\n2. Whereas high standards of safety for adult passengers in air travel have been\nachieved;\n3. Whereas strict safety procedures are being followed in air travel that greatly increase\nthe chance of survival during emergency situations for properly secured adults;\n4. Whereas infants and children are not always guaranteed adequate and appropriate\nsafety measures during emergency situations in aircraft;\n5. Whereas restraint and safety systems for infants and children have been successfully\ntested to reduce the risk of suffering injuries during emergency situations in aircraft;\n6. Whereas child restraint systems have been approved for usage in standard passenger\naircrafts and successfully introduced by several airlines;\nTherefore, the World Medical Association\n1. Expresses grave concern regarding the fact that adequate safety systems for infants\nand children have not been generally implemented;\n2. Calls on all airline companies to take immediate steps to introduce safe, thoroughly\ntested and standardized child restraint systems;\n3. Calls on all airline companies to train their staff in the appropriate handling and usage\nof child restraint systems;\n4. Calls for the establishment of a universal standard or specification for the testing and\nmanufacturing of child restraint systems; and\n5. Calls on national legislators and air transportation safety authorities to:\na. require for infants and children, as a matter of law, safe individual child restraint\nsystems that are approved for use in standard passenger aircraft;\nb. ensure that airlines provide child restraint systems or welcome passengers using their\nown systems, if the equipment is qualified and approved for the specific aircraft;\nc. ban the usage of inappropriate \"Loop Belts\" frequently used to secure infants and\nchildren in passenger aircraft;\nd. provide appropriate information about infant and child safety on board of aircraft to all\nairline passengers.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nR-\u00ad\u20102006-\u00ad\u201003-\u00ad\u20102006\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nCOMBATING\t\n \u00a0HIV\/AIDS\t\n \u00a0\nAdopted by the 57th\nWMA General Assembly, Pilanesberg, South Africa, October 2006\nMINDFUL that the WMA Statement on HIV\/AIDS and the Medical Profession was\nadopted at the 57th\nWMA General Assembly in Pilanesberg, Republic of South Africa, on\n14 October 2006; and\nRECOGNIZING the alarming statistic from UNAIDS that some 37-38 million people\nworldwide are infected with HIV, with the number increasing daily, and that 60% percent\nof them live in sub-Saharan Africa; and\nNOTING that there exist evidence-based methods for preventing the spread of the infec-\ntion and also for life-prolonging treatment; therefore\nThe WMA urges governments to work closely with health professionals and their repre-\nsentative organizations to identify and implement the critical steps to ensure\n1. that all efforts are made to prevent the spread of HIV\/AIDS;\n2. that the diagnosis, counselling and treatment of patients for HIV\/AIDS is undertaken\nonly by appropriately trained physicians and other healthcare personnel, according to\nestablished evidence-based principles;\n3. that patients be given accurate, relevant and comprehensive information to enable\nthem to make informed decisions about their health care treatment; and\n4. that barriers preventing people from coming forward for testing and treatment be\nidentified and eliminated.\nThe WMA calls on National Medical Associations to use this resolution in their advocacy\nefforts to their governments, their patients and the public.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0R-\u00ad\u20102006-\u00ad\u201004-\u00ad\u20102006\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nNORTH\t\n \u00a0KOREAN\t\n \u00a0NUCLEAR\t\n \u00a0TESTING\t\n \u00a0\nAdopted by the 57th\nWMA General Assembly, Pilanesberg, South Africa, October 2006\nRECALLING the WMA Declaration on Nuclear Weapons that was adopted at the WMA\nGeneral Assembly in Ottawa, Canada, in October 1998;\nThe WMA:\n1. Denounces North Korean nuclear testing conducted at a time of heightened global\nvigilance on nuclear testing and arsenals;\n2. Calls for the immediate abandonment of the testing of nuclear weapons; and\n3. Requests all member National Medical Associations to urge their governments to\nunderstand the adverse health and environmental consequences of the testing and use\nof nuclear weapons.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nR-\u00ad\u20102006-\u00ad\u201005-\u00ad\u20102006\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nTUBERCULOSIS\t\n \u00a0\nAdopted by the 57th\nWMA General Assembly, Pilanesberg, South Africa, October 2006\nPREAMBLE\t\n \u00a0\n\t\n \u00a0\n1. According to the World Health Organization, tuberculosis is a problem affecting over\n9 million people every year and ranks among the leading infectious diseases with an\nannual incidence rate of 1%. The Eastern European region is particularly affected.\n2. In developing countries, the incidence of tuberculosis has risen dramatically due\nmainly to its prevalence in areas with a high rate of HIV\/AIDS. The increased move-\nment of populations has also exacerbated the problem.\n3. The multi-resistant forms of tuberculosis, a by-product of original bacilli resistant to\nthe action of the main tuberculosis medicines, also present great difficulties in con-\ntrolling the disease.\n4. Radiological detection and sputum examination targeted at high-risk subjects con-\ntinues to be an essential element of tuberculosis prevention.\n5. Among migrants, the homeless, prisoners and other high risk groups, such a strategy\nis particularly efficient in preventing epidemics.\n6. The reactivation of screening and follow-up programmes and the application on a\nlarge scale of rapid and strictly supervised daily treatment should help address the epi-\ndemic.\n7. The vaccination policy for BCG (bacille Calmette-Gu\u00e9rin) should be targeted at child-\nren from their first vaccination.\nRESOLUTIONS\t\n \u00a0\n\t\n \u00a0\n1. The World Medical Association, in consultation with the WHO and national and\ninternational health authorities and organisations, will continue to work for the im-\nprovement of tuberculosis treatment and surveillance and will also promote surveys of\nindividual cases, the reactivation of screening and surveillance programs, and the\nlarge-scale application of daily care delivery and treatment supervision.\n\t\n \u00a0\n\t\n \u00a0Pilanesberg\t\n \u00a0\u23d0\uf8e6\t\n \u00a0R-\u00ad\u20102006-\u00ad\u201005-\u00ad\u20102006\t\n \u00a0\nTuberculosis\t\n \u00a0\n2. The WMA supports calls for adequate financial, material and human resources for\ntuberculosis and HIV\/AIDS prevention, including adequately trained health care pro-\nviders and adequate public health infrastructure, and will participate with health pro-\nfessionals in providing information on tuberculosis and its treatment.\n3. The WMA encourages continuing professional development for healthcare profes-\nsionals in the field of tuberculosis. Specialized courses on multi-drug-resistant TB are\nparticularly important.\n4. The WMA calls on its National Member Associations to support the WHO in its\nDOTS strategy and in other work to promote the more effective management of tuber-\nculosis.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nR-\u00ad\u20102007-\u00ad\u201001-\u00ad\u20102007\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nHEALTH\t\n \u00a0AND\t\n \u00a0HUMAN\t\n \u00a0RIGHTS\t\n \u00a0ABUSES\t\n \u00a0IN\t\n \u00a0ZIMBABWE\t\n \u00a0\nAdopted by the 58th\nWMA General Assembly, Copenhagen, Denmark, October 2007\nPREAMBLE\t\n \u00a0\t\n \u00a0\n\t\n \u00a0\nNoting information and reports of systematic and repeated violations of human rights,\ninterference with the right to health in Zimbabwe, failure to provide resources essential for\nprovision of basic health care, declining health status of Zimbabweans, dual loyalties and\nthreats to health care workers striving to maintain clinical independence, denial of access\nto health care for persons deemed to be associated with opposition political parties and\nescalating state torture, the WMA wishes to confirm its support of, and commitment to:\n\u2022 Attaining the World Health Organization principle that the \"enjoyment of the\nhighest attainable standard of health is one of the fundamental rights of every\nhuman being\"\n\u2022 Defending the fundamental purpose of physicians to alleviate distress of patients\nand not to let personal, collective or political will prevail against such purpose\n\u2022 Supporting the role of physicians in upholding the human rights of their patients as\ncentral to their professional obligations\n\u2022 Supporting physicians who are persecuted because of their adherence to medical\nethics\nRECOMMENDATION\t\n \u00a0\t\n \u00a0\n\t\n \u00a0\nTherefore, the World Medical Association, recognizing the collapsing health care system\nand public health crisis in Zimbabwe, calls on its affiliated national medical associations to:\n1. Publicly denounce all human rights abuses and violations of the right to health in\nZimbabwe\n2. Actively protect physicians who are threatened or intimidated for actions which are\npart of their ethical and professional obligations\n3. Engage with the Zimbabwean Medical Association (ZiMA) to ensure the autonomy of\nthe medical profession in Zimbabwe\n4. Urge and support ZiMA to invite an international fact finding mission to Zimbabwe\nas a means for urgent action to address the health and health needs of Zimbabweans\n\t\n \u00a0\n\t\n \u00a0Copenhagen\t\n \u00a0\u23d0\uf8e6\t\n \u00a0R-\u00ad\u20102007-\u00ad\u201001-\u00ad\u20102007\t\n \u00a0\nHuman\t\n \u00a0Rights\t\n \u00a0Abuses\t\n \u00a0in\t\n \u00a0Zimbabwe\t\n \u00a0\nIn addition, the WMA encourages ZiMA, as a member organization of the WMA, to:\n1. Uphold its commitment to the WMA Declarations of Tokyo, Hamburg and Madrid as\nwell as the WMA Statement on Access to Health Care\n2. Facilitate an environment where all Zimbabweans have equal access to quality health\ncare and medical treatment, irrespective of their political affiliations\n3. Commit to eradicating torture and inhumane, degrading treatment of citizens in Zim-\nbabwe\n4. Reaffirm their support for the clinical independence of physicians treating any citizen\nof Zimbabwe\n5. Obtain and publicize accurate and necessary information on the state of health ser-\nvices in Zimbabwe\n6. Advocate for inclusion in medical curricula, teachings on human rights and the ethical\nobligations of physicians to maintain full and clinical independence when dealing\nwith patients in vulnerable situations\nThe WMA encourages ZiMA to seek assistance in achieving the above by engaging with\nthe WMA, the Commonwealth Medical Association and the NMAs of neighboring coun-\ntries and to report on its progress from time to time.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nR-\u00ad\u20102007-\u00ad\u201002-\u00ad\u20102007\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nRESOLUTION\t\n \u00a0\t\n \u00a0\nIN\t\n \u00a0\t\n \u00a0\nSUPPORT\t\n \u00a0OF\t\n \u00a0THE\t\n \u00a0MEDICAL\t\n \u00a0ASSOCIATIONS\t\n \u00a0\t\n \u00a0\nIN\t\n \u00a0LATIN\t\n \u00a0AMERICA\t\n \u00a0AND\t\n \u00a0THE\t\n \u00a0CARIBBEAN\t\n \u00a0\nAdopted by the 58th\nWMA General Assembly, Copenhagen, Denmark, October 2007\nThere are credible reports that arrangements between the Cuban government and certain\nLatin American and Caribbean governments to supply Cuban health workers as physicians\nto these countries are bypassing systems, established to protect patients, that have been set\nup to verify physicians\u2019 credentials and competence.\nThe World Medical Association is significantly concerned that patients are put at risk by\nunregulated medical practices.\nThere exist already duly constituted and legally authorized medical associations within\nthis region that are charged with the registration of physicians and which should be con-\nsulted by their respective Ministries of Health.\nTherefore, the WMA:\n1. Condemns any actions by governments in policies and practices that subvert or bypass\nthe accepted standards of medical credentialing and medical care;\n2. Calls upon the governments in Latin America and the Caribbean to work with the me-\ndical associations on all matters related to physician certification and the practice of\nmedicine and to respect the role and rights of these medical associations and the\nautonomy of the medical profession.\n3. Urges, as a matter of utmost concern, that the governments in Latin America and the\nCaribbean respect the WMA International Code of Medical Ethics and the Decla-\nration of Madrid that guide the medical practice of physicians all over the world.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0R-\u00ad\u20102008-\u00ad\u201001-\u00ad\u20102008\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nTHE\t\n \u00a0ECONOMIC\t\n \u00a0CRISIS\t\n \u00a0\n-\u00ad\u2010\t\n \u00a0\t\n \u00a0IMPLICATIONS\t\n \u00a0FOR\t\n \u00a0HEALTH\t\n \u00a0\t\n \u00a0-\u00ad\u2010\t\n \u00a0\nAdopted by the 59th\nWMA General Assembly, Seoul, Korea, October 2008\nThe current global economic crisis is affecting individuals as well as national and global\neconomies and will have implications for health. Individuals face uncertainties about their\nfuture and psychological consequences are beginning to emerge. Governments facing eco-\nnomic downturns have to respond by cutting down national expenses. There is a risk that\nexpenditure on health care will decrease nominally and proportionally in the coming\nyears. Experience has shown that this response can have serious consequences on the\nhealth of individuals and on their contribution to the national economy. Any savings will\ntherefore be reduced.\nThe WMA therefore urges NMAs to work with their governments to:\n\u2022 Initiate programs for families and individuals needing medical and psychological\nsupport because of the current economic crisis.\n\u2022 Preserve at least the current expenditure on health.\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nR-\u00ad\u20102008-\u00ad\u201002-\u00ad\u20102008\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nPOPPIES\t\n \u00a0FOR\t\n \u00a0MEDICINE\t\n \u00a0PROJECT\t\n \u00a0FOR\t\n \u00a0AFGHANISTAN\t\n \u00a0\nAdopted by the 59th\nWMA General Assembly, Seoul, Korea, October 2008\nWhereas the World Health Organization (WHO) has indicated that a small number of\ncountries in the world consume 80% of the opiates legally available worldwide, leaving\nsignificant unmet needs in the rest of the world, especially in developing countries;\nWhereas morphine and diamorphine play an essential role in the treatment of moderate\nand severe pain, especially in meeting the pain needs of the growing number of end-stage\nHIV\/AIDS and cancer patients;\nWhereas the International Narcotics Control Board (INCB) has asked the international\ncommunity to promote the prescription of painkillers, especially in poor countries, as\nsevere under-treatment is reported in more than 150 countries where hardly anyone in\nneed of treatment is being treated, and in another 30 countries, where under-treatment is\neven more prevalent or where no data are available;\nWhereas there exists an illegal opium crisis in Afghanistan, with growing poppy culti-\nvation and opium production;\nTherefore, the World Medical Association:\n\u2022 Supports the investigation of possibilities for the controlled production of opium\nfor medical purposes in Afghanistan through a scientific pilot project in Afgha-\nnistan; and\n\u2022 Urges governments to support a scientific pilot project to investigate whether cer-\ntain areas of Afghanistan could provide the right conditions for the strictly con-\ntrolled production of morphine and diamorphine for medical purposes.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0R-\u00ad\u20102008-\u00ad\u201003-\u00ad\u20102008\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nCOLLABORATION\t\n \u00a0BETWEEN\t\n \u00a0HUMAN\t\n \u00a0AND\t\n \u00a0VETERINARY\t\n \u00a0MEDICINE\t\n \u00a0\nAdopted by the 59th\nWMA General Assembly, Seoul, Korea, October 2008\nThe majority of the emerging infectious diseases, including the bioterrorist agents, are\nzoonoses. Zoonoses can, by definition, infect both animals and humans. By their very\nnature, the fields of human medicine and veterinary medicine are complementary and\nsynergistic in confronting, controlling and preventing zoonotic diseases from infecting\nacross species.\nCollaboration and communication between human medicine and veterinary medicine have\nbeen limited in recent decades, yet the challenges of the 21st\nCentury demand that these\ntwo professions work together.\nAn initiative, often called the \"One Health\" initiative, is being developed to improve the\nlives of all species-human and animal-through the integration of human and veterinary\nmedicine.1\n\"One Health\" aims to promote and implement close meaningful collaboration\nand communication between human medicine, veterinary medicine and all allied health\nscientists with the goal of hastening human public health efficacy as well as advanced\nhealth care options for humans (and animals) via comparative biomedical research.\nThe World Medical Association (WMA) recognizes the ways in which animals and animal\ncare may affect human health and disease through its own current policies, particularly its\nstatements on Animal Use in Biomedical Research, Resistance to Antimicrobial Drugs and\nAvian and Pandemic Influenza. The WMA already works with other health professions\nincluding dentists, nurses and pharmacists though the World Health Professions Alliance.\nRECOMMENDATIONS\t\n \u00a0\n\t\n \u00a0\nThat the World Medical Association:\n\u2022 Support collaboration between human and veterinary medicine;\n\u2022 Support the concept of joint educational efforts between human medical and ve-\nterinary medical schools;\n\u2022 Encourage joint efforts in clinical care through the assessment, treatment, and pre-\nvention of cross-species disease transmission;\n\u2022 Support cross-species disease surveillance and control efforts in public health, par-\nticularly the identification of early disease and outbreak trends;\n\t\n \u00a0\n\t\n \u00a0R-\u00ad\u20102008-\u00ad\u201003-\u00ad\u20102008\t\n \u00a0\u23d0\uf8e6\t\n \u00a0Seoul\t\n \u00a0\nVeterinary\t\n \u00a0Medicine\t\n \u00a0\n\u2022 Support the need for joint efforts in the development, integration and evaluation of\nscreening tools, diagnostic methods, medicines, vaccines, surveillance systems and\npolicies for the prevention, management and control of zoonotic diseases;\n\u2022 Engage in a dialogue with the World Veterinary Association to discuss strategies\nfor enhancing collaboration between human and veterinary medical professions in\nmedical education, clinical care, public health, and biomedical research.\n\u2022 Encourage National Medical Associations to engage in a dialogue with their veteri-\nnary counterparts to discuss strategies for enhancing collaboration between human\nand veterinary medical professions within their own countries\n1\nJ. Zinsstag, et al. Lancet 2005; 366: 2142-2145 and E.P.J. Gibbs. Veterinary Record 2005;\n157:673-679\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0R-\u00ad\u20102009-\u00ad\u201001-\u00ad\u20102009\t\n \u00a0\nWMA\t\n \u00a0EMERGENCY\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nLEGISLATION\t\n \u00a0AGAINST\t\n \u00a0ABORTION\t\n \u00a0IN\t\n \u00a0NICARAGUA\t\n \u00a0\nAdopted by the 60th\nWMA General Assembly, New Delhi, India, October 2009\nWHEREAS,\n\t\n \u00a0\nLegislative changes in Nicaragua (Articles 143, 145, 148 and 149 Law No. 641, revised\nPenal Code) criminalise abortion in all circumstances; including any medical treatment of\na pregnant woman which results in the death of or injury to an embryo or fetus; and\nThis legislation\n\u2022 may have a negative impact on the health of women in Nicaragua country.\n\u2022 could result in preventable deaths of women and the embryo or fetus they are\ncarrying.\n\u2022 places physicians at risk of imprisonment if they break this law, and at risk of sus-\npension from medical practice if they fail to follow the Nicaraguan Ministry of\nHealth\u2019s 2006 Obstetric Protocols, which sometimes requires treatment of a preg-\nnant woman that is contrary to the legislation.\nTHEREFORE, the World Medical Association urges the Nicaraguan government to repeal\nthe above legislation.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nR-\u00ad\u20102009-\u00ad\u201002-\u00ad\u20102009\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nSUPPORTING\t\n \u00a0THE\t\n \u00a0RIGHTS\t\n \u00a0OF\t\n \u00a0PATIENTS\t\n \u00a0AND\t\n \u00a0PHYSICIANS\t\n \u00a0\t\n \u00a0\nIN\t\n \u00a0THE\t\n \u00a0ISLAMIC\t\n \u00a0REPUBLIC\t\n \u00a0OF\t\n \u00a0IRAN\t\n \u00a0\nAdopted by the 60th\nWMA General Assembly, New Delhi, India, October 2009\nWHEREAS,\nPhysicians in the Islamic Republic of Iran have reported:\nUnsettling practices of injured persons being taken to prisons, without adequate medical\ntreatment or the consensus of the attending physicians;\nPhysicians being hindered from treating patients;\nConcern about the veracity of documentation related to the death of patients and physi-\ncians being forced to clinically inaccurate documentation; and\nCorpses and badly injured political and religious prisoners who were admitted to hospitals\nwith signs of brutal torture, including sexual abuse.\nTHEREFORE, the World Medical Association\n1. Reaffirms its Declaration of Lisbon: Declaration on the Rights of the Patient, which\nstates that whenever legislation, government action or any other administration or\ninstitution denies patients the right to medical care, physicians should pursue appro-\npriate means to assure or to restore it.\n2. Reaffirms its Declaration of Hamburg: Declaration Concerning Support for Medical\nDoctors Refusing to Participate in, or to Condone, the Use of Torture or Other Forms\nof Cruel, Inhuman or Degrading Treatment, which encourages doctors to honor their\ncommitment as physicians to serve humanity and to resist any pressure to act contrary\nto the ethical principles governing their dedication to this task.\n3. Reaffirms its Declaration of Tokyo: Guidelines for Physicians Concerning Torture\nand other Cruel, Inhuman or Degrading Treatment or Punishment in Relation to De-\ntention and Imprisonment, which:\n\u2022 prohibits physicians from participating in, or even being present during the\npractice of torture or other forms of cruel or inhuman or degrading procedures;\n\u2022 requires that physicians maintain utmost respect for human life even under\nthreat, and prohibits them from using any medical knowledge contrary to the\nlaws of humanity.\n\t\n \u00a0\n\t\n \u00a0New\t\n \u00a0Delhi\t\n \u00a0\u23d0\uf8e6\t\n \u00a0R-\u00ad\u20102009-\u00ad\u201002-\u00ad\u20102009\t\n \u00a0\nRights\t\n \u00a0of\t\n \u00a0Patients\t\n \u00a0and\t\n \u00a0Physicians\t\n \u00a0in\t\n \u00a0Iran\t\n \u00a0\n4. Reaffirms its Resolution on the Responsibility of Physicians in the Documentation\nand Denunciation of Acts of Torture or Cruel or Inhuman or Degrading Treatment;\nwhich states that physicians should attempt to:\n\u2022 ensure that detainees or victims of torture or cruelty or mistreatment have ac-\ncess to immediate and independent health care;\n\u2022 ensure that physicians include assessment and documentation of symptoms of\ntorture or ill-treatment in the medical records using the necessary procedural\nsafeguards to prevent endangering detainees.\n5. Refers to the WMA International Code of Medical Ethics, which states that physi-\ncians shall be dedicated to providing competent medical service in full professional\nand moral independence, with compassion and respect for human dignity.\n6. Urges the government of the Islamic Republic of Iran to respect the International\nCode of Medical Ethics and the standards included in the aforementioned declarations\nto which physicians are committed.\n7. Urges National Medical Associations to speak out in support of this resolution.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nR-\u00ad\u20102009-\u00ad\u201003-\u00ad\u20102009\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nTASK\t\n \u00a0SHIFTING\t\n \u00a0FROM\t\n \u00a0THE\t\n \u00a0MEDICAL\t\n \u00a0PROFESSION\t\n \u00a0\nAdopted by the 60th\nWMA General Assembly, New Delhi, India, October 2009\nIn health care, the term \"Task Shifting\" is used to describe a situation where a task nor-\nmally performed by a physician is transferred to a health professional with a different or\nlower level of education and training, or to a person specifically trained to perform a\nlimited task only, without having a formal health education. Task shifting occurs both in\ncountries facing shortages of physicians and those not facing shortages.\nA major factor leading to task shifting is the shortage of qualified workers resulting from\nmigration or other factors. In countries facing a critical shortage of physicians, task shift-\ning may be used to train alternate health care workers or laypersons to perform tasks gene-\nrally considered to be within the purview of the medical profession. The rationale behind\nthe transferring of these tasks is that the alternative would be no service to those in\nneed. In such countries, task shifting is aimed at improving the health of extremely vul-\nnerable populations, mostly to address current shortages of healthcare professionals or\ntackle specific health issues such as HIV. In countries with the most extreme shortage of\nphysicians, new cadres of health care workers have been established. However, those per-\nsons taking over physicians' tasks lack the broad education and training of physicians and\nmust perform their tasks according to protocols, but without the knowledge, experience\nand professional judgement required to make proper decisions when complications arise\nor other deviations occur. This may be appropriate in countries where the alternative to\ntask shifting is no care at all but should not be extended to countries with different cir-\ncumstances.\nIn countries not facing a critical shortage of physicians, task shifting may occur for\nvarious reasons: social, economic, and professional, sometimes under the guise of effi-\nciency, savings or other unproven claims. It may be spurred, or, conversely, impeded, by\nprofessions seeking to expand or protect their traditional domain. It may be initiated by\nhealth authorities, by alternate health care workers and sometimes by physicians them-\nselves. It may be facilitated by the advancement of medical technology, which stand-\nardizes the performance and interpretation of certain tasks, therefore allowing them to be\nperformed by non-physicians or technical assistants instead of physicians. This has typi-\ncally been done in close collaboration with the medical profession. However, it must be\nrecognized that medicine can never be viewed solely as a technical discipline.\nTask shifting may occur within an already existing medical team, resulting in a reshuffling\nof the roles and functions performed by the members of such a team. It may also create\nnew types of personnel whose function is to assist other health professionals, specifically\nphysicians, as well as personnel trained to independently perform specific tasks.\n\t\n \u00a0\n\t\n \u00a0New\t\n \u00a0Delhi\t\n \u00a0\u23d0\uf8e6\t\n \u00a0R-\u00ad\u20102009-\u00ad\u201003-\u00ad\u20102009\t\n \u00a0\nTask\t\n \u00a0Shifting\t\n \u00a0\nAlthough task shifting may be useful in certain situations, and may sometimes improve the\nlevel of patient care, it carries with it significant risks. First and foremost among these is\nthe risk of decreased quality of patient care, particularly if medical judgment and decision\nmaking is transferred. In addition to the fact that the patient may be cared for by a lesser\ntrained health care worker, there are specific quality issues involved, including reduced\npatient-physician contact, fragmented and inefficient service, lack of proper follow up,\nincorrect diagnosis and treatment and inability to deal with complications.\nIn addition, task shifting which deploys assistive personnel may actually increase the\ndemand on physicians. Physicians will have increasing responsibilities as trainers and\nsupervisors, diverting scarce time from their many other tasks such as direct patient care.\nThey may also have increased professional and\/or legal responsibility for the care given\nby health care workers under their supervision.\nThe World Medical Association expresses particular apprehension over the fact that task\nshifting is often initiated by health authorities, without consultation with physicians and\ntheir professional representative associations.\nRECOMMENDATIONS\t\n \u00a0\n\t\n \u00a0\nTherefore, the World Medical Association recommends the following guidelines:\n1. Quality and continuity of care and patient safety must never be compromised and\nshould be the basis for all reforms and legislation dealing with task shifting.\n2. When tasks are shifted away from physicians, physicians and their professional repre-\nsentative associations should be consulted and closely involved from the beginning in\nall aspects concerning the implementation of task shifting, especially in the reform of\nlegislations and regulations. Physicians might themselves consider initiating and train-\ning a new cadre of assistants under their supervision and in accordance with principles\nof safety and proper patient care.\n3. Quality assurance standards and treatment protocols must be defined, developed and\nsupervised by physicians. Credentialing systems should be devised and implemented\nalongside the implementation of task shifting in order to ensure quality of care. Tasks\nthat should be performed only by physicians must be clearly defined. Specifically, the\nrole of diagnosis and prescribing should be carefully studied.\n4. In countries with a critical shortage of physicians, task shifting should be viewed as\nan interim strategy with a clearly formulated exit strategy. However, where conditions\nin a specific country make it likely that it will be implemented for the longer term, a\nstrategy of sustainability must be implemented.\n5. Task shifting should not replace the development of sustainable, fully functioning\nhealth care systems. Assistive workers should not be employed at the expense of un-\nemployed and underemployed health care professionals. Task shifting also should not\nreplace the education and training of physicians and other health care professionals.\nThe aspiration should be to train and employ more skilled workers rather than shifting\ntasks to less skilled workers.\n\t\n \u00a0\n\t\n \u00a0R-\u00ad\u20102009-\u00ad\u201003-\u00ad\u20102009\t\n \u00a0\u23d0\uf8e6\t\n \u00a0New\t\n \u00a0Delhi\t\n \u00a0\nTask\t\n \u00a0Shifting\t\n \u00a0\n6. Task shifting should not be undertaken or viewed solely as a cost saving measure as\nthe economic benefits of task shifting remain unsubstantiated and because cost driven\nmeasures are unlikely to produce quality results in the best interest of patients. Credi-\nble analysis of the economic benefits of task shifting should be conducted in order to\nmeasure health outcomes, cost effectiveness and productivity.\n7. Task shifting should be complemented with incentives for the retention of health pro-\nfessionals such as an increase of health professionals' salaries and improvement of\nworking conditions.\n8. The reasons underlying the need for task shifting differ from country to country and\ntherefore solutions appropriate for one country cannot be automatically adopted by\nothers.\n9. The effect of task shifting on the overall functioning of health systems remains un-\nclear. Assessments should be made of the impact of task shifting on patient and health\noutcomes as well as on efficiency and effectiveness of health care delivery. In parti-\ncular, when task shifting occurs in response to specific health issues, such as HIV,\nregular assessment and monitoring should be conducted of the entire health system.\nSuch work is essential in order to ensure that these programs are improving the health\nof patients.\n10. Task shifting must be studied and assessed independently and not under the auspices\nof those designated to perform or finance task shifting measures.\n11. Task shifting is only one response to the health workforce shortage. Other methods,\nsuch as collaborative practice or a team\/partner approach, should be developed in pa-\nrallel and viewed as the gold standard. Task shifting should not replace the develop-\nment of mutually supportive, interactive health care teams, coordinated by a physi-\ncian, where each member can make his or her unique contribution to the care being\nprovided.\n12. In order for collaborative practice to succeed, training in leadership and teamwork\nmust be improved. There must also be a clear understanding of what each person is\ntrained for and capable of doing, clear understanding of responsibilities and a defined,\nuniformly accepted use of terminology.\n13. Task shifting should be preceded by a systematic review, analysis and discussion of\nthe potential needs, costs and benefits. It should not be instituted solely as a reaction\nto other developments in the health care system.\n14. Research must be conducted in order to identify successful training models. Work\nwill need to be aligned to various models currently in existence. Research should also\nfocus on the collection and sharing of information, evidence and outcomes. Research\nand analysis must be comprehensive and physicians must be part of the process.\n15. When appropriate, National Medical Associations should collaborate with associa-\ntions of other health care professionals in setting the framework for task shifting. The\nWMA shall consider establishing a framework for the sharing of information on this\ntopic where members can discuss developments in their countries and their effects on\npatient care and outcomes.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0R-\u00ad\u20102010-\u00ad\u201001-\u00ad\u20102010\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nDRUG\t\n \u00a0PRECSRIPTION\t\n \u00a0\nAdopted by the 61st\nWMA General Assembly, Vancouver, Canada, October 2010\nPREAMBLE\t\n \u00a0\n\t\n \u00a0\nFrom the beginning of their studies and throughout their professional careers, doctors ac-\nquire the knowledge, training and competence required to treat their patients with the ut-\nmost skill and care.\nPhysicians determine the most accurate diagnosis and the most effective treatment to cure\nillness, or alleviate its effects, taking into consideration the overall condition of the patient.\nPharmaceutical products are often an essential part of the treatment approach. In order to\nmake the right decisions in accordance with the ethical and professional principles of me-\ndical practice, the doctor must have a thorough knowledge and understanding of the prin-\nciples of pharmacology and possible interactions among different drugs and their effects\non the health of the patient.\nThe prescribing of medication is a significant clinical intervention, which should be pre-\nceded by multiple, integrated processes to assess the patient and determine the correct cli-\nnical diagnosis. These processes include:\n\u2022 Taking a history of the current condition and past medical history;\n\u2022 The ability to make differential diagnosis;\n\u2022 Understanding any multiple chronic and complex illnesses involved;\n\u2022 Taking a history of the medications currently being administered successfully or\npreviously withdrawn and also being aware of possible interactions.\nInappropriate drug prescription without proper knowledge and accurate diagnosis may\ncause serious adverse effects on the patient\u2019s health. In view of the possible serious conse-\nquences that may result from an inappropriate therapeutic decision, the WMA affirms the\nfollowing principles on high quality treatment and ensuring patient safety:\nPRINCIPLES\t\n \u00a0\n\t\n \u00a0\nPrescription of drugs should be based on a correct diagnosis of the patient\u2019s condition and\nshould be performed by those who have successfully completed a curriculum on disease\nmechanisms, diagnostic methods and medical treatment of the condition in question.\n\t\n \u00a0\n\t\n \u00a0R-\u00ad\u20102010-\u00ad\u201001-\u00ad\u20102010\t\n \u00a0\u23d0\uf8e6\t\n \u00a0Vancouver\t\n \u00a0\nDrug\t\n \u00a0Prescription\t\n \u00a0\nPrescriptions issued by physicians are vital for ensuring patient safety, which in turn is\ncritical for maintaining the relationship of trust between patients and their physicians.\nAlthough nurses and other healthcare workers cooperate in the overall treatment of\npatients, the physician is the best qualified individuals to prescribe independently. In some\ncountries, laws may allow for other professionals to prescribe drugs under specific circum-\nstances, generally with extra training and education and most often under medical super-\nvision. In all cases, the responsibility for the patient\u2019s treatment must remain with the phy-\nsician. Each country\u2019s medical system should ensure the protection of public interest and\nsafety in the diagnosis and treatment of patients. If a system fails to comply with this basic\nframework due to social, economical or other compelling reasons, it should make every\neffort to improve the situation and to protect the safety of the patients.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0R-\u00ad\u20102010-\u00ad\u201002-\u00ad\u20102010\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nVIOLENCE\t\n \u00a0AGAINST\t\n \u00a0WOMEN\t\n \u00a0AND\t\n \u00a0GIRLS\t\n \u00a0\nAdopted by the 61st\nWMA General Assembly, Vancouver, Canada, October 2010\nViolence is a worldwide, institutionalised phenomenon, and a complex issue, which in-\ncludes many manifestations. The nature of the violence experienced by victims is at least\npartly dependent upon the social, cultural, political and economic contexts within which\nthe victims and their abusers live. Some violence is deliberate, systematic and widespread\nwhile others will experience it in covert circumstances; this is especially true of domestic\nviolence in settings where women enjoy legislated equal and protected rights to those of\nmen but culturally still have an increased likelihood of experiencing life-threatening do-\nmestic violence.\nThere is clear evidence in most countries that men can be and are often the victims of\nviolence, including intimate partner violence. They are also statistically far more likely to\nbe the victims of random violence on the streets. Research shows that while men fre-\nquently experience such events, they are not associated with systemic abuse in terms of\ndenial of rights, which makes the experience of women so much worse in many cul-\ntures. Nothing in this paper suggests that violence against men including boys should be\ncondoned. Actions to protect women and girls are likely to reduce everyone\u2019s experience\nof violence.\nDEFINING\t\n \u00a0VIOLENCE\t\n \u00a0\n\t\n \u00a0\nDefinitions of violence vary (see footnote), but it is essential that the various forms vio-\nlence may take are recognised by policy makers. Violence against women and girls in-\ncludes violence within the family, within the community and violence perpetrated by (or\ncondoned by) the state. Many excuses are given for violence generally and specifically; in\ncultural and societal terms these include tradition, beliefs, customs, values and religion.\nAlthough rarely cited the traditional power differential between men and women is also a\nmajor cause.\nWithin the family and domestic settings violence includes the denial of rights and free-\ndoms enjoyed by boys and men. This includes female feticide and infanticide, systematic\nand deliberate neglect of girls, including poor nutrition and denial of educational oppor-\ntunities1\nas well as direct physical, psychological and sexual violence. Specific cultural\npractices that harm women, including female genital mutilation, forced marriages, dowry\nattacks and so-called \u201chonour\u201d killings are all practices that may occur within the family\nsetting.\n\t\n \u00a0\n\t\n \u00a0R-\u00ad\u20102010-\u00ad\u201002-\u00ad\u20102010\t\n \u00a0\u23d0\uf8e6\t\n \u00a0Vancouver\t\n \u00a0\nViolence\t\n \u00a0against\t\n \u00a0Women\t\n \u00a0and\t\n \u00a0Girls\t\n \u00a0\nWithin society, attitudes towards rape, sexual abuse and harassment, intimidation at work\nor in education, modern slavery, trafficking and forced prostitution, are all forms of vio-\nlence condoned by some societies. One extreme form of such violence is sexual violence\nused as a weapon of war. In several recent conflicts (e.g. the Balkans, Rwanda) rape was\nboth associated with ethnic cleansing and specifically, in some cases, used to introduce\nwidespread AIDS into a community. The ICRC has examined this issue, and recognises\nthat sexual violence of this sort may be commonly perpetrated against women and girls.2\nSexual violence or the threat of it can also be used against men, but culturally, women are\nmore vulnerable and more likely to be targeted. Current conflicts are not based upon\nbattles fought in far away places, but are increasingly concentrated around dense centres\nof population increasing the exposure of women to soldiers and armed groups. In war and\nin immediate post-conflict situations, societal fabric can collapse, making women in-\ncreasingly vulnerable to group attacks.\nLack of economic independence, and of basic education, also mean that women who sur-\nvive abuse are more likely to be or to become more dependent upon the state or society\nand less able to support themselves and contribute to that society. Biologically and beha-\nviourally, women are likely to outlive men; denial of the opportunity to be economically\nindependent leaves society with a cohort of older, economically dependent women.\nAll these forms of violence may be condoned by the state, or it may remain silent on them,\nrefusing to condemn or act against them. In some cases the state may legislate to allow\nviolent practices (for example rape within marriage) and itself become a perpetrator.\nAll human beings enjoy certain fundamental human rights; the examples listed above of\nviolence against women and girls involve denial of many of those rights, and each abuse\ncan be examined against the UN convention on human rights (and for children the Con-\nvention on the Rights of the Child).3\nIn health terms, the denial of rights and the violence itself have health consequences to the\ngirls and women and to the society of which they are a part. In addition to the specific and\ndirect physical and health consequences, the general way in which girls and women are\ntreated can lead to an excess of mental health problems; suicide is the second leading cause\nof premature death in women.\nCONSEQUENCES\t\n \u00a0OF\t\n \u00a0VIOLENCE\t\n \u00a0\n\t\n \u00a0\nThe direct health consequence of the violence depends upon the nature of the act. Female\ngenital mutilation for example may kill the woman at the time of infliction, may lead to\ndifficulty in voiding the body of waste products including those of menses, and will give\nrise to difficulties in childbearing. It also reinforces the ideological concept of women as\nthe possessions of men (on its own, a form of abuse) who control their sexuality. Gang\nrape or other forms of sexual violence may result in long-term gynaecological, urological\nand intestinal difficulties including the development of fistulae and incontinence, which\nfurther diminishes societal support for the abused female.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0R-\u00ad\u20102010-\u00ad\u201002-\u00ad\u20102010\t\n \u00a0\nThe short and long term mental health consequences of violence may severely influence\nlater wellbeing, enjoyment of life, function in society and the ability to provide appropri-\nate care for dependants.\nGathering evidence is an important role for doctors. Currently many countries do not have\nmandatory registration of all births, making evidence about infanticide or the effects of\nneglect difficult to document. Equally, some countries allow marriage at any age, ex-\nposing girls to the high risks associated with childbearing before their own bodies are fully\nmature, let alone the mental health risks involved. The health consequences of such poli-\ncies and their relationship to other health costs must be better documented.\nDenial of good nutritional opportunities leads to generations of women with poorer health,\npoorer growth and development leading to women who are less fit to survive pregnancy\nand childbirth or to rear their families. Denial of educational opportunities leads to poorer\nhealth for all the family members; good education is a major factor in the mother provi-\nding optimal care for all her family. In addition to being wrong in and of itself, violence\nagainst women is also socially and economically damaging to the family and to society.\nThere are direct and indirect economic consequences to violence against women that are\nfar greater than the direct health sector costs.\nThe costs and consequences of violence, including neglect, against women have been\nreported in many fora including by WHO4\n. The health consequences to the women, their\nchildren and thus to society are clear and need to be made explicit to policy makers.\nWHAT\t\n \u00a0CAN\t\n \u00a0THE\t\n \u00a0WMA\t\n \u00a0DO?\t\n \u00a0\n\t\n \u00a0\nThe WMA has a number of policies on violence including the WMA Statement on\nViolence and Health and the WMA Statement on Family Violence. This current (State-\nment\/resolution\/ declaration) brings some of these policies together with a coordinated set\nof action points for the WMA, NMAs and individual physicians.\nAs most human beings look first for the advantages to themselves, their families and their\nsocieties in enabling change, making the benefits of change obvious from the beginning\ncreates a \u201cwin:win\u201d solution. Concentrating first on the health aspects, for women, their\nchildren, and the broad family is therefore a useful way to enter the debate.\nDoctors have a unique insight into the combined effects upon wellbeing of social, cultural,\neconomic and political environments. If all persons are to achieve health and wellbeing,\nall these factors need to operate positively. The holistic view from doctors can be used to\ninfluence society and politicians. Gaining societal support for improving the rights, free-\ndom and status of women is essential.\nACTIONS\t\n \u00a0\n\t\n \u00a0\nThe\t\n \u00a0WMA:\t\n \u00a0\n\t\n \u00a0\n\u2022 Asserts that violence is not only about physical, psychological and sexual violence\nbut includes abuses such as harmful cultural and traditional practices, and actions\nsuch as complicity in trafficking of women, and is a major public health crisis.\n\t\n \u00a0\n\t\n \u00a0R-\u00ad\u20102010-\u00ad\u201002-\u00ad\u20102010\t\n \u00a0\u23d0\uf8e6\t\n \u00a0Vancouver\t\n \u00a0\nViolence\t\n \u00a0against\t\n \u00a0Women\t\n \u00a0and\t\n \u00a0Girls\t\n \u00a0\n\u2022 Recognizes the linkage between better education and other rights for women with\nfamily and societal health and wellbeing and emphasizes that equality in civil li-\nberties and human rights is a health issue.\n\u2022 Will prepare briefing and advocacy materials for NMAs to use with national\ngovernments and intergovernmental groups addressing the health and wellbeing\nimplications of discrimination against women and girls, including adolescents.\nThis material will include relevant references about the impact of violence on\nfamily wellbeing and on societal financial sustainability.\n\u2022 Will work with others to prepare and distribute to physicians and other health\nworkers briefing and advocacy materials dealing with harmful traditional and cul-\ntural practices, including female genital mutilation, dowry, and honour killings,\nand emphasizing the health impact as well as the violations of human rights.\n\u2022 Prepare practical examples of the impact of violence and strategies for reducing it,\nsuch as consensus guidelines that are based upon the best available evidence.\n\u2022 Will advocate at WHO, other UN agencies and elsewhere for ending discrimina-\ntion and violence against women.\n\u2022 Will work with others to prepare templates of educational materials for use by\nindividual practitioners for documenting and reporting individual cases of abuse.\n\u2022 Encourages others to develop free educational materials online to provide guidance\nto front line health care workers on abuse and its effects, and on prevention strate-\ngies.\n\u2022 Encourage legislation that classifies gang rape used as a weapon of war as a crime\nagainst humanity that is eligible for litigation through the jurisdiction of the Inter-\nnational Criminal Court system.\nNMAs\t\n \u00a0should:\t\n \u00a0\n\t\n \u00a0\n\u2022 Use and promote the available materials on preventing and treating the conse-\nquences of violence against women and girls and act as advocates within their own\ncountry.\n\u2022 Seek to ensure that those devising and delivering education to doctors and other\nhealth care workers are aware of the likelihood of exposure to violence, its conse-\nquences, and the evidence on preventative strategies that work, and place appro-\npriate emphasis on this in undergraduate, graduate and continuing education of\nhealth care workers.\n\u2022 Recognise the importance of more complete reporting of the sequelae of violence\nand encourage the development of training that emphasises violence awareness and\nprevention, in addition to using better reporting and research into incidence, pre-\nvalence and health impact of all forms of violence.\n\u2022 Encourage medical journals to publish more of the research on the complex inter-\nactions in this area, thus keeping it in the professions\u2019 awareness and contributing\nto the development of a solid research base and ongoing documentation of types\nand incidence of violence.\n\u2022 Encourage medical journals to consider publishing theme issues on violence in-\ncluding neglect of women and girls.\n\u2022 Advocate for universal registration of births, and a higher age limit for marriage.\n\u2022 Advocate for effective implementation of universal human rights.\n\u2022 Advocate for parental education and support on the care, nurturing, development,\neducation and protection of children, especially girls.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0R-\u00ad\u20102010-\u00ad\u201002-\u00ad\u20102010\t\n \u00a0\n\u2022 Advocate for the monitoring of statistics on children, including both positive and\nnegative indicators of health and well-being, and social determinants of health.\n\u2022 Advocate for legislation against specific harmful practices including female feti-\ncide, female genital mutilation, forced marriage, and corporal punishment.\n\u2022 Advocate for the criminalisation of rape in all circumstances including within mar-\nriage.\n\u2022 Condemn the use of gang rape as a weapon of war and work with others to docu-\nment and report it.\n\u2022 Advocate for the development of research data on the impact of violence and\nneglect upon primary and secondary victims and upon society, and for increased\nfunding for such research.\n\u2022 Advocate for the protection of those who speak out against abuse, including physi-\ncians and other health workers.\nPhysicians\t\n \u00a0should:\t\n \u00a0\n\t\n \u00a0\n\u2022 Use the material developed for their education to better inform themselves about\nthe effects of abuse and the successful strategies for prevention.\n\u2022 Provide health care and protection to children, (especially in times of crisis) and\ndocument and report all cases of violence against children, taking care to safeguard\nthe patient\u2019s privacy as much as possible.\n\u2022 Treat and reverse, where possible, the complications and adverse effects of female\ngenital mutilation and refer the patient for social support services.\n\u2022 Oppose the publication or broadcast of victims\u2019 names, addresses or likenesses\nwithout the explicit permission of the victim.\n\u2022 Assess for risk of family violence in the context of taking a routine social history.\n\u2022 Be alert to the association between current alcohol or drug dependence among\nwomen and a history of abuse.\n\u2022 Support colleagues who become personally involved in work to end abuse.\n\u2022 Work to establish the necessary relationship of trust with abused women and child-\nren including respect for confidentiality.\n\u2022 Support global and local action to better understand the health consequences both\nof abuse and of the denial of rights, and advocate for increased services for vic-\ntims.\n1\nAt first glance neglect does not seem to equate with violence. But the acceptance of neglect and\nthe lesser rights given to women and girls are major factors in reinforcing an acceptance of causal\nand systematic violence. In that it denies basic rights, many would classify neglect as a form of\nviolence in and of itself.\n2\nRape is considered to be a method of warfare when armed forces or groups use it to torture, in-\njure, extract information, degrade, displace, intimidate, punish or simply to destroy the fabric of the\ncommunity, The mere threat of sexual violence can cause entire communities to flee their homes.\nfrom Women and War, ICRC 2008\n3\nWomen\u2019s Health and Human Rights: the Promotion and Protection of Women\u2019s Health through\nInternational Human Rights Law. Rebecca Cook. Presented at the 1999 Adapting to Change\nCore Course\n4\nWomen and Health: Today\u2019s Evidence, Tomorrow\u2019s Agenda. WHO November 2009. ISBN 978\n92 4 156385 7\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nR-\u00ad\u20102011-\u00ad\u201001-\u00ad\u20102011\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nTHE\t\n \u00a0ACCESS\t\n \u00a0TO\t\n \u00a0ADEQUATE\t\n \u00a0PAIN\t\n \u00a0TREATMENT\t\n \u00a0\nAdopted by the 62nd\nWMA General Assembly, Montevideo, Uruguay, October 2011\nPREAMBLE\t\n \u00a0\nAround the world, tens of millions of people with cancer and other diseases and conditions\nexperience moderate to severe pain without access to adequate treatment. These people\nface severe suffering, often for months on end, and many eventually die in pain, which is\nunnecessary and almost always preventable and treatable. People who may not be able to\nadequately express their pain - such as children and people with intellectual disabilities or\nwith consciousness impairments - are especially at risk of receiving inadequate pain treat-\nment.\nIt is important to acknowledge the indirect consequences of inadequate pain treatment,\nsuch as a negative economic impact, as well as the individual human suffering directly\nresulting from untreated pain.\nIn most cases, pain can be stopped or relieved with inexpensive and relatively simple\ntreatment interventions, which can dramatically improve the quality of life for patients.\nIt is accepted that some pain is particularly difficult to treat and requires the application of\ncomplex techniques by, for example, multidisciplinary teams. Sometimes, especially in\ncases of severe chronic pain, psycho-emotional factors are even more important than bio-\nlogical factors.\nLack of education for health professionals in the assessment and treatment of pain and\nother symptoms, and unnecessarily restrictive government regulations (including limiting\naccess to opioid pain medications) are two major reasons for this treatment gap.\nPRINCIPLES\t\n \u00a0\n\t\n \u00a0\nThe right to access to pain treatment for all people without discrimination, as laid down in\nprofessional standards and guidelines and in international law, should be respected and\neffectively implemented.\nPhysicians and other health care professionals have an ethical duty to offer proper clinical\nassessments to patients with pain and to offer appropriate treatment, which may require\nprescribing medications - including opioid analgesics - as medically indicated. This also\napplies to children and other patients who cannot always adequately express their pain.\n\t\n \u00a0\n\t\n \u00a0Montevideo\t\n \u00a0\u23d0\uf8e6\t\n \u00a0R-\u00ad\u20102011-\u00ad\u201001-\u00ad\u20102011\t\n \u00a0\nAdequate\t\n \u00a0Pain\t\n \u00a0Treatment\t\n \u00a0\nInstruction on pain management, including clinical training lectures and practical cases,\nshould be included in mandatory curricula and continuing education for physicians and\nother health professionals. Such education should include evidence-based therapies effec-\ntive for pain, both pharmacological and non-pharmacological. Education about opioid\ntherapy for pain should include the benefits and risks of the therapy. Safety concerns re-\ngarding opioid therapy should be emphasized to allow the use of adequate doses of analge-\nsia while mitigating detrimental effects of the therapy. Training should also include recog-\nnition of pain in those who may not be able to adequately express their pain, including\nchildren, and cognitively impaired and mentally challenged individuals.\nGovernments must ensure the adequate availability of controlled medicines, including opi-\noids, for the relief of pain and suffering. Governmental drug control agencies should re-\ncognize severe and\/or chronic pain as a serious and common health care issue and appro-\npriately balance the need to relieve suffering with the potential for the illegal use of anal-\ngesic drugs. Under the right to health, people facing pain have a right to appropriate pain\nmanagement, including effective medications such as morphine. Denial of pain treatment\nviolates the right to health and may be medically unethical.\nMany countries lack necessary economic, human and logistic resources to provide optimal\npain treatment to their population. The reasons for not providing adequate pain relief must\ntherefore be fully clarified and made public before accusations of violating the right to\nhealth are made.\nInternational and national drug control policies should balance the need for adequate avail-\nability and accessibility of controlled medicines like morphine and other opioids for the\nrelief of pain and suffering with efforts to prevent the misuse of these controlled sub-\nstances. Countries should review their drug control policies and regulations to ensure that\nthey do not contain provisions that unnecessarily restrict the availability and accessibility\nof controlled medicines for the treatment of pain. Where unnecessarily or disproportion-\nately restrictive policies exist, they should be revised to ensure the adequate availability of\ncontrolled medicines.\nEach government should provide the necessary resources for the development and imple-\nmentation of a national pain treatment plan, including a responsive monitoring mechanism\nand process for receiving complaints when pain is inadequately treated.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nR-\u00ad\u20102011-\u00ad\u201002-\u00ad\u20102011\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nBAHRAIN\t\n \u00a0\nAdopted by the 62nd\nWMA General Assembly, Montevideo, Uruguay, October 2011\nThe\t\n \u00a0WMA\t\n \u00a0General\t\n \u00a0Assembly\t\n \u00a0notes\t\n \u00a0that\t\n \u00a0\nA number of doctors, nurses and other health care professionals in the Kingdom of\nBahrain were arrested in March 2011 after the civil unrest in that country and tried under\nemergency powers before a special court, led by a military judge. Twenty of this group\nwere found guilty of a number of charges, on 29 September 2011 and sentenced to fifteen,\nten or five years imprisonment.\nThese trials failed to meet international standards for fair trials, including the accused not\nbeing allowed to make statements in their own defence, and their lawyers not being\nallowed to question all the witnesses. Allegations from the accused and their lawyers of\nmistreatment, abuse and other human right violations during arrest and while in detention\nhave not been investigated.\nWhile various criminal charges were brought it appears that the major offence was treating\nall the patients who presented for care, including leaders and members of the rebellion.\nOther charges appear to be closely related to providing such treatment and were, in any\ncase, not proven to the standard expected in court proceedings. In treating patients without\nconsidering the circumstances of their injury these health care professionals were honour-\ning their ethical duty as set out in the Declaration of Geneva.\nThe WMA welcomes the announcement by the government of Bahrain of 6 October 2011\nthat all twenty will be re-tried before a full civil court.\nTherefore, the WMA requires that no doctor or other health care professional be arrested,\naccused or tried for treating patients, regardless of the origins of the patient's injury or\nillness.\nThe WMA demands that all states understand, respect and honour the concept of medical\nneutrality. This includes providing working conditions which are as safe as possible, even\nunder difficult circumstances, including armed conflict or civil unrest.\nThe WMA expects that if any individual, including health care professionals, are subject\nto trial that there is due process of law including during arrest, questioning and trial in\naccordance with the highest standards of international law.\nThe WMA demands that states investigate any allegations of torture or cruel and inhu-\nmane treatment by prisoners against its agents, and act quickly to stop such abuses.\n\t\n \u00a0\n\t\n \u00a0Montevideo\t\n \u00a0\u23d0\uf8e6\t\n \u00a0R-\u00ad\u20102011-\u00ad\u201002-\u00ad\u20102011\t\n \u00a0\nBahrain\t\n \u00a0\nThe WMA recommends that independent international assessors are allowed to observe\nthe trials and meet privately with the accused, so that the state of Bahrain can prove to the\nwatching world that the future legal proceedings follow fair process.\nThe WMA recognises that health care workers and health care facilities are increasingly\nunder attack during wars, conflicts and civil unrest. We demand that states throughout the\nworld recognise, respect and honour principles of medical neutrality and their duty to pro-\ntect health care institutions and facilities for humanitarian reasons.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nR-\u00ad\u20102011-\u00ad\u201003-\u00ad\u20102011\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0REAFFIRMING\t\n \u00a0THE\t\n \u00a0WMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nECONOMIC\t\n \u00a0EMBARGOES\t\n \u00a0AND\t\n \u00a0HEALTH\t\n \u00a0\nAdopted by the 62nd\nWMA General Assembly, Montevideo, Uruguay, October 2011\nThe World Medical Association is deeply concerned about reports of potential serious\nhealth impacts resulting from economic sanctions imposed by the European Union against\nIvory Coast leader, Laurent Gbagbo, and numerous individuals and entities associated\nwith his regime, including two major ports linked to Gbagbo's government. The sanctions\naim to severely restrict EU-registered vessels from transacting business with these ports,\nwhich could inhibit the delivery of necessary and life-saving medicines.\nThe WMA General Assembly reiterates the following position from the WMA Resolution\non Economic Embargoes and Health:\n\u2022 All people have the right to the preservation of health; and,\n\u2022 the Geneva Convention (Article 23, Number IV, 1949) requires the free passage\nof medical supplies intended for civilians;\n2.\nThe WMA therefore urges the European Union to take steps immediately to ensure the\ndelivery of medical supplies to the Ivory Coast, in order to protect the life and health of\nthe population.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0R-\u00ad\u20102011-\u00ad\u201004-\u00ad\u20102011\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nTHE\t\n \u00a0INDEPENDENCE\t\n \u00a0OF\t\n \u00a0NATIONAL\t\n \u00a0MEDICAL\t\n \u00a0ASSOCIATIONS\t\n \u00a0\nAdopted by the 62nd\nWMA General Assembly, Montevideo, Uruguay, October 2011\nNational medical associations are established to act as representatives of their physicians,\nand to negotiate on their behalf, sometimes as a trade union or regulatory body but also as\na professional association, representing the expertise of medical doctors in relation to mat-\nters of public health and wellbeing.\nThey represent the views of the medical profession, including attempting to ensure the\npractice of ethical medicine, the provision of good quality medical care, and the adherence\nto high standards by all practitioners.\nThese associations may also campaign or advocate on behalf of their members, often in\nthe field of public health. Such advocacy is not always welcomed by governments who\nmay consider the advocacy to have oppositional politics attached, when in reality it is\nbased upon an understanding of the medical evidence and the needs of patients and popu-\nlations.\nThe WMA is aware that because of those advocacy efforts some governments attempt to\nsilence the medical association by placing it's own nominated representatives into posi-\ntions of authority, to subvert the message into one they are better able to tolerate.\nThe WMA denounces such action and demands that no government interferes with the\nindependent functioning of national medical associations. It encourages governments to\nunderstand better the reasons behind the work of their national medical association, to\nconsider the medical evidence and to work with physicians to improve the health and well\nbeing of their populations.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nR-\u00ad\u20102012-\u00ad\u201001-\u00ad\u20102012\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nA\t\n \u00a0MINIMUM\t\n \u00a0UNIT\t\n \u00a0PRICE\t\n \u00a0FOR\t\n \u00a0ALCOHOL\t\n \u00a0\nAdopted by the 63rd\nWMA General Assembly, Bangkok, Thailand, October 2012\nEvidence from epidemiological and other research demonstrates a clear link between the\nprice of alcohol and levels of consumption, especially amongst young drinkers and those\nwho are heavy alcohol users.\nSetting a minimum unit price at a level that will reduce alcohol consumption is a strong\npublic health measure, which will both reduce average alcohol consumption throughout\nthe population and be especially effective in heavy drinkers and young drinkers.\nSome states are intending to set a minimum unit price in order to reduce the medical and\nsocial effects of excessive alcohol consumption.\nThe WMA supports states seeking to use such innovative measures to combat the serious\npublic and individual health effects of excessive and problem drinking.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0R-\u00ad\u20102012-\u00ad\u201002-\u00ad\u20102012\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nPLAIN\t\n \u00a0PACKAGING\t\n \u00a0OF\t\n \u00a0CIGARETTES\t\n \u00a0\nAdopted by the 63rd\nWMA General Assembly, Bangkok, Thailand, October 2012\nThe WMA recognises that:\n\u2022 Cigarettes offer a serious threat to the life and health of individuals that use them,\nand a considerable cost to the health care services of every country;\n\u2022 Those who smoke predominantly start to do so while adolescents;\n\u2022 There is a proven link between brand recognition and likelihood of starting to\nsmoke;\n\u2022 Brand recognition is strongly linked to cigarette packaging;\n\u2022 Plain packaging reduces the impact of branding, promotion and marketing of\ncigarettes.\nThe WMA encourages national governments to support moves to introduce plain packaging\nof cigarettes, initially by the Federal Government of Australia, to break the brand recog-\nnition\/ smoking cycle and commends adoption of this policy to other national govern-\nments and deplores the legal moves being taken by the tobacco industry to oppose this\npolicy.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nR-\u00ad\u20102012-\u00ad\u201003-\u00ad\u20102012\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nTO\t\n \u00a0REAFFIRM\t\n \u00a0\t\n \u00a0\nTHE\t\n \u00a0WMA\u2019S\t\n \u00a0PROHIBITION\t\n \u00a0OF\t\n \u00a0PHYSICIAN\t\n \u00a0PARTICIPATION\t\n \u00a0\t\n \u00a0\nIN\t\n \u00a0CAPITAL\t\n \u00a0PUNISHMENT\t\n \u00a0\nAdopted by the 63rd\nWMA General Assembly, Bangkok, Thailand, October 2012\nThere is universal agreement that physicians must not participate in executions because\nsuch participation is incompatible with the physician's role as healer. The use of a\nphysician's knowledge and clinical skill for purposes other than promoting health,\nwellbeing and welfare undermines a basic ethical foundation of medicine---first, do no\nharm.\nThe WMA Declaration of Geneva states: \"I will maintain the utmost respect for human\nlife\"; and, \"I will not use my medical knowledge to violate human rights and civil\nliberties, even under threat.\"\nAs citizens, physicians have the right to form views about capital punishment based on\ntheir individual moral beliefs. As members of the medical profession, they must uphold\nthe prohibition against participation in capital punishment.\nTherefore, be it RESOLVED that:\n\u2022 Physicians will not facilitate the importation or prescription of drugs for execution.\n\u2022 The WMA reaffirms: \"that it is unethical for physicians to participate in capital\npunishment, in any way, or during any step of the execution process, including its\nplanning and the instruction and\/or training of persons to perform executions\", and\n\u2022 The WMA reaffirms: that physicians \"will maintain the utmost respect for human\nlife and will not use [my] medical knowledge to violate human rights and civil\nliberties, even under threat.\"\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0R-\u00ad\u20102012-\u00ad\u201004-\u00ad\u20102012\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nIN\t\n \u00a0\t\n \u00a0\nSUPPORT\t\n \u00a0OF\t\n \u00a0PROFESSOR\t\n \u00a0CYRIL\t\n \u00a0KARABUS\t\n \u00a0\nAdopted by the 63rd\nWMA General Assembly, Bangkok, Thailand, October 2012\nThe WMA welcomes the bail granted on the 11th\nof October to the retired South African\npaediatric haematologist, 78-year-old Professor Cyril Karabus, as a positive step given his\nstate of health; he has cardiac disease. Dr Karabus had been detained in an Abu Dhabi,\nUAE prison since August 18th\n2012. He was arrested in Dubai, whilst in transit to South\nAfrica, owing to alleged charges emanating from a brief period that he worked in the UAE\nin 2002.\nProfessor Karabus was neither informed of the charges leveled against him nor the subse-\nquent trial that was held in absentia relating to the unfortunate death of a child with acute\nleukemia under his care during his tenure in the UAE in 2002. His defense lawyer has also\nbeen unable to access any documents or files relating to the case that may assist in\nproviding a fair defense.\nTherefore,\nThe WMA General Assembly urgently calls on the authorities of the United Arab\nEmirates to ensure that Professor Karabus:\n\u2022 Is guaranteed a fair trial according to international standards;\n\u2022 Has access to the relevant documents or information he may require to prepare his\ndefense.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nR-\u00ad\u20102013-\u00ad\u201001-\u00ad\u20102013\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nCRIMINALISATION\t\n \u00a0OF\t\n \u00a0MEDICAL\t\n \u00a0PRACTICE\t\n \u00a0\nAdopted as a Council Reolution by the 194th\nWMA Council Session, Bali, Indonesia,\nApril 2013\nand adopted by the 64th\nWMA General Assembly, Fortaleza, Brazil, October 2013\nPREAMBLE\t\n \u00a0\nDoctors who commit criminal acts which are not part of patient care must remain as liable\nto sanctions as all other members of society. Serious abuses of medical practice must be\nsubject to sanctions, usually through professional regulatory processes.\nNumerous attempts are made by governments to control physicians\u2019 practice of medicine\nat local, regional and national levels worldwide. Physicians have seen attempts to:\n\u2022 Prevent medically indicated procedures;\n\u2022 Mandate medical procedures that are not indicated; and\n\u2022 Mandate certain drug prescribing practices.\nCriminal penalties have been imposed on physicians for various aspects of medical prac-\ntice, including medical errors, despite the availability of adequate non-criminal redress.\nCriminalizing medical decision making is a disservice to patients.\nIn times of war and civil strife, there have also been attempts to criminalize compassionate\nmedical care to those injured as a result of these conflicts.\nRECOMMENDATIONS\t\n \u00a0\nTherefore, the WMA recommends that its members:\n1. Oppose government intrusions into the practice of medicine and in healthcare\ndecision making, including the government\u2019s ability to define appropriate medical\npractice through imposition of criminal penalties.\n2. Oppose criminalizing medical judgment.\n3. Oppose criminalizing healthcare decisions, including physician variance from\nguidelines and standards.\n4. Oppose criminalizing medical care provided to patients injured in civil conflicts.\n\t\n \u00a0\n\t\n \u00a0Fortaleza\t\n \u00a0\u23d0\uf8e6\t\n \u00a0R-\u00ad\u20102013-\u00ad\u201001-\u00ad\u20102013\t\n \u00a0\nCriminalisation\t\n \u00a0of\t\n \u00a0Medical\t\n \u00a0Practice\t\n \u00a0\n5. Implement action plans to alert opinion leaders, elected officials and the media\nabout the detrimental effects on healthcare that result from criminalizing healthcare\ndecision making.\n6. Support the principles set forth in the WMA\u2019s Declaration of Madrid on Profes-\nsional Autonomy and Self-Regulation.\n7. Support the guidance set forth in the WMA\u2019s Regulations in Times of Armed\nConflict and Other Situations of Violence.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nR-\u00ad\u20102013-\u00ad\u201002-\u00ad\u20102013\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nTHE\t\n \u00a0HEALTHCARE\t\n \u00a0SITUATION\t\n \u00a0IN\t\n \u00a0SYRIA\t\n \u00a0\nAdopted by the 64th\nWMA General Assembly, Fortaleza, Brazil, October 2013\nPREAMBLE\t\n \u00a0\nDuring wars and armed conflicts, hospitals and other medical facilities have often been\nattacked and misused and patients and medical personnel have been killed or wounded.\nSuch attacks are a violation of the Geneva Conventions (1949), Additional Protocols to the\nGeneva Conventions (1977) and WMA policies, in particular, the WMA Statement on the\nProtection and Integrity of Medical Personnel in Armed Conflicts and Other Situations of\nViolence (Montevideo 2011) as well as WMA Regulations in Times of Armed Conflicts\nand Other Situations of Violence (Bangkok 2012).\nThe World Medical Association (WMA) has been active in condemning documented\nattacks on medical personnel and facilities in armed conflicts, including civil wars. The\nGeneva Conventions and their Additional Protocols are designed to protect medical\npersonnel, medical facilities and their patients in international and non-international armed\nconflicts. The parties on both sides of the conflict have legal and moral duties not to inter-\nfere with medical care for wounded or sick combatants and civilians, and to not attack,\nthreaten or impede medical functions. Physicians and other health care personnel must act\nas and be considered neutral and must not be prevented from fulfilling their duties.\nRECOMMENDATIONS\t\n \u00a0\n\u2022\n\u2022 The WMA calls upon all parties in the Syrian conflict to ensure the safety of\nhealthcare personnel and their patients, as well as medical facilities and medical\ntransport.\n\u2022 The WMA calls upon its members to approach local governments in order to\nfacilitate international cooperation in the United Nations, the European Union or\nother international body with the aim of ensuring the safe provision of health care\nto the Syrian people.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0R-\u00ad\u20102013-\u00ad\u201003-\u00ad\u20102013\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nTHE\t\n \u00a0PROHIBITION\t\n \u00a0OF\t\n \u00a0CHEMICAL\t\n \u00a0WEAPONS\t\n \u00a0\nAdopted by the 64th\nWMA General Assembly, Fortaleza, Brazil, October 2013\nPREAMBLE\t\n \u00a0\nIt has been recognised for centuries that certain chemical agents can affect consciousness,\nor other factors influencing the ability of an individual to take part in fighting, predomi-\nnantly during warfare. More recently some agents have been used to temporarily disable\nparticipants in civil unrest, protests or riots. In warfare such agents have, historically, had\na significant morbidity and mortality and included nerve gases and related agents.\nDespite widespread condemnation such weapons were extensively used in the early 20th\ncentury. A global movement to outlaw the use of such weapons led to the development of\nthe Chemical Weapons Convention (CWC), which entered into force in 1997 having been\nopened to signature in 1993. Currently only six countries have not ratified or acceded to\nthe CWC.\nThe production, stockpiling and use of CW is prohibited. Despite this, such weapons have\nbeen used by state forces and by non-state actors in a number of countries. By their nature\nsuch weapons are indiscriminate. This use has led to deaths, injuries and human suffering\nin those countries.\nChemical agents used in policing actions, including by the military acting in a policing\nrole, are allowed under the CWC. There is a significant international dialogue underway\non the definition of such agents and the situations in which they can be used. It should be\nnoted that the CWC appears to assume such agents will not be lethal, but the use of any\nagent might have fatal consequences. Those using them, or authorising their use, must\nseek to ensure that they are not used in a manner which risks death or serious injury to\ntargeted persons.\nRECOMMENDATIONS\t\n \u00a0\nThe WMA notes that the development, production, stockpiling and use of Chemical\nWeapons is banned under the CWC, and that use of such weapons is regarded by some to\nbe a crime against humanity, regardless of whether the target populations are civilian or\nmilitary.\nThe WMA urges all relevant parties to make active efforts to abide by the CWC ban on\nthe development, production, stockpiling and use of Chemical Weapons.\n\t\n \u00a0\n\t\n \u00a0R-\u00ad\u20102013-\u00ad\u201003-\u00ad\u20102013\t\n \u00a0\u23d0\uf8e6\t\n \u00a0Fortaleza\t\n \u00a0\nProhibition\t\n \u00a0of\t\n \u00a0Chemical\t\n \u00a0Weapons\t\n \u00a0\nThe WMA urges support from all states party to the CWC for the safe destruction of all\nstockpiles of Chemical weapons.\nThe WMA supports UN initiatives to identify anyone who is responsible for the use of\nChemical Weapons and to bring them to justice.\nThe WMA urges states using chemical agents in riot control and related situations to\ncarefully consider and minimise the risks and to, wherever possible, refrain from such\nuse. Any use must follow the establishment of the necessary procedures to reduce the risk\nof death or serious injury. They should not be used in a manner, which deliberately\nincreases the risk of injury, harm or death to their targets.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0R-\u00ad\u20102013-\u00ad\u201004-\u00ad\u20102013\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nSTANDARDISATION\t\n \u00a0IN\t\n \u00a0MEDICAL\t\n \u00a0PRACTICE\t\n \u00a0\t\n \u00a0\nAND\t\n \u00a0PATIENT\t\n \u00a0SAFETY\t\n \u00a0\nAdopted as a Council Resolution by the 194th\nWMA Council Session, Bali, Indonesia,\nApril 2013\nand adopted by the 64th\nWMA General Assembly, Fortaleza, Brazil, October 2013\nEnsuring patient safety and quality of care is at the core of medical practice. For patients, a\nhigh level of performance can be a matter of life or death. Therefore, guidance and stand-\nardisation in healthcare must be based on solid medical evidence and has to take ethical\nconsiderations into account.\nCurrently, trends in the European Union can be observed to introduce standards in clinical,\nmedical care developed by non-medical standardisation bodies, which neither have the\nnecessary professional ethical and technical competencies nor a public mandate.\nThe WMA has major concerns about such tendencies which are likely to reduce the\nquality of care offered, and calls upon governments and other institutions not to leave\nstandardisation of medical care up to non-medical self selected bodies.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nR-\u00ad\u20102013-\u00ad\u201005-\u00ad\u20102013\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nIN\t\n \u00a0\t\n \u00a0\nSUPPORT\t\n \u00a0OF\t\n \u00a0THE\t\n \u00a0BRAZILIAN\t\n \u00a0MEDICAL\t\n \u00a0ASSOCIATION\t\n \u00a0\nAdopted by the 64th\nWMA General Assembly, Fortaleza, Brazil, October 2013\nThere are credible reports that the Brazilian Government program \u201cMais M\u00e9dicos\u201d to\ncreate more medical schools, extend the duration of the medical course, compulsorily\nplace last years medical students to work in public services and attract foreign physicians\nto work in remote areas of the country and in the poorest outskirts of big cities, was\nproposed without the appropriate consultation to the medical community and medical\nschools, and departs from a wrong diagnosis about the causes of the insufficient health\ncare provided to the Brazilian population. The program as proposed bypass systems\nestablished to verify physicians' credentials, medical competence and language skills in\norder to protect patients.\nThe World Medical Association is concerned that patients are put at risk by unregulated\nmedical license, inadequate medical competence and potential misunderstanding of patient\ncommunication and of drugs and medical supplies labels.\nTherefore, the WMA:\n\u2022 Condemns any policy and practice that disrupt the accepted standards of medical\ncredentialing and medical care;\n\u2022 Calls upon the Brazilian government to work with the medical community and\nmedical schools on all matters related to medical education, physician certification\nand the practice of medicine, and to respect the role of the Brazilian Medical\nAssociation on behalf of the Brazilian physicians and population;\n\u2022 Urges, as a matter of utmost concern, that the Brazilian government respect the\nWMA International Code of Medical Ethics that guides the medical practice of\nphysicians all over the world.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0R-\u00ad\u20102014-\u00ad\u201001-\u00ad\u20102014\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nEBOLA\t\n \u00a0VIRAL\t\n \u00a0DISEASE\t\n \u00a0\nAdopted by the 65th\nWMA General Assembly, Durban, South Africa, October 2014\nBACKGROUND\t\n \u00a0\nA number of viral diseases have caused occasional health emergencies in parts of Africa,\nwith local or wider spread epidemics. These include Lassa, Marburg and Ebola Viral\nDiseases (EVD). The 2013-14 outbreak of EVD in West Africa has proven far more dif-\nficult to control than previous epidemics and is now present in Sierra Leone, Liberia and\nGuinea with more than 2000 deaths. This epidemic appears to have a case related mor-\ntality of approximately 55% against a range for EVD of 50~95%.\nFollowing infection, patients remain asymptomatic for a period of 2~21 days, and during\nthis time tests for the virus will be negative, and patients are not infectious, posing no\npublic health risk. Once the patient becomes symptomatic, EVD is spread through contact\nwith body fluids including blood. Symptoms include diarrhea, vomiting and bleeding, and\nall these body fluids are potentially sources of infection.\nManagement is primarily through infection control, the use of personal protective equip-\nment (PPE) by health care workers and those disposing of body fluids and of bodies, and\nsupportive care for sick patients including using IV fluids and inotropes. Contact tracing is\nalso important but may be difficult in many of the communities currently affected. Vac-\ncines are in development as are some antivirals, but they will arrive late in this epidemic if\nthey are proven successful.\nEvidence from those treating patients in affected communities is that a shortage of re-\nsources, including health care workers and PPE, as well as poor infection control training\nof health care workers, caregivers and others at risk are making epidemic control difficult.\nSome governments have indicated that they will build new treatment centres in affected\nareas as a matter of urgency, while others are directly providing personal protective equip-\nment and other supplies.\nRECOMMENDATIONS\t\n \u00a0\n1. The WMA honours those working in these exceptional circumstances, and strongly\nrecommends that national governments and international agencies work with health\ncare providers on the ground and offer stakeholders training and support to reduce\nthe risks that they face in treating patients and in seeking to control the epidemic.\n\t\n \u00a0\n\t\n \u00a0R-\u00ad\u20102014-\u00ad\u201001-\u00ad\u20102014\t\n \u00a0\u23d0\uf8e6\t\n \u00a0Durban\t\n \u00a0\nEbola\t\n \u00a0Viral\t\n \u00a0Disease\t\n \u00a0\n2. The WMA commends those countries that have committed resources for the urgent\nestablishment of new treatment and isolation centres in the most heavily burdened\ncountries and regions. The WMA calls upon all nations to commit enhanced sup-\nport for combatting the EVD epidemic.\n3. The WMA calls on the international community, acting through the United Nations\nand its agencies as well as aid agencies, to immediately provide the necessary sup-\nplies of PPE to protect health care workers and ancillary staff and reduce the risk\nof cross infection. This must include adequate supplies of gloves, masks and gowns,\nand distribution must include treatment centres at all levels.\n4. The WMA calls on all those managing the epidemic, including local and national\ngovernments and agencies such as WHO, to commit to adequate training in infec-\ntion control measures, including PPE for all staff and caregivers who might come\ninto contact with infective materials.\n5. The WMA calls on national and local governments to increase public communica-\ntion about basic infection control practices.\n6. The WMA calls upon WHO to facilitate research into the timeliness and effective-\nness of international interventions, so that planning and interventions in future health\nemergencies can be better informed.\n7. The WMA strongly urges all countries, especially those not yet affected, to educate\nhealth care providers about the current case definition in addition to strengthening\ninfection control methodologies and contact tracing in order to prevent transmis-\nsion within their countries.\n8. The WMA calls for NMAs to contact their national governments to act as des-\ncribed in this document.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0R-\u00ad\u20102014-\u00ad\u201002-\u00ad\u20102014\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nMIGRANT\t\n \u00a0WORKERS'\t\n \u00a0HEALTH\t\n \u00a0AND\t\n \u00a0SAFETY\t\n \u00a0IN\t\n \u00a0QATAR\t\n \u00a0\nAdopted by the 65th\nWMA General Assembly, Durban, South Africa, October 2014\nPREAMBLE\t\n \u00a0\nReliable reports indicate that migrant workers in Qatar suffer from exploitation and viola-\ntion of their rights. Workers basic needs, e.g. access to sufficient water and food, are not\nmet. Less than half of the workers are entitled to health care. Hundreds of workers have\nalready died in the construction sites since 2010 as the country prepares to host the 2022\nFIFA1 World Cup. Workers are not free to leave when they see their situation hopeless or\nhealth endangered since their passports are confiscated.\nDespite the pleas of international labour and human rights organizations, such as ITUC\n(International Trade Union Confederation) and Amnesty International, the response of the\nQatar government to solve the situation has not been adequate. FIFA has been inefficient\nand has not taken the full responsibility to facilitate the improvements to the worker\u00b4s\nliving and working conditions.\nThe World Medical Association reminds that health is a human right that should be safe-\nguarded in all situations.\nThe World Medical Association is concerned that migrant workers are continuously put at\nrisk in construction sites in Qatar, and their right to freedom of movement and right to\nhealth care and safe working conditions are not respected.\nRECOMMENDATIONS\t\n \u00a0\n\t\n \u00a0\n1. The WMA calls upon the Qatar government and construction companies to ensure\nthe health and safety of migrant workers;\n2. The WMA demands the FIFA as the responsible organization of the World Cup to\ntake immediate action by changing the venue as soon as possible;\n3. The WMA calls upon its members to approach local governments in order to fa-\ncilitate international cooperation with the aim of ensuring the health and safety of\nmigrant workers in Qatar.\n1\nF\u00e9d\u00e9ration Internationale de Football Association\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nR-\u00ad\u20102014-\u00ad\u201003-\u00ad\u20102014\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nUNPROVEN\t\n \u00a0THERAPY\t\n \u00a0AND\t\n \u00a0THE\t\n \u00a0EBOLA\t\n \u00a0VIRUS\t\n \u00a0\nAdopted by the 65th\nWMA General Assembly, Durban, South Africa, October 2014\nIn the case of Ebola virus, the WMA strongly supports the intention of Paragraph 37 of the\n2013 revision of the Declaration of Helsinki, which reads:\nIn the treatment of an individual patient, where proven interventions do not exist or other\nknown interventions have been ineffective, the physician, after seeking expert advice, with\ninformed consent from the patient or a legally authorized representative, may use an un-\nproven intervention if in the physician\u2019s judgement it offers hope of saving life, re-\nestablishing health or alleviating suffering. This intervention should subsequently be made\nthe object of research, designed to evaluate its safety and efficacy. In all cases, new in-\nformation must be recorded and, where appropriate, made publicly available.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0CR-\u00ad\u20102003-\u00ad\u201001-\u00ad\u20102003\t\n \u00a0\nWMA\t\n \u00a0COUNCIL\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nTHE\t\n \u00a0RELATION\t\n \u00a0OF\t\n \u00a0LAW\t\n \u00a0AND\t\n \u00a0ETHICS\t\n \u00a0\nAdopted by the 164th\nWMA Council Session, Divonne-les-Bains, France, May 2003\nEthical Values and legal principles are usually closely related, but ethical obligations\ntypically exceed legal duties. In some cases, the law mandates unethical conduct. The fact\nthat a physician has complied with the law does not necessarily mean that the physician\nacted ethically.\nWhen law is in conflict with medical ethics, physicians should work to change the law. In\ncircumstances of such conflict, ethical responsibilities supersede legal obligations.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nCR-\u00ad\u20102005-\u00ad\u201001-\u00ad\u20102005\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0COUNCIL\t\n \u00a0RESOLUTION\t\n \u00a0\nON\t\n \u00a0\nCHRONIC\t\n \u00a0NON-\u00ad\u2010COMMUNICABLE\t\n \u00a0DISEASES\t\n \u00a0\nAdopted by the 171st\nWMA Council Session, Santiago, Chile, October 2005\nChronic non-communicable diseases are a rapidly growing problem worldwide. They have\nmajor adverse health, social and economic effects especially in poor nations.\nThe WMA Council welcomes the work of the WHO on \u201cPreventing Chronic Diseases, a\nvital in-vestment\u201d and recommends that all NMAs work with health professional organi-\nzations, interested stakeholders and their governments to prevent and relieve the increas-\ning burden of chronic disease.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0CR-\u00ad\u20102005-\u00ad\u201002-\u00ad\u20102005\t\n \u00a0\nWMA\t\n \u00a0COUNCIL\t\n \u00a0RESOLUTION\t\n \u00a0\nON\t\n \u00a0\nTHE\t\n \u00a0HEALTHCARE\t\n \u00a0SKILLS\t\n \u00a0DRAIN\t\n \u00a0\nAdopted by the 170th\nWMA Council Session, Divonne-les-Bains, France, May 2005\nRecognising that the lack of healthcare workers in developing countries, particularly those\nin sub-Saharan Africa, is one of the most serious global problems of today and that the\nimpact of healthcare worker migration from developing to developed countries is a signi-\nficant component in the crisis,\nTherefore, be it resolved:\n1. That the WMA reaffirms its 2003 Statement on Ethical Guidelines for the Interna-\ntional Recruitment of Physicians, particularly para. 14: \"Every country should do its\nutmost to educate an adequate number of physicians, taking into account its needs\nand resources. A country should not rely on immigration from other countries to meet\nits need for physicians\"; and para. 15: \"Every country should do its utmost to retain\nits physicians in the profession as well as in the country by providing them with the\nsupport they need to meet their personal and professional goals, taking into account\nthe country's needs and resources.\"\n2. That developed countries must assist developing countries to expand their capacity to\ntrain and retain physicians and nurses, to enable developing countries to become self-\nsufficient.\n3. That action to combat the skills drain in this area must balance the right to health of\npopulations (Universal Declaration of Human Rights (1948), Article 25.1; Interna-\ntional Covenant on Economic, Social, and Cultural Rights (1976), Article 12.1.) and\nother individual human rights.\n4. That the WMA reconvene the expert working group on physician resources to co-\nordinate development of WMA input to WHO preparations for the decade on human\nresources for health.\n5. That the WMA commend WHO for taking a leadership role in the global challenges\nof human resources for health; commend to WHO the afore-mentioned principles (1,\n2 and 3); and call upon WHO to convene a global roundtable to discuss HHR issues.\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nCR-\u00ad\u20102005-\u00ad\u201003-\u00ad\u20102005\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0COUNCIL\t\n \u00a0RESOLUTION\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nGENOCIDE\t\n \u00a0IN\t\n \u00a0DARFUR\t\n \u00a0\nAdopted by the 170th\nWMA Council Session, Divonne-les-Bains, France, May 2005\nand reaffirmed by the 176th\nWMA Council Session, Berlin, Germany, May 2006\nWHEREAS, a reported 300,000 Darfurians have been killed and one million refugees dis-\nplaced since early 2003, on the basis of racial or ethnic origins; and\nWHEREAS, there have been official reports of savage killing, torture, rape and mutila-\ntion of men, women and children by the Government of Sudan and its allied militia; and\nWHEREAS, many of these reports, including that of the UN Commission of Inquiry on\nDarfur, have only recently been publicized; and\nWHEREAS, genocide, as defined by the 1948 UN Convention on the Prevention and\nPnishment of the Crime of Genocide, is the killing or destroying of populations on the\nbasis of their racial or ethnic identity; and\nWHEREAS, the WMA, as an international medical organization committed to the pro-\ntection of health and human rights for all, has expressed its support for human rights in\nstatements and resolutions, among them the Resolution on Human Rights, adopted by the\nWMA in Rancho Mirage during the 42nd\nGeneral Assembly and amended by the 45th\n, 46th\nand 47th\nGeneral Assemblies,\nTHEREFORE, BE IT RESOLVED, that the WMA condemns the genocide in Darfur\nand calls upon its member NMAs to urge their governments and the international commu-\nnity to take immediate action to stop the mass killings, expulsions, rape and destruction in\nDarfur and to protect the health and safety of refugees in the region.\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0CR-\u00ad\u20102005-\u00ad\u201004-\u00ad\u20102005\t\n \u00a0\nWMA\t\n \u00a0COUNCIL\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nOBSERVER\t\n \u00a0STATUS\t\n \u00a0FOR\t\n \u00a0TAIWAN\t\n \u00a0TO\t\n \u00a0THE\t\n \u00a0\t\n \u00a0\nWORLD\t\n \u00a0HEALTH\t\n \u00a0ORGANIZATION\t\n \u00a0(WHO)\t\n \u00a0\t\n \u00a0\nAND\t\n \u00a0INCLUSION\t\n \u00a0AS\t\n \u00a0PARTICIPATING\t\n \u00a0PARTY\t\n \u00a0TO\t\n \u00a0THE\t\n \u00a0\nINTERNATIONAL\t\n \u00a0HEALTH\t\n \u00a0REGULATIONS\t\n \u00a0(IHR)\t\n \u00a0\nAdopted by the 170th\nWMA Council Session, Divonne-les-Bains, France, May 2005\nPREAMBLE\t\n \u00a0\n\t\n \u00a0\n1. The ethical obligation of health professionals is to serve all human beings irres-\npective of their political or religious affiliation or any other factor. The goal of all\nnations must be the protection of health of all human beings without any discrimina-\ntion. Protection of human health can only be achieved if all people and health care\nsystems collaborate. WHO must be able to invite all people and health care systems\nto participate in the fight against disease and premature death. Protection of human\nhealth must be separated from politics.\n2. A burning example of discrimination in the recent years has been Taiwan. There are\n23 million people living in Taiwan, of which a significant number required medical\nassistance or help from international relief organizations in the aftermath of the 1999\nearthquake. In addition, Taiwan was significantly affected and suffered several deaths\ndue to the SARS epidemic during 2002 and 2003 and is under threat by the current\noutbreak of Avian Flu in South East Asia.\n3. There are 23 million people who are willing and take pride in contributing to inter-\nnational relief efforts when other people are in need, as demonstrated again by gene-\nrous donations and significant humanitarian aid support in the aftermath of the\ntsunami disaster during 2004.\n4. 23 million people should not be excluded from the work of the World Health Organi-\nzation, but without taking a stand as to the legal status of Taiwan.\nRESOLUTION\t\n \u00a0\n\t\n \u00a0\n5. The World Medical Association (WMA), as a non-governmental organization in offi-\ncial relations with WHO, calls on WHO to grant Taiwan observer status to WHO;\n6. The WMA calls on WHO and all its Member States to ensure that Taiwan is in-\ncluded as a participating party to the WHO International Health Regulations;\n7. The World Medical Association further urges its members to call on their national\ngovernments to advocate for observer status for Taiwan at WHO, as well as inclu-\nsion as a participating party to the WHO International Health Regulations.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nCR-\u00ad\u20102005-\u00ad\u201005-\u00ad\u20102005\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0COUNCIL\t\n \u00a0RESOLUTION\t\n \u00a0\nON\t\n \u00a0\nIMPLEMENTATION\t\n \u00a0OF\t\n \u00a0THE\t\n \u00a0WHO\t\n \u00a0FRAMEWORK\t\n \u00a0CONVENTION\t\n \u00a0\nON\t\n \u00a0TOBACCO\t\n \u00a0CONTROL\t\n \u00a0\nAdopted by the 170th\nWMA Council Session, Divonne-les-Bains, France, May 2005\nThe World Medical Association\nWelcomes the recognition of the essential role of health professionals in tobacco control\nas the focus of World No Tobacco Day, 31 May 2005;\nRecognises the importance of the WHO Framework Convention on Tobacco Control\n(FCTC) in furthering the campaign to protect people from exposure and addiction to to-\nbacco;\nEncourages national medical associations to work assiduously and energetically to get\ntheir governments to ratify and implement the FCTC;\nUrges governments to introduce regulation and other measures as set out in the FCTC.\nGovernments should also introduce a ban on smoking in enclosed public places and work\nplaces as an urgent public health intervention;\nRecognises the vital role of health professionals in public health education and in support\nfor smoking cessation;\nCommits, with the other members of the World Health Professions Alliance, to mobilise\nhealth professionals in the fight to implement the FCTC and to reduce the human cost of\ntobacco.\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0CR-\u00ad\u20102006-\u00ad\u201001-\u00ad\u20102006\t\n \u00a0\nWMA\t\n \u00a0COUNCIL\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nIN\t\n \u00a0\t\n \u00a0\nSUPPORT\t\n \u00a0OF\t\n \u00a0THE\t\n \u00a0BOLIVIAN\t\n \u00a0MEDICAL\t\n \u00a0ASSOCIATION\t\n \u00a0\nAdopted by the 174th\nWMA Council Session, Pilanesberg, South Africa, October 2006\nThere are credible reports that arrangements between the Cuban government and the Boli-\nvian government to supply Cuban physicians to Bolivia are bypassing systems, esta-\nblished to protect patients, that have been set up to verify physicians' credentials and com-\npetence.\nThe World Medical Association is significantly concerned that patients are put at risk by\nunregulated medical practices, including the provision of drugs and medical supplies that\nare improperly labeled and of uncertain origin.\nThere exists already a duly constituted and legally authorized Bolivian Medical Associa-\ntion, which is charged with the registration of physicians and which is required to be con-\nsulted by the Bolivian Ministry of Health.\nTherefore, the WMA:\n1. Condemns any collusion of two countries in policies and practices that disrupt the\naccepted standards of medical credentialing and medical care;\n2. Calls upon the Bolivian government to work with the Bolivian Medical Association\non all matters related to physician certification and the practice of medicine and to\nrespect the role and rights of the Bolivian Medical Association;\n3. Urges, as a matter of utmost concern, that the Bolivian government respect the WMA\nInternational Code of Medical Ethics that guides the medical practice of physicians all\nover the world.\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nCR-\u00ad\u20102006-\u00ad\u201002-\u00ad\u20102006\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0COUNCIL\t\n \u00a0RESOLUTION\t\n \u00a0\nON\t\n \u00a0\nORGAN\t\n \u00a0DONATION\t\n \u00a0IN\t\n \u00a0CHINA\t\n \u00a0\nAdopted by the 173rd\nWMA Council Session, Divonne-les-Bains, France, May 2006\nWHEREAS, the WMA Statement on Human Organ and Tissue Donation and Trans-\nplantation stresses the importance of free and informed choice in organ donation; and\nWHEREAS, the statement explicitly states that prisoners and other individuals in custody\nare not in a position to give consent freely, and therefore their organs must not be used for\ntransplantation; and\nWHEREAS, there have been reports of Chinese prisoners being executed and their organs\nharvested for donation;\nTHEREFORE, the WMA reiterates its position that organ donation be achieved through\nthe free and informed consent of the potential donor.\nThe WMA demands that the Chinese Medical Association condemn any practice in viola-\ntion of these ethical principles and basic human rights and ensure that Chinese doctors are\nnot involved in the removal or transplantation of organs from executed Chinese prisoners.\nThe WMA demands that China immediately cease the practice of using prisoners as organ\ndonors.\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0CR-\u00ad\u20102009-\u00ad\u201001-\u00ad\u20102009\t\n \u00a0\nWMA\t\n \u00a0COUNCIL\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nSUPPORTING\t\n \u00a0THE\t\n \u00a0PRESERVATION\t\n \u00a0OF\t\n \u00a0\t\n \u00a0\nINTERNATIONAL\t\n \u00a0STANDARDS\t\n \u00a0OF\t\n \u00a0MEDICAL\t\n \u00a0NEUTRALITY\t\n \u00a0\nAdopted by the 182nd\nWMA Council Session, Tel Aviv, Israel, May 2009\nWHEREAS:\t\n \u00a0\n\t\n \u00a0\nRecent international conflicts, including the Israeli-Palestinian conflict in Gaza, the con-\nflict in Sri Lanka, the conflict in Darfur, and the conflict in the Democratic Republic of\nCongo, have led to loss of life and the impairment of living conditions; and International\nstandards of medical neutrality must be upheld throughout such conflicts;\nTHEREFORE,\t\n \u00a0the\t\n \u00a0WMA\t\n \u00a0\n\t\n \u00a0\n1. Reaffirms its policy, \"Regulations in Time of Armed Conflict\" and the obligations of\nphysicians stated in this document. The WMA calls on its members to act in accor-\ndance with all internationally accepted principles of healthcare delivery in times of\nconflict.\n2. Reiterates its commitment to the universal right to health, and access to the highest\nattainable standard of health care. This universal right is not conditional on peaceful\nexistence, although a peaceful existence accommodates greater ability to provide\nhealth to all.\n3. Reaffirms the obligation incumbent on all parties involved in conflict situations to\nabide by the rules of international medical ethics, a swell as the provisions of inter-\nnational humanitarian law, as expressed in the Geneva Conventions, particularly their\ncommon article 3, and, specifically, to assure the provision of medical care and\/or\nevacuation of the trapped and wounded and to refrain from targeting medical per-\nsonnel and medical facilities.\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nCR-\u00ad\u20102009-\u00ad\u201002-\u00ad\u20102009\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0COUNCIL\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nPROHIBITION\t\n \u00a0OF\t\n \u00a0PHYSICIAN\t\n \u00a0PARTICIPATION\t\n \u00a0IN\t\n \u00a0TORTURE\t\n \u00a0\nAdopted by the 182nd\nWMA Council Session, Tel Aviv, Israel, May 2009\nWHEREAS:\n\t\n \u00a0\nReports worldwide have alluded to deeply unsettling practices by health professionals,\nincluding direct participation in the infliction of ill-treatment, monitoring specific methods\nof ill-treatment, and participation in interrogation processes;\nTHEREFORE, the WMA\n\t\n \u00a0\n1. Reaffirms its Declaration of Tokyo: Guidelines for Physicians Concerning Torture and\nother Cruel, Inhuman or Degrading Treatment or Punishment in Relation to Detention\nand Imprisonment, which prohibits physicians from participating in, or even being pre-\nsent during, the practice of torture or other forms of cruel, inhuman or degrading proce-\ndures, and urges National Medical Associations to inform physicians and governments\nof the Declaration and its contents.\n2. Reaffirms its Declaration of Hamburg: Support for Medical Doctors Refusing to Partici-\npate in or to Condone the use of Torture or other Forms of Cruel, Inhuman or Degrad-\ning Treatment.\n3. Reaffirms its Resolution: Responsibility of Physicians in the Denunciation of Acts of\nTorture or Cruel or Inhuman or Degrading Treatment of Which they are Aware.\n4. Urges national medical associations to speak out in support of this fundamental princi-\nple of medical ethics and to investigate any breach of these principles by association\nmembers of which they are aware.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0CR-\u00ad\u20102012-\u00ad\u201001-\u00ad\u20102012\t\n \u00a0\nWMA\t\n \u00a0COUNCIL\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nDANGER\t\n \u00a0IN\t\n \u00a0HEALTH\t\n \u00a0CARE\t\n \u00a0IN\t\n \u00a0SYRIA\t\n \u00a0AND\t\n \u00a0BAHRAIN\t\n \u00a0\nAdopted by the 191st\nWMA Council Session, Prague, Czech Republic, April 2012\nThe WMA recognises that attacks on health care facilities, health care workers and\npatients are an increasingly common problem and the WMA Council denounces all such\nattacks in any country.\nThese often occur during armed conflict and also in other situations of violence, including\nprotests against the state. Patients, including those injured during protests, often come\nfrom the poorest and most marginalised parts of the community and suffer a higher pro-\nportion of serious health problems than those from wealthier backgrounds.\nGovernments have an obligation to ensure that health care facilities and those working in\nthem can operate in safety and without interference either from state or non-state actors,\nand to protect those receiving care.\nWhere services are not available to patients due to government action or inaction, the\ngovernment, not the health practitioners, should be held responsible.\nNoting that recent and ongoing conflicts in Bahrain and Syria have seen physicians, other\nhealth care personnel and their patients attacked while in health care facilities, the WMA\ndemands:\n1. That states fulfill their obligations to all their citizens and residents, including\npolitical protestors, patients and health care workers, and protect health care\nfacilities and their occupants from interference, intimidation or attack.\n2. That governments enter into meaningful negotiations wherever such attacks are\npossible, likely or already occurring to stop the attacks and protect the institutions\nand their occupants, and\n3. That governments consider how they can contribute positively to the work of the\nInternational Committee of the Red Cross on promoting the safety of health care\nprovision through awareness of the concepts within their project Health Care in\nDanger.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nCR-\u00ad\u20102012-\u00ad\u201002-\u00ad\u20102012\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0COUNCIL\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nTHREATS\t\n \u00a0TO\t\n \u00a0PROFESSIONAL\t\n \u00a0AUTONOMY\t\n \u00a0AND\t\n \u00a0\t\n \u00a0\nSELF-\u00ad\u2010REGULATION\t\n \u00a0IN\t\n \u00a0TURKEY\t\n \u00a0\nAdopted by the 191st\nWMA Council Session, Prague, Czech Republic, April 2012\nINTRODUCTION\t\n \u00a0\nThe WMA is extremely concerned about recent actions by the Turkish government that\ndrastically reduce the self-governing authority and professional autonomy of the medical\nprofession in Turkey. In particular, the newly enacted Government Decree 663 on the\nOrganization and Duties of the Ministry of Health and its Associated Organizations\nestablishes a Health Professions Board, controlled by the Ministry of Health, and delegates\nauthority to this Board for certain critical functions that should remain with the Turkish\nMedical Association in keeping with the principles of professional autonomy and physi-\ncian self governance. The Turkish Medical Association was established by the Turkish\nParliament in 1953, while Decree 663 was passed by the government ministers of Turkey\nin an extraordinary process that bypassed the Parliament.\nOf grave concern is the fact that the Turkish Medical Association no longer has the\nauthority to:\n\u2022 Establish and issue ethical guidelines concerning physician conduct\n\u2022 Conduct investigations regarding alleged malpractice by physicians\n\u2022 Determine disciplinary sanctions against physicians in cases of malpractice\n\u2022 Develop core curricula for medical education, post-graduate medical specialty curri-\ncula, and content and accreditation for continuing medical education (all of which\nwere previously done in partnership between the TMA and universities)\nIn addition, Decree 663 amends Article 1 of the Constituting Law of the Turkish Medical\nAssociation (originally drafted and adopted by the Parliament) by removing the following\nlanguage in the TMA's mandate: \"ensuring that medical profession is practiced and\npromoted in line with public and individual well-being and benefit\". As a result of this\nrestriction of its mandate, the TMA no longer has the right to legally challenge actions and\nregulations that adversely affect the right to health, the provision of health care, public\nhealth, and individual patient well-being. Examples might include, for instance, efforts\nagainst restrictions on which medical procedures would be reimbursed under the national\nhealth system or initiation of action to address public health hazards such as the use of\ncyanide in silver and gold mining and processing. The narrowing of the TMA's mandate in\nthis regard not only diminishes the independence of physicians, but also jeopardizes the\nhealth of their patients.\n\t\n \u00a0\n\t\n \u00a0Prague\t\n \u00a0\u23d0\uf8e6\t\n \u00a0CR-\u00ad\u20102012-\u00ad\u201002-\u00ad\u20102012\t\n \u00a0\nProfessional\t\n \u00a0Autonomy\t\n \u00a0and\t\n \u00a0Self-\u00ad\u2010regulation\t\n \u00a0in\t\n \u00a0Turkey\t\n \u00a0\nTHEREFORE:\t\n \u00a0\nReaffirming its unequivocal commitment to the independence and professional self-\ngovernance of the medical profession, as defined in the WMA Declaration of Madrid on\nProfessional Autonomy and Self-Regulation, and the WMA Resolution on the Indepen-\ndence of National Medical Associations, the WMA Council:\n1. Urges the Turkish government to rescind Decree 663 and restore to the Turkish\nMedical Association its duties and responsibilities for professional autonomy and\nself regulation, properly established by the Parliament in 1953 through the legiti-\nmate and transparent national democratic process.\n2. Urges all physician members of Parliament, regardless of political affiliation, to\nrecall their duties as physician leaders and support the right of the medical pro-\nfession to autonomy and self-regulation.\n3. Supports and commends the Turkish Medical Association and those members of\nthe Turkish Parliament who have challenged these recent actions and requested a\nlegal review of this Decree by the Constitutional Court.\n4. Calls on all physicians in Turkey and around the world to join actively in advocacy\nefforts to promote and support professional independence, the right to health, and\nthe health of the people of Turkey.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nCR-\u00ad\u20102012-\u00ad\u201003-\u00ad\u20102012\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0COUNCIL\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nTHE\t\n \u00a0AUTONOMY\t\n \u00a0OF\t\n \u00a0PROFESSIONAL\t\n \u00a0ORDERS\t\n \u00a0IN\t\n \u00a0WEST\t\n \u00a0AFRICA\t\n \u00a0\nAdopted by the 191st\nWMA Council Session, Prague, Czech Republic, April 2012\nPREAMBLE\t\n \u00a0\nThe Economic and Monetary Union of West Africa (Union Economique et Mon\u00e9taire\nOuest Africaine; UEMOA) brings together eight countries of West Africa using CFA\nFranc as a currency. This tool of integration advocates for the free circulation and settle-\nment of physicians in the countries of UEMOA.\nThere is a College of the Orders of Physicians, bringing together the Orders of member\ncountries of the Union. The Orders are often under the supervision of the health ministries.\nThis situation often confines the technical and administrative autonomy and impedes the\ngood management of the medical mapping of the region, undermining access to health\ncare for the populations.\nRECOMMENDATION\t\n \u00a0\nReiterating its Declaration of Madrid on Professional Autonomy and Self-Regulation and\nits Resolution on the Independence of National Medical Associations, the WMA requests\nthat the independence, professional autonomy and self-regulation be guaranteed within the\ncountries of the Economic and Monetary Union of West Africa.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0CR-\u00ad\u20102013-\u00ad\u201001-\u00ad\u20102013\t\n \u00a0\nWMA\t\n \u00a0COUNCIL\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nPROFESSOR\t\n \u00a0CYRIL\t\n \u00a0KARABUS\t\n \u00a0\nAdopted by the 194th\nWMA Council Session, Bali, Indonesia, April 2013\nThe World Medical Association is extremely concerned that Professor Cyril Karabus, a\nretired paediatric oncologist remains remanded on bail in the UAE despite a long and slow\njudicial process, which has absolved him of all the charges against him.\nThe WMA notes that the expert medical panel, appointed by the court to advise it whether\nthere was any evidence against Professor Karabus, has advised the judge that Professor\nKarabus has no case to answer. Consequently the judge dismissed all charges and a ruling\nof not guilty was given. It also notes with concern that the prosecutors have indicated they\nwill appeal the courts ruling meaning that Professor Karabus needs to remain in the UAE\nindefinitely.\nGiven the findings of the medical panel, the WMA believes that Professor Karabus is\nbeing treated in a manner, which fails to meet international fair trial standards and should\nbe allowed to return home immediately.\nIn light of the above experience, the WMA will publish an advisory notice in the WMJ\nand on the WMA website to advise doctors thinking of working in the UAE to note the\nworking conditions and the legal risks of employment there. The WMA will encourage\nmember NMAs to publish similar advisory notices in their national publications.\n\t\n \u00a0\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nCR-\u00ad\u20102013-\u00ad\u201002-\u00ad\u20102013\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0COUNCIL\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nCRIMINALISATION\t\n \u00a0OF\t\n \u00a0MEDICAL\t\n \u00a0PRACTICE\t\n \u00a0\nAdopted by the 194th\nWMA Council Session, Bali, Indonesia, April 2013\nPREAMBLE\t\n \u00a0\n\t\n \u00a0\nDoctors who commit criminal acts which are not part of patient care must remain as liable\nto sanctions as all other members of society. Serious abuses of medical practice must be\nsubject to sanctions, usually through professional regulatory processes.\nNumerous attempts are made by governments to control physicians\u2019 practice of medicine\nat local, regional and national levels worldwide. Physicians have seen attempts to:\n\u2022 Prevent medically indicated procedures;\n\u2022 Mandate medical procedures that are not indicated; and\n\u2022 Mandate certain drug prescribing practices.\nCriminal penalties have been imposed on physicians for various aspects of medical prac-\ntice, including medical errors, despite the availability of adequate non-criminal redress.\nCriminalizing medical decision making is a disservice to patients.\nIn times of war and civil strife, there have also been attempts to criminalize compassionate\nmedical care to those injured as a result of these conflicts.\nRECOMMENDATIONS\t\n \u00a0\nTherefore, the WMA recommends that its members:\n1. Oppose government intrusions into the practice of medicine and in healthcare\ndecision making, including the government\u2019s ability to define appropriate medical\npractice through imposition of criminal penalties.\n2. Oppose criminalizing medical judgment.\n3. Oppose criminalizing healthcare decisions, including physician variance from\nguidelines and standards.\n4. Oppose criminalizing medical care provided to patients injured in civil conflicts.\n\t\n \u00a0\n\t\n \u00a0Bali\t\n \u00a0\u23d0\uf8e6\t\n \u00a0CR-\u00ad\u20102013-\u00ad\u201002-\u00ad\u20102013\t\n \u00a0\nCriminalisation\t\n \u00a0of\t\n \u00a0Medical\t\n \u00a0Practice\t\n \u00a0\n5. Implement action plans to alert opinion leaders, elected officials and the media\nabout the detrimental effects on healthcare that result from criminalizing healthcare\ndecision making.\n6. Support the principles set forth in the WMA\u2019s Declaration of Madrid on Profes-\nsional Autonomy and Self-Regulation.\n7. Support the guidance set forth in the WMA\u2019s Regulations in Times of Armed Con-\nflict and Other Situations of Violence.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nCR-\u00ad\u20102013-\u00ad\u201003-\u00ad\u20102013\t\n \u00a0\u23d0\uf8e6\t\n \u00a0World\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\t\n \u00a0\nWMA\t\n \u00a0COUNCIL\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nSTANDARDISATION\t\n \u00a0IN\t\n \u00a0MEDICAL\t\n \u00a0PRACTICE\t\n \u00a0AND\t\n \u00a0PATIENT\t\n \u00a0SAFETY\t\n \u00a0\nAdopted by the 194th\nWMA Council Session, Bali, Indonesia, April 2013\nEnsuring patient safety and quality of care is at the core of medical practice. For patients, a\nhigh level of performance can be a matter of life or death. Therefore, guidance and stand-\nardisation in healthcare must be based on solid medical evidence and has to take ethical\nconsiderations into account.\nCurrently, trends in the European Union can be observed to introduce standards in clinical,\nmedical care developed by non-medical standardisation bodies, which neither have the\nnecessary professional ethical and technical competencies nor a public mandate.\nThe WMA has major concerns about such tendencies which are likely to reduce the\nquality of care offered, and calls upon governments and other institutions not to leave\nstandardisation of medical care up to non-medical self selected bodies.\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0CR-\u00ad\u20102015-\u00ad\u201001-\u00ad\u20102015\t\n \u00a0\nWMA\t\n \u00a0COUNCIL\t\n \u00a0RESOLUTION\t\n \u00a0\t\n \u00a0\nON\t\n \u00a0\t\n \u00a0\nTRADE\t\n \u00a0AGREEMENTS\t\n \u00a0AND\t\n \u00a0PUBLIC\t\n \u00a0HEALTH\t\n \u00a0\nAdopted by the 200th\nWMA Council Session, Oslo, Norway, April 2015\nPREAMBLE\t\n \u00a0\nTrade agreements are sequelae of globalization and seek to promote trade liberalization.\nThey can have a significant impact on the social determinants of health and thus on public\nhealth and the delivery of health care.\nTrade agreements are designed to produce economic benefits. Negotiations should take\naccount of their potential broad impact especially on health and ensure that health is not\ndamaged by the pursuit of potential economic gain.\nTrade agreements may have the ability to promote the health and wellbeing of all people,\nincluding by improving economic structures, if they are well constructed and protect the\nability of governments to legislate, regulate and plan for health promotion, health care de-\nlivery and health equity, without interference.\nBACKGROUND\t\n \u00a0\nThere have been many trade agreements negotiated in the past. New agreements under\nnegotiation include the Trans Pacific Partnership (TPP),1\nTrans Atlantic Trade and Invest-\nment Partnership (TTIP)2\nthe Trade in Services Agreement (TiSA) and the Comprehensive\nEconomic and Trade Agreement (CETA).3\nThese negotiations seek to establish a global governance framework for trade and are un-\nprecedented in their size, scope and secrecy. A lack of transparency and the selective\nsharing of information with a limited set of stakeholders are anti-democratic.\nInvestor-state dispute settlement (ISDS) provides a mechanism for investors to bring\nclaims against governments and seek compensation, operating outside existing systems of\naccountability and transparency. ISDS in smaller scale trade agreements has been used to\nchallenge evidence-based public health laws including tobacco plain packaging. Inclusion\nof a broad ISDS mechanism could threaten public health actions designed to effect to-\nbacco control, alcohol control, regulation of obesogenic foods and beverages, access to\nmedicines, health care services, environmental protection\/climate change and occupational\n\/ environmental health improvements. This especially in nations with limited access to re-\nsources.\n\t\n \u00a0\n\t\n \u00a0CR-\u00ad\u20102015-\u00ad\u201001-\u00ad\u20102015\t\n \u00a0\u23d0\uf8e6\t\n \u00a0Oslo\t\n \u00a0\nTrade\t\n \u00a0Agreements\t\n \u00a0and\t\n \u00a0Public\t\n \u00a0Health\t\n \u00a0\nAccess to affordable medicines is critical to controlling the global burdens of communica-\nble and non-communicable diseases. The World Trade Organization\u2019s Agreement on\nTrade-Related Aspects of Intellectual Property Rights (TRIPS) established a set of com-\nmon international rules governing the protection of intellectual property including the\npatenting of pharmaceuticals. TRIPS safeguards and flexibilities including compulsory\nlicensing seek to ensure that patent protection does not supersede public health.4\nTiSA may impact on eHealth provision by changing rules in licensing and telecoms. Its\nimpact on the delivery of eHealth could be substantial and damage the delivery of com-\nprehensive, effective, cost-effective efficient health care.\nThe WMA Statement on Patenting Medical Procedures states that patenting of diagnostic,\ntherapeutic and surgical techniques is unethical and \u201cposes serious risks to the effective\npractice of medicine by potentially limiting the availability of new procedures to\npatients.\u201d\nThe WMA Statement on Medical Workforce states that the WMA has recognized the\nneed for investment in medical education and has called on governments to \u201c\u2026allocate\nsufficient financial resources for the education, training, development, recruitment and\nretention of physicians to meet the medical needs of the entire population\u2026\u201d\nThe WMA Declaration of Delhi on Health and Climate Change states that global climate\nchange has had and will continue to have serious consequences for health and demands\ncomprehensive action.\nRECOMMENDATION\t\n \u00a0\nTherefore the WMA calls on national governments and national member associations to:\n1. Advocate for trade agreements that protect, promote and prioritize public health over\ncommercial interests and ensure wide exclusions to secure services in the public inter-\nest, especially those impacting on individual and public health. This should include\nnew modalities of health care provision including eHealth, Tele-Health, mHealth and\nuHealth.\n2. Ensure trade agreements do not interfere with governments\u2019 ability to regulate health\nand health care, or to guarantee a right to health for all. Government action to protect\nand promote health should not be subject to challenge through an investor-state\ndispute settlement (ISDS) or similar mechanism.\n3. Oppose any trade agreement provisions which would compromise access to health\ncare services or medicines including but not limited to:\n\u2022 Patenting (or patent enforcement) of diagnostic, therapeutic and surgical tech-\nniques;\n\u2022 \u201cEvergreening\u201d, or patent protection for minor modifications of existing drugs;\n\u2022 Patent linkage or other patent term adjustments that serve to as a barrier to generic\nentry into the market;\n\u2022 Data exclusivity for biologics;\n\t\n \u00a0\n\t\n \u00a0\nHandbook\t\n \u00a0of\t\n \u00a0WMA\t\n \u00a0Policies\t\n \u00a0\nWorld\t\n \u00a0Medical\t\n \u00a0Association\t\n \u00a0\u23d0\uf8e6\t\n \u00a0CR-\u00ad\u20102015-\u00ad\u201001-\u00ad\u20102015\t\n \u00a0\n\t\n \u00a0\t\n \u00a0\t\n \u00a0\n\u2022 Any effort to undermine TRIPS safeguards or restrict TRIPS flexibilities including\ncompulsory licensing;\n\u2022 Limits on clinical trial data transparency.\n4. Oppose any trade agreement provision which would reduce public support for or\nfacilitate commercialization of medical education.\n5. Ensure trade agreements promote environmental protection and support efforts to re-\nduce activities that cause climate change.\n6. Call for transparency and openness in all trade agreement negotiations including\npublic access to negotiating texts and meaningful opportunities for stakeholder\nengagement.\n1\nTPP negotiations currently include twelve parties: the United States, Canada, Mexico, Peru,\nChile, Australia, New Zealand, Brunei, Singapore, Malaysia, Japan and Vietnam.\n2\nTTIP negotiations currently include the European Union and the United States.\n3\nCETA negotiations currently include European Union and Canada.\n4\nSee World Trade Organization, Declaration on TRIPS and Public Health (\u201cDoha Declaration\u201d)\n(2001)\n\n<\/p>\n"},"caption":{"rendered":"<p>HB-E-2015-1 \u00a0 \u00a0 Handbook \u00a0of \u00a0WMA \u00a0Policies \u00a0 The \u00a0World \u00a0Medical \u00a0Association, \u00a0Inc. \u00a0 \u00a0 \u00a0 \u00a0Version \u00a0History \u00a0 \u00a0 \u00a0 \u00a9 \u00a0The \u00a0World \u00a0Medical \u00a0Association, \u00a0Inc. \u00a0 \u00a0 \u00a0 Version \u00a02010, \u00a0Vancouver; \u00a0Printed \u00a0in \u00a0March \u00a02011 \u00a0 Version \u00a02011, \u00a0Montevideo; \u00a0Printed \u00a0in \u00a0December \u00a02011 \u00a0 \u00a0 \u2022 Replacements \u00a0 Code \u00a0 Short \u00a0Title \u00a0 [&hellip;]<\/p>\n"},"alt_text":"","media_type":"file","mime_type":"application\/pdf","media_details":{},"post":928,"source_url":"https:\/\/www.wma.net\/wp-content\/uploads\/2016\/11\/HB-E-2015-1.pdf","_links":{"self":[{"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/media\/7355"}],"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\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/comments?post=7355"}]}}