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wmj201404<\/a><\/p>\n

COUNTRY
\n\u2022 Council Session and General Assembly. South
\nAfrica,Durban
\n\u2022 Anniversary of the Declaration of Helsinki
\nvol. 60
\nMedicalWorld
\nJournal
\nOfficial Journal of the World Medical Association, INC
\nG20438
\nNr. 4, December 2014
\nh
\nCover picture from LATVIA
\nEditor in Chief
\nDr. P\u0113teris Apinis
\nLatvian Medical Association
\nSkolas iela 3, Riga, Latvia
\nPhone +371 67 220 661
\npeteris@arstubiedriba.lv
\neditorin-chief@wma.net
\nCo-Editor
\nProf. Dr. med. Elmar Doppelfeld
\nDeutscher \u00c4rzte-Verlag
\nDieselstr. 2, D-50859 K\u00f6ln, Germany
\nAssistant Editor
\nVelta Poz\u0146aka
\nwmj-editor@wma.net
\nJournal design and
\ncover design by
\nP\u0113teris Gricenko
\nLayout and Artwork
\nThe Latvian Medical Publisher
\n\u201cMedic\u012bnas apg\u0101ds\u201d,
\nPresident Dr. Maija \u0160etlere,
\nKatr\u012bnas iela 2, Riga, Latvia
\nCover painting by Latvian graphic artist
\nGuntars\u00a0Sieti\u0146\u0161, 1994
\nPublisher
\nThe World Medical Association, Inc. BP 63
\n01212 Ferney-Voltaire Cedex, France
\nPublishing House
\nPublishing House
\nDeutscher-\u00c4rzte Verlag GmbH,
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\nThe magazine is published bi-mounthly.
\nSubscriptions will be accepted by
\nDeutscher \u00c4rzte-Verlag or
\nthe World Medical Association
\nSubscription fee \u20ac 22.80 per annum (incl. 7%
\nMwSt.). For members of the World Medical
\nAssociation and for Associate members the
\nsubscription fee is settled by the membership
\nor associate payment. Details of Associate
\nMembership may be found at the World
\nMedical Association website
\nwww.wma.net
\nPrinted by
\nDeutscher \u00c4rzte-Verlag
\nCologne, Germany
\nISSN: 0049-8122
\nDr. Xavier DEAU
\nWMA President
\nConseil National de l\u2019Ordre des
\nM\u00e9decins (CNOM)
\n180, Blvd. Haussmann
\n75389 Paris Cedex 08
\nFrance
\nDr. Leonid EIDELMAN
\nWMA Chairperson of the Finance
\nand Planning Committee
\nIsrael Medical Asociation
\n2 Twin Towers, 35 Jabotinsky St.
\nP.O.Box 3566, Ramat-Gan 52136
\nIsrael
\nDr. Masami ISHII
\nWMA Vice-Chairman of Council
\nJapan Medical Assn
\n2-28-16 Honkomagome
\nBunkyo-ku
\nTokyo 113-8621
\nJapan
\nDr. Margaret MUNGHERERA
\nWMA Immediate Past-President
\nUganda Medical Association
\nPlot 8, 41-43 circular rd., P.O. Box
\n29874
\nKampala
\nUganda
\nJoseph M.HEYMAN,MD,FACOG
\nWMA Chairperson
\nof the Associate Members
\n163\u00a0Middle Street
\nWest Newbury, Massachusetts 01985
\nUnited States
\nProf. Dr. Frank Ulrich
\nMONTGOMERY
\nWMA Treasurer
\nBundes\u00e4rztekammer
\nHerbert-Lewin-Platz 1
\n(Wegelystrasse)
\n10623 Berlin
\nGermany
\nSir Michael MARMOT
\nWMA President-Elect
\nBritish Medical Association
\nBMA House,Tavistock Square
\nLondon WC1H 9JP
\nUnited Kingdom
\nDr. Heikki P\u00c4LVE
\nWMA Chairperson of the Medical
\nEthics Committee
\nFinnish Medical Association
\nP.O. Box 49
\n00501 Helsinki
\nFinland
\nDr. Mukesh HAIKERWAL
\nWMA Chairperson of Council
\n2\/174 Millers Road\/PO Box 577
\nAltona North, VIC 3025
\nAustralia
\nDr. Otmar KLOIBER
\nSecretary General
\nWorld Medical Association
\n13 chemin du Levant
\n01212 Ferney-Voltaire
\nFrance
\nWorld Medical Association Officers, Chairpersons and Officials
\nOfficial Journal of the World Medical Association
\nOpinions expressed in this journal\u00a0\u2013 especially those in authored contributions\u00a0\u2013 do not necessarily reflect WMA policy or positions
\nwww.wma.net
\n121
\nWMA News
\nThe Declaration of Helsinki (DoH) trans-
\nlates the willingness of the World Medical
\nAssociation and its Founding President,
\nEug\u00e8ne Marquis, French Physician, to
\nbring the ethics of medical practice and
\nresearch at the highest level with a twofold
\ngoal:
\n\u2022 to ensure a universality of ethics in re-
\nsearch on human beings as well as the
\nprotection of people subjected to these
\nresearches.
\n\u2022 to make definitely impossible the horrible
\nabuse of Medicine encountered during
\nthe thirties and forties.
\nThese ethical principles are often translated
\ninto the codes of Ethics of each country
\nor laid down in the resolutions of interna-
\ntional organisms which are usual partners
\nof the Word Medical Association (WHO,
\nUNESCO, UNITED NATIONS, ICRC..)
\nAnd Governments felt encouraged to include the DoH principles
\ninto their legislation.
\nThis Declaration conciles with pragmatism and wisdom \u201cprimacy
\nof the individual\u201d dear to and the \u201csocietal primacy\u201d. This raises
\nawareness of the physician to the fundamental importance of the
\ninformed consent and information of the
\npatient, the secrecy of personal and espe-
\ncially patient data, and the value of the pro-
\nfessional autonomy of the physician., Under
\nthe aegis of independent research commit-
\ntees, the DoH rigorously codifies the scien-
\ntific studies and trials, and in particular, the
\nprotection of the research subjects against
\ndangerous experiments and exploitation.
\nThe declaration commands the application
\nof the necessary scientific rigor, including
\nthe usage of placebos when necessary.
\nThe sustainability of the DoH is a shining
\nexample of universality of medical ethics.
\nEven if its drafting seemed to be labori-
\nous, our Declaration of Helsinki has the
\nmerit to be a historical and yet modern
\ndocument, compiling the cultures of more
\nthan 100\u00a0medical associations.Thus, it is an
\nauthentic factor of peace and union between medical professions
\naround the world in full respect for the patients for who we care.
\nThe DoH ensures a rigorous application of sciens as well as the eth-
\nics on the grounds of a genuine respect for the patient and human
\nrights we are caring for.
\nDr. Xavier DEAU
\nWMA President
\nEditorial
\nXavier Deau
\n122
\nWMA News
\nWednesday October 8
\nAt the invitation of the South African
\nMedical Association,delegates from 46 Na-
\ntional Medical Associations met at the In-
\nternational Convention Centre in Durban,
\nSouth Africa from October 8\u201311.
\nCouncil
\nDr. Mukesh Haikerwal AO, Chair of the
\nWMA, opened the 198th
\nCouncil session.
\nThe Secretary General, Dr. Otmar Kloiber,
\nwelcomed a new member of the Council,
\nDr. Steven J. Stack (American Medical
\nAssociation) and gave apologies from del-
\negates from Austria and Brazil, welcoming
\ntheir replacements, Dr. Reiner Bretten-
\nthaler (Austria) and Dr. Miguel R. Jorge
\n(Brazil).
\nPresident\u2019s report
\nThe President, Dr. Margaret Mungherera,
\nreported on her activities since April, vis-
\niting many national medical associations.
\nShe said she had attended several mental
\nhealth meetings and many countries did
\nnot have mental health policies or laws.
\nIn addition no mention had been made of
\nmental health in the post 2015 sustainable
\ndevelopment goals. On the African de-
\nvelopment initiative, she said the findings
\nfrom a survey carried out among African
\nNMAs justified the need for a capacity
\nbuilding programme. She spoke about the
\nimportance of strengthening NMA activi-
\nties and continuing professional develop-
\nment and the need for training. There was
\nalso a need to work on universal health
\ncoverage and the social determinants of
\nhealth.
\nShe said there were now twinning arrange-
\nments between the New Zealand Medical
\nAssociation and Tanzania, the Danish and
\nRwanda, and Japan and Malawi.
\nFinally, she referred to the fact that there
\nwere 33 African NMAs that were not
\nmembers of the WMA. The plan was that
\nevery year at least four NMAs joined and
\nthis year four had applied to join \u2013 Zambia,
\nKenyan, Rwanda and Lesotho.
\nInfluenza
\nDr. Julia Tainijoki-Seyer, WMA medical
\nadviser, updated the meeting about the next
\nstage of the WMA\u2019s influenza campaign,
\nwhich was to be launched the following day.
\nThis was based on encouraging physicians
\nto become role models and to meet their
\nethical obligations to protect their patients.
\nThe evidence was that if physicians got vac-
\ncinated they were more likely to ask their
\npatients to be vaccinated. She said a micro
\nsite as part of the WMA website had been
\ndeveloped to enable greater use of digital
\nand social media to get this message across.
\nThe micro site was being launched the fol-
\nlowing day.
\nChair\u2019s report
\nDr. Haikerwal reported briefly on his ac-
\ntivities over the past year, including the
\nsuccessful Council meetings in Bali, Indo-
\nnesia and Fortaleza, Brazil. The year had
\nproceeded with the usual full, diverse and
\nintense agendas pursued with consider-
\nation and in a timely way. He emphasised
\nthree important thoughts \u2013 that health was
\na core component of a successful fair and
\njust society, a wise investment bringing hu-
\nman, political and economic dividends and
\nthat physicians were part of the solution
\nin health and healthcare research planning
\nimplementation.
\nResolution on Ebola Viral Disease
\nProfessor Vivienne Nathanson (British
\nMedical Association) introduced an emer-
\ngency Resolution on Ebola. She said this
\nwas a global problem, but some govern-
\nments had been treating it as a local prob-
\nlem for a few countries in West Africa.
\nHowever, because of air travel every coun-
\ntry was affected. At the moment Ebola was
\ndisproportionately affecting countries with
\nthe least money to deal with it and the
\npoorest infrastructures because of their rel-
\native poverty. She said that although some
\ncountries had been doing a lot, there were
\nmany countries who could do more to help.
\nThere were also many health staff who were
\ntrying to deal with this crisis who were not
\nbeing given the facilities to do this safely.
\nNor did they have the contact tracing facil-
\nities to help them shut this epidemic down.
\nShe said the WMA should be supporting
\ntheir colleagues in Sierra Leona, Guinea
\nand Liberia and saying something to force
\ngovernments to recognise that this was a
\nglobal.
\nThis led to a lengthy debate, with several
\nproposals being suggested for amending
\nthe proposed Resolution. Dr. Ardis Hoven
\n(American Medical Association) suggested
\nan amendment urging all countries, es-
\npecially those not yet affected, to educate
\nhealth care providers about the current case
\ndefinition. In addition they should be edu-
\ncated about strengthening infection control
\nmethodologies and contact tracing to pre-
\nvent transmission in their countries. She
\nsaid it was important for everyone to \u2018gird
\nup their borders\u2019.Her proposed amendment
\nwas accepted by the Council.
\nDr. Ames Dhai (South Africa) suggested
\nincluding support for the use of unproven
\ninterventions for the treatment of patients
\nwith the Ebola virus. However, Dr. Na-
\nthanson said the proposed Resolution was
\nWMA 2014 General Assembly Report
\nDurban, South Africa, October 8\u201311
\n123
\nWMA News
\nabout providing resources to manage the
\nepidemic. She was not sure that unproven
\ntreatment should be part of the recommen-
\ndations. It was an extraordinarily complex
\nissue that required a much longer explana-
\ntion. Dr. Ajay Kumar (India) also opposed
\nintroducing the issue of unproven treat-
\nment, while Dr. Heikki P\u00e4lve (Finland)
\nagreed that it was outside the scope of the
\nresolution.
\nThe amendment proposed by Dr. Dhai was
\neventually withdrawn.
\nDr. P\u00e4lve proposed an addition that nation-
\nal medical associations should urge their
\ngovernments to act on the WMA\u2019s recom-
\nmendations in the Resolution. The Presi-
\ndent, Dr. Mungherera, said she would like
\nto see a recommendation that international
\nagencies work with the medical experts on
\nthe ground. These experts and local physi-
\ncians felt they were being ignored, she said.
\nThese suggestions were accepted.
\nDr. Xaviour Walker, Past Chair of the Ju-
\nnior Doctors Network, wanted to see a ref-
\nerence in the Resolution to the special role
\nthat junior physicians faced with inadequate
\nprotection equipment and supervision.
\nHowever, this did not find support.
\nDr. Juan Rodriguez Sendin (Spanish Med-
\nical Association) reported on the situation
\nin Spain where a nurse had been infected
\nafter being in contact with a patient suf-
\nfering from Ebola. Other speakers com-
\nplained about the inaccurate information
\nappearing on social media. Dr Yoshitake
\nYokokura (Japan) reported on activities
\nin his country, while Dr. Mungherera sug-
\ngested that the issue of prevention and
\nhealth promotion should be considered.
\nShe was particularly concerned that these
\nfevers were common in Africa and there
\nwas a need for joint animal-human disease
\nsurveillance.
\nEventually, the emergency Resolution, as
\namended, was approved.
\nCouncil was then suspended for the three
\ncommittee meetings
\nSocio Medical Affairs Committee
\nSir Michael Marmot, Chair of the Com-
\nmittee, in his opening remarks, referred
\nto progress on the social determinants of
\nhealth. He reported that a joint letter had
\nbeen sent to UN Secretary General Ban Ki-
\nmoon from the British Medical Associa-
\ntion, the NCD Alliance, the International
\nPlanned Parenthood Federation and many
\nother concerned organisations drawing his
\nattention to the fact that most of the sus-
\ntainable goals impacted on health and that,
\nas a consequence, social determinants of
\nhealth should be fully mainstreamed in the
\nprocess. The WMA leadership had signed
\nthe letter.
\nHe also raised the opportunity of develop-
\ning collaboration with the World Psychi-
\natric Association with a view to making
\nmental health a public health issue. The
\nnewly-elected President of the WPA, Dr.
\nDinesh Bhugra, whom he met with recent-
\nly, welcomed future such collaboration with
\nthe WMA.
\nFinally, Sir Michael informed the commit-
\ntee that three WHO regional offices (Eu-
\nrope, PAHO and EMRO) had made health
\nequity a main objective within the frame-
\nwork of their activities. As a consequence,
\na process for health equity and social deter-
\nminants of health has been set up.
\nDr. Kloiber, Secretary General, reported on
\nthree items of interest to the committee.
\nThe first was the trial of the Turkish Medi-
\ncal Association, which had begun the pre-
\nvious week in Turkey, following the health
\ncare given by doctors during the Gezi Park
\ndemonstrations. Dr. Kloiber said he had
\nattended the opening of trial on behalf of
\nthe WMA. The Standing Committee of
\nEuropean Doctors and Physicians for Hu-
\nman Rights were also present. But unfor-
\ntunately the court did not dismiss the case
\nas requested, but postponed the trial until
\nDecember 23.
\nThe second item was that, on the initia-
\ntive of the government of Norway, a group
\nof countries had been working on a draft
\nresolution on the protection of health care
\npersonnel in situations of armed conflicts
\nand other emergencies for submission to
\nthe United Nations General Assembly. The
\nWMA had been consulted about this.
\nThe final issue was the fruitful coopera-
\ntion with the World Veterinary Association
\n(WVA). The WMA was currently working
\nwith the WVA on an international confer-
\nence on zoonosis in Madrid in 2015.
\nHealth Care in Danger
\nDr. Nathanson (British Medical Associa-
\ntion), Chair of the Work Group on Health
\nCare in Danger, reported on the activities
\nof the group. Dr. Bruce Eshaya-Chauvin,
\nof the International Committee of the Red
\nCross, had presented a detailed report on
\nthe HCiD project. Members of the group
\nagreed to reflect further on how the WMA
\nand its members could bring forward issues
\nat the national level.
\nThe group had also discussed the issue of
\nviolence against health care workers out-
\nside of armed conflicts, in particular in the
\narea of mental health. It was now working
\non a revision of the current WMA policy
\non Ethical Issues Concerning Patients with
\nMental Illness and planned to consult the
\nWorld Psychiatric Association.
\nDr. Nathanson concluded by informing the
\ncommittee that she was working on the de-
\nvelopment of a booklet for doctors in situa-
\ntions of violence.
\nViolence against Women & Girls
\nSir Michael Marmot reported on the suc-
\ncessful seminar organized by the WMA
\n124
\nWMA News
\nand the International Federation of Medi-
\ncal Students Associations in Geneva dur-
\ning the World Health Assembly last May.
\nThe event was very well attended, reflecting
\nthe strong interest of the health community
\nto engage further in this area. In terms of
\nfollow-up, the Chair proposed convening
\na small meeting of interested NMAs at
\nthe BMA in London to consider how the
\nWMA could continue working on address-
\ning violence against women. Medical as-
\nsociations from the Netherlands, India and
\nSouth Africa had expressed an interest in
\nattending.
\nRole of Physicians and NMAs, SDH and
\nHealth Equity
\nThe committee received a report of Dr.
\nJeff Blackmer (Canadian Medical Asso-
\nciation) on the international meeting on
\nsocial determinants of health which would
\ntake place on March 24\u201325 at the British
\nMedical Association in London. Invita-
\ntions had been sent out and many medical
\nassociations had already confirmed their
\nparticipation or expressed an interest. Dr.
\nAndr\u00e9 Bernard (Canadian Medical Asso-
\nciation) underlined that this was expected
\nto be a high level meeting, providing a real
\nopportunity for NMAs to explore potential
\nactions in terms of SDH.
\nMedical Education
\nDr. Andreas Rudkjoebing (Danish Medi-
\ncal Association) reported on the activities of
\nthe Work Group on Medical Education on
\nproviding guidance to the World Federa-
\ntion of Medical Education on their revision
\nof their global standards for post gradu-
\nate medical education. He thanked group
\nmembers (South Africa, Netherlands and
\nJDN) for their useful input.
\nRole of Physicians in Preventing the Traffick-
\ning with Minors and Illegal Adoptions
\nDr. Fernando Rivas (Spain), Chair of the
\nWork Group, informed the committee that
\na new draft of a Resolution on the Role of
\nPhysicians in Preventing the Trafficking
\nwith Minors would be submitted at the next
\nCouncil meeting in Oslo in April 2015.
\nPhysicians\u2019 Well-being
\nDr. Robert Wah (American Medical As-
\nsociation), Chair of the Work Group on
\nPhysicians\u2019 Well-being, reported that the
\ngroup had been busy since being set up last
\nApril. It had held a meeting the previous
\nday, during which it worked on a first draft
\nproposal. It hoped to have a final propos-
\nal ready for the next Council meeting in
\nOslo.
\nNon-Commercialization of Human Repro-
\nductive Material
\nThe committee considered the proposed
\nrevision of the WMA Resolution on the
\nNon-Commercialization of Human Repro-
\nductive Material, which called on NMAs
\nto urge their governments to prohibit com-
\nmercial transactions in human ova, sperm
\nand embryos and any human material for
\nreproductive purpose. Following further
\ninformal discussions the committee agreed
\nseveral amendments and recommended
\nthat the document be sent to the Council
\nfor adoption by the Assembly.
\nAesthetic Treatments
\nThe committee considered the proposed
\nWMA Statement on Aesthetic Treat-
\nments, a document that combined draft
\ndocuments originally submitted by the
\nIsraeli and Swedish medical associations.
\nThe statement expressed concern that
\nin many countries aesthetic procedures
\nwere not adequately regulated and it set
\nout new guidelines, primarily for physi-
\ncians, warning that many treatments in-
\nvolved risks and might potentially harm
\nthe health of patients. There was a brief
\ndebate about prohibiting advertisements
\nshowing patients before and after opera-
\ntions and it was agreed to strengthen the
\ndocument to read that \u2018unrealistic or al-
\ntered photographs showing patients before
\nand after treatments must not be used in
\nadvertising\u2019. Suggestions were put forward
\nfor stating that only \u2018qualified\u2019 physicians
\nshould be allowed to carry out these treat-
\nments. However, this was opposed and in-
\nstead it was agreed to amend the document
\nto read that \u2018aesthetic treatments must only
\nbe performed by practitioners with suffi-
\ncient knowledge, skills and experience of
\nthe interventions performed\u2019.
\nThe committee recommended that the pro-
\nposed Statement, as amended, be approved
\nby the Council and forwarded to the Gen-
\neral Assembly for approval and adoption.
\nAir Pollution
\nThe proposed Statement on the Prevention
\nof Air Pollution Due to Vehicle Emissions
\nwas submitted by the Austrian Medical
\nChamber for discussion. This called for the
\nintroduction of more stringent emission
\nstandards for all new diesel vehicles to
\nlimit the concentration of soot particles in
\nthe air. After a brief debate it was agreed
\nto make it clear in the document that there
\nwere also other ways of reducing the vol-
\nume of harmful emissions. The committee
\ndecided to recommend that, as amended,
\nthe Statement be approved by the Council
\nand be forwarded to the General Assembly
\nfor adoption.
\nSolitary Confinement
\nThe committee considered the proposed
\nStatement on Solitary Confinement, in-
\ntroduced by the Finnish Medical Associa-
\ntion. This urged those authorities respon-
\nsible for overseeing solitary confinement to
\ntake account of an individual\u2019s health and
\nstated that solitary confinement should not
\nbe imposed when it would adversely af-
\nfected the medical condition of prisoners
\nwith a mental illness. An amendment was
\nproposed by the British Medical Associa-
\ntion and accepted that doctors had a duty
\n125
\nWMA News
\nto consider the conditions in solitary con-
\nfinement and to protest to the authorities
\nif they believed that they were unacceptable
\nor might amount to inhumane or degrad-
\ning treatment. A further debate took place
\non whether prolonged solitary confinement,
\nwithout the will of the prisoner, must be
\navoided and the recommendation that phy-
\nsicians should never participate in any part
\nof the decision-making process resulting in
\nsolitary confinement.
\nThe committee agreed that as amended, the
\nStatement be approved by the Council and
\nforwarded to the General Assembly for ap-
\nproval and adoption.
\nProtection of Healthcare Workers
\nThe German Medical Association put for-
\nward a proposed Declaration on the Protec-
\ntion of Healthcare Workers in Situations
\nof Violence. This called on those in power
\nand all parties involved in violence to ensure
\nthe protection of healthcare workers and
\nfacilities and to respect their neutrality. It
\nwas argued that this document was needed
\nto focus on the responsibilities of govern-
\nments and others in positions of author-
\nity to provide the necessary protection for
\nhealth care workers. Some speakers argued
\nabout whether such a document was needed
\nor whether it replicated other WMA policy
\ndocuments.
\nAfter agreeing on several detailed amend-
\nments, the committee recommended that
\nthe Declaration be sent to the Council for
\nforwarding to the General Assembly for
\nadoption.
\nStreet Children
\nA proposed Statement on Providing Health
\nSupport to Street Children presented by
\nthe Conseil National de l\u2019Ordre des M\u00e9-
\ndecins was considered by the committee.
\nIt was suggested that although good will
\nwas often expressed about helping these
\nchildren it was not followed by action. Yet
\nthousands of children over 14 were com-
\npelled to work, while thousands more were
\nsubjected to trafficking and sexual abuse
\nor were involved in armed conflict. Several
\nspeakers argued that the Statement was not
\nyet ready for adoption and that further work
\nwas needed to incorporate comments from
\nmembers.
\nThe committee recommended that the doc-
\nument be re-circulated among constituent
\nmembers for comments.
\nWater and Health
\nThe committee considered several minor
\nrevisions to the WMA Statement on Water
\nand Health, adding the words that an ad-
\nequate supply of fresh water was \u2018central to
\nliving a life in dignity and upholding human
\nrights\u2019and supporting \u2018the promotion of the
\nuniversal access to clean and affordable wa-
\nter as a human right and as a common good
\nof humanity\u2019.
\nThe committee agreed these and other
\namendments and recommended that the
\nrevised Statement be sent to the Council
\nfor forwarding to the General Assembly for
\nadoption.
\nChemical Weapons
\nA proposed Statement on Chemical Weap-
\nons presented by the Turkish Medical As-
\nsociation was considered by the committee.
\nThis recommended strongly to States to re-
\nfrain from using riot control agents because
\nof the potential grave impact on the health
\nof those exposed.
\nThe committee agreed to recommend that
\nthe Statement be circulated among mem-
\nbers for comment.
\nDeclaration on Alcohol
\nA draft International Declaration on Alco-
\nhol was proposed by the Australian Medi-
\ncal Association. The document outlined the
\nmain objectives of alcohol harm-reduction,
\nand recommended priority measures to ad-
\ndress alcohol-related harm.
\nThe committee decided to recommend to
\nCouncil that the document be circulated for
\ncomment.
\nMobile Health
\nThe committee considered a proposed
\nStatement on Mobile Health proposed
\nby the German Medical Association. The
\ndocument drew attention to the oppor-
\ntunities and risks associated with mobile
\nhealth and called for appropriate regula-
\ntion to protect patient safety and user data.
\nSpeakers from several NMAs welcomed
\nthe document and said this had become a
\nvery important issue.
\nThe committee recommended that the
\nStatement be circulated among members
\nfor comment.
\nWorld Day for Health Professionals
\nA proposal for a World Day of Combat-
\ning Violence against Health Professionals
\non April 17 was suggested by the Turk-
\nish Medical Association. Its draft State-
\nment said this would be in memory of the
\nyoung Turkish doctor Dr. Ersin Arslan
\nwho was killed by a patient\u2019s relative in
\nhospital. The idea was to increase public
\nawareness of what the medical associa-
\ntion said was a worldwide problem. An
\namendment was agreed to change the title
\nof the document to \u2018preventing\u2019 violence
\nand the committee recommended that the
\ndocument should be circulated to mem-
\nbers for comment.
\nMigrant Workers\u2019 Health in Qatar
\nThe committee considered a proposed
\nResolution on Migrant Workers\u2019 Health in
\nQatar. The Resolution, from Finland, de-
\nmanded that FIFA as the responsible orga-
\nnization of the World Cup take immediate
\n126
\nWMA News
\naction to secure the life, safety and free-
\ndom of movement of migrant workers in
\nthe World Cup construction sites in Qatar
\nor change the venue as soon as possible.
\nDuring a debate that followed, it was said
\nthat workers elsewhere were being simi-
\nlarly treated. It was decided to strengthen
\nthe Resolution by amending it to read that
\nFIFA should take immediate action and
\nchange the venue.
\nThe committee recommended that, as
\namended, the Resolution be sent to the
\nCouncil for forwarding to the General As-
\nsembly for adoption.
\nEthical Principles of Health Care in Times of
\nArmed Conflict and other Emergencies
\nThe committee considered a document on
\nproposed Ethical Principles of Health Care
\nin Times of Armed Conflict and other
\nEmergencies. This was submitted within
\nthe framework of the Health Care in Dan-
\nger Project of the International Commit-
\ntee of the Red Cross. It was explained that
\ndifferent organisations had different sets of
\nprinciples and the document was a common
\ndenominator of ethical principles of health
\ncare applicable in times of armed conflict
\nthat has been agreed by the WMA, the In-
\nternational Committee of Military Medi-
\ncine, the International Council of Nurses
\nand the International Pharmaceutical Fed-
\neration.
\nThe committee agreed to recommend that
\nthe document be forwarded to the Council
\nfor adoption by the Assembly.
\nMedical Ethics Committee
\nThe committee met under the chairmanship
\nof Dr. Heikki P\u00e4lve.
\nPerson Centred Medicine
\nDr. Andr\u00e9 Bernard (Canada), Chair of
\nthe Work Group, informed the commit-
\ntee about the development of the group\u2019s
\nwork and highlighted discussions about the
\nmeaning of the terms \u2018person centred\u2019 and
\n\u2018patient centred\u2019 healthcare. The group did
\nnot have a clear enough understanding of
\nthese terms and further consensus building
\nwas needed. He said the group would invite
\nadvice from outside experts and would sub-
\nmit a further paper to the committee.
\n50th
\nAnniversary Celebration of the Declara-
\ntion of Helsinki
\nDr. Leonid Eidelman (Israel), Chair of the
\nWork Group, reported on the event to be
\nheld in Helsinki, on November 11 due to be
\nattended by the President of Finland.
\nHealth Databases
\nThe committee heard that NMA comments
\nhad been received about the draft policy pa-
\nper circulated by the Work Group on da-
\ntabases. The recent Work Group meeting
\nin Copenhagen in August had focused on
\nthe links between this document and the
\nDeclaration of Helsinki, on broad consent,
\nanonymity, pseudo-anonymity, medical
\ntransfer agreements and the recently ad-
\nopted CMAAO (Confederation of Medical
\nAssociations in Asia and Oceania) policy on
\nhealth databases. The group had also dis-
\ncussed initiating an open consultation out-
\nside of NMAs, similar to that carried out
\nduring the recent revision of the Declara-
\ntion of Helsinki.
\nThe committee decided to recommend to
\nCouncil that the Workgroup be authorized
\nto continue drafting policy and that the Ex-
\necutive Committee be mandated to approve
\nthe start of an open consultation as soon
\nas the Workgroup considered that it had a
\ndraft version appropriate for sharing.
\nHuman Rights
\nClarisse Delorme, WMA Advocacy Advi-
\nsor, reported that the WMA had met the
\nnewly appointed United Nations Special
\nRapporteur on the right to health, Dr.
\nDainius P\u016bras from Lithuania. Dr. Puras
\nwas the first physician to hold this position.
\nThe WMA was considering further col-
\nlaboration with him.
\nFinance and Planning Committee
\nThe committee met under the chairmanship
\nof Dr. Leonid Eidelman.
\nFinancial Statement
\nThe Audited Financial Statement for 2013
\nwas considered and the committee recom-
\nmended that it be approved by Council and
\nforwarded to the Assembly for adoption.
\nBudget and Membership Dues Payments
\nThe committee considered documentation
\non the Budget for 2015 vs. Actual 2013 Ex-
\npenditures and membership dues payments
\nfor 2014 and agreed that the documents be
\nsent to Council for approval and forwarding
\nto the Assembly for information.
\nStatutory Meetings
\nThe committee considered arrangements
\nfor future WMA meetings \u2013 the Council
\nSession in Oslo in April 2015, the 2015
\nGeneral Assembly in Moscow, the April
\n2016 Council in Buenos Aires and the
\n2016 Assembly in Taipei, Taiwan. No in-
\nvitation had yet been received yet for the
\nCouncil meeting in 2017, but the commit-
\ntee recommended that the 2017 General
\nAssembly be held in Chicago from 11\u201314
\nOctober.
\nSpecial Meetings
\nThe Chair of Council, Dr. Haikerwal, re-
\nported on three meetings \u2013 the pre-G20
\nHealth Summit in Melbourne in No-
\nvember, the One Health conference with
\nthe World Association of Veterinarians
\nin Spain in cooperation with the Spanish
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\nWMA News
\nMedical Association and a possible confer-
\nence on eHealth\/Telehealth in Italy.
\nMembership
\nThe committee considered applications
\nfor membership from the Kenya Medical
\nAssociation, the Lesotho Medical Asso-
\nciation, the Zambian Medical Association
\nand the Rwanda Medical Association and
\nagreed to forward these to the Assembly
\nfor adoption.
\nThursday October 9
\nAssociate Members Meeting
\nDr. Joseph Heyman (American Medical
\nAssociation), a gynaecologist from Mas-
\nsachusetts, was elected unopposed as Chair
\nfor 2014\u201316. He succeeded Dr. Guy Du-
\nmont.
\nJunior Doctors Network
\nThe meeting received an oral report from
\nDr. Nivio Moreira, immediate past Chair
\nof the Junior Doctors Network, who spoke
\nabout the Network\u2019s activities. He said
\nthat a meeting had been held at the begin-
\nning of the week in Durban, attended by
\n23 junior doctors. Dr. Ahmet Murt from
\nTurkey had been elected JDN Chair for
\n2014\u201315.
\nPast Presidents and Chairs of Council Net-
\nwork
\nA report was also received on the Past
\nPresidents and Chairs of Council Network.
\nDr.\u00a0Jon Snaedal said this new group would
\nhave a vital role within the WMA in future.
\nProposed Revision of WMA Statement on
\nNuclear Weapons
\nDr. Xaviour Walker, former Chair of the
\nJunior Doctors, said the JDN would like
\nto propose revisions to the Statement on
\nNuclear Weapons on the basis that the
\nthreat of a limited nuclear war was more
\nlikely. The revisions included new advice to
\nall governments that even a limited nuclear
\nwar would have catastrophic effects on the
\nworld\u2019s food supply and would put a sig-
\nnificant proportion of the world\u2019s popula-
\ntion at risk from a nuclear famine. A fur-
\nther amendment would urge NMAs to use
\navailable educational resources to educate
\nthe general public.
\nThe meeting agreed to forward the amend-
\nments to the Assembly for adoption.
\nDestruction of smallpox virus stockpiles
\nDr. Walker also proposed a Statement on
\nthe destruction of smallpox virus stockpiles.
\nThis recommended that the World Health
\nAssembly pursue an international witnessed
\ndestruction of the remaining stockpile of
\nsmallpox virus, that the World Health Or-
\nganization have access to adequate smallpox
\nvaccine and antiviral stockpiles and that
\ngovernments had appropriate emergency
\npandemic planning for outbreak for small-
\npox virus. It also encouraged the urgent
\noutlining of robust international laws and
\nguidelines to stop the use of recombinant
\nlaboratory technology to recreate the small-
\npox virus.
\nThe proposed Statement attracted some
\ncriticism that it needed more work and it
\nwas agreed the document should be sent to
\nthe Assembly with a suggestion that fur-
\nther consideration should be given to the
\nissue.
\nInvestments
\nA suggestion was made that future potential
\ninvestments of the WMA should exclude
\nfossil fuel based energy companies. The
\nSecretary General, Dr. Kloiber, said that the
\nAssociation did not have any investments in
\nstock shares,but the Chair promised that he
\nwould present the suggestion to the Gen-
\neral Assembly.
\nScientific Session
\n\u201cHealth Determinants Beyond the MDGs\u201d
\nThe Chair of the first session, Dr. Mung-
\nherera, opened the proceedings by asking
\nwhat the priorities post 2015 would be. She
\nsaid physicians would have a role to play in
\nproviding the professional leadership that
\nwould be required. Their role was to moti-
\nvate others and to ensure communication
\nbetween with those they led.
\nDr. Mzukisi Grootboom, Chair of the
\nSouth African Medical Association, said
\nit was 350 days before they started tak-
\ning stock of what the nations of the world
\nhad achieved on MDGs. These goals had
\nachieved universal support because they
\nwere ambitious.But they now needed to ad-
\ndress the post-MDG agenda and the social
\ndeterminants of health.
\nThe first speaker in the Scientific Session
\nwas Sir Michael Marmot, Research Pro-
\nfessor of Epidemiology and Public Health
\nat the University College London. He
\nsaid doctors needed to concern themselves
\nwith sustainable development and people
\nconcerned with sustainable development
\nshould bother about health. What hap-
\npened with the draft Millennium Devel-
\nopment Goals post 2015 would have a
\nprofound impact on health and the fair
\ndistribution of health between countries
\nand within countries. Health and wellbe-
\ning should be the outcome, the mission
\nand the overarching goal of sustainable
\ndevelopment. And doctors and the WMA
\nshould be advocates of health and wellbe-
\ning. Physicians were the advocates of the
\npoor.
\nSir Michael spoke about the work going
\non to draft new goals, but said there ap-
\npeared to be no focus on equity. He said
\nuniversal health coverage was required as
\nwell as concerted action on the social de-
\nterminants of health. They were comple-
\nmentary.
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\nWMA News
\nMeasurement and monitoring could drive
\nequity and although many countries said
\nthey did not have the systems, they had to
\nstart with what was feasible.
\nHe looked at what had been happening
\nwith MDGs in eradicating poverty. In sub
\nSaharan Africa 48 per cent of people were
\nstill in poverty, living on less than $1.25 a
\nday.Here there had been a colossal failure to
\nbring about a sufficient reduction.There had
\nbeen a decline in poverty in Southern Asia,
\nalthough the figure was still 30 per cent.
\nLess than a quarter of the world\u2019s poor lived
\nin low income countries and half the world\u2019s
\npoor lived in India and China.
\nHe spoke about the importance of educa-
\ntion for women and said this was a health
\nissue. He said we had the resources to im-
\nprove global health but those resources were
\nso inequitably distributed that they were
\nmaking things very difficult.
\nAnswering questions he said that health
\nwas getting better and global poverty was
\ncoming down.
\nThe next speaker was Prof. Hoosen (Jerry)
\nCoovadia, a Director at MatCH Health
\nSystems (Maternal, Adolescent and Child
\nHealth),with a speech entitled \u2018Countdown
\nto 2015: the global situation\u2019. He spoke
\nabout progress in achieving the MDGs.
\nThere had been monitoring of MDG goals
\nand many of them had been met. But peo-
\nple had not analysed whether the MDGs
\nfrom 2000 had made a substantial differ-
\nence. The problem was that the difference
\nmade by MDGs could not be easily mea-
\nsured. Throwing money at things it might
\nnot always make a difference.
\nMalebona Precious Matsoso,Director Gen-
\neral of the South African National Depart-
\nment of Health, spoke about South Africa
\nand the MDGs.She said that in 2008,eight
\nyears after the MDGs were adopted the
\nworld faced three crises \u2013 a financial crisis, a
\nfood crisis and a fuel crisis, the three Fs. But
\nover and above these crises, in some parts
\nof the world they had conflict which was
\nstill continuing. Lately they had seen what
\nhappened in post-conflict countries when
\nsystems had failed,when countries were un-
\nable to thrive and when health systems were
\nfragile. West Africa was a reminder to all of
\nthem that post-conflict, if they failed to de-
\nvelop countries, they could not talk about
\ndevelopment.
\nShe said there were some countries that
\nhad shown progress. There was a wide-
\nspread feeling among policy makers that
\nprogress against hunger, poverty and dis-
\nease was notable and that MDGs had
\nplayed a role in a world that had been un-
\ndergoing the three Fs. Referring to South
\nAfrica\u2019s achievements she said that the
\nproportion of the population living below
\n$1 a day in 2000 was 11.3 per cent and in
\n2011 was down to four per cent. But even
\nthat four per cent was not acceptable.There
\nhad also been an improvement in educa-
\ntion. However one survey undertaken had
\nshown that in early school entrants about
\n89,000 of the children had learning dis-
\nabilities, such as sight problems. Others
\nhad serious hearing problems and others
\nwere suspected TB cases.
\nShe went on to say that investments in
\nSouth Africa required that they dealt with
\nsocial determinants of health and also pro-
\nmoted inter-sectoral collaboration. It was
\nnot enough to say they had a ministry of
\nwater affairs or a ministry dealing with
\nsanitation because where other sectors had
\nfailed health had to serve as a safety net. If
\nthe water ministry did not do its work there
\nwould be problems with diarrhoea. If the
\nministry of trade did not create employ-
\nment they would have to ensure they had
\ngot psychologists and psychiatrists to look
\nafter people with depression because they
\ncould not look after their families. So they
\nwere setting up inter-ministerial and so-
\ncial clusters that could specifically look at
\nthe social determinants of health. She was
\npleased to say that with the interventions
\nthey had made they were seeing an increas-
\ning life expectancy, improvements in under
\nfive mortality and in infant mortality rates.
\nBut these improvements would not be sus-
\ntainable if they did not address the social
\ndeterminants of health. As the countdown
\nto post 2015 MDGs continued, they had
\nidentified 15 interventions that could help
\nthem save 10,000 more lives between now
\nand 2015. She would like to see this unfin-
\nished business continue.
\nIn the next session, entitled \u2018Is Univer-
\nsal Access and National Health Insurance
\nthe same concept?\u2019 Professor Diane Mc-
\nIntyre, Professor of Health Economics in
\nthe School of Public Health and Family
\nMedicine at the University of Cape Town,
\nsaid the simple answer to the question in
\nthe title of her presentation was \u2018No!\u2019 She
\nsaid that often the concept of universal ac-
\ncess was equated with health insurance. But
\nthe misconception that universal coverage
\nmight equal health insurance was quite dan-
\ngerous and allowed government to abrogate
\nits responsibility. Speaking about terminol-
\nogy \u2013 universal health coverage, universal
\ncoverage or access \u2013 she said she preferred
\nuniversal health system. This definition
\ndrew on the most common definition put
\nforward by the World Health Organisation
\nwhich had said it was about everyone hav-
\ning access to needed care, of sufficient qual-
\nity to be effective as well as financial protec-
\ntion from the costs of using health services.
\nA universal health system realised the right
\nand entitlement.
\nShe spoke about the key things needed
\nfrom the health care financial perspective,
\nincluding funds coming from mandatory
\npre-payment sources. People should be
\npaying in advance,but government revenue
\nwas also a form of pre-payment through
\ntaxes. She drew on international data to
\nillustrate the importance of this and the
\nimportance of large quantities of govern-
\nment revenue going towards health. There
\nwas an onus on governments to make suf-
\nficient revenue available. If they were going
\n129
\nWMA News
\nto pursue a universal health system they
\ncould not do it without adequate govern-
\nment revenue.
\nSome people asked how much was enough.
\nThe Chatham House health care financ-
\ning discussions, recently published, looked
\nat the relationship between government
\nspending on health as a percentage to
\nGDP and the conclusion was that govern-
\nment spending on health should be at least
\nfive per cent of GDP. Some people might
\nask why it should be as a percentage of
\nGDP and not 15 per cent of government
\nexpenditure.The answer was that the target
\nof 15 per cent was nothing if government
\nexpenditure was small. If it was expressed
\nas a percentage of GDP pressure was ap-
\nplied on government to raise revenue and
\nto how much it spent. From the social de-
\nterminants perspective high levels of gov-
\nernment spending was needed in all social
\nsectors. One of the discussions happening
\ninternationally was a growing call that
\ngovernments should be seeking to generate
\nrevenue and have expenditure in the region
\nof 35 per cent of GDP in order to achieve
\nthe sustainable development goals.
\nProf. McIntyre went on to talk about the
\npools of funds in South Africa and frag-
\nmentation within the pools and the issue
\nof strategic or active purchasing.They were
\nnot going to have universal access un-
\nless they started getting purchasing right.
\nSouth Africa had said it intended to in-
\ntroduce a national health insurance fund.
\nBut would this proposed NHI and the
\nway it was being rolled out actually pro-
\nmote progress to a universal health sys-
\ntem? They were in the preliminary phases
\nof these reforms and these reforms focused
\non the service delivery and management
\nside. She said the current reforms would
\ncreate the conditions for efficient and eq-
\nuitable provision of quality services within
\nthe public sector. There had been a lot of
\ndebate around the National Health Insur-
\nance Fund and a lot of confusion. A lot of
\npeople thought that it would be just a big
\ninsurance scheme. But her understanding
\nwas that it would be fully tax funded. Al-
\nthough it was called the National Health
\nInsurance Fund it was not going to be on
\na contributory basis where only those who
\ncontributed would benefit from it. It was
\ngoing to be universal and would create a
\nuniversal entitlement to services and would
\nbe tax funded. So why were they going to
\ncreate the national health insurance fund?
\nHer understanding was that the primary
\nrole of that institution would be to under-
\ntake strategic purchasing. If they created a
\ngood institution that was a strategic pur-
\nchaser it would take them an enormous
\ndistance towards a universal health system.
\nIn conclusion she said that the proposed
\nreforms had the potential to move them
\ntowards a universal health system. The in-
\ntention was that the majority of health care
\nfunding would be from mandatory pre-pay-
\nment tax funding. There would be reduced
\nfragmentation in the funding pools. The
\nmajority of funds would be in a single pool
\nand lastly they would strive to get strategic
\npurchasing through an independent public
\ninstitution.
\nThe final speaker, Professor Olive Shisana,
\nChief Executive Officer of the Human
\nSciences Research Council, spoke about
\nSouth Africa\u2019s journey to National Health
\nInsurance and traced the history of its de-
\nvelopment. She compared the proposals
\nfirst made in 1935 with the 2011 green
\npaper. For almost 50 years from 1944 and
\n1994 there was no action. In 1994 the
\nANC took the decision to have a NHI
\nreview. The green paper now in the pub-
\nlic domain had several principles, one of
\nwhich was the right to access to health
\ncare and the transformation of the health
\ncare system in such a way that it would be
\nevidence based.
\nShe compared the differences between the
\nproposals from the past and today\u2019s green
\npaper. Previously it was planned to include
\nemployers and employees only and the pro-
\nposals would cover only the urban working
\npopulation.Those that were poor or lived in
\nrural areas would not be included. In other
\nwords, it was a racially based system. In
\n2011 the plan envisaged was for a compre-
\nhensive universal entitlement programme in
\nwhich everyone would be included except
\nmigrants not resident in South Africa.
\nQuality control under past proposals lay
\nwith the doctors. Now it was proposed than
\nan independent body would be responsible
\nfor compliance.
\nThere were now many key stakeholders
\nwho were not involved years ago. While
\nmany of the health professionals and po-
\nlitical parties were ambivalent towards
\nNHI, the public said they supported the
\nproposed reforms.
\nShe said there had been missed opportuni-
\nties since the 2011 green paper had been
\npublished. A wide consultation had taken
\nplace with further proposals being made.
\nBut she said that the system of NHI was
\nnot being piloted. What was now needed
\nwas strong stewardship. Consultation must
\ncontinue with stakeholders and there would
\nhave to be more changes. It was also impor-
\ntant that pilots took place.
\nThe session ended with a panel discussion
\ninvolving Prof. Yosuf Veriava and Prof. Alex
\nvan der Heever, both from the University
\nof the Witwatersrand, and Dr. Jonathan
\nBroomberg (Discovery Health).
\nIn the afternoon there was a session on ad-
\nvocacy entitled \u2018Can Physicians be activists
\nfor change?\u2019
\nThe first speaker, Dr. Nivio Moreira (Bra-
\nzil), Past Chair of Junior Doctors Network,
\nspoke about the role of the junior doctors
\nwithin the WMA and the way they could
\nbecome more active within the Association.
\nHe stressed the way in which the JDN used
\nsocial media, through the use of twitter and
\nFacebook.
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\nWMA News
\nDr. Jeff Blackmer, Director of Ethics at
\nthe Canadian Medical Association spoke
\nabout physicians as activists for change and
\nexplained why physicians should become
\nactivists. He posed the question \u2013 was this
\nan option or an ethical obligation? He gave
\nseveral examples from Canada of where
\ndoctors had become involved actively on
\nbehalf of their patients and said doctors had
\nthe power individually and collectively to
\nact on their social conscience.They had cer-
\ntain rights, but along with these came cer-
\ntain responsibilities. Putting patients above
\nall else was one of these. Another was to ad-
\nvocate on behalf of patients. Doctors were
\nin a unique situation to influence policies,
\nparticularly health policies and WMA pol-
\nicy made it clear that doctors had an ethical
\nobligation to undertake advocacy activities.
\nThe final three speakers gave examples of
\nhow effective advocacy could be. Dr. Cecil
\nWilson (American Medical Association),
\nPast President of the WMA, and Dr. An-
\ndr\u00e9 Bernard (Canada), Chair of the WMA\u2019s
\nAdvocacy Advisory Group, spoke about the
\nadvocacy activities of the WMA, giving
\nrecent examples of successful media cam-
\npaigns. Dr. Bernard said that advocacy was
\nkey to everything the WMA did and had
\nto be mainstreamed into all NMA activities.
\nAnd Bruce Eshaya-Chauvin, Medical Ad-
\nvisor with the International Committee of
\nthe Red Cross, and head of the Health Care
\nin Danger Project, spoke about the way the
\nproject had been developed.
\nFriday October 10
\nCouncil
\nThe Council resumed under the Chair
\nDr.\u00a0Haikerwal to consider reports from the
\nthree committees.
\nMedical Ethics Committee
\nThe report from the committee was ap-
\nproved. The report from the Finance and
\nPlanning Committee was approved after
\nDr. Haikerwal reported on plans to hold
\na pre G20 meeting in November in Mel-
\nbourne on health as an investment.
\nThe Council also agreed to recommend to
\nthe Assembly that four new members be
\nadmitted from the national medical as-
\nsociations of Kenya, Lesotho, Zambia and
\nRwanda.
\nSocio Medical Affairs Committee
\nEnvironment
\nAn oral report was received about a meet-
\ning of the Environment Caucus.The caucus
\nmeeting had heard about the greening of
\nhospitals and clinics and the issue of disin-
\nvesting from fossil fuel.
\nStreet Children
\nThe French Medical Association raised
\nagain the issue of the UNESCO Interna-
\ntional Day for Street Children on Novem-
\nber 26 and said it hoped that the WMA
\nwould support the day. Meanwhile the
\nConseil National de l\u2019Ordre des M\u00e9decins
\nwould continue to fine tune its document
\non proposals for assisting street children
\naround the world.
\nAlcohol
\nThe Australian Medical Association ex-
\nplained further how its International Dec-
\nlaration on Alcohol had emerged. A similar
\ndocument had been pursued in Australia.
\nAlcohol was a scourge and the harmful ef-
\nfects of alcohol killed about two and a half
\nmillion people every year, almost four per
\ncent of all the deaths worldwide.
\nIt was significant burden of disease. The
\nAustralian Medical Association had worked
\nwith a strong coalition in Australia to de-
\nvelop this statement. They accepted that it
\nwould be a long campaign, and it was one
\nthat should not be joined by the alcohol in-
\ndustry which did not have the best interests
\nof patients at heart. The Council approved
\nthe Socio Medical Committee report.
\nAssembly Ceremonial Session
\nProf. Ames Dhai, President of the South
\nAfrican Medical Association, officially wel-
\ncomed delegates to the 65th
\nGeneral Assem-
\nbly.She said it had been an honour for South
\nAfrica to host the WMA Assembly for the
\nsecond time since 2006. She said that one of
\nthe most important issues which the WMA
\nwas in an excellent position to address was
\nthe importance of strong national medi-
\ncal associations. At a time when healthcare
\nwas under so much pressure from a number
\nof conflicting interests NMAs had to take
\nup the role as the conscience of the medical
\nprofession. It was also important to maintain
\nthe unity of medical professionals at both
\nnational and international levels. Keeping
\na united front was absolutely necessary as
\nit was the only way NMAs could have the
\nnecessary positive impact to bring about the
\nchanges needed to make the world a better
\nplace. NMAs were particularly important as
\nvital components of national health systems.
\nThe current Ebola crisis had demonstrated
\nagain what they had known in advance that
\nbadly managed and poorly supported health
\nsystems lead inevitably to disaster. If they
\ncompared the current Ebola outbreak to the
\nSARS outbreak a few years ago it became
\napparent how much of a difference adequate
\nhealth systems made.
\nDr. Haikerwal then paid tribute to the
\nretiring WMA President, Dr. Margaret
\nMungherera. He said she had been a very
\npowerful leader who led from the front and
\nhad travelled widely during her Presidency.
\nDr. Mungherera delivered her valedictory
\nspeech and was given a standing ovation.
\nDr.Xavier Deau,a general practitioner from
\nFrance and President of the European and
\nInternational Delegation of the French
\nMedical Council speech, was then installed
\n131
\nWMA News
\nas the 65th
\nPresident of the WMA to serve
\nin 2014\/15.
\nHe took the oath of office as President
\nand delivered his inaugural speech, speak-
\ning partly in French, partly in Spanish and
\npartly in English.
\nThe ceremonial session ended with a presen-
\ntation from Bruce Eshaya-Chauvin, Medical
\nAdvisor with the International Committee of
\nthe Red Cross, and head of the Health Care
\nin Danger Project ICRC, who spoke about
\nplans to launch an e learning module on the
\nproject. This would be a simple tool explain-
\ning physicians\u2019rights and responsibilities.
\nSaturday October 11
\nPlenary Assembly Session
\nPresident 2015\/16
\nProfessor Sir Michael Marmot, Research
\nProfessor of Epidemiology and Public
\nHealth at University College London, was
\nelected unopposed as President for 2015\/16
\nafter the only other candidate, Dr. Osahon
\nEnabulele (Nigerian Medical Association)
\nwithdrew his nomination.
\nThanking the Assembly Sir Michael said he
\nwas on a mission to promote health equity
\nin the world through action on the social
\ndeterminants of health.
\n\u2018I chaired the WHO Commission on Social
\nDeterminants of Health. When we pub-
\nlished, one government as a form of criti-
\ncism said our report was ideology with evi-
\ndence. That was meant as a criticism I took
\nit as praise. I do have an ideology. Health
\ninequalities that are avoidable are wrong,
\nunjust, unfair.That is an ideology.\u2019
\nHe said what he brought to the debate was
\na deep respect for the evidence. Good in-
\ntentions were not enough.Since that WHO
\nreport he had been talking to governments
\nmaking the case that there needed to be ac-
\ntion right across government on social de-
\nterminants of health. He said he would like
\nto represent the voice of the world\u2019s doctors
\nin those discussions.
\n\u2018Who cares more about health than we do.
\nWe should be the voice for health. We want
\naction from the whole of government. The
\ndoctors are absolutely key. Of course, the
\nWMA represents the interests of doctors and
\nthat\u2019s absolutely right.But we have a key eth-
\nical role to play in representing the interests
\nof our patients and indeed of populations.\u2019
\nHe said he had been asked what advice he
\nwould give to young doctors considering
\nworking the field of social determinants of
\nhealth. \u2018What I would say to young doctors
\nis what a privilege it is every day to know
\nthat your work is trying to improve the
\nhealth of the most disadvantaged.\u2019
\nCommittee Reports
\nThe Assembly adopted the following policy
\ndocuments:
\n\u2022 Declaration on the Protection of Health-
\ncare Workers in Situations of Violence
\n\u2022 Statement on Aesthetic Treatment
\n\u2022 Statement on the Ethical Guidelines for
\nthe International Migration of Health
\nWorkers (Revised)
\n\u2022 Statement on the Prevention of Air Pol-
\nlution and Vehicle Emissions
\n\u2022 Statement on Solitary Confinement
\n\u2022 Statement on Water and Health (Revised)
\n\u2022 Resolution on Ebola Viral Disease
\n\u2022 Resolution on Unproven Therapy and the
\nEbola Virus
\n\u2022 Resolution on the Non-Commercializa-
\ntion of Human Reproductive Material
\n(Revised)
\n\u2022 Resolution on Migrant Workers\u203a Health
\nand Safety in Qatar
\nFinancial Report
\nThe Treasurer, Prof. Dr. Frank Ulrich Mont-
\ngomery, gave an oral report on the past two
\nyears,thanking NMAs for their prompt pay-
\nment of their dues. He also spoke about the
\nbudget for 2015 and said the positive finan-
\ncial development he could report on was due
\nto the frugal use of budgetary means,efficient
\ncost control and a risk free investment poli-
\ncy. The Assembly approved the Financial
\nStatement for 2013 and the 2015 Budget.
\nMeetings
\nThe Assembly agreed that the 2017 General
\nAssembly be held in Chicago, USA (Oct
\n11\u201314) and that the 2018 Assembly be held
\nin Reykjavic, Iceland.
\nNew Members
\nThe Assembly approved an application for
\nconstituent membership from the Ordre
\nNational des Medicins de Guin\u00e9e and ap-
\nproved four new members from the nation-
\nal medical associations of Kenya, Lesotho,
\nZambia and Rwanda.
\nEbola
\nDr.Haikerwal reported that the Council had
\napproved an emergency Resolution on Ebola
\non Wednesday and he asked the Assembly
\nto adopt this. Dr. Mark Sonderup (South
\nAfrica) suggested amending the Resolution
\nto give more emphasis to honouring those
\nworking in dealing with the Ebola crisis. He
\nalso wanted to see a paragraph inserted on
\nthe use of untested therapies. The WMA
\nwas the author of the Declaration of Hel-
\nsinki and given the debate around the use of
\ntherapies and untested therapies which was
\nreferred to in the Declaration he believed the
\nWMA should re-emphasise this.
\nThe Assembly voted in favour of amending
\nthe Council Resolution by re-ordering the
\nrecommendations to give more priority to
\nhonouring those fighting the Ebola crisis.
\nBut Prof. Nathanson opposed putting the
\nissue of untested therapies into the Council
\nResolution. The use of unproven therapies
\n132
\nWMA News
\nwas extraordinarily complicated. She said
\nthe WHO had got this issue right and had
\nreferred to Declaration of Helsinki. To in-
\nsert something on untested therapies in the
\nCouncil Resolution would require a great
\ndeal of information and it would distort
\nthe Resolution which was about supporting
\npeople in West Africa with the resources
\nthey needed to safely care for patients with
\nEbola.She suggested the issue should be in-
\ncluded in a separate statement.
\nProf. Montgomery (Germany) also argued
\nagainst changing the Council Resolution,as
\nthis had already been publicised and would
\ncause confusion. He agreed that a second
\nstatement could be issued.
\nDr. Grootboom (South Africa) said all that
\nwas being proposed was an addition to the
\nResolution. But Dr. Deardon (British Medi-
\ncal Association) believed changing the Res-
\nolution would dilute its effectiveness. Dr.
\nMungherera supported leaving the Resolu-
\ntion unamended and said the most important
\nthing was to try to engage with the commu-
\nnities affected by Ebola. She said the differ-
\nence between the Nigerian response and that
\nof others was community engagement.
\nDr. Sonderup said he had heard the objec-
\ntions to his proposal and still wanted to add
\nto the Resolution. He proposed inserting
\nthe words \u2018The WMA draws attention to
\nthe ethical principle that given that proven
\ninterventions currently do not exist and that
\nthe case fatality rate for EVD is high, the
\nWMA supports the use of unproven inter-
\nventions if in the physician\u2019s judgment it
\noffers reasonable hope of saving life as ex-
\npressed in the Declaration of Helsinki\u2019.
\nDr. Kayode Obembe (Nigeria) said the
\nexperience of Nigeria was very important
\nbecause they had controlled and contained
\nEbola completely. Other countries had a lot
\nto learn from Nigeria in terms of mobili-
\nzation, quick response, community epide-
\nmiologists and all other aspects. This was
\na disease that was global and must be con-
\ntained. He said if they prevented other in-
\nterventions which had not been proven they
\nwould open their practice to the possibility
\nthat may occur in the future. He said the
\nResolution should be left as it was but they
\nshould emphasise that physicians\u2019judgment
\nshould be taken into consideration.
\nDr. Joyce Banda (Zambia) urged caution.
\nWhat they had been standing for all along
\nwas the Declaration of Helsinki where they
\nsaid they should not use unproven interven-
\ntions. Now what were they saying? Were
\nthey going back on that?
\nProf. Montgomery suggested that the
\nCouncil Resolution should not be amended
\nbut that a second emergency Resolution
\nshould be considered.He proposed that this
\nwould read: \u2018In the case of Ebola the WMA
\nstrongly supports the intentions of Article
\n37 of the newly revised Declaration of Hel-
\nsinki which reads \u201cUnproven interventions
\nin clinical practice: In the treatment of an
\nindividual patient, where proven interven-
\ntions do not exist or other known interven-
\ntions have been ineffective, the physician,
\nafter seeking expert advice, with informed
\nconsent from the patient or a legally autho-
\nrized representative, may use an unproven
\nintervention if in the physician\u2019s judgment
\nit offers hope of saving life, re-establishing
\nhealth or alleviating suffering. This inter-
\nvention should subsequently be made the
\nobject of research, designed to evaluate its
\nsafety and efficacy. In all cases, new infor-
\nmation must be recorded and, where appro-
\npriate, made publicly available\u201d.
\nDr. Sonderup said the suggested Resolution
\nwould be acceptable.
\nProf. Montgomery\u2019s proposed emergency
\nResolution, slightly amended, was adopted
\nby the Assembly .
\nAssociate Members
\nDr. Joseph Heyman, newly elected Chair of
\nthe Associate Members, reported on their
\nmeeting and brought two recommendations
\nfor consideration by the Assembly, one on
\nnuclear weapons and the other on smallpox.
\nNuclear Weapons
\nThe first,the proposed Revision of the WMA
\nStatement on Nuclear Weapons, was intro-
\nduced by Dr. Xaviour Walker. He explained
\nthat the Junior Doctors Network wanted to
\nupdate the statement to highlight the effect
\nthat even a limited nuclear war would have on
\nthe world\u2019s food supply. He also wanted the
\nStatement amended to focus on how NMAs
\ncould educate their physicians and the gen-
\neral public about this threat and he wanted
\nthe WMA to join a coalition urging govern-
\nments to advocate a ban on nuclear weapons.
\nProf. Montgomery said this was a paper of
\nhigh importance and he suggested that it
\nshould be circulated to NMAs for further
\nconsideration.
\nDr. Walker said he wanted to see the pro-
\nposed revision adopted by the meeting. But
\nthe Assembly decided that the proposal be
\nsent to Council for further consideration.
\nSmallpox
\nDr. Walker also proposed a Statement on
\nthe destruction of smallpox virus stockpiles.
\nHe said smallpox was eradicated in 1980
\nbut live samples were still retained in the
\nUnited States and in the Russian Federa-
\ntion. He said he would like a proposal for
\nthe destruction of the remaining stockpile
\nto be sent to the Council for further consid-
\neration.This was agreed.
\nBioethics
\nDr. Yoram Blachar (Israel) delivered a pre-
\nsentation on the new curriculum for medi-
\ncal ethics to be taught at medical schools
\nand the annual conference to be held by the
\nUNESCO Chair in Bioethics in Jerusalem
\nin January 6\u20138 2015, sponsored jointly by
\nWMA and others.
\n133
\nWMA News
\nEbola
\nThe Assembly then heard an address from
\nDr. Andrew Medina-Marino, an epidemi-
\nologist with Medecin sans Frontieres,on his
\nrecent experiences dealing with the Ebola
\noutbreak in Liberia. Dr. Medina-Marino,
\nHead of the research unit of the disease
\nsurveillance and laboratory systems, Foun-
\ndation for Professional Development, said
\nthat the virus was first identified in Zaire
\nin 1976 and until recently all previous out-
\nbreaks had occurred in east and central Af-
\nrica.
\nThe current outbreak was unprecedented
\nand was already 20 times greater than any
\nprevious outbreak. Ebola was a zoonotic
\ndisease and one of its reservoirs was bats.
\nHe spoke about how the infection spread.
\nCurrently in West Africa many individuals
\nhad been exposed due to certain types of
\nburial traditions. This was not specific to
\none religion. But unfortunately, at least in
\nLiberia, there were particular communities
\nthat had found it difficult to break with
\ncertain burial traditions. The current out-
\nbreak in West Africa was first identified in
\nthe south east region of Guinea in March
\nthis year. It was inevitable that this disease
\nwould be transmitted across borders and
\nby late March cases had been reported in
\nLiberia. The first wave started in March
\nand ended around mid-April, or so people
\nthought. Local and national governments
\ntook their foot off the pedal and did not
\ncontinue to provide the extensive contact
\ntracing and isolation of individuals. So a
\nsecond wave flared up, starting at the be-
\nginning of May, and this was the current
\noutbreak. He explained how MSF had re-
\nsponded by sending additional support to
\nthe affected countries. But their resources
\nhad become very strained and in mid-June
\nMSF urged the international community
\nto mobilise resources. Unfortunately this
\ndid not materialise and certain interna-
\ntional organisations were well behind the
\ncurve in identifying this as an international
\nemergency.
\nHe then spoke about his own personal
\nexperiences in Liberia. When he arrived
\nthere were 231 cases against a background
\nof a recent conflict and hostilities. It was a
\ndegrading situation, with significant resis-
\ntance to the government entering commu-
\nnities because of the recent civil war. As a
\nresult MSF personnel were often attacked
\neither because of fear and ignorance. The
\ngovernment was overwhelmed during
\nthis period. Civil war had decimated the
\nleadership and the health structure in the
\ncountry. The Ministry of Health was un-
\nable to cope with the situation which was
\nnot surprising and this was coupled with
\na lack of international response. This re-
\nsponse was still lagging.The World Health
\nOrganisation had a mandate to co-ordi-
\nnate activities but unfortunately at this
\nstage it had not stepped up to the plate.
\nThere was an extreme impact on healthcare
\nworkers and to date there had been more
\nthan 200 healthcare workers in Liberia
\nalone who had become infected, of whom
\nmore than 94 had died. This included
\n11\u201312 doctors who had died, 10 per cent
\nof the country\u2019s total number of medical
\ndoctors. By the time he left Liberia in Au-
\ngust there were 768 cases, a tripling over a
\nperiod of a month. And between the time
\nhe left the country and that moment there
\nwere nearly 4,000 cases alone in Liberia.
\nThe situation was still quite dire.
\nHe said the international community\u2019s slow
\nresponse had been quite deadly. Support
\nhad often not materialised and donations
\nwithout proper co-ordination had gone un-
\nutilised. He challenged the WMA to ask
\ntheir members to urge their national gov-
\nernments to provide an organised response
\nto the West Africa crisis.
\nMoscow General Assembly
\nThe Russian Ambassador to South Africa,
\nHis Excellency Mikhail Petrakov, then for-
\nmally invited delegates to the next WMA
\nGeneral Assembly in Moscow in October
\n2015.
\nNuclear War
\nDr. Ira Helfand, Co-President of the In-
\nternational Physicians for the Prevention
\nof Nuclear War, spoke about the threat of
\nnuclear war. Such a possibility was loom-
\ning so large that it should demand people\u2019s
\nattention as much as Ebola as the medical
\nconsequences would be catastrophic. There
\nwere more than 16,000 nuclear warheads
\nheld by nine countries, the vast major-
\nity by the United States and the Russian
\nFederation. The use of even only a small
\npercentage of these warheads would be a
\nglobal catastrophe. He described the hor-
\nrific consequences of nuclear warfare, even
\nlimited nuclear warfare, and set out what
\nhe thought the medical profession could do
\nto prevent this eventuality. Physicians were
\nnot speaking out at the moment, but he said
\nthey should speak out to terminate these
\nweapons. He asked Assembly delegates to
\nengage with their national medical associa-
\ntion to take action.
\nPolio
\nDr. Kenneth Collins AM, former Director
\nof Rotary International from Western Aus-
\ntralia, talked about Rotary\u2019s involvement in
\nthe global partnership to eradicate polio.
\nHe charted the start of the project in the
\nPhilippines and its spread to other parts of
\nthe world. The eventual worldwide cam-
\npaign led Rotary to raise sufficient funding
\nfor 606 million children to be vaccinated.
\nA total of $1.3billion had been raised dur-
\ning this period. National governments and
\nthe Gates Foundation joined the campaign
\nand in 1991 national immunization days
\nwere started. He spoke about the campaign
\nin India and said there were now just three
\nendemic countries, Pakistan, Afghanistan
\nand Nigeria. Pakistan was the only country
\nwhere the number of cases was escalating.
\nAs a result of the global polio eradication
\ninitiative 10\u00a0million polio cases and 1.5 mil-
\nlion deaths had been averted. He urged the
\nWMA and its members to do what they
\ncould to help the campaign.
\n134
\nWMA News
\nOpen Session
\nDuring this session NMAs had the op-
\nportunity to present any profession-specific
\nproblem they believed the WMA should
\nknow about. Several delegates took the op-
\nportunity to address the Assembly.
\nCosta Rica
\nDr. Alexis Castillo Guttierez (Union Med-
\nica Nacional Costa Rica) spoke about what
\nhe called \u2018the dearth of medical services in
\nLatin America\u2019.He spoke particularly about
\nthe importation of Cuban medical man-
\npower which was affecting Brazil, Venezu-
\nela and other countries and was leading to
\na health crisis. He said he was speaking on
\nbehalf not only of Costa Rica but also of the
\nLatin American Confederation of medical
\ncolleges, of Uruguay, Argentina and Brazil
\nand supported by Spain and Portugal who
\nwere partly responsible for the training of
\nmillions of their colleagues.
\nHe said his Peruvian colleagues could not
\nattend because of their very fragile situa-
\ntion. He appealed to the WMA on behalf
\nof Peruvian physicians in their conflict with
\ntheir Government. They had been taking
\nstrike action since May 2014. The Peruvian
\nMedical Association had not found a way
\nout of the difficulties despite a great num-
\nber of consultations with the Government.
\nIn May the Latin American Forum issued a
\nstatement supporting the Peruvian Medical
\nAssociation. Several appeals had been made
\nto the Government and to the President
\nof Peru, but with no positive outcome. In
\nSeptember a new statement was made re-
\ngarding the right to strike and non-violence
\ndue to acts of violence perpetrated by the
\nPeruvian police against doctors. Dr. Gut-
\ntierez said they had brought evidence of
\nthis violence to the WMA Assembly and
\nhe urged the WMA to get involved in this
\nconflict, by denouncing the violent treat-
\nment against physicians and requesting the
\nPeruvian Government to find a solution to
\nthe conflict.
\nDr. Kloiber responded by saying that the
\nWMA would certainly support the Peru-
\nvian physicians.
\nIndia
\nDr. Narendra Kumar Saini (Indian Medi-
\ncal Association) talked about the emergency
\ndeclared by WHO on MDR tuberculosis.
\nThere were 9.3 million cases every year
\nand 1.8 million deaths. Of the nine million
\ncases, one million were multi drug resistant
\ntuberculosis. He said that according to the
\nWHO there were three million missing
\ncases. One undetected case gave rise to be-
\ntween ten and 15 more cases. So this was a
\nvery grave statistic. He said 70 per cent of
\naffected patients went to the private sector
\nfor treatment. Unfortunately many coun-
\ntries did not have the capacity to diagnose
\ncases. Airborne transmission was very high
\nand people often did not complete their
\ncourse of treatment. He said this was a very
\ngrave situation and as grave as Ebola and
\nhe urged NMAs to help detect these three
\nmillion cases.
\nTurkey
\nDr. Bayazit Ilhan (Turkish Medical Asso-
\nciation) raised the issue of problems follow-
\ning the Gezi Park Demonstrations. Thou-
\nsands of people had been injured as a result
\nof police force and tear gas. There were dif-
\nficulties in accessing health care services.
\nThe Turkish Ministry of Health had failed
\nto organize health services and did nothing
\nto stop the violence. Injured people being
\ntreated were asked to give their personal
\ndetails. As a result many people were afraid
\nto go to hospital. Physicians ran to help the
\ninjured. But the Ministry of Health then
\nbegan inquiring about those healthcare
\nworkers who were involved.
\nHe said the Turkish Medical Association
\nreconfirmed its commitment to give first aid
\ncare to all without any distinction. It gath-
\nered information about the health status of
\ndemonstrators and it had conducted a web
\nbased scientific study of health problems
\nexperienced by people exposed to tear gas.
\nIt had also issued a statement on the use of
\nriot control agents.
\nThe Ministry of Health had since appealed
\nto the court for the dismissal of members
\nof the Ankara Chamber of Medicine saying
\nthey gave unauthorized and unsupervised
\nmedical care. There was a pre-trial hearing
\nin September, attended by the WMA Sec-
\nretary General, but the judge had refused
\nto dismiss the case, but postponed it until
\nDecember 23.
\nThere had also been trials against individual
\nphysicians. Now new legislation had been
\nintroduced about delivering unauthorised
\nhealth services, a new type of offence with
\nsanctions of one to three year prison sen-
\ntences and fines of up to $900,000 dollars.
\nUSA
\nDr. Cecil Wilson, Past President of the
\nWMA, gave a report on a meeting he had
\nheld with the US Defense Health Subcom-
\nmittee on the subject of \u201cmedical profes-
\nsional practice policies and guidelines\u201d. The
\npurpose was to have the Defense Health
\nBoard deal with the challenges faced by
\nmilitary medical professions in their dual-
\nhatted positions as a military officer and a
\nmedical provider.
\nDr. Wilson said the Board had asked two
\nquestions \u2013 how could military professionals
\nmost appropriately balance their obligations
\nto their patients against their obligations as
\nmilitary officers to help commanders main-
\ntain military readiness? And how much lati-
\ntude should military medical professionals
\nbe given to refuse participation in medical
\nprocedures or request excusal from military
\noperations with which they had ethical res-
\nervations or disagreement?
\nHe said the Defense Health Board was a
\ncivilian-appointed body responsible for
\nproviding guidance on ethics to the De-
\n135
\nWMA News
\npartment of Defense under Secretary of
\nDefense Chuck Hagel and the current
\npresident of the Board was Nancy Dickey,
\nPast President of the American Medical
\nAssociation.
\nDr. Wilson said that to the question as to
\nwhether the issues for the military related
\nto dual responsibility were increasing the
\nresponse was, perhaps. However in 98 to 99
\nper cent of cases the situations were worked
\nthrough without problem. However in the
\ncases that did involve a conflict meant that
\nfor that one individual professional the
\nconsequences for his or her life\u2019s work were
\ncatastrophic.
\nHe gave two examples. One concerned a
\nyoung female primary care physician de-
\nployed in Afghanistan who was directed to
\nperform physicals on male detainees prior
\nto their interrogations.
\nFemale physical exams performed on male
\nMuslims were considered highly embarrass-
\ning. She refused and was threatened with
\na court martial. She subsequently did the
\nphysicals, fearing the risk of a court martial
\nand serving a two-jail term.This doctor had
\na young daughter and did not want to miss
\ntime with her daughter.
\nThe second example related to a team phy-
\nsician for critical care transport stationed
\noutside the US who was directed to trans-
\nport four critically ill civilians to another
\nhospital. The team physician on boarding
\nthe plane determined that the facilities of
\nthe newer hospital were not able to pro-
\nvide care and the civilians would die. He
\ndirected the aircraft pilot to return the
\nplane. The pilot refused \u2013 he had differ-
\nent orders. There was potentially a court
\nmartial.
\nDr. Wilson said he had also discussed the
\nWMA\u2019s Tokyo Declaration and the issue of
\nforced feeding as there was interest in how
\nthe WMA representing physicians saw the
\nproblems with forced feeding worldwide.
\nHe said the discussions for the day had
\ngone well and he was hopeful that problems
\nwere being assessed.
\nCote d\u2019Ivoire
\nThe meeting also heard an appeal from the
\nIvory Coast medical profession for physi-
\ncians to do more to protect themselves from
\nEbola. Some simple medical practices were
\nnot being abided by and routine measures
\nwere not being applied. Physicians were not
\nwashing their hands regularly after attend-
\ning patients. They were not wearing gowns
\nor gloves when examining patients. In the
\ncase of confirmed cases the request was for
\nall physicians to incinerate all the materials
\nand equipment used.
\nGermany
\nDr. Armin Ehl (Germany), Executive Di-
\nrector of Marburger Bund, the trade union
\nof employed doctors in Germany, invited
\ndelegates to attend the first congress of
\nmedical trade unions to be held in Berlin in
\nJune 2016. The conference would deal with
\nphysicians\u2019working conditions and with the
\nmigration of doctors.
\nCouncil
\nThe WMA Council briefly reconvened to
\nconsider the two motions sent to it by the
\nAssembly on nuclear war and smallpox.
\nIt was agreed that both motions should be
\nsent to the Socio Medical Committee for
\nconsideration.
\nMr. Nigel Duncan,
\nPublic Relations Consultant,
\nWMA
\n136
\nWMA News
\nThe Guest of Honour, the Chair of the
\nWorld Medical Association Council,
\nDr.\u00a0 Mukesh Haikerwal. The Immediate
\nPast President, Dr.\u00a0Cecil Wilson.The Presi-
\ndent Elect, Dr.\u00a0 Xavier Deau. The Secre-
\ntary General, Dr.\u00a0Otmar Kloiber. Council
\nMembers, delegates, observers, ladies and
\ngentlemen,
\nI want to begin by again thanking our
\nhosts, the South African Medical Asso-
\nciation for having accorded us such warm
\nhospitality.
\nThen I want to pay tribute to those physi-
\ncians and other health workers who are on
\nground working very hard to overcome the
\nEbola outbreaks in Sierra Leone, Guinea,
\nLiberia and until recently, Nigeria.
\nAs is the African culture,I ask for a moment
\nof silence to remember all those physicians
\nwho have succumbed to the Ebola haemor-
\nrhagic fever since the outbreaks started in
\nWest Africa.
\nOver the last one year I\u00a0have listened care-
\nfully to physicians, speak of their work
\nand the issues that confront them. What
\nstrikes me is that the challenges of physi-
\ncians working in high income countries are
\nthe same as those of physicians working in
\npoorer countries. The only difference is the
\nscale. Physicians everywhere are concerned
\nabout the increasing burden of chronic
\ndiseases and the need for something to be
\ndone about the lifestyles of people. Physi-
\ncians everywhere are faced with an increas-
\ning plethora of stakeholders inside and out-
\nside the health sector and the challenge of
\nfinding ways of engaging more effectively
\nwith them. Everywhere you go, physicians
\nare concerned about the increasing work
\nload, the wider scope of work, the bureau-
\ncracy and fears of litigation. Physicians all
\nover the world have recognized the need to
\nstrengthen inter- professional collaboration
\nand team work.
\nAnd In Low and Middle Income countries
\nin Asia, South America and Africa, physi-
\ncians are particularly concerned about the
\nmassive brain drain resulting in a human
\nresource for health crisis and unsatisfied
\nwith the response of governments and the
\nlack of priority given to health especially
\nwhen allocating funding. In many areas of
\nthe world, physicians are confronted with
\nharassment and their right to clinical in-
\ndependence is threatened by governments
\nwhich should be protecting them. Unfor-
\ntunately, in many places, these incidences
\ndo not get reported because the physicians
\nthemselves fear the repercussions of report-
\ning or have nowhere to report.
\nWhat is encouraging however is the resolve,
\nthe commitment and the passion with
\nwhich physicians all over the world regard-
\nless of the challenges they face, continue to
\ndo their work. It is for instance inspiring
\nwhen you hear of the courage shown by the
\nTurkish Medical Society in protecting their
\nphysicians.
\nOne important challenge facing physicians
\nis the Information Age. Physicians indeed
\nneed to play their part in contributing to
\nthe global movement to build what is re-
\nferred to as the Information Society. WMA
\nshould be at the forefront of advocacy for
\ninstance in Africa against the negative
\nperceptions policy makers have towards
\nICT and especially social media and lobby
\nstrongly for the cost of ICT infrastructure
\nto come down. These are among the major
\ncauses of the lack of or underdevelopment
\nof e-health approaches that you find in Low
\nand Middle Income countries.
\nThe Information Age, global security and
\nthe global economy are among the key chal-
\nlenges for global health in the 21st
\nCentury.
\nThe physicians of the 21st
\ncentury therefore
\nare likely to face challenges that are very
\ndifferent from those that were faced by the
\nphysicians of the 20th
\nCentury. Physicians
\nof the 21st
\nCentury will be required to be
\nmore effective change agents, stronger hu-
\nman rights advocates, patients\u2019 advocates,
\nmore effective communicators with patients
\nand communities they serve. They will also
\nincreasingly be expected to play a larger role
\nin convincing governments and other stake-
\nholders, as to why it makes economic and
\ndevelopment sense to invest more in health.
\nNMAs of the 21st
\nCentury therefore must
\nplay different roles from the NMAs of the
\n20th
\nCentury.NMAs must speak out against
\nviolence and other injustices their physi-
\ncians face. They must be at the forefront of
\ncivil society advocacy campaigns. And they
\nmust advocate more strongly for the right to
\nhealth of the communities they serve.
\nThe WMA will continue to provide oppor-
\ntunities for NMAs to develop their leader-
\nship capacity by providing guidelines, train-
\ning modules, networking opportunities and
\nthe leadership development course at the
\nINSEAD in Singapore. NMAs must make
\nan effort to access these resources and use
\nthem to build the capacity of their physi-
\ncians so they are able to do the action and
\nadvocacy required
\nThe WMA must be more proactive in
\nreaching out especially to those NMAs in
\npoor countries. In response to requests by
\nthe membership, WMA has embarked on a
\nprocess to strengthen the advocacy capacity
\nof NMAs.
\nOver the last one year, I\u00a0 have played my
\nrole and represented WMA at a total of 15
\nglobal meetings, speaking about the role of
\nWMA and the potential roles for NMAs in
\naddressing issues of brain drain, regulation,
\nmedical education, access to quality health
\ncare for patients and protection of health
\nworkers in armed conflict and other emer-
\ngencies, the Social Determinants of Health,
\nMental Health, Violence against Women,
\nViolence in the Health care setting, Pa-
\nValedictory address
\nDr. Margaret Mungherera,
\nPresident of the World Medical Association 2013-2014
\n137
\nWMA News
\ntient Safety, ethical issues around health
\ncare, post 2015 priorities and health sys-
\ntem challenges in Low and Middle Income
\ncountries. And as a Rotarian, I am eager to
\nsee that WMA works closely with Rotary
\nInternational and that NMAs participate
\nactively in the campaign to eradicate polio
\nfrom this planet.
\nWhat has made a big impression on me
\nhowever, are the discussions we have had
\nduring my interaction with many of you.
\nMany NMAs have extended to me an in-
\nvitation to visit them and as a result, I\u00a0have
\nspoken at a total of 10 annual general
\nmeetings in a period of only 12 months
\nand have visited a total of 20 countries
\nin 6 continents, some of them more than
\nonce. I\u00a0 have also had the pleasure to be
\ninvited by several of you to participate in
\nyour NMA activities \u2013 like the Medical
\nMission in Benin City in Nigeria, where
\nI looked at the expressions of relief on the
\nfaces of mothers of ill children which made
\nme even more convinced that this is what
\nNMAs are supposed to do. The reception I
\nreceived at the studios of Radio New Zea-
\nland further convinced me that the media
\ncan be an effective partner for NMAs in
\npromoting health.
\nThe WMA is making an effort to address
\nmany of these issues in the working groups
\nand through collaboration with other orga-
\nnizations. The WMA of the 21st
\nCentury
\nhowever cannot be the same as the WMA of
\nthe 20th
\nCentury. The roles are different and
\nso are the expectations of the NMAs, physi-
\ncians and other stakeholders.This requires the
\nWMA to review its institutions with a view
\nto strengthen them based on the needs. The
\nCouncil has introduced the idea of Round
\nTable conferences as a means of fundraising.
\nHowever,these efforts must be improved.
\nTwo groups of people will be useful in pro-
\npelling NMAs to cope with the new chal-
\nlenges of the 21st
\nCentury. These are junior
\ndoctors and medical students.They are truly
\nthe future of the profession, the NMAs and
\nthe WMA. And through my own interac-
\ntion this year with the Junior Doctors Net-
\nwork and the International Federation of
\nMedical Students Associations, I\u00a0have be-
\ncome more and more convinced that these
\n2 groups are ready to take on the mantle of
\nleadership. As NMAs therefore, let us open
\nour doors, provide them space to participate
\neffectively in the NMAs and invite them to
\nget involved in the leadership.
\nAs far as Leadership is concerned, in 2015
\nthe world celebrates 20 years since the Bei-
\njing Conference on Women. We shall be
\ncelebrating the achievements of the world
\nin terms of empowerment of women in
\nmany areas including leadership. The very
\nfirst speech I made after my election as
\nWMA President was the keynote speech at
\nthe Congress of the Medical Women Inter-
\nnational Association last year in Seoul, Ko-
\nrea. I spoke at great length about the roles
\nthat women physicians can and should play
\nin influencing the health agendas in their
\ncountries and in strengthening the roles
\nof their national medical associations. As
\nI move around the world, I\u00a0have been im-
\npressed by the work women physicians do
\nin their national medical associations.
\nThere are several NMAs that do not have
\nor have very few women in their leadership.
\nYet there are benefits of allowing women to
\nparticipate in the NMA leadership. I\u00a0have
\nmet and interacted with vibrant and com-
\nmitted women NMA Presidents in the
\nUS, in UK, in Ethiopia, in Sweden and in
\nRwanda and in South Africa. Having a
\nwoman as the NMA President is a good
\nthing but what is even better is to have
\nmore women and achieve a gender balance
\nwithin the leadership of the NMA. We are
\nencouraging NMAs to involve themselves
\nmore in issues around women\u2019s health and
\nViolence against Women. Women leaders
\ncan more easily become actively involved in
\nsuch programs because they are more likely
\nto appreciate the related socio-cultural is-
\nsues. It also encourages more women to join
\nthe profession and more importantly more
\nwomen will be encouraged to take up po-
\nsitions of leadership within the profession.
\nOur NMAs must therefore reflect what we
\nwould like to see in other public and private
\ninstitutions and in society as a whole. Good
\nexamples of NMAs where I found gender
\nbalance in the governance structure were
\nthe Philippines Medical Association and
\nthe Ethiopian Medical Association. Maybe
\nWMA should consider taking up the re-
\nsponsibility of leading the way and setting
\nan example for NMAs.
\nEvery WMA President gets to choose a
\ntheme around which he or she will do their
\nadvocacy work. I chose Africa as my theme.
\nI set out to increase the focus of WMA on
\nthe African continent and particularly on
\nthe African NMAs. The reason contrary to
\nwhat some people may think is not because
\nI am an African. It is because Africa is part
\nof the world and in fact, 11% of the world\u2019s
\npopulation lives on the African continent.
\nAfrica\u2019s health therefore impacts on global
\nhealth. And as has now finally been realized
\nwith the Ebola outbreaks, the world\u2019s sur-
\nvival depends on Africa\u2019s survival.
\nThe African continent is the continent with
\nthe largest disease burden, one that is dis-
\nproportionate to its population. For instance,
\nwith 11% of the world\u203as population, Africa
\nhas 45% of the world\u203as women dying from
\nchildbirth related complications and 62% of
\nthe world\u203as HIV patients. This huge disease
\nburden can be attributed to natural disasters,
\nwars, political instabilities etc. But the most
\nsignificant causative factor is the weak health
\nsystems that African countries have especial-
\nly those that are in the Sub Saharan region.
\nIt is however, unfortunate that it has taken
\nthe recent Ebola outbreaks for the world to
\nrealize that it is the weak health systems of
\nAfrica that are the biggest threat to global
\nhealth. Millions have been dying from Ma-
\nlaria and other diseases as a result of these
\nweak health systems. And yet there is little
\ndone to strengthen these systems. In fact,
\nthe main problems that are making over-
\ncoming the Ebola outbreaks difficult is not
\nlack of hospital beds or health workers but
\nthe lack of disease surveillance systems,
\n138
\nWMA News
\nepidemic preparedness and an effective epi-
\ndemic response.
\nAfrican Governments have responded to
\nthe challenge of weak health systems by
\nratifying several international and regional
\ndeclarations with several countries further
\ndeveloping national policies and health sec-
\ntor strategic plans and incorporating them
\ninto national development plans. Subse-
\nquently, massive amounts of funds from do-
\nnor and foreign sources have been pumped
\ninto African health sectors for the purpose
\nof implementing these policies. It is how-
\never estimated that 20-40% of these funds
\nare wasted largely due to massive corruption
\nand due to implementation that is not in line
\nwith the policies.The major cause of Africa\u203as
\nweak health systems therefore is not a short-
\nage of policies or road maps or funding. It is
\neffective leadership to implement the policies
\nand road maps. Let us hope however that it
\nwill not need many more Africans and oth-
\ners to die before the world realizes that the
\nkey solution to strengthening these systems
\nlies in effective leadership from within Africa
\nrather than from outside the continent.
\nA good leader has followers. A Malawian
\nproverb says \u201cA leader without followers is
\nsimply taking a walk\u201d. Africa has too many
\nleaders without followers, leaders simply
\ntaking a walk. A common example is the
\ndelay in the local response to the Ebola
\noutbreaks by the governments affected, the
\nAfrican Union and others on the continent,
\nclearly showing a lack of effective leader-
\nship. Developing leadership capacity should
\ntherefore be the main emphasis of any effort
\naimed at to strengthening health systems
\nand reducing Africa\u2019s disease burden.
\nThe solutions for Africa\u2019s health problems
\nlie within the African continent. The inter-
\nnational community must allow Africa to
\ntake charge of their health sector by helping
\nAfrica to develop its professional leadership.
\nSo during my term as WMA President,
\nI\u00a0have spearheaded the WMA Africa Medi-
\ncal Initiative. The Initiative set out to assess
\nthe strength of African NMAs. A capacity
\nneeds assessment has been carried out this
\nyear consisting of 4 regional consultative
\nmeetings held in Kenya, Nigeria, Tunisia
\nand South Africa and as a result 8 key the-
\nmatic areas have been identified. These are
\nOrganizational Strengthening, Migration
\nand Retention, promoting quality Medi-
\ncal Education, improving physicians\u2019 access
\nto Continuing Professional Development,
\nSocial Determinants of Health, Universal
\nHealth Coverage, Research and Publication.
\nOver a period of 5 years, African NMAs ir-
\nrespective of whether they are members or
\nnot) will be offered capacity building op-
\nportunities to enable them more effectively
\ninfluence their health systems. We have in-
\ntroduced the WMA Initiative to the Afri-
\ncan Union, the African Development Bank
\nand to 44 African Ministers of Health who
\nI spoke to explaining the potential role of
\ntheir NMAs in strengthening their health
\nsystems in their countries.
\nThe next stage is for the identified Lead Fa-
\ncilitators to design the Program basing on
\nthe findings and then work with resource
\npersons who have been identified from
\namong NMAs outside Africa and from
\namong African physicians in the diaspora
\nin the UK. And anyone or NMA interested
\nis welcome to participate.
\nThe Program will involve online discussions,
\nskills training workshops and conferences.
\nTwinning is also being encouraged between
\nstrong NMAs outside the African conti-
\nnent and African NMAs. I want to there-
\nfore appreciate those NMAs outside the
\nAfrica region who have offered to twin with
\nAfrican NMAs- the New Zealand Medical
\nAssociation, h will twin with Medical As-
\nsociation of Tanzania, the Japan Medical
\nAssociation with the Malawi Medical As-
\nsociation and the Danish Medical Associa-
\ntion with the Rwanda Medical Association.
\nAfrican NMAs that have not yet joined the
\nWMA have been invited to join. Our target
\nis to see that at least 4 new African NMAs
\njoin WMA every year. This target has been
\nmet this year with NMAs of Kenya, Zam-
\nbia, Rwanda and Lesotho applying to join.
\nHowever, we still have 29 of the 54 coun-
\ntries in Africa which are not represented in
\nthe WMA. This is half, so we have a long
\nway to go.
\nAt this juncture I wish to thank the Dan-
\nish Medical Association for offering to sup-
\nport the Chair of the Kenya Medical As-
\nsociation and the President of the Rwanda
\nMedical Association to attend this meeting
\nas observers. We shall need more of such
\nsupport from other NMAs.
\nWe again look forward to many more of you
\nparticipating in this important initiative be-
\ncause again I say when the health of Africa
\nis threatened, global health and survival is
\nalso threatened.
\nThis flight of WMA 2014-15 took off on
\nthe 19th
\nOctober 2013 in Fortaleza, Brazil.
\nSome of you looked uneasy seeing an Afri-
\ncan woman from one of the poorest nations
\nin the world taking charge and yes,the flight
\ndid experience some turbulence from time
\nto time. Generally, it was a smooth flight.
\nAnd as I was assured from the beginning
\nby my good friends Vivienne and Ardis and
\nMzukisi, I\u00a0 have had tremendous support.
\nI\u00a0have had an excellent co-pilot,Mukesh you
\nhave taught me a lot, and Otmar, you have
\nbeen an excellent flight engineer, and the
\ncrew, Julia, Clarisse, Sunny, Anna, Lamine,
\nAnnabel and the volunteers, Salma and
\nStintje have been very supportive, and more
\nimportantly the passengers, that is you the
\nconstituent members have been exceptional.
\nWell now, a new Captain takes over. Xavier
\nmon ami, I wish you all the best in this im-
\nportant and prestigious position. I pledge
\nmy support to you. I am very confident that
\nwith your commitment, and you being calm
\nand clear headed you will take the WMA to
\ngreater heights.
\nI want to end by expressing sincere appre-
\nciation to my husband Richard and the rest
\nof my family for their patience and unwav-
\nering support.
\nTo all of you again, I say, thank you for this
\nwonderful opportunity to serve. It has in-
\ndeed been a wonderful year and thank you
\nall for listening to me.
\n139
\nWMA News
\nIt is a great honour and pleasure for me to
\nbe here in Durban to take on the Presidency
\nof the World Medical Association in front
\nof all of you and to represent the 106 Medi-
\ncal Associations of our Association.I\u2019m sure
\nyou will understand that it is with some
\nemotion that I address you today.
\nAllow me first to pay tribute to our Past
\nPresident,Dr Margaret Mungherera,whose
\ngreat amount of work over the past year
\nhas contributed to promoting the ethical
\nstandards of our Association at the highest
\nlevel, particularly on the African continent
\nthrough the African Forum project.
\nLet me introduce myself:
\nI am a medical specialist in general medi-
\ncine, and since 1976 I\u00a0have been working
\nin Epinal (in the Eastern part of France) in
\na multi-professional medical practice locat-
\ned in a socially disadvantaged area (which
\nincludes a re-housing centre, a children\u2019s
\nhome and social housing\u2026). I founded this
\nmulti-professional and multidisciplinary
\nmedical practice in order to optimize the
\nquality of healthcare and answer the spe-
\ncific needs of a precarious population in a
\ncoordinated manner.
\nHaving lived in Lorraine, 20 meters from
\nthe German border, for the first 25 years
\nof my life, I\u00a0have always been sensitive to
\nmulticulturalism, to the importance of re-
\nspecting difference, and to the construction
\nof a Europe in the spirit of peace and un-
\nderstanding so dear to Robert Schuman,the
\nfounder of the European Union who was
\nborn in the same region. Therefore, I\u00a0have
\nalways held within me great faith in a world
\nof peace, fraternity and joy.
\nThis spirit of peace,respect and understand-
\ning has led me to take on professional re-
\nsponsibilities within the French Medical
\nCouncil as an Elected Representative, first
\nat Departmental level, then at National
\nlevel as Vice-President, then as President of
\nthe European and International Relations
\nDelegation, and lastly as Secretary General
\nof the European Council of Medical Or-
\nders and of the Francophone Conference of
\nMedical Orders gathering of 22 countries,
\nincluding 15 from the African continent.
\nI would like to express my gratitude to the
\nFrench Medical Council for making all
\nthese commitments possible.
\nDuring my studies, I was fortunate enough
\nto get to know Doctor Bernard Kouchner
\nand Doctor Xavier Emmanuelli, found-
\ners of Doctors without Borders and of the
\nSAMU Social International, who have been
\noutstanding examples of the universality of
\nmedical ethics for me.
\nLastly, I could never forget my daily source
\nof energy: the affection of my wife who is
\nhere with us today, as well as my 5 children
\nand 12 grandchildren, who are not physi-
\ncally present, but who are in my heart and
\nsoul.
\nTherefore, you will understand that, as
\nis true for each of us, my path has been
\nmarked by my own family and my own cul-
\ntural determinants. I would like to thank
\nall of those who have helped me to be here
\nwith you today.
\nAll your actions within the World Medical
\nAssociation have allowed me to continue
\nalong this path.
\nThe question I am now asking myself is
\nprobably the same one that you have in
\nmind:
\nWhy did I accept the role of the Presidency
\nof the WMA?
\nI would first like to call to mind one of the
\nfathers of the WMA, the French doctor
\nEug\u00e8ne Marquis, who, following the atroci-
\nties of the last World War, showed along
\nwith many of his colleagues a very strong
\nwillingness to work for peace by raising the
\nethical standards of medical practice to the
\nhighest level through the foundation of the
\nWMA.
\nSince its creation in 1947, the WMA has
\nbeen constantly affirming loud and clear
\nthrough its declarations and statements the
\nuniversality of essential ethical values for
\npracticing our profession.
\nI want to maintain continuity with my pre-
\ndecessors; it is with humility that I will head
\nour Association.
\nTherefore, throughout the coming year
\nI\u00a0will endeavour to enhance our ethical val-
\nues even further because, beyond the deon-
\ntology proper to the legislation in each of
\nour countries, these ethical values should
\nsway the mind of each and every doctor,
\nregardless of his or her culture, religion or
\nskin colour.
\nAlong with you, I will seek to protect and
\nfurther develop:
\nThe independence of the medical profes-
\nsion, which should be duly respected by
\npolitical, administrative, military as well as
\nreligious authorities. The independence of
\ndoctors\u2019 decision-making forms the basis
\nof the trust indispensable to the doctor\u2013pa-
\ntient relationship.
\nProfessional secrecy: in all circumstances,
\nincluding during armed conflicts, profes-
\nsional secrecy must be respected along
\nwith all information on patients and their
\nconsent to the health care proposed to
\nthem.
\nA high-level, good quality education is the
\ncornerstone of the competence of doctors,
\nand it is essential that the WMA be one of
\nthe effective players in this field, especially
\nthrough the development of the worldwide
\njunior doctors network. The JDN has dem-
\nonstrated its role within the WMA. The
\nWMA should remain at the service of the
\neducation of the doctors of tomorrow.
\nLet us not forget the protection of our
\npatients\u2019 personal data at this time of new
\ntechnologies, e-health and m-health. The
\nprotection of these sensitive data should be
\nenhanced as rigorously as possible without
\nInaugural speech
\nDr. Xavier Deau,
\nPresident of the World Medical Association 2014-2015
\n140
\nWMA News
\njeopardizing the evolution of our medical
\nscience.
\nAt the same time, in a world where every-
\nthing tends to have a monetary value, we
\nshould remain very watchful of all poten-
\ntial conflicts of interest. Human values must
\nalways prevail over financial considerations,
\nbearing in mind that the well-being of hu-
\nmans cannot be dissociated from financial
\ncontingencies.The WMA has to participate
\nin finding a balance between the \u201cprimacy
\nof the individual\u201d and \u201csocietal primacy\u201d.
\nAll of these ethical values have been under-
\nlined in the latest version of the Declaration
\nof Helsinki, which is a shining example of
\nthe universality of medical ethics. Even if
\nits drafting seemed laborious at times, our
\nDeclaration of Helsinki has the merit of
\ncompiling the cultures of 106 medical as-
\nsociations, and thus is an authentic factor
\nin promoting peace and the union between
\nmedical professions around the world in full
\nrespect for patients and their care.
\nNonetheless, these ethical values cannot ex-
\nist without a structured and organized soci-
\nety, taking into account the social determi-
\nnants of health in order to optimize health
\nequity.
\nThis coordination should include all the dif-
\nferent players around patients, both in care
\nand prevention, as well as in health educa-
\ntion, in one single, all-encompassing and
\ndynamic vision within a given territory.
\nThe WMA should contribute to a genuine
\nrevolution in primary care by promoting
\nholistic and personalized medicine, coordi-
\nnated between the different health profes-
\nsions.
\nIn this respect, I would particularly like to
\npraise the work of Sir Michael Marmot for
\nhis contribution towards this goal, both in
\nhis own country and worldwide.
\nTaking account of our cultural differences
\nnecessarily raises the level of care require-
\nments, particularly at a time when viruses
\nlike Ebola have no more borders and require
\na maximum level of coordination from all
\nhealth care professionals and politicians. In
\nthis regard, the role of the WMA becomes
\nindispensable. We must all mobilize our-
\nselves.
\nWorking through their constant perspec-
\ntive of multiculturalism, I would like to pay
\ntribute to the efforts of our WMA lead-
\ners: our Chairman of the Board, Mukesh
\nHaikerwal, our Secretary General, Otmar
\nKloiber, as well as the rigorous and care-
\nful vigilance of our Treasurer, Frank Ulrich
\nMontgomery, not forgetting our legal advi-
\nsor, Annabel Seebohm and ethical advisor
\nJeff Blackmer. I would also like to thank
\nall the members of the WMA\u2019s Executive
\nCommittee, not forgetting the efficiency of
\nthe entire Secretariat and those who sup-
\nport their work (Sunny,Clarisse,Anne-Ma-
\nrie, Roderic, Rosie, Julia and Lamine, and
\nof course\u2026Nigel,always looking out for the
\nlatest news).
\nI am French and my country, France, is not
\nonly a country with a strong human rights
\nrecord, but also a republic which has been
\nbased on the triptych: liberty, equality, fra-
\nternity since 1789 (and the French Revolu-
\ntion).
\nI will therefore strive during this mandate
\nto promote healthcare equity for every hu-
\nman being regardless of his or her language,
\nculture or religion.
\nTo conclude, I\u00a0 have one final wish: our
\nworld is currently going through a dramatic
\nincrease in armed conflicts,which are seeing
\nthe values of our Association permanently
\nviolated. Impartiality remains an inescap-
\nable ethical value, as much in our schools
\nas in our administrations and our hospitals.
\nThis impartiality guarantees a deep respect
\nfor all cultural differences and the rejection
\nof all forms of fundamentalism.
\nThat is why I am asking everyone to act as
\npeacemakers by strictly observing these val-
\nues within your Associations, towards your
\ngovernments and also with respect to each
\nof your patients.
\nToday marks the 12th
\nWorld Day Against
\nthe Death Penalty, and I would like to
\nstress the importance of this issue for the
\nWMA. This gives me an opportunity to
\npay tribute to the work of our association
\nin this field through its policies aimed at
\nsupporting doctors working in prisons to
\npromote human rights and ethics. I refer
\nin this regard to the Declaration of Tokyo,
\nwhich provides Guidelines for Physicians
\nConcerning Torture and Other Cruel, In-
\nhuman or Degrading Treatment or Pun-
\nishment in Relation to Detention and
\nImprisonment, the Declaration of Malta
\non Hunger Strikers and the Declaration of
\nEdinburgh on Prison Conditions and the
\nSpread of Tuberculosis and Other Com-
\nmunicable Diseases.
\nOn this special day of my election, I would
\nalso like to underline the crucial action of
\ntwo South African Nobel Peace Prize Lau-
\nreates, Nelson Mandela and Archbishop
\nDesmond Tutu. These two men have man-
\naged to be drivers for peace and impartiality
\nbeyond the borders of South Africa.
\nLet us be the actors and also the builders of
\na healthier, fairer and more equitable soci-
\nety, in which human rights, but also liberty,
\nequality and fraternity, as well as high qual-
\nity health care, enable each person to grow
\nand live in peace.
\nLet us be doctors acting towards peace in
\nthe name of the universality of the ethics of
\nour Medical Association\u2026!
\nSeamos m\u00e9dicos actores de paz en nombre de
\nla universalidad de la \u00e9tica de nuestra aso-
\nciaci\u00f3n\u2026 !
\nI thank you all.
\n141
\nWMA News
\nWMA Declaration on the
\nProtection of Health Care
\nWorkers in situation of Violence
\nAdopted by the 65th
\nWMA General Assembly, Durban, South Africa,
\nOctober 2014
\nPreamble
\nThe right to health is a fundamental element of human rights which
\ndoes not change in situations of conflict and violence. Access to
\nmedical assistance for the sick and wounded, whether they have
\nbeen engaged in active combat or not,is guaranteed through various
\ninternational agreements, including the Geneva Convention and
\nthe Basic Principles on the Use of Force and Firearms by Law En-
\nforcement Officials of the United Nations.
\nThe primary obligation of physicians is always to their patients, and
\nphysicians have the same ethical responsibilities to preserve health
\nand save life in situations of violence or armed conflicts as in peace-
\ntime. These are as set out in the WMA Regulations in Times of
\nArmed Conflict and Other Situations of Violence.
\nIt is essential to ensure the safety and personal security of healthcare
\nworkers in order to enable the provision of the highest standard of
\ncare to patients. If healthcare workers are not safe, they might not
\nbe able to provide care, and patients will suffer.
\nIn situations of violence,the delivery of healthcare is frequently obstruct-
\ned and the sick and wounded deprived of essential treatment through:
\n1. Medical workers being prevented from attending to the injured;
\n2. Interference by the state or others in positions of power through
\nintimidation, detention or other legal measures;
\n3. Patients being denied access to medical facilities;
\n4. Targeted attacks upon medical facilities and medical transport;
\n5. Targeted attacks upon medical personnel,including kidnapping;
\n6. Non-targeted violent acts which result in the damage to or
\ndestruction of facilities or vehicles, or cause injury or death to
\nmedical personnel.
\nSuch actions have serious humanitarian implications and violate interna-
\ntional standards of medical neutrality as set out in the provisions of inter-
\nnational human rights and humanitarian law and codes of medical ethics.
\nAttacks on the fundamental ethical principles of the medical pro-
\nfession, such as attempts to coerce medical professionals into pro-
\nviding details regarding those under their care, can undermine the
\nconfidence of patients and discourage injured people from seeking
\nnecessary treatment.
\nRecommendations
\nThe WMA calls upon governments and all parties involved in situ-
\nations of violence to:
\n1. Ensure the safety,independence and personal security of health-
\ncare personnel at all times, including during armed conflicts and
\nother situations of violence, in accordance with the Geneva
\nConventions and their additional protocols;
\n2. Enable healthcare personnel to attend to injured and sick patients,
\nregardless of their role in a conflict,and to carry out their medical
\nduties freely, independently and in accordance with the principles
\nof their profession without fear of punishment or intimidation;
\n3. Safe access to adequate medical facilities for the injured and
\nothers in need of medical aid should not be unduly impeded;
\n4. Protect medical facilities, medical transport and the people
\nbeing treated in them and provide the safest possible working
\nenvironment for healthcare workers and protect them from in-
\nterference and attack;
\n5. Respect and promote the principles of international humanitar-
\nian and human rights law which safeguard medical neutrality in
\nsituations of conflict;
\n6. Establish reporting mechanisms to document violence against
\nmedical personnel and facilities as set out in the WMA State-
\nment on the Protection and Integrity of Medical Personnel in
\nArmed Conflicts and Other Situations of Violence.
\n7. Raise awareness of international norms on the protection of
\nhealthcare workers and cooperate with different actors to identify
\nstrategies to tackle threats to healthcare.The collaboration between
\nthe WMA and the International Committee of the Red Cross on
\nthe Health Care in Danger project provides one example of this.
\nWMA Resolution on Ebola Viral
\nDisease
\nAdopted by the 65th
\nWMA General Assembly, Durban, South Africa,
\nOctober 2014
\nBackgound
\nA number of viral diseases have caused occasional health emergen-
\ncies in parts of Africa, with local or wider spread epidemics. These
\n142
\nWMA News
\ninclude Lassa, Marburg and Ebola Viral Diseases (EVD). The
\n2013\u201314 outbreak of EVD in West Africa has proven far more dif-
\nficult to control than previous epidemics and is now present in Si-
\nerra Leone, Liberia and Guinea with more than 2000 deaths. This
\nepidemic appears to have a case related mortality of approximately
\n55% against a range for EVD of 50\u201395%.
\nFollowing infection, patients remain asymptomatic for a period of
\n2\u201321 days, and during this time tests for the virus will be nega-
\ntive, and patients are not infectious, posing no public health risk.
\nOnce the patient becomes symptomatic, EVD is spread through
\ncontact with body fluids including blood. Symptoms include diar-
\nrhoea, vomiting and bleeding, and all these body fluids are poten-
\ntially sources of infection.
\nManagement is primarily through infection control, the use of per-
\nsonal protective equipment (PPE) by health care workers and those
\ndisposing of body fluids and of bodies, and supportive care for sick
\npatients including using IV fluids and inotropes. Contact tracing is
\nalso important but may be difficult in many of the communities cur-
\nrently affected. Vaccines are in development as are some antivirals,
\nbut they will arrive late in this epidemic if they are proven successful.
\nEvidence from those treating patients in affected communities is
\nthat a shortage of resources,including health care workers and PPE,
\nas well as poor infection control training of health care workers,
\ncaregivers and others at risk are making epidemic control difficult.
\nSome governments have indicated that they will build new treat-
\nment centres in affected areas as a matter of urgency, while others
\nare directly providing personal protective equipment and other sup-
\nplies.
\nRecommendations
\nThe WMA honours those working in these exceptional circumstanc-
\nes, and strongly recommends that national governments and inter-
\nnational agencies work with health care providers on the ground and
\noffer stakeholders training and support to reduce the risks that they
\nface in treating patients and in seeking to control the epidemic.
\nThe WMA commends those countries that have committed re-
\nsources for the urgent establishment of new treatment and isola-
\ntion centres in the most heavily burdened countries and regions.
\nThe WMA calls upon all nations to commit enhanced support for
\ncombatting the EVD epidemic.
\nThe WMA calls on the international community, acting through
\nthe United Nations and its agencies as well as aid agencies, to im-
\nmediately provide the necessary supplies of PPE to protect health
\ncare workers and ancillary staff and reduce the risk of cross infec-
\ntion. This must include adequate supplies of gloves, masks and
\ngowns, and distribution must include treatment centres at all levels.
\nThe WMA calls on all those managing the epidemic,including local
\nand national governments and agencies such as WHO, to commit
\nto adequate training in infection control measures, including PPE
\nfor all staff and caregivers who might come into contact with infec-
\ntive materials.
\nThe WMA calls on national and local governments to increase pub-
\nlic communication about basic infection control practices.
\nThe WMA calls upon WHO to facilitate research into the timeli-
\nness and effectiveness of international interventions, so that plan-
\nning and interventions in future health emergencies can be better
\ninformed.
\nThe WMA strongly urges all countries, especially those not yet af-
\nfected, to educate health care providers about the current case defi-
\nnition in addition to strengthening infection control methodologies
\nand contact tracing in order to prevent transmission within their
\ncountries.
\nThe WMA calls for NMAs to contact their national governments
\nto act as described in this document.
\nWMA Resolution on Migrant
\nWorkers\u2019 Health and Safety in
\nQatar
\nAdopted by the 65th
\nWMA General Assembly, Durban, South Africa,
\nOctober 2014
\nPreamble
\nReliable reports indicate that migrant workers in Qatar suffer from
\nexploitation and violation of their rights. Workers basic needs, e.g.
\naccess to sufficient water and food, are not met. Less than half of
\nthe workers are entitled to health care. Hundreds of workers have
\nalready died in the construction sites since 2010 as the country pre-
\npares to host the 2022 FIFA [1] World Cup. Workers are not free
\nto leave when they see their situation hopeless or health endangered
\nsince their passports are confiscated.
\n143
\nWMA News
\nDespite the pleas of international labour and human rights organi-
\nzations, such as ITUC (International Trade Union Confederation)
\nand Amnesty International, the response of the Qatar government
\nto solve the situation has not been adequate. FIFA has been inef-
\nficient and has not taken the full responsibility to facilitate the im-
\nprovements to the worker\u00b4s living and working conditions.
\nThe World Medical Association reminds that health is a human
\nright that should be safeguarded in all situations.
\nThe World Medical Association is concerned that migrant workers
\nare continuously put at risk in construction sites in Qatar, and their
\nright to freedom of movement and right to health care and safe
\nworking conditions are not respected.
\nRecommendations
\nThe WMA calls upon the Qatar government and construction
\ncompanies to ensure the health and safety of migrant workers.
\nThe WMA demands the FIFA as the responsible organization of
\nthe World Cup to take immediate action by changing the venue as
\nsoon as possible.
\nThe WMA calls upon its members to approach local governments
\nin order to facilitate international cooperation with the aim of en-
\nsuring the health and safety of migrant workers in Qatar.
\n[1] F\u00e9d\u00e9ration Internationale de Football Association
\nWMA Resolution on the Non-
\nCommercialisation of Human
\nReproductive Material
\nAdopted by the 54th
\nWMA General Assembly, Helsinki, Finland, Sep-
\ntember 2003 and revised by 65th
\nWMA General Assembly, Durban,
\nSouth Africa 2014
\nPreamble
\nThe rapid advances in biomedical technologies have led to growth
\nof the reproductive assistance industry, which tends to be poorly
\nregulated. Despite the fact that many governments have laws pro-
\nhibiting commercial transactions of reproductive material, most
\nhave not been successful in universally preventing the sale of human
\nova, sperm and embryos on the internet and elsewhere. The market
\nvalue of human material, including cells, tissues, and cellular tissue
\ncan be lucrative, creating a potential conflict for physicians and oth-
\ners between economic interests and professional ethical obligations.
\nFor the purposes of this resolution human reproductive material is
\ndefined as human gametes and embryos.
\nAccording to the WHO, transplant commercialism \u201cis a policy or
\npractice in which cells, tissues or organs are treated as a commodity,
\nincluding by being bought or sold or used for material gain.\u201d [1]
\nThe principle that the \u201chuman body and its parts shall not, as such,
\ngive rise to financial gain\u201d[2] is laid down in numerous international
\ndeclarations and recommendations.[3] The 2006 WMA Statement
\non Human Organ Donation and Transplantation and the 2012
\nWMA Statement on Organ and Tissue Donation call for the pro-
\nhibition of the sale of organs and tissues for transplantation. The
\nWMA Statement on Assisted Reproductive Technologies (2006)
\nalso 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 repro-
\nductive material in the area of medical research. The International
\nBioethics Committee of the United Nations Educational, Scientific
\nand Cultural Organization (UNESCO IBC) in its report on the
\nethical aspects of human embryonic stem cell research states that
\nthe transfer of human embryos must not be a commercial transac-
\ntion and that measures should be taken to discourage any financial
\nincentive.
\nIt is important to distinguish between the sale of clinical assisted re-
\nproductive services, which is legal, and the sale of the human repro-
\nductive materials, which is usually illegal. Due to the special nature
\nof human embryos, the commercialization of gametes is unlike that
\nof other cells and tissues as sperm and eggs may develop into a child
\nif fertilization is successful.
\nBefore human reproductive material is donated,the donor must give
\ninformed consent that is free of duress. This requires that the indi-
\nvidual donor is deemed fully competent and has been given all the
\navailable information regarding the procedure and its outcome. If
\nresearch is to be conducted on the material,it is subject to a separate
\nconsent process that must be consistent with the provisions in the
\nWMA\u203as Declaration of Helsinki. There must not be any induce-
\nment or other undue pressure to donate or offers of compensation.
\nMonetary compensation given to individuals for economic losses,
\nexpenses or inconveniences associated with the retrieval of donated
\n144
\nWMA News
\nreproductive materials should be distinguished from payment for
\nthe purchase of reproductive materials.
\nRecommendations
\nNational Medical Associations (NMAs) should urge their govern-
\nments to prohibit commercial transactions in human ova,sperm and
\nembryos and any human material for reproductive purpose.
\nPhysicians involved in the procurement and use of human ova,
\nsperm, and embryos should implement protocol to ensure that ma-
\nterials have been acquired appropriately with the consent and au-
\nthorization of the source individuals. In doing so, they can uphold
\nthe ethical principle of non-commercialization of human reproduc-
\ntive material.
\nPhysicians should consult with potential donors prior to donation
\nin order to ensure free and informed consent.
\nPhysicians should adhere to the WMA Statement on Conflict of
\nInterest when treating patients who seek reproductive services.
\n[1] Global Glossary of Terms and Definitions on Donation and
\nTransplantation, WHO, November 2009
\n[2] European convention of human rights and biomedicine \u2013 Ar-
\nticle 21 \u2013 Prohibition of financial gain
\n[3] Declaration of Istanbul guiding principle 5
\nWMA Resolution on Unproven
\nTherapy and the Ebola Virus
\nAdopted by the 65th
\nWMA General Assembly, Durban, South Africa,
\nOctober 2014
\nIn the case of Ebola virus, the WMA strongly supports the inten-
\ntion of Paragraph 37 of the 2013 revision of the Declaration of Hel-
\nsinki, which reads:
\nIn the treatment of an individual patient, where proven interventions
\ndo not exist or other known interventions have been ineffective, the
\nphysician, after seeking expert advice, with informed consent from
\nthe patient or a legally authorized representative, may use an unprov-
\nen intervention if in the physician\u2019s judgement it offers hope of sav-
\ning life, re-establishing health or alleviating suffering. This interven-
\ntion should subsequently be made the object of research, designed to
\nevaluate its safety and efficacy. In all cases, new information must be
\nrecorded and, where appropriate, made publicly available.
\nWMA Statement on Aesthetic
\nTreatment
\nAdopted by the 65th
\nWorld Medical Assembly, Durban, South Africa, Oc-
\ntober 2014
\nPreamble
\nAesthetic treatments have become increasingly common in recent
\nyears as society appears to have become more preoccupied with
\nphysical appearance. These treatments are performed by practitio-
\nners with widely differing clinical and educational backgrounds.
\nFor the purpose of this statement, aesthetic treatment is defined as
\nan intervention that is performed not to treat an injury, a disease or
\na deformity, but for non-therapeutic reasons, with the sole purpose
\nof enhancing or changing the physical appearance of the individual
\nconcerned. In this statement, the individual undergoing treatment
\nis referred to as the patient.The treatments available include a great
\nvariety of interventions, ranging from surgical procedures to injec-
\ntions and different kinds of skin treatments. This statement focuses
\non interventions that are methodologically similar to those per-
\nformed in conventional health care. Tattooing, scarring and similar
\ninterventions are therefore not considered in this statement. Body
\nimage affects a person\u2019s self-esteem and mental health and is an
\nintegral part of a person\u2019s overall health and well-being. However,
\nmedia images of \u201cperfect bodies\u201d have become the norm, causing
\nsome people, to develop unrealistic and unhealthy body images.
\nMany aesthetic treatments involve risks and may potentially harm the
\nhealth of the patient. Minors [1] are particularly vulnerable, as their
\nbodies are often not fully developed. In order to protect persons con-
\nsidering 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 Dec-
\nlaration of Geneva, the WMA Declaration of Lisbon on the Rights
\nof the Patient and the WMA International Code of Medical Ethics,
\nand consistent with the mandate of the WMA, this statement is ad-
\ndressed primarily to physicians. However, the WMA encourages other
\npractitioners performing aesthetic treatments to adopt these principles.
\nPrinciples
\n1. The patient\u00b4s dignity, integrity and confidentiality must always
\nbe respected.
\n2. Physicians have a role in helping to identify unhealthy body im-
\nages and to address and treat disorders when these exist.
\n145
\nWMA News
\n3. Aesthetic treatments must only be performed by practitioners
\nwith sufficient knowledge, skills and experience of the interven-
\ntions performed.
\n4. All practitioners providing aesthetic treatments must be regis-
\ntered with and\/or licensed by the appropriate regulatory author-
\nity. Ideally, the practitioner should also be authorized by this
\nauthority to provide these specific aesthetic treatments.
\n5. All aesthetic treatments must be preceded by a thorough exami-
\nnation of the patient. The practitioner should consider all circum-
\nstances,physical and psychological,that may cause an increased risk
\nof harm for the individual patient and should refuse to perform the
\ntreatment if the risk is unacceptable. This is especially true in the
\ncase of minors.Practitioners should always choose the most appro-
\npriate treatment option,rather than the most lucrative one.
\n6. Minors may need or benefit from plastic medical treatments but
\npure aesthetic procedures should not be performed on minors. If,
\nin exceptional cases,aesthetic treatment is performed on a minors,
\nit should only be done with special care and consideration and
\nonly if the aim of the treatment is to avoid negative attention
\nrather than gain positive attention. All relevant medical factors,
\nsuch as whether the minor is still growing or whether the treat-
\nment will need to be repeated at a later date, must be considered.
\n7. The patient must consent explicitly to any aesthetic treatment,
\npreferably in writing. Before seeking consent the practitioner
\nshould inform the patient of all relevant aspects of the treat-
\nment, including how the procedure is performed, possible risks
\nand the fact that many of these treatments may be irreversible.
\nThe patient should be given sufficient time to consider the infor-
\nmation before the treatment starts. Where the patient request-
\ning the treatment is a minor, the informed consent of his or her
\nparents or legally authorized representative should be obtained.
\n8. All aesthetic treatments performed should be carefully documented
\nby the practitioner. The documentation should include a detailed
\ndescription of the treatment performed, information on medica-
\ntions used,if any,and all other relevant aspects of the treatment.
\n9. Aesthetic treatments must only be performed under strictly hy-
\ngienic and medically safe conditions on premises that are adequately
\nstaffed and equipped.This must include equipment for treating life-
\nthreatening allergic reactions and other potential complications.
\n10. Advertising and marketing of aesthetic treatments should be re-
\nsponsible and should not foster unrealistic expectations of treat-
\nment results. Unrealistic or altered photographs showing patients
\nbefore and after treatments must not be used in advertising.
\n11. Advertising and marketing of aesthetic treatments should never
\nbe targeted to minors.
\n12. Practitioners should never offer or promote financial loans as a
\nmeans of paying for aesthetic treatment.
\n[1] For the purpose of this statement minor is defined as a person
\nwho, according to applicable national legislation, is not an adult.
\nWMA Statement on Ethical
\nGuidelines for the International
\nMigration of Health Workers
\nAdopted by the 54th
\nWMA General Assembly, Helsinki, Finland, Sep-
\ntember 2003 and revised by the 65th
\nWMA General Assembly, Durban,
\nSouth Africa, October 2014
\nPreamble
\nThe WMA acknowledges that temporary stays of physicians in
\nother countries help both the receiving and the sending countries
\nto exchange medical knowledge, skills and attitudes. The exchange
\nof medical professionals is therefore beneficial for the development
\nof medicine and healthcare systems and in general deserves the sup-
\nport of national medical associations as well as governments.
\nThe WMA Statement on Medical Manpower \u2013 1 (1983, 1986)
\ncalled upon all National Medical Associations to work with their
\ngovernments towards solutions to the emerging problems related to
\nthe medical workforce.
\nThe WMA Resolution on the Medical Workforce (1998) identified
\nthe major components of the medical workforce situation that need
\nto be taken into account when developing a national workforce policy.
\nFor several decades many governments, employers and medical as-
\nsociations have misinterpreted demographical data regarding the
\nnumber of physicians that are required. Young people seeing em-
\nployment as physicians have often been seriously affected by poor
\nmedical workforce planning.
\nIn many countries, including the wealthiest ones, there is a short-
\nage of physicians. A major reason for the shortage is a failure to
\neducate enough physicians to meet the needs of the country. Other
\nreasons for the net loss of physicians are the recruitment of physi-
\ncians to other professions, early retirement and emigration, and the
\nproblems of combining professional and family responsibilities, all
\nof which are often due to poor working conditions for physicians.
\nSome countries have traditionally solved their need for physicians
\nby recruiting medical graduates from other countries. This practice
\ncontinues today.
\nThe flow of international migration of physicians is generally from
\npoorer to wealthier countries.The poorer countries bear the expense
\n146
\nWMA News
\nof educating the migrating physicians and receive no recompense
\nwhen they enter other countries.The receiving countries gain a valu-
\nable resource without paying for it, and in the process they save the
\ncost of educating their own physicians.
\nPhysicians do have valid reasons for migrating, for example, to seek
\nbetter career opportunities and to escape poor working and living
\nconditions,which may include the pursuit of more political and per-
\nsonal freedoms and other benefits.
\nRecommendations
\nNational medical associations, governments and employers should
\nexercise utmost care in utilizing demographic data to make projec-
\ntions about future requirements for physicians and in communicat-
\ning these projections to young people contemplating a medical career.
\nEvery country should do its utmost to educate an adequate number
\nof physicians,taking into account its needs and resources.A country
\nshould not rely on immigration from other countries to meet its
\nneed for physicians.
\nEvery country should do its utmost to retain its physicians in the
\nprofession as well as in the country by providing them with the sup-
\nport they need to meet their personal and professional goals, taking
\ninto account the country\u2019s needs and resources.
\nCountries that wish to recruit physicians from another country should
\nonly do so in terms of and in accordance with the provisions of a
\nMemorandum of Understanding entered into between the countries.
\nPhysicians should not be prevented from leaving their home or ad-
\nopted country to pursue career opportunities in another country.
\nCountries that recruit physicians from other countries should en-
\nsure that recruiters provide full and accurate information to poten-
\ntial recruits on the nature and requirements of the position to be
\nfilled, on immigration, administrative and contractual requirements,
\nand on the legal and regulatory conditions for the practice of medi-
\ncine in the recruiting country, including language skills.
\nPhysicians who are working, either permanently or temporarily, in
\na country other than their home country should be treated fairly
\nin relation to other physicians in that country (for example, equal
\nopportunity career options and equal payment for the same work).
\nNothing should prevent countries from entering into bilateral
\nagreements and agreements of understanding, as provided for in
\ninternational law and with due cognizance of international human
\nrights law, so as to effect meaningful co-operation on health care
\ndelivery, including the exchange of physicians.
\nThe WHO Global Code of Practice on the International Recruit-
\nment of Health Personnel (May 2010) was established to promote
\nvoluntary principles and practices for the ethical international re-
\ncruitment of health professionals and to facilitate the strengthening
\nof health systems. The Code takes into account the rights, obliga-
\ntions and expectations of source countries and migrant health pro-
\nfessionals.The WMA was involved in the drafting of the Code and
\nsupports its implementation.
\nThe WHO Code states that international recruitment should be \u201ccon-
\nducted in accordance with the principles of transparency, fairness and
\npromotion of sustainability of health systems in developing countries.\u201d
\nThe monitoring and information-sharing system established by
\nthe WHO should be robustly supported with the goal of interna-
\ntional cooperation. Stakeholders should regularly collate and share
\ndata, which should be monitored and analysed by the WHO. The
\nWHO should provide substantive critical feedback to governments.
\nInformation should be shared about how to overcome challenges
\nencountered.
\nWMA Statement on Solitary
\nConfinement
\nAdopted by the 65th
\nWMA General Assembly, Durban, South Africa,
\nOctober 2014
\nPreamble
\nIn many countries substantial numbers of prisoners are held at times
\nin solitary confinement. Prisoners are typically kept in isolation for
\nmost of the day,and are allowed out of their cells only a short period
\nof time of solitary exercise. Meaningful contact with other people
\n(prisoners, prison staff, outside world) is kept to a minimum. Some
\ncountries have strict provisions on how long and how often prison-
\ners can be kept in solitary confinement, but many countries lack
\nclear rules on this.
\nThe reasons for the use of solitary confinement vary in different ju-
\nrisdictions. It may be used as a disciplinary measure when a prisoner
\ndoes not respond to other sanctions intended to address his or her
\nbehaviour,for example,in response to seriously disruptive behaviour,
\nthreats of violence or suspected acts of violence.
\n147
\nWMA News
\nThe legal authorities in some nations allow individuals to be held in
\nsolitary confinement during an on-going criminal investigation or to
\nbe sentenced to solitary confinement, even when the individual poses
\nno threat to others. Individuals with mental illness may be kept in
\nhigh-security or super-maximum security (supermax) units or prisons.
\nSolitary confinement can be imposed for hours to days or even years.
\nReliable data on the use of solitary confinement are lacking. Various
\nstudies estimate that tens of thousands or even hundreds of thousands
\nof prisoners are currently held in solitary confinement worldwide.
\nPeople react to isolation in different ways. For a significant number
\nof prisoners, solitary confinement has been documented to cause
\nserious psychological, psychiatric, and sometimes physiological ef-
\nfects, including insomnia, confusion, hallucinations and psychosis.
\nSolitary confinement is also associated with a high rate of suicidal
\nbehaviour. Negative health effects can occur after only a few days,
\nand may in some cases persist when isolation ends.
\nCertain populations are particularly vulnerable to the negative
\nhealth effects of solitary confinement. For example, persons with
\npsychotic disorders, major depression, or post-traumatic stress dis-
\norder or people with severe personality disorders may find isolation
\nunbearable and suffer health harms.Solitary confinement may com-
\nplicate treating such individuals and their associated health prob-
\nlems successfully later in the prison environment or when they are
\nreleased back into the community.
\nHuman rights conventions prohibit the use of torture,cruel,inhuman
\nor degrading treatment or punishment. The use of pronged solitary
\nconfinement against a prisoner\u00b4s own will or the use of solitary con-
\nfinement during pre-trial detention or against minors can be regarded
\nas a breach of international human rights law, and must be avoided.
\nRecommendations
\nThe WMA urges National Medical Associations and governments
\nto promote the following principles:
\n1. Solitary confinement should be imposed only as a last resort
\nwhether to protect others or the individual prisoner, and only
\nfor the shortest period of time possible. The human dignity of
\nprisoners confined in isolation must always be respected.
\n2. Authorities responsible for overseeing solitary confinement
\nshould take account of the individual\u2019s health and medical con-
\ndition and regularly re-evaluate and document the individual\u2019s
\nstatus. Adverse health consequences should lead to the immedi-
\nate cessation of solitary confinement.
\n3. All decisions on solitary confinement must be transparent and
\nregulated by law. The use of solitary confinement should be
\ntime-limited by law. Prisoners subject to solitary confinement
\nshould have a right of appeal.
\n4. Prolonged solitary confinement, against the will of the prisoner,
\nmust be avoided. Where prisoners seek prolonged solitary con-
\nfinement, for whatever reason, they should be medically and
\npsychologically assessed to ensure it is unlikely to lead to harm.
\n5. Solitary confinement should not be imposed when it would ad-
\nversely affect the medical condition of prisoners with a mental
\nillness. If it is essential to provide safety for the prisoner or other
\nprisoners then especially careful and frequent monitoring must
\noccur, and an alternative found as soon as possible.
\n6. Prisoners in isolation should be allowed a reasonable amount of
\nregular human contact. As with all prisoners, they must not be
\nsubjected to extreme physical and mentally taxing conditions.
\n7. The health of prisoners in solitary confinement must be moni-
\ntored regularly by a qualified physician. For this purpose, a phy-
\nsician should be allowed to check both the documentation of
\nsolitary confinement decisions in the institution and the actual
\nhealth of the confined prisoners on a regular basis.
\n8. Prisoners who have been in solitary confinement should have
\nan adjustment period before they are released from prison. This
\nmust never extend their period of incarceration.
\n9. Physician\u00b4s role is to protect, advocate for, and improve pris-
\noners\u00b4 physical and mental health, not to inflict punishment.
\nTherefore, physicians should never participate in any part of the
\ndecision-making process resulting in solitary confinement.
\n10. Doctors have a duty to consider the conditions in solitary con-
\nfinement and to protest to the authorities if they believe that
\nthey are unacceptable or might amount to inhumane or degrad-
\ning treatment.
\nWMA Statement on the
\nPrevention of Air pollution due
\nto Vehicle Emissions
\nAdopted by the 65th
\nWorld Medical Assembly, Durban, South Africa, Oc-
\ntober 2014
\nPreamble
\nThere are a number of ways in which the volume of harmful emis-
\nsions can be reduced. These include encouraging fewer road traf-
\nfic journeys, active transport for individuals undertaking relatively
\nshort journeys, the use of mass public transit in preference to indi-
\nvidual vehicles, and alternative energy sources for vehicles, includ-
\n148
\nWMA News
\ning electric and hybrid technologies. Where vehicle use is essential,
\nmeans of reducing harmful emissions should be used.
\nPhysicians around the world are aware of air pollution. It impacts
\nthe quality of life for hundreds of millions of people worldwide,
\ncausing both, a large burden of disease as well as economic losses
\nand increased health care costs. According to WHO estimates, in
\n2012, urban outdoor air pollution was responsible for 3.7 million
\nannual deaths, representing 6.7% of the total deaths (WHO, 2014).
\nEspecially, diesel soot is acknowledged as a proven carcinogen
\n(IARC,07\/2012).Furthermore,it has many other toxic effects,most
\nprominently in the cardiovascular (Brook et al.,2010) and respirato-
\nry systems (ERS,2010).Moreover,in the context of global warming,
\nsoot,along with methane,is identified as the second most important
\ngreenhouse driving force substance after CO2 (Kerr, 2013).
\nDespite the fact that new vehicles will have to comply with stricter
\nemission standards which take into account most harmful ultra fine
\nparticles too, a high-polluting in-use fleet, including off-road vehi-
\ncles such as construction engines and ships, will continue polluting
\nfor many more years.
\nBackground
\nIn many densely populated cities around the world, fine dust concen-
\ntrations measurable as aerosols exceed up to 50 times the maximum
\nWHO recommendation. High volumes of transport, power gener-
\nated from coal, and pollution caused by construction machinery are
\namong the contributing factors.People living and working near major
\n(high density volume traffic) streets are most affected by pollutants.
\nFor fighting the health risks mentioned above, there exist a variety
\nof highly efficient and reliable filter systems on the market (Best
\nAvailable Technology (BAT) filters[1]). They are applicable to all
\ninternal combustion engines and they reduce even most harmful
\nultra-fine particles by a factor of over one hundred.
\nAs soon as 90% of heavy duty vehicles, both, new and upgraded
\nones, satisfy this standard, health problems attributable to emissions
\nof heavy duty traffic will be greatly reduced, and no further tight-
\nening of emission standards will be possible or even needed at all
\nbecause of an almost total elimination of the pollutant as such.
\nIn a variety of countries on different continents and under varying
\nconditions retrofit or upgrading programs have been successfully
\nperformed. The UN\u2019s Working Party on Pollution Prevention and
\nEnergy in Geneva has just proposed a technical standard for regula-
\ntion in their member states, which will be applicable worldwide.
\nThe WMA supports these efforts and calls on policy makers in
\nall countries, especially in urban regions, to introduce regula-
\ntory restrictions of access for vehicles without filter, and\/or to
\nprovide financial assistance to support the retrofitting of in-use
\nvehicles.
\nRecommendations
\nThe WMA therefore recommends that all NMAs should encourage
\ntheir respective governments to:
\n\u2022 Introduce BAT standards for all new diesel vehicles (on road and
\noff-road)
\n\u2022 Incentivise retrofitting with BAT filters for all in-use engines
\n\u2022 Monitor and limit the concentration of nanosize soot particles in
\nthe urban breathing air
\n\u2022 Conduct epidemiological studies detecting and differentiating
\nthe health effects of ultrafine particles
\n\u2022 Build professional and public awareness of the importance of die-
\nsel soot and the existing methods of eliminating the particles
\n\u2022 Contribute to developing strategies to protect people from soot
\nparticles in aircraft passenger cabins, trains, homes and in the
\ngeneral environment.These strategies should include plans to de-
\nvelop and increase use of public transportation systems.
\nAbbreviations:
\n\u2022 EPA: Environmental Protection Agency (US)
\n\u2022 ERS: European Respiratory Society
\n\u2022 IARC: International Agency for Research of Cancer
\n\u2022 BAT Standards: Emission standards for passenger cars, heavy-
\nduty vehicles and off-road machinery, based on count of ultrafine
\nparticles rather than mass and aimed at the protection of human
\nhealth from the most hazardous soot particles, the lung and even
\ncell membrane penetrating ultra-fines.
\nReferences:
\n\u2022 Brook, Robert D. et al. (2010): AHA Scientific Statement: Par-
\nticulate Matter Air Pollution and Cardiovascular Disease. An
\nUpdate to the Scientific Statement from the American Heart As-
\nsociation. Circulation 121: 2331-2378.
\n\u2022 ERS (2010): The ERS report on air pollution and public health.
\nEuropean Respiratory Society, Lausanne, Switzerland. ISBN:
\n978-1-84984-008-8
\n\u2022 IARC (2012): \u201cIARC: Diesel Engine Exhaust Carcinogenic\u201d.
\nPress Release No. 213.http:\/\/www.iarc.fr\/en\/media-centre\/
\npr\/2012\/pdfs\/pr213_E.pdf. (access: 14\/02\/14)
\n\u2022 Kerr, Richard R. (2013): \u201cSoot is Warming the World Even More
\nThan Thought\u201d. In: Science 339(6118), p. 382.
\n149
\nWMA News
\n\u2022 WHO (2014): \u201cBurden of disease from Ambient Air Pollution for
\n2012.\u201dhttp:\/\/www.who.int\/phe\/health_topics\/outdoorair\/databas-
\nes\/AAP_BoD_results_March2014.pdf?ua=1 (access: 26\/08\/14)
\n[1] Euro 6\/VI, US\/EPA\/CARB, Chinese and equivalent standards.
\nWMA Statement on Water and
\nHealth
\nApproved by the 55th
\nWMA General Assembly, Tokyo, Japan, October
\n2004 and revised by the 65th
\nWMA General Assembly, Durban, South
\nAfrica 2014
\nPreamble
\nAn adequate supply of fresh (i.e. clean and uncontaminated) water
\nis essential for individual and public health. It is central to living a
\nlife in dignity and upholding human rights. Unfortunately, over half
\nof the world\u2019s population does not have access to such a supply, and
\neven in those places where there is an abundance of fresh water, it is
\nthreatened by pollution and other negative forces.
\nIn keeping with its mission to serve humanity by endeavouring to
\nachieve the highest international standards in health care for all
\npeople in the world, the World Medical Association has devel-
\noped this statement to encourage all those responsible for health
\nto consider the importance of water for individual and public
\nhealth.
\nConsiderations
\nWater-borne diseases account for a large proportion of mortality
\nand morbidity, especially in developing countries. These problems
\nare accentuated in times of disasters such as wars, nuclear and man-
\nmade accidents with oil and\/or chemicals, earthquakes, epidemics,
\ndroughts and floods.
\nAnthropogenic changes to ecosystems, lowered retention by the
\nearth\u2019s surface, and the limitation of the inherent capacity of nature
\nto filter dirt from the water are causing increasing damage to the
\nnatural environment, especially the water environment.
\nThe commodification of water, whereby it is provided for profit
\nrather than as a public service, has implications for access to an ad-
\nequate supply of drinking water.
\nThe development of sustainable infrastructure for the provision of
\nsafe water contributes greatly to sound public health and national
\nwell-being. Curtailing infectious diseases and other ailments that
\nare caused by unsafe water alleviates the burden of health care costs
\nand improves productivity. This creates a positive ripple effect on
\nnational economies.
\nWater as a vital and necessary resource for life has become scarce
\nin many parts of the world and therefore has to be used reasonably
\nand with care. Water is an asset that is shared by humanity and the
\nearth.Thus, water-related issues should be addressed collaboratively
\nby the global community.
\nRecommendations
\nPhysicians, National Medical Associations and health authorities
\nare encouraged to support the following measures related to water
\nand health:
\n\u2022 International and national programmes to provide access to safe
\ndrinking water at low cost to every human on the planet and to
\nprevent the pollution of water supplies. International, national
\nand regional programmes to provide access to sanitation and to
\nprevent the degradation of water resources. Research on the re-
\nlationship between water supply systems, including waste-water
\ntreatment, and health.
\n\u2022 The development of plans for providing potable water and proper
\nwastewater disposal during emergencies.These will vary according to
\nthe nature of the emergency,but may include on-site water disinfec-
\ntion, identifying sources of water, and back-up power to run pumps.
\n\u2022 Preventive measures to secure safe water for health care institu-
\ntions after the occurrence of natural disasters, especially earth-
\nquakes. Such measures should include the development of infra-
\nstructure and training programs to help health care institutions
\ncope with such crises. The implementation of continued emer-
\ngency water supply programs should be done in conjunction with
\nregional authorities and with community involvement.
\n\u2022 More efficient use of water resources by each nation. The WMA
\nespecially urges hospitals and health institutions to examine their
\nimpact on sustainable water resources. Preventive measures and
\nemergency preparedness to save water from pollution. The pro-
\nmotion of the universal access to clean and affordable water as a
\nhuman right [1] and as a common good of humanity.
\n[1] In 2010, the United Nations General Assembly and the Human
\nRights Council explicitly recognized the human right to water and
\nsanitation,derived from the right to an adequate standard of living
\nas stipulated in article 11 of the International Covenant on Eco-
\nnomic, Social and Cultural Rights and other international human
\nrights treaties. Hence, it is part of international human rights law.
\n150
\nDeclaration of Helsinki
\nThe 50th
\nanniversary of the signing of the
\nDeclaration of Helsinki in 1964 was cel-
\nebrated in style at a day-long seminar in
\nHelsinki on November 11. The event, at-
\ntended by around 200 people, was held in
\nthe magnificent P\u00f6rssitalo building in the
\ncity and hosted by the Finnish Medical As-
\nsociation (FMA).
\nThe audience was welcomed by Dr. Tuula
\nRajaniemi, President of the FMA, and the
\nmorning session was entitled \u201cThe Dec-
\nlaration of Helsinki in a real world \u2013 The
\nImplementation of the Declaration\u201d.
\nThe first speaker was Dr. Ramin Parsa-
\nParsi, from the German Medical Associa-
\ntion, who chaired the WMA workgroup on
\nrevising the Declaration in 2013. He said it
\nwas in Helsinki that, 50 years ago, the 18th
\nGeneral Assembly of the WMA adopted
\nthe very first Declaration of Helsinki set-
\nting out \u201crecommendations guiding doctors
\nin clinical research\u201d. It was therefore fitting
\nthat they should return to Helsinki five de-
\ncades later to celebrate the anniversary of
\nits adoption and to reflect on its abiding
\nrole in providing the highest ethical stan-
\ndards for medical research involving hu-
\nman subjects.
\nHe went on: \u201cMany changes have taken
\nplace in medical science since the prom-
\nulgation of the first version of the Decla-
\nration in 1964, and it has been repeatedly
\nrevised to take account of these. The most
\nrecent revision lasted two years and was the
\nmost comprehensive and inclusive revision
\nprocess yet undertaken.
\nDuring the revision process,national medi-
\ncal associations, international organisations
\nand other key stakeholders were invited to
\nprovide their input at expert conferences on
\nfour continents, as well as during an inter-
\nnational online public consultation, which
\nattracted responses from 36 countries and
\nregions of the world. It was the task of the
\nworkgroup members to examine all of the
\narguments put forward and to evaluate
\ntheir merits. Our shared goal was to revise
\nthe document in such a way as to promote
\ngood quality clinical research, while at the
\nsame time ensuring the utmost protection
\nfor research subjects. The workgroup was
\nvery pleased that it could be completed in
\ntime for this anniversary year.
\n\u201cThe current, eighth version of the Decla-
\nration of Helsinki, was adopted by a large
\nmajority at the WMA General Assembly
\nin Fortaleza in October 2013. The result
\nwas an altogether more comprehensive,
\nmethodical and usable document. Despite
\nthe new structure of the revised Declara-
\ntion, five decades after its original promul-
\ngation it still retains its unique character as
\na concise set of ethical principles drawn up
\nby physicians for physicians. This is a tes-
\ntimony to the strength of the Declaration
\nand to the dedication of the World Medical
\nAssociation as its guardian.
\n\u201cThe importance of having an internation-
\nally recognised global ethical standard for
\nphysicians has again been underlined dur-
\ning the current Ebola crisis. For example,
\nwhen concerns were raised about the ethical
\nacceptability of using unproven interven-
\ntions to treat Ebola patients, the WMA was
\nable to react immediately by referring to
\nParagraph 37, which permits the use of an
\nunproven intervention with the informed
\nconsent of the patient, where no proven
\nintervention exists and if it offers hope of
\nsaving life. The WMA General Assembly
\nreferred to this in an emergency resolution
\nthis October.\u201d
\nHe concluded by saying: \u201cI am sure that
\nthese anniversary celebrations will raise
\nfurther awareness of the importance of this
\nguideline and the ethical responsibilities
\nof physicians and researchers to promote
\nprogress in medical science without com-
\npromising the health, well-being and rights
\nof research subjects.\u201d
\nJeff Blackmer
\nHe was followed by Dr. Jeff Blackmer,
\nDirector of Ethics at the Canadian Medi-
\ncal Association and medical ethics adviser
\nto the WMA, who spoke about the imple-
\nAnniversary of the Signing
\nof the Declaration of Helsinki
\n11 november 2014
\nRamin Parsa-Parsi
\n151
\nDeclaration of Helsinki
\nmentation of the Declaration in North and
\nSouth America.
\nDr. Jeff Blackmer, said the Declaration was
\nnot a legally binding document under inter-
\nnational laws. However, it exerted authority
\nthrough the extent to which it had directly
\nand indirectly influenced national and in-
\nternational legislation and regulations. In
\nsome cases, it had been codified into those
\nlaws and regulations. It was important to
\nalways keep in mind, however, that the
\nDeclaration was morally binding on physi-
\ncians, and that this obligation was generally
\nconsidered to override any national or local
\nlaws or regulations.
\nAmong international documents, the DoH
\nwas relatively unique in that it represented
\na set of ethical principles combined with
\nsome degree of proscriptive detail, while
\nmany of the other documents were more
\ntechnical in nature. However, their pres-
\nence had meant that a number of national
\nregulatory bodies had decided to make
\nreference primarily to one particular docu-
\nment or standard.
\nFor some, this has meant \u201cchoosing\u201d be-
\ntween using the DoH as a standard versus
\nanother more static and\/or technical docu-
\nment.He went on to consider how the Dec-
\nlaration was viewed in the United States
\nand in Latin America.
\nIn April 2006, the United States Food
\nand Drug Administration (FDA) had
\npublished a regulatory change ending the
\nneed for clinical trials conducted outside of
\nthe US to comply with the Declaration of
\nHelsinki.
\nPrevious to this, the FDA had already re-
\njected the 2000 version of the DoH and all
\nsubsequent revisions, recognizing only the
\n1989 version in its regulations. These deci-
\nsions were made largely over the question
\nof whether placebos should be allowed in
\nclinical trials in resource-poor settings (and
\nto a lesser extent on the issue of post-trial
\naccess). Representatives from the FDA had
\nactively engaged on the placebo issue with
\nthe WMA, including during the DoH revi-
\nsion processes and as part of the placebo-
\ncontrol meetings held in Sao Paulo.
\nHe said that what the FDA said was: \u201cWe
\ndidn\u201dt think the World Medical Associa-
\ntion understood you really do need pla-
\ncebos to learn something in a lot of cases.
\nFundamentally, in a lot of symptomatic
\nconditions, it\u201ds common for studies that
\ncompare a new drug with placebo to fail. If
\ndoing the right design, or doing an infor-
\nmative design would mean denying some-
\nbody a therapy that would really save their
\nlives, then you just can\u201dt do the study at all.
\nEverybody agrees on that. But if it\u201ds just
\na matter of symptoms, having a headache
\na little longer, being depressed for a few
\nmore days, I would say most people and
\ncertainly we believe that you could ask a
\nperson to participate in a study [using pla-
\ncebos]. But it\u201ds not unethical to do a trial
\nlike that.\u201d
\nDr. Blackmer also outlined the concerns in
\nthe pharmaceutical industry and fears that
\nthe new obligations, to use a comparator
\nother than placebo, would make it harder to
\nprove the efficacy of a new drug and would
\ndrive up the costs of development. He re-
\nferred to one observation that pharmaceuti-
\ncal companies ultimately looked to see what
\nwere the regulations and laws they must
\ncomply with in whatever countries they
\nwere going to seek approval to market a
\nparticular product.To the extent that it was
\neasier and perhaps less costly to conduct
\ntheir research in settings that appeared to
\nhave looser standards or less rigorous ethical
\nprocesses, then we\u201dve seen a trend in which
\nthey had been moving more towards doing
\nresearch in that setting.
\nHe said that the FDA\u201ds adoption of less
\nmorally stringent guidelines could encour-
\nage pharmaceutical companies to take ethi-
\ncal short cuts. It could also have practical
\nconsequences for trial ethics in developing
\ncountries, especially where research ethics
\ncommittees might not be promoting high
\nstandards of protection for participants in
\nclinical trials, due to lack of financial and
\nhuman resources. Pharmaceutical compa-
\nnies might also pressurise research ethics
\ncommittees to relax guidelines and legisla-
\ntion, in order to facilitate future clinical tri-
\nals in developing and emerging countries
\nthat lack the resources to conduct their own
\nclinical research on epidemics such as HIV\/
\nAIDS, which have devastating effects on
\ntheir populations.
\nTurning to the position in South America,
\nDr.Blackmer said that in Uruguay the Dec-
\nlaration was used as the main research eth-
\nics guideline by which all researchers must
\nabide. National legislation had incorpo-
\nrated the 2000 revised version of the docu-
\nment. But later modifications on the use
\nof placebo were not part of the legislation.
\nIn Brazil, following the 2008 revision, the
\nposition adopted by the WMA concern-
\ning the use of placebo in research involving
\nhuman beings was immediately contested.
\nAccording to the position advocated offi-
\ncially by the Brazilian government, through
\na Resolution from its National Health
\nBoard, \u201cthe benefits, risks, difficulties and
\neffectiveness of a new method should be
\ntested by comparing them with the best
\npresent methods\u201d.
\nHe said there remained in some parts of
\nSouth America a concern about a \u201cdouble
\nstandard\u201d for research that they felt was
\nnot fully addressed by the DoH. Subjects
\nin resource-poor settings might be exposed
\nto placebo controls or to controls that are
\nless than standard of care in more developed
\ncountries. Research might not be responsive
\nto the needs of the community in which it
\nis conducted. While revisions of the DoH
\nhad attempted to address some of these
\nconcerns, they had not done so to the satis-
\nfaction of all of those involved.
\nFinally Dr. Blackmer referred to the Decla-
\nration of Cordoba.He said that in November
\n152
\n2008, the Congress of the Latin-Ameri-
\ncan and Caribbean Bioethics Network of
\nUNESCO (Redbioetica) had approved the
\nDeclaration of Cordoba on Ethics in Research
\nwith Human Beings. This document pro-
\nposed that Latin American countries, gov-
\nernments and organisations should refuse
\nto follow 2008 version of the Declaration
\nof Helsinki, which was approved in Seoul,
\nSouth Korea. It recommended instead as
\nan ethical and normative frame of reference
\nthe principles of the Universal Declaration
\non Bioethics and Human Rights, proclaimed
\nin October 2005 at the UNESCO General
\nConference.
\nHe concluded by saying that the use and
\nimplementation of the DoH in the Amer-
\nicas was, to say the least, inconsistent
\nand controversial. In the United States,
\nthe FDA did not endorse the document,
\nand only referenced the 1989 version. In
\nSouth American countries, there remained
\na concern that the DoH did not contain
\nsufficient safeguards when it came to the
\nissues of placebo controls and post-trial
\naccess.
\nDominique Sprumont
\nThe next speaker, Professor Dominique
\nSprumont, a health lawyer from the Uni-
\nversity of Neuchatel, Switzerland, said that
\nthe original Declaration was not meant to
\nreinforce the Nuremberg Code, but had
\nrather been adopted in opposition to the
\nCode. To a large extent, the Nuremberg
\nCode was not well accepted within the
\nresearch community and was often dis-
\nregarded by the same countries that con-
\ntributed to its promulgation. The Helsinki
\nDeclaration was originally drafted to allow
\nthe medical profession to maintain its con-
\ntrol of the conduct of biomedical research.
\nThe main purpose was not so much the
\nprotection of human participants but an at-
\ntempt to accelerate research involving hu-
\nman participants.
\nHe went on: \u201cThe medical profession was
\nfacing a number of challenges. There was
\nnot only a proposal from a human rights
\nlawyers\u201d organization to develop an inter-
\nnational treaty on biomedical research, but
\nsome countries such as the US were con-
\nsidering adopting legislation in the field.
\nThe DoH was an attempt to prevent such
\na move toward the end of research self-
\nregulation. It was also supported by the in-
\ndustry that looked for a more user-friendly
\nregulation than the Nuremberg Code and
\nwhat was planned by the US and EU drug
\nauthorities. Ironically, it is worth mention-
\ning that WMA was suffering from certain
\nfinancial difficulties in 1964 and the support
\nfrom the industry seems to have been wel-
\ncome. This may also explain why the docu-
\nment adopted in Helsinki in 1964 did not
\ncontain the same level of protection for re-
\nsearch participants than earlier draft docu-
\nments such as the one from 1962\u201d.
\nProf. Sprumont added that the drafting of
\nthe DoH coincided with the emergence of
\nbioethics as new discipline of applied eth-
\nics. At that time society was going through
\nimportant changes. The years after WWII
\nwere characterized by unprecedented eco-
\nnomic growth, but people were becoming
\nmore aware of the negative consequences
\nfor society and the environment. In the 60s
\npeople started to question that model.
\nThe medical profession did not escape this
\nreality. It was also under pressure to change
\nits paternalistic attitude. This resulted in
\nthe development of a more equal relation
\nbetween doctors and patients based on the
\nrule of informed consent. The right of self-
\ndetermination became the rule in society in
\ngeneral and in medical practice in particular.
\nThe medical profession realized the need to
\nbe more receptive to the patients\u201d wishes.
\nEthics gained a new role in medical edu-
\ncation and practice. This \u201cmoralization\u201d of
\nmedicine also served the previous objective,
\nnamely to avoid unnecessary intervention
\nfrom the State to regulate the profession.
\nThe DoH was the product of this move-
\nment.
\n\u201cToday, as we are celebrating the DoH
\n50th
\nanniversary, we can only be impressed
\nby how the WMA managed to develop
\nthis document, one among many others
\nto become what is often coined the \u201ccon-
\nstitution of research ethics\u201d. The fact that
\nthe DoH is playing such a central role in
\nresearch ethics, promoting high ethical
\nprinciples in the field seems partially in
\ncontradiction with the fact the DoH has
\nbeen revised seven times (or even nine if
\none includes the two notes of clarifica-
\ntion concerning the placebo rule). A closer
\nlook at those revisions shows that the core
\nelements of the DoH were never altered,
\nbut that the main changes were adapta-
\ntions to the law and also improvement in
\nthe structure and the formulation of some
\nprovisions.\u201d
\nHe said the DoH had evolved in parallel
\nwith legislation and the fact that it managed
\nto stay in line with the legal framework at a
\ntime when many countries adopted legisla-
\ntion in favour of the protection of research
\nparticipants could explain its success. The
\nWMA changed its original attitude that
\nwas primarily to facilitate research. Since
\nthe late 90s, the DoH clearly focused on
\nthe protection of the participants, their dig-
\nnity, rights and welfare. Another important
\nelement was that until the late 1990s, laws
\nand regulation of biomedical research were
\nmostly limited to developed countries. To-
\nDeclaration of Helsinki
\n153
\nday, the situation had changed as a grow-
\ning number of countries in the South and
\nin the North had recently adopted new laws
\nand regulation in the field. On one hand,
\nthis had modified the status of the DoH as
\ntoday researchers would primarily refer to
\ntheir national laws on biomedical research
\nin the conduct of research, but on the other
\nhand, the DoH was often cited in the laws
\nand regulation as the main source of inspi-
\nration concerning the principles of research
\nethics.
\nProf. Sprumont went on to ask why there
\nwas a need to formulate rules on fundamen-
\ntal freedoms and human rights, and said it
\nwas because the rules were violated. \u201cIt may
\nseem a contradiction but if everyone would
\nact according to the highest ethical and le-
\ngal standards, there would be no need to
\nspecify them. For instance, if doctors would
\nalways spontaneously inform their patients
\nbefore asking their consent, there would be
\nno need to specify the rule of informed con-
\nsent.\u201d
\nHe went on: \u201cIt is a fact that the DoH is
\nlimited to ethical principles or, in other
\nwords, ethical norms of the highest rank
\nthat makes it a universal document that
\ncan be used and applied in all regions and
\ncultures of the world. There is a famous
\nstatement from Confucius \u201cseeking har-
\nmony within difference\u201d that describes
\nwell what the DoH is all about. The DoH
\nallows differences in its implementation
\nwhile defending a universal and harmoni-
\nous understanding of the highest ethical
\nprinciples in the protection of research
\nparticipants\u201d.
\nHe said that the DoH was not merely an
\nacademic document. It was the product of
\nhistory, lobbying from various stakeholders,
\nof the development strategy of the WMA,
\nits adaptation to the laws, etc. Its present
\nstructure and content was the expression of
\na carefully built consensus within the medi-
\ncal profession and also the research commu-
\nnity, the RECs and the competent authori-
\nties worldwide. In fact, they should salute
\nthe last two revisions as a true attempt from
\nWMA to conduct broad consultations and
\nseek consensus on difficult issues related to
\nresearch ethics worldwide. During the last
\ndecade,the ethics and regulation of research
\ninvolving human participants had expe-
\nrienced some important changes, moving
\nfrom broad principles to detailed regula-
\ntion, from self-regulation to legislation and
\nto the bureaucratization of research. For the
\nWMA, this meant both challenges and op-
\nportunities. The DoH was bound to remain
\nan essential document in the field as it of-
\nfered a clear statement of the accepted and
\napplicable principles in the field.
\nHe concluded: \u201cThe WMA should main-
\ntain the DoH as it stands: a document of
\nprinciples focusing on the protection of hu-
\nman participants. If people have a clear un-
\nderstanding of their responsibilities in view
\nof the ethical principles, there is less need
\nfor specific regulation. This is an essential
\nbarrier against the present bureaucratiza-
\ntion of research ethics. The system should
\nbe able to rely more on responsible actors
\nable to interpret and implement fundamen-
\ntal principles of research ethics, rather than
\non technicians applying check lists\u201d.
\nLasse Lehtonen
\nThe next speaker, Prof. Lasse Lehtonen
\nfrom the University of Helsinki, spoke
\nabout the impact of the Declaration on
\nEuropean human rights development. He
\nsaid that from a purely legal perspective,
\nthe authority of the Declaration was lim-
\nited. It was a professional recommenda-
\ntion in nature. The original wording stated
\nthat the standards set by the Declaration
\nwere only a guide to physicians all over
\nthe world. Doctors were not relieved from
\ncriminal, civil and ethical responsibilities
\nunder the laws of their own country. Even
\nthe current version of the Declaration
\nstated that it was addressed primarily to
\nphysicians. However, the WMA encour-
\naged others who were involved in medical
\nresearch involving human subjects to adopt
\nthese principles.
\nProf. Lehtonen went on to compare the
\nDeclaration with the Conventions of Eu-
\nropean Council and with European Union
\nregulation on clinical trials, which had re-
\ncently been approved and which was ap-
\nplied in all Member States of the European
\nUnion from May 2016 onwards. In Europe
\nthe postwar development in the field of hu-
\nman rights had most notably been guided
\nby the Council of Europe and the European
\nConvention on Human Rights. In 1992
\nthe Council of Europe had set up a specific
\nSteering Committee on Bioethics which
\nhad led to the Convention on Human
\nRights in Biomedicine and in this way the
\nethical principles set out by the Declaration
\nof Helsinki had found their way into bind-
\ning European Human Rights regulations.
\nThe standards created by the Council of
\nEurope and the Court had had a major im-
\npact on the legislation of European Union.
\nHe went on to compare some of the recom-
\nmendations set by the DoH to the regula-
\ntions in European Conventions and in the
\nEuropean Union law.
\nHe referred at first to the general principle
\nthat the interests of the subject must always
\nprevail over the interests of science and
\ncompared that to the totalitarian ideolo-
\ngies of the 1930s when it was common to
\nclaim that the interests of society overrode
\nDeclaration of Helsinki
\n154
\nthe interest of an individual also in relation
\nof research. It could be concluded that more
\nor less the principle of primacy of the hu-
\nman being as presented in the Declaration
\nin 1975 had been adopted by both the Bio-
\nmedicine Convention and by the EU regu-
\nlation on clinical trials.
\nHe discussed the fact that the requirement
\nfor an independent review before an ex-
\nperiment could start was a safe-guarding
\nprocedure that had truly been invented by
\nthe WMA in its Declaration.There was no
\nmention of that in the Nuremberg code
\nor in any preceding ethical document. The
\n1975 revision of the Declaration also fur-
\nther emphasized the oversight of research
\nprotocols by an independent committee
\nand the transparency and independence
\nof these committees. He compared the
\ninformed consent requirements of the dif-
\nferent documents.The requirement for vol-
\nuntary consent for human subject research
\nwas a key part of the Nuremberg code, but
\nthe DoH put much more emphasis on the
\nnecessary information that was given the
\nresearch subject prior to the study. In its
\ncurrent form the Declaration required that
\neach potential subject must be adequately
\ninformed of the aims, methods, sources of
\nfunding, any possible conflicts of interest,
\ninstitutional affiliations of the researcher,
\nthe anticipated benefits and potential risks
\nof the study and the discomfort it might
\nentail, post-study provisions and any other
\nrelevant aspects of the study. Furthermore,
\nthe potential subject must be informed
\nof the right to refuse to participate in the
\nstudy or to withdraw consent to participate
\nat any time without reprisal. The Declara-
\ntion also supported the requirement of
\nconsent for research with identifiable hu-
\nman material or data and the consent re-
\nquirements for research in the Convention
\non Biomedicine were more or less identical
\nto those in the Declaration.
\nFinally, Prof. Lehtonen made some com-
\nparisons about the status of incapacitated
\nsubjects and minors. One of the recom-
\nmendations of the original Helsinki Dec-
\nlaration was to substitute the consent of the
\nresearch subject with the consent of the le-
\ngal guardian in cases of legal incompetence.
\nThe Nuremberg code did not have this op-
\ntion and it mandated that medical research
\ncould only be carried out with a legally com-
\npetent subject. This would have would pre-
\nvented valid research, such as in the field of
\npaediatrics.The Convention of Biomedicine
\nfound research in subjects not able to con-
\nsent possible. However, it could be carried
\nout only for his or her direct benefit. The
\nrequirements in the Convention were thus
\nclearly stricter than in the current Decla-
\nration. Paragraph 20 of the Declaration,
\nhowever, stated that medical research with
\na vulnerable group was only justified if the
\nresearch was responsive to the health needs
\nor priorities of this group and the research
\ncould not be carried out in a non-vulnerable
\ngroup. In addition, this group should stand
\nto benefit from the knowledge, practices or
\ninterventions that result from the research.
\nThe EU clinical trials regulation, on the
\nother hand,set even more stringent rules for
\ntrials in incapacitated subjects or in minors.
\nFor incapacitated subjects, the trial should
\nbring direct benefit for the research subject
\nin comparison to risks or at least some ben-
\nefit for the population represented by the
\nincapacitated subject concerned, if the trial
\nrelated to a life-threatening or debilitat-
\ning medical condition. Similar rule applied
\nfor trials in minors. Furthermore, the trial
\nmight impose only minimal burden on the
\nresearch subject concerned in comparison
\nwith the standard treatment of the condi-
\ntion.
\nIn conclusion, he said that the influence of
\nthe Declaration had been far-reaching for
\nthe development of national and interna-
\ntional guidelines and regulations. The prin-
\nciples of the Declaration had more or less
\ndirectly been implemented to the Conven-
\ntion on Biomedicine of the Council of Eu-
\nrope and many principles of the Declaration
\ncould be found also in the regulation con-
\ncerning clinical trials in European Union.
\nHowever, information technology made
\nit easy to gather information on patients
\nwithout their consent and there might be
\nnew problems arising with the availability
\nof whole genome-sequencing both in re-
\nsearch and in the treatment of patients. It
\nwas noteworthy that the science community
\nwas very committed to follow the principles
\nof the Declaration, but it was by no means
\nthat clear that the business community de-
\nveloping new technologies was that well ac-
\nquainted with these principles.
\n\u201cThus far the Declaration has followed
\nthe development of science and is likely
\nto be updated, when times and conditions
\nchange. It is, however, important that the
\ncompliance of the research practices with
\nthe principles is actively monitored not
\nonly by physicians, but by the society as a
\nwhole.\u201d
\nAmes Dhai
\nProfessor Ames Dhai, immediate Past-
\nPresident of the South African Medical
\nAssociation, and Director of the Steve
\nBiko Centre for Bioethics at the Uni-
\nversity of the Witwatersrand in Johan-
\nnesburg, spoke about the DoH from the
\nperspective of the developing world. She
\nsaid the moral authority of DoH was in-
\ntricately linked with respecting the hu-
\nman dignity of participants in research.
\nThe principles of the DoH accentuated
\nDeclaration of Helsinki
\n155
\nthat research participants were not to be
\ntreated as a means to answer a hypoth-
\nesis posed or as mere things, and every
\nwrong done to them infringed their hu-
\nman dignity. Respecting dignity was both
\nimplicit and pervasive in the Declaration.
\nShe illustrated from a developing world
\nperspective how this respect for dignity
\ntranslated to safeguards in particular for
\nparticipants with vulnerabilities. In Afri-
\nca there were large numbers of vulnerable
\npopulations and individuals, little or no
\nhealth care, failing and failed health sys-
\ntems, low levels of literacy or no literacy,
\nand an acceptance of authority without
\nquestion.
\nShe referred to the references in the DoH
\nthat appropriate compensation and treat-
\nment for subjects who were harmed as a
\nresult of participating in research must
\nbe ensured, as well as the issue of un-
\nproven interventions in clinical practice.
\nIn South Africa sponsors for clinical tri-
\nals ranged from pharmaceutical companies
\nto research organisations, such as the US
\nNational Institutes of Health (NIH) and
\nCenters for Disease Control and Preven-
\ntion (CDC). A typical statement from an
\ninformed consent document for an NIH-
\nsponsored clinical trial read \u201cIf you are
\ninjured as a result of being in this study,
\nyou will be given immediate treatment for
\nyour injuries. The cost of this treatment
\nwill be provided by the Department of
\nHealth in a referral hospital or your in-
\nsurance company. There is no program for
\ncompensation either through this institu-
\ntion or the National Institutes of Health.
\nThe investigators will provide you with
\nreasonable medical care as is available at
\nthe. . . hospital\u201d.
\n\u201cAt first glance this statement seems fair,
\nbut human research ethics committees in
\nSouth Africa do not agree. The consent
\nstatement is such that the overburdened
\nand under-resourced health system that is
\ntrying to provide care to poor vulnerable
\npopulations without medical insurance will
\nhave to cover for research injuries caused by
\nresearch sponsored by a wealthy developed-
\ncountry institution.
\nNaturally, research ethics committees
\nhave questioned this practice. The NIH
\nresponse is that US federal regulations do
\nnot allow payment for treatment of re-
\nsearch injuries, nor do they allow inclusion
\nin NIH grants of funds sufficient for local
\nresearchers to take out suitable insurance
\nor pay for suitable care. Indeed no agency
\nwithin the US federal health system has
\na formal compensation policy for research
\ninjuries\u201d.
\n\u201cVulnerability\u201d was now understood as ex-
\ntending beyond an inability to consent or
\nto protect one\u201ds own interests. In addition,
\nusing \u201cwrong\u201d recognised that participants
\nwho were harmed as a result of their in-
\nvolvement in research were not necessarily
\nalways wronged. \u201cWrong\u201d denoted greater
\nmoral burden and significance as compared
\nto \u201charm\u201d. It indicated a moral transgres-
\nsion. The strength of the DoH was that it
\nconsidered vulnerable individuals as well as
\ngroups. Vulnerability could differ between
\nindividuals. For instance, in South Africa a
\nwhite Constitutional Court Judge from an
\nadvantaged background with HIV infection
\nhad far less of a chance of being wronged as
\ncompared to a black, illiterate woman from
\na township or rural setting who had HIV
\ninfection. With her, wrongs ranged from
\nphysical, social, psychological, consent, to
\njustice.
\nFinally, Prof. Dhai referred to the relevance
\nof the Helsinki Declaration to the out-
\nbreak of the Ebola virus. There were several
\nparagraphs within the DoH that were ap-
\nplicable to the outbreak, in particular the
\nprovision that the duty of the physician was
\nto promote and safeguard the health, well-
\nbeing and rights of patients,including those
\ninvolved in medical research, that research
\nshould be conducted only by individuals
\nwith appropriate ethics, and scientific edu-
\ncation, training and qualifications and the
\nissue of unproven interventions in clinical
\npractice.
\n\u201cBecause no cure or vaccine exists for the
\ndisease, the WHO on the 11th
\nAugust con-
\nvened a special consultation to assess the
\nethical implications of the use of unregis-
\ntered interventions which existed in the
\nlaboratory in small quantities at that time
\nand a day later put out a statement that in
\nthe face of the EVD threat, it was ethical
\nto offer unproven interventions with as yet
\nunknown efficacy and adverse effects as po-
\ntential treatment or prevention. The ethical
\ncriteria to guide the provision of such in-
\nterventions should include transparency re-
\ngarding all aspects of care,ensuring freedom
\nof choice and informed consent, respecting
\nconfidentiality, human dignity and involv-
\ning the community.
\n\u201cThe WHO decision is in line with the
\nDeclaration of Helsinki which in section
\n37, on \u201cUnproven Interventions in Clini-
\ncal Practice\u201d states: \u201cIn the treatment of an
\nindividual patient, where proven interven-
\ntions do not exist or other known interven-
\ntions have been ineffective, the physician,
\nafter seeking expert advice, with informed
\nconsent from the patient or a legally autho-
\nrised representative, may use an unproven
\nintervention if in the physician\u201ds judgement
\nit offers hope of saving life, re-establishing
\nhealth or alleviating suffering. This inter-
\nvention should subsequently be made the
\nobject of research, designed to evaluate its
\nsafety and efficacy. In all cases, new infor-
\nmation must be recorded and, where appro-
\npriate, made publicly available.\u201d
\nShe said the Ebola virus continued to spiral
\nand external sources had now come forward
\nto assist the affected countries.However,for
\nas long as governments in these countries
\ndid not commit to strengthen their health-
\ncare systems and improve the underlying
\nsocial determinants of health attempts at
\ncombatting the Ebola crisis and other crises
\nthat followed could end up being ineffec-
\ntive.
\nDeclaration of Helsinki
\n156
\nDuring the afternoon session, speakers fo-
\ncused on \u201cEthics as a Foundation of Re-
\nsearch\u201d.
\nThe session was opened by Dr. Xavier
\nDeau, President of the WMA. He said the
\nDeclaration of Helsinki had translated the
\nwillingness of the WMA and its Found-
\ning President, Eug\u00e8ne Marquis, a French
\nphysician, to bring the ethics of medical
\npractice and research to the highest level
\nwith a twofold goal – to ensure a universal-
\nity of ethics in research on human beings
\nas well as the protection of people subject-
\ned to this research and to make definitely
\nimpossible the horrible abuse of medicine
\nencountered during the thirties and for-
\nties. These ethical principles were now
\ntranslated into the codes of ethics of many
\ncountries or laid down in the resolutions
\nof international organisations, such as the
\nWHO, UNESCO, United Nations and
\nthe ICRC. Governments also felt encour-
\naged to include the DoH principles into
\ntheir legislation.
\nHe continued: \u201cThis Declaration combines
\npragmatism and wisdom with the \u201cprimacy
\nof the individual\u201d. This raises awareness of
\nthe physician to the fundamental impor-
\ntance of informed consent and information
\nof the patient, the secrecy of personal and
\nespecially patient data, and the value of the
\nprofessional autonomy of the physician.
\nUnder the aegis of independent research
\ncommittees, the DoH rigorously codifies
\nthe scientific studies and trials, and in par-
\nticular, the protection of the research sub-
\njects against dangerous experiments and
\nexploitation. The Declaration commands
\nthe application of the necessary scientific
\nrigour, including the use of placebos when
\nnecessary. The sustainability of the DoH is
\na shining example of universality of medi-
\ncal ethics. Even if its drafting seemed to be
\nlaborious, our Declaration of Helsinki has
\nthe merit to be a historical and yet modern
\ndocument, combing the cultures of more
\nthan one hundred medical associations.
\nThus, it is an authentic factor of peace and
\nunion between medical professions around
\nthe world in full respect for the patients
\nfor whom we care. The DoH ensures a rig-
\norous application of science as well as the
\nethics on the grounds of a genuine respect
\nfor the patient and human rights we are
\ncaring for\u201d.
\nUrban Wiesing
\nProfessor Urban Wiesing, ethics adviser
\nto the WMA on the Helsinki Declaration
\nand Director of the Institute for Ethics
\nand History of Medicine at the University
\nof T\u00fcbingen, was the next speaker. He said
\nthat delegates attending the WMA Assem-
\nbly 50 years ago could hardly have imagined
\nthe historical significance of their decision
\nto adopt the Declaration of Helsinki. \u201cOne
\ntiny step had been taken by the delegates
\nthat would later turn out to be a giant leap\u201d.
\nBut the road to the Declaration was neither
\nstraight nor smooth. The work took more
\nthan a decade, with discussions starting fol-
\nlowing the Nuremberg Code.
\n\u201cThe Nuremberg code was meant to pre-
\nvent crimes like those committed by Nazi
\ndoctors in the concentration camps.There-
\nfore it demanded to obtain participants\u201d
\nvoluntary consent without any exception.
\nln addition, the code set a limit on rea-
\nsonable risks and demanded that subjects
\nhave the right to leave the experiment at
\nany time. However, the code attracted little
\ninterest at first. How could it? lt served
\nto justify the judgment of an American
\nmilitary court. It was a secret document
\nin some countries. What authority could
\nsuch a Code claim to have? This was a dif-
\nficult question to answer. The Nuremberg
\nCode was an important document, but it
\ndid not serve as an influential answer to the
\ndemanding situation in medical research.
\nAnother answer was needed.\u201d
\nHe said it was in 1953 that a first proposal
\nfor a position paper was submitted to the
\nMedical Ethics Committee of the WMA,
\npublished a year later as the \u201cResolution
\non Human Experimentation\u201d. Seven years
\nlater, in 1961, the Medical Ethics Commit-
\ntee presented the first draft of the Declara-
\ntion. Three additional years of intense and
\ncontroversial debates had to pass until it was
\nadopted.
\n\u201cThe Declaration is what it is because it
\ngives an answer, an answer to a question
\nthat is desperately needed to be answered in
\nmodern medicine; an answer to the funda-
\nmental ethical question of research involv-
\ning human subjects, an answer to a dilem-
\nma. What is the dilemma modern medicine
\nis confronted with? On the one hand, mod-
\nern medicine knows that precise knowl-
\nedge concerning the \u201cefficacy and safety
\nof interventions can only be gained from
\nresearch involving human subjects. Animal
\nor laboratory experimentation is necessary
\nand a prerequisite to clinical research. On
\nthe other hand, research involving human
\nsubjects is fraught with ethical conflicts that
\ncannot be completely prevented. lf one con-
\nducts research on human subjects, there will
\nalways be the risk of harming them. Expos-
\ning the patients to such risks is inconsistent
\nwith the medical professional\u201ds obliga-
\ntions, especially with the old Hippocratic
\nprinciple primum nil nocere, do no harm.
\nHowever, harmful effects are inevitable in
\nresearch.lf the researcher knows beforehand
\nthat the patient will not be exposed to any
\nrisks because the intervention is effective
\nand does not inflict any harm, then no fur-
\nDeclaration of Helsinki
\n157
\nther research is needed. Research involving
\nhuman subjects is controversial because of
\nthe risks.\u201d
\nBut abstaining from conducting research
\nto avoid ethical conflicts would mean treat-
\ning future patients with previously untest-
\ned drugs. This would significantly lessen
\nthe quality of medical practice. Yet clini-
\ncal research was ethically critical because
\nit violated the principle \u201cdo no harm\u201d. The
\nDeclaration stressed the protection of the
\nparticipants on the one hand and medicine\u201ds
\nneed for research on the other.
\n\u201cAfter the adoption of the Declaration the
\ninevitable happened. The Declaration was
\ndebated. It was classified from the very
\nbeginning as too permissive by some com-
\nmentators and as too restrictive by others.
\nThe debate on whether the Declaration is
\ntoo \u201cresearch-friendly\u201d or too restrictive
\npersists up to the present day. But if a docu-
\nment is criticized to be too liberal and also
\ncriticized to be too restrictive it may very
\nwell be a balanced compromise.\u201d
\nHe said the Declaration was now a living
\ndocument that had been adapted to a chang-
\ning environment and improved. Thanks to
\nthe Declaration and others this research no
\nlonger had an exclusively negative image.
\nThe Declaration not only limited research
\non human beings, but it also legitimized
\nit. The Declaration not only protected the
\nparticipants but the researchers as well.This
\nnot only stabilized the medical profession
\nbut gave the system of research hope that
\nthe people would accept it.
\nAnd he added: \u201cThe Declaration was cre-
\nated and adopted by an organization of
\nphysicians for physicians, thus creating a
\nclose relationship to the profession and the
\nprofessionals. The Declaration remains an
\nexpression of professional self-reflection. lt
\nis living proof that a profession can regulate
\nnot only scientific but also ethical aspects
\nresponsibly.The adoption and the successful
\nefforts of the World Medical Association
\nfor self-imposed regulations confirm the
\nfundamental willingness and ability to learn
\nas a professional self-organization.Thus,the
\nDeclaration is an expression of responsibil-
\nity\u201d.
\nLooking to the future scientific and tech-
\nnological development of modern medicine,
\nProf. Wiesing said: \u201cThey will confront us
\nwith new challenges. I only have to remind
\nyou of some of the latest medical projects
\nlike individualized medicine, system medi-
\ncine, new developments in genetics or bio-
\nbanks. And I am sure there are more to
\ncome and are already coming.I am speaking
\nin particular of the Ebola crisis. In the case
\nof Ebola, we can see how adequate the ethi-
\ncal principles of the Declaration are. We do
\nnot need a new ethics in the case of Ebola.
\nHowever, we do need to make new deci-
\nsions in the face of such a global crisis, but
\nthese decisions must be made on the basis of
\nexisting ethical principles. The ethical prin-
\nciples laid down in the Declaration remain
\nvalid. They are applicable to the current sit-
\nuation and indeed helpful. The Declaration
\nstresses the importance of protecting par-
\nticipants on the one hand and medicine\u201ds
\nneed for research on the other. Both must
\nbe balanced. This holds true when it comes
\nto Ebola as well. A balance between expos-
\ning current patients to potential risks for
\ntheir own benefit as well as the benefit of
\nfuture patients is absolutely crucial in order
\nto prevent a pandemic\u201d.
\nThe Declaration allowed the \u201ctreatment of
\nan individual patient, where proven inter-
\nventions do not exist\u201d under certain con-
\nditions\u201d. The case of Ebola illustrated just
\nhow appropriate the ethical principles of
\nthe Declaration were.
\nThe main question now was not how often
\nthe Declaration should be revised. It was
\nhow the Declaration could keep providing
\nthe ethical principles for research involving
\nhuman subjects in the face of rapid devel-
\nopments in science and society. While the
\nfrequency of revisions should be low, they
\nshould also be appropriate to keep up with
\nscientific and ethical progress\u201d.
\n\u201cAs long as the Declaration remains the
\nmost important answer to one of the fun-
\ndamental challenges of modern medicine
\nI\u00a0have no doubt that there will be good rea-
\nsons to meet again in 10, 25, in 50 years for
\nthe next anniversaries. And where should a
\nmeeting take place? There is no doubt- in
\nthe city, where it started, in Helsinki, where
\nelse?\u201d
\nSauli Niinist\u00f6
\nAn official greeting was then given by the
\nPresident of Finland,His Excellency Sau-
\nli Niinist\u00f6, who said the Declaration had
\nbeen described as the most widely accepted
\nguidance worldwide on medical research in-
\nvolving human subjects.
\n\u201cDuring the past 50 years theory has turned
\ninto practice. Guidelines and principles
\ncontained in the Declaration have been en-
\nshrined in national and international law
\nand conventions regulating medical research
\ntoday. For instance, in Finland ethical com-
\nmittees have been statutory since the late
\n1990s. Regardless of their field of study, re-
\nsearchers have a great thirst for new knowl-
\nedge. However, the pursuit of knowledge is
\nnever without risk. But we will have no new
\nknowledge without active research. Clinical
\nmedicine has made immense progress in the
\nDeclaration of Helsinki
\n158
\nlast 50 years.This would not have been pos-
\nsible without countless studies.
\n\u201cIn general, ethical principles do not adapt
\nin step with the opportunities offered by
\nmedicine to examine and treat patients.
\nModern methods for the management and
\nanalysis of information are at a completely
\ndifferent level than in the 1960s.These days,
\nwe place a particular emphasis on the right
\nof individuals to control personal informa-
\ntion. Despite the speed of development in
\nmedical science, the World Medical Asso-
\nciation has managed to keep the Declara-
\ntion up-to-date. And the Association has
\nfound a well-functioning compromise both
\nin terms of manner and pace of updating.
\nThe Declaration provides a valuable guide
\nfor all parties involved in research\u201d.
\nHe said that continuous, open discussion
\non the ethics of medicine and its basis in
\nresearch was necessary to ensure the sus-
\ntainable well-being of societies and people.
\nThe Declaration had proved to be a well-
\nfunctioning cure, but they had to continue
\nwith this treatment. He hoped the Declara-
\ntion would continue to play a key role in en-
\nabling medical advances of a high standard
\nin the years to come.
\nLaura R\u00e4ty
\nThe final speaker was Dr.Laura R\u00e4ty,Finn-
\nish Minister for Health and Social Affairs.
\nAs a politician and a physician, she asked
\nwhether there was room for physician\u201ds eth-
\nics in political decision-making. She said
\nthere were six main principles in medical
\nand care ethics: respect for life, respect for
\nhuman dignity, self-determination (autono-
\nmy), caring, justice (fairness) and maximiz-
\ning of benefit. She addressed each of these
\nprinciples and said they could be reflected
\nagainst the political decision-making that
\nhad been and was being carried out in Fin-
\nland, on one hand, at local government level
\nand, on the other hand, in central govern-
\nment policy.
\nIn addition there was the essential principle
\nin the work of a physician of confidential-
\nity. The basic condition for a good doctor-
\npatient relationship was that the patient
\ncould be confident that his or her informa-
\ntion could not be accessed by others than
\nthe health care professionals that participate
\nin the care of the patient.
\nReturning to the title of her address \u201cIs
\nthere room for physician\u00b4s ethics in political
\ndecision-making?\u201d her answer was \u201cThere is
\nand there must be\u201d.
\nShe concluded: \u201cWe in Finland are aware
\nthat all those conditions where people are
\nborn, grow up, live, work and age contrib-
\nute to wellbeing and health. Therefore we
\nconsider that the different sectors of soci-
\nety must in their decision-making evaluate
\nthe impact of their decisions on wellbeing
\nand health. Health in all policies has been
\non the agendas of international forums at
\nFinland\u201ds initiative for about ten years, and
\nin spring this year the World Health Or-
\nganization (WHO) adopted a resolution on
\nthe issue. Integrating health and wellbeing
\nextensively into societal decision-making
\ncan bring concrete benefits to citizens. For
\ninstance the systematic and consistent to-
\nbacco policy conducted in Finland has re-
\nduced smoking, and the nutrition policy
\nhas improved the composition of nutrition
\namong the population. The cardiovascular
\ndisease mortality in working-age men has
\nfallen by 80 per cent in 40 years. The im-
\nproved level of education and working con-
\nditions and the improved living conditions
\nin general have had a favourable impact on
\nthe population\u201ds health.
\n\u201cWhen treating patients as a physician
\nI\u00a0have been well aware of the responsibility
\nI\u00a0have for the health of an individual. As a
\npolitician I\u00a0have a broader responsibility to
\ninfluence the population\u201ds health and well-
\nbeing. I see this responsibility not only as
\na political but also as an ethical issue. We
\nmust all act ethically so that the citizens\u201d
\ninterests are taken into account.
\nThe slogan of the Finnish Medical Asso-
\nciation \u2013 my own association \u2013 is: \u201cFor the
\npatient\u201ds best with physician\u201ds skills.\u201d I am
\nconvinced also on the basis of my own ex-
\nperience that a physician can help a patient
\neven in the field of politics \u2013 and a poli-
\ntician can help a patient without having
\nmedical education. Health in all policies
\nis our \u2013 physicians\u201d and politicians\u201d \u2013 joint
\nethics.
\nYes \u2013 there is room for physician\u201ds ethics in
\npolitical decision-making\u201d.
\nDr. Mukesh Haikerwal, Chair of the
\nWMA, concluded the day\u201ds proceedings
\nwith a vote of thanks to the speakers and all
\nthe participants.
\nMr. Nigel Duncan,
\nPublic Relations Consultant, WMA
\nDeclaration of Helsinki
\n159
\nNMA News
\nMelbourne Health Summit
\nMemoranda
\nHealth Care in Danger
\nThe H20 Health (Melbourne 2014) Summit urges the Worlds\u2019
\nLeaders, including those at the G20 Australia, to be aware of the
\nmortal danger of those providing and receiving health care across
\nthe world and the resulting effects on peoples\u2019 health.
\nWe commend the efforts of the International Committee of the
\nRed Cross to secure safe access to Healthcare and call on Govern-
\nments to legislate and not tolerate infringements against health fa-
\ncilities and personnel.
\nhttps:\/\/www.icrc.org\/eng\/resources\/documents\/event\/2014\/violence-
\nagainst-aid-workers-future-of-humanitarianism-overseas-develop-
\nment-institute-htm.htm
\nClimate And Health
\nThe H20 Health (Melbourne 2014) Summit urges the Worlds\u2019
\nLeaders, including those at the G20 Australia, to prioritise action
\non the Climate as a matter of urgency in the interest of the Health
\nof the Public.
\nHuman influence on the climate system is clear,and recent anthropo-
\ngenic emissions of greenhouse gases are the highest in history.Recent
\nclimate changes have had widespread impacts on human and natural
\nsystems. http:\/\/www.ipcc.ch\/news_and_events\/docs\/ar5\/ar5_syr_head-
\nlines_en.pdf
\nThe environment influences human health in many ways \u2014 through
\nexposures to physical, chemical and biological risk factors, and
\nthrough related changes in behaviour in response to those factors.
\nAccording to the WHO, 13 million deaths annually are due to pre-
\nventable environmental causes.Mitigating environmental risk could
\nsave as many as four million lives a year in children alone, mostly in
\ndeveloping countries.https:\/\/www.wma.net\/en\/20activities\/30publich
\nealth\/30healthenvironment\/10climate\/
\nHealth is a Wise Investment
\nThe H20 Health \u2013 Health People,Successful Economy (Melbourne
\n2014) \u2013 Summit wishes to emphasise to the Worlds\u2019 Leaders, in-
\ncluding those at the G20 Australia, that health and health care are
\ncore components of a fair, just and successful economy.
\nWe urge that there be meaningful dialogue with the Health Sector
\nto progress better health outcomes across Nations.
\nWe note that:
\n\u2022 Concerns about health costs exist in all nations.
\n\u2022 Health of Nations is a core component of the Wealth of Nations.
\n\u2022 Good health systems are a marker of a fair and just society.
\n\u2022 The Health Sector employs significant numbers of people.
\n\u2022 A productive society depends on a healthy, engaged and
\n\u2022 Confident workforce.
\n\u2022 People participating and contributing in the economy continue
\nto do so if kept healthy. \u201cHealth is the greatest social capital a
\nnation can have\u201d.
\nNon-Communicable Diseases
\nThe H20 Health (Melbourne 2014) Summit urges the Worlds\u2019
\nLeaders, including those at the G20 Australia, to work con-
\nstructively and meaningfully with the Health Sector to address
\nthe catastrophic effects of unresolved \u201cNon-Communicable Di-
\nseases\u201d.
\nWMA asserts all NCDs need to be addressed and in a systematic,
\ncoordinated and sustainable way: the work is more urgent now.http:\/\/
\nwww.wma.net\/en\/20activities\/30publichealth\/10noncommunicabledise
\nases\/
\nThe spread of non-communicable diseases remains a socio-econom-
\nic and development challenge of \u201cepidemic proportions.\u201d Govern-
\nments in 2011 pledged to work with the United Nations to adopt
\nbefore the end of 2012 targets to combat heart disease, cancers,
\ndiabetes and lung disease and to devise voluntary policies that cut
\nsmoking and slashed the high salt, sugar and fat content in foods
\nthat caused them. http:\/\/www.un.org\/press\/en\/2011\/ga11138.doc.
\nhtm
\nSocial Determinants of Health
\nThe H20 Health (Melbourne 2014) Summit has resolved that ad-
\ndressing the Social Determinants of Health is a core strategy for a
\nfair and just Society. We stand prepared to work with the Worlds\u2019
\nLeaders, including those at the G20 Australia, to act on and address
\nthe Social Determinants of Health and request that the G20 Aus-
\ntralia secretariat progress this.
\n\u201cThe Social Determinants of Health, Health inequality among
\npeople between and within countries is significant and consti-
\ntutes an urgent issue of social justice. It is clear that these health
\ninequalities are the result of differences in living conditions; the
\nenvironment in which a person is born, grows, lives, works, ages,
\nand dies.The International community including the health sector,
\nmust redouble our efforts to address these and reach a more fair
\nand just society.\u201d https:\/\/www.wma.net\/en\/20activities\/30publicheal
\nth\/80socialdeterminants\/
\n160
\nNMA News
\nHungarian Medical Chamber
\nOffice Bearers (2011\u20132015)
\nPresident: Dr. Istv\u00e1n \u00c9ger
\n1st Vice President: Prof. Dr. J\u00e1nos Banai
\n2nd Vice President: Dr. J\u00e1nos Gerle
\n3rd Vice President: Dr. Attila Kov\u00e1ts
\nSecretary General: Dr. Ferenc Nagy
\n1st Secratary: Dr. G\u00e1bor Holl\u00f3s
\n2nd Secretary: Dr. J\u00e1nos Lengyel
\n3rd Secretary: Dr. Zsolt Pataki
\n4th Secretary: Dr. P\u00e9ter Tak\u00e1cs
\nMembership
\nAny medical doctor from all States of Hungary can join the
\nHungarian Medical Chamber as a regular member. Since 1994
\nthe Hungarian law says all medical doctor, who is practicing
\nhave to join the Hungarian Medical Chamber. Between 2007
\nand 2011 the membership temporarily was voluntary. In 2011
\nthe law have been reconstructed and since then the membership
\nis mandatory.
\nServices Provided
\nThe Hungarian Medical Chamber is an independent, democratic
\nbody which preserve professional, moral and substantial interest
\nof doctors. Functionally it is a public body as a representative de-
\nmocracy. With an open structure and influence it serves people and
\npeople\u2019s health.
\nActivities
\n\u2022 With Members: A monthly newspaper with scientific and
\nhealth publications for all member of the Hungarian Medical
\nChamber.
\n\u2022 With the Public:Serves people\u2019s health with the principle of \u201csal-
\nvation of patient is the primary law\u201d.
\n\u2022 With the Governments:Law proposal and estimate, lobby at the
\nMinistry of Health for better medical basic services.
\n\u2022 With the Media: Press releases and interviews to health issues of
\npublic interest and promotion of debates related to health poli-
\ncies.
\n\u2022 With Strategic Partners: Collaboration with Chamber of Nurs-
\nes, Chamber of Pharmacies health insurance companies and pro-
\nmotion of public health.
\nSzondi street 100., Budapest 1068, Hungary
\nPhone: +36-1\/302-0065
\nE-mail: elnok@mok.hu
\nwww.mok.hu
\nSomali Medical Association
\n(SMA)
\nOffice Bearers (2014-2016):
\nPresident: Prof. Mohamed Yusuf Hassan
\nVice-President: Dr.Shafii Mohamed Jamale
\nGeneral Secretary: Dr.Hassan Mohamed Habibullah
\nFinance Secretary: Dr.Mohamed Mohamud Omar
\nPublic & International relations Secretary: Dr.Nor Abdullahi
\nKarshe
\nSocial & Emergency Secretary: Dr. Lul Mohamud Mohamed
\nCPD & Research Secretary: Dr.Mohamed Abdulrahman Jama
\nMembership: Any registered medical or dental practitioner in So-
\nmalia is eligible to join SMA.
\nServices provided: The main services provided by SMA to their
\nmembers are: Continued professional development (finding schol-
\narships for junior doctors), Welfare services, and representation of
\ntheir interests locally and internationally.
\nActivities:
\n\u2022 With Members: Support for newly qualified doctors, Continued
\nprofessional development Programs including scholarships, wel-
\nfare,
\n\u2022 With the Public: Emergency relief programs for displaced peo-
\nple, Mobile clinics for areas where low socioeconomic people live,
\nEducation of the public on the prevention of infectious and Non
\nCommunicable Chronic diseases with the help of MOH.
\n\u2022 With the Government:develop protocols and guidelines for hos-
\npitals and district hospitals with Ministry of Health. Advise the
\nministry of Higher education for improving the quality existing
\nmedical schools.
\n\u2022 With the Media: press releases related to health issues of public
\ninterest,promotion of debates related to health policies,education
\non health related issues.
\n\u2022 With Strategic Partners: on the process of establishing relations
\nwith worldwide medical associations to get assistance of contin-
\nued professional development. Also on the process of creating ac-
\ncess to E-Libraries with the help of WHO to provide free access
\nto scientific publications to the Somali doctors.
\nKPP, Wadnaha Street,
\nHodon district, Mogadishu-Somalia
\nPhone: +2521652641
\nE-mail: Intl@sma.org.so , Info@sma.org.so
\nwww.sma.org.so
\nIII
\nNMA News
\nTrinidad & Tobago Medical
\nAssociation (T&TMA)
\nMotto: Teach, Treat, Mentor, Advocate (TTMA)
\nOrigin: Originally formed as a branch of the British Medical Associa-
\ntion 1891. Formally created by an act of Parliament in 1974.
\nOffice Bearers: (2014)
\nPresident: Liane Conyette
\n1st
\nVice President: Muhammad Rahman
\nSecretary: Stacey Chamely
\nTreasurer: Edmund Chamely
\nPublic Relations Officer: Austin Trinidade
\nInternational Liaison Officer: Solaiman Juman
\nMembership: All medical doctors registered with the Medical
\nBoard of Trinidad and Tobago to practice medicine in the country
\nare eligible to be members of T&TMA
\nServices Provided:
\n\u2022 The T&TMA is the official agent of the Medical Protection. So-
\nciety (MPS) of the United Kingdom.
\n\u2022 The Caribbean Medical Journal (CMJ) \u2013 a peer reviewed journal
\ncontinuously printed since 1938 \u2013 is distributed to all our mem-
\nbers.
\n\u2022 We are the biggest provider of Continuous Professional. Devel-
\nopment (CPD) activities for doctors in the country.
\n\u2022 We have been approved by the American Academy of Continu-
\ning Medical Education (AACME) to provide AACME credits
\nfor eligible activities in the Country
\n\u2022 The T&TMA does regular outreach clinics and activities to un-
\nderserved areas.
\nAffiiations
\n\u2022 University of the West Indies (UWI).We work closely with UWI
\n(the largest Medical School in the Caribbean) to provide high
\nquality CME activities.
\n\u2022 Medical Board of Trinidad & Tobago (MBTT). We are working
\nin an ongoing project with the MBTT to ensure and facilitate the
\nimplementation of mandatory CME requirements for all doctors
\nto obtain annual registration.
\n\u2022 Ministry of Health (MOH). There is ongoing discussion and
\ncommunication with the MOH
\n\u2022 International Associations. We are active members of the World
\nMedical Association and the Commonwealth Medical Associa-
\ntion
\n\u2022 Other Professional Medical Organizations and Societies. We
\nare developing links with other medical bodies to strengthen the
\nmedical lobby in our country.
\n#1 Sixth Ave.,
\nXavier Street Ext., Gardens,
\nChaguanas, Trinidad
\nTel: (1-868) 671-7378
\nTel\/fax: (1-868) 671-5160
\nE-mail: medassoc@tntmedical.com
\nWebsite: www.tntmedical.com
\nGerman Medical Association
\nOffice Bearers:
\nPresident: Prof. Dr. Frank Ulrich Montgomery (Hamburg)
\nVice-President: Dr. Martina Wenker (Lower Saxony)
\nVice-President: Dr. Max Kaplan (Bavaria)
\nThe German Medical Association (Bundes\u00e4rztekammer), based in
\nBerlin, is the umbrella organisation in the system of physicians\u2019
\nself-governance in Germany. As the joint association of the 17 state
\nchambers of physicians (Landes\u00e4rztekammer), it represents the pro-
\nfessional interests of the 470,000 physicians in Germany at the na-
\ntional, European and international level.
\nThe structure of physicians\u2019self-governance in Germany reflects the
\nfederal nature of the German healthcare system, which is adminis-
\ntered at the State (Land) rather than the national level.The GMA\u2019s
\nExecutive Board is comprised of the presidents of all state cham-
\nbers of physicians and two further physician representatives. Its
\npresident and two vice-presidents are elected every four years by the
\n250 delegates of the annual German Medical Assembly (Deutscher
\n\u00c4rztetag). Individual physicians are only indirectly members of the
\nGMA via compulsory membership of the state chamber of physi-
\ncians in the State where they work.
\nIn addition to its politically representative function,the GMA also pro-
\nmotes the exchange of experiences and coordinates the activities of the
\nstate chambers of physicians. Among other things, it draws up model
\nguidelines intended to facilitate uniformity in medical regulation across
\nthe country. Once adopted by the German Medical Assembly, it is up
\nto the boards of the individual state chambers to determine the extent
\nto which these guidelines will be implemented at the state level. The
\nGMA also hosts numerous expert committees and advisory boards,
\nwhich provide the medical profession with information and advice re-
\nlating to specific areas of medical science, ethics and healthcare policy.
\nIV
\nContents
\nThe GMA arose from the Working Group of West German Medi-
\ncal Associations, which was founded in 1947. Following the reuni-
\nfication of Germany in 1990, the system of physicians\u2019 self-gover-
\nnance was extended to the former East German states, where state
\nchambers of physicians were also established.As corporations under
\npublic law, the state chambers of physicians have responsibility for
\nthe following main areas:
\n\u2022 Physician registration
\n\u2022 Organisation and regulation of specialty training and continuing
\nmedical education (CME)
\n\u2022 Upholding professional ethics and monitoring adherence to their
\nProfessional Code
\n\u2022 Maintaining ethics committees to assess clinical research proj-
\nects
\n\u2022 Establishing expert commissions and\/or arbitration boards to
\npromote the out of court settlement of conflicts between physi-
\ncians and patients over malpractice claims
\n\u2022 Representing the interests of the medical profession in the politi-
\ncal and public sphere, including in the media.
\nThe GMA has been representing the physicians of Germany as an
\nactive member of the World Medical Association since 1951. The
\nmaintenance of close relations with the international medical com-
\nmunity has always been an important aspect of the GMA\u2019s work,
\nand is listed as one of its functions in its statutes.
\nBundes\u00e4rztekammer\/German Medical Association
\nHerbert-Lewin-Platz 1
\n10623 Berlin, Germany
\nEditorial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
\nWMA 2014 General Assembly Report . . . . . . . . . . . . . . . 122
\nValedictory address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
\nInaugural speech . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
\nWMA Declaration on the Protection of Health Care
\nWorkers in situation of Violence . . . . . . . . . . . . . . . . . . . . 141
\nWMA Resolution on Ebola Viral Disease . . . . . . . . . . . . . 141
\nWMA Resolution on Migrant Workers\u2019 Health and Safety
\nin Qatar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
\nWMA Resolution on the Non-Commercialisation of
\nHuman Reproductive Material . . . . . . . . . . . . . . . . . . . . . . 143
\nWMA Resolution on Unproven Therapy and the Ebola
\nVirus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
\nWMA Statement on Aesthetic Treatment . . . . . . . . . . . . . 144
\nWMA Statement on Ethical Guidelines for the International
\nMigration of Health Workers . . . . . . . . . . . . . . . . . . . . . . . 145
\nWMA Statement on Solitary Confinement . . . . . . . . . . . . 146
\nWMA Statement on the Prevention of Air pollution due
\nto Vehicle Emissions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
\nWMA Statement on Water and Health . . . . . . . . . . . . . . . 149
\nAnniversary of the Signing of the Declaration of Helsinki . . . 150
\nMelbourne Health Summit Memoranda . . . . . . . . . . . . . . 159
\nHungarian Medical Chamber . . . . . . . . . . . . . . . . . . . . . . 160
\nSomali Medical Association (SMA) . . . . . . . . . . . . . . . . . . 160
\nTrinidad & Tobago Medical Association (T&TMA) . . . . III
\nGerman Medical Association . . . . . . . . . . . . . . . . . . . . . . . III<\/p>\n"},"caption":{"rendered":"

wmj201404 COUNTRY \u2022 Council Session and General Assembly. South Africa,Durban \u2022 Anniversary of the Declaration of Helsinki vol. 60 MedicalWorld Journal Official Journal of the World Medical Association, INC G20438 Nr. 4, December 2014 h Cover picture from LATVIA Editor in Chief Dr. P\u0113teris Apinis Latvian Medical Association Skolas iela 3, Riga, Latvia Phone +371 […]<\/p>\n"},"alt_text":"","media_type":"file","mime_type":"application\/pdf","media_details":{},"post":727,"source_url":"https:\/\/www.wma.net\/wp-content\/uploads\/2016\/11\/wmj201404.pdf","_links":{"self":[{"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/media\/3671"}],"collection":[{"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/media"}],"about":[{"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/types\/attachment"}],"author":[{"embeddable":true,"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/comments?post=3671"}]}}