World Medical Association 50th General Assembly

The following were among the decisions reached at the WMA’s five-day meeting in Ottawa, Canada, which ended at the weekend:

Declaration of Ottawa on the Right of the Child to Health Care
The General Assembly approved a new Declaration aimed at improving the rights of children throughout the world to health care. The new initiative, entitled the Declaration of Ottawa, builds on the 1989 United Nations Convention on the Rights of the Child. Among other rights, it states that:

• parents whose children are admitted to hospital should, wherever possible, be provided with appropriate accommodation in or near the hospital at minimal or no cost. In addition parents should be allowed time off work without prejudice to their continued employment;
• parents, guardians or children of sufficient maturity should be free to change their physician or to seek a second opinion;
• the wishes of children should be taken into account in decisions involving their care;
• a competent child patient, their parents or guardians should be entitled to withhold consent to any procedure or therapy;
• the child patient is entitled to be fully informed about their medical condition.

Dr James Appleyard, chairman of the WMA’s medical ethics committee, said: “This Declaration provides an international bench mark for children’s health care and a bench mark that many governments fail to reach. This bench mark will empower national medical associations throughout the world to persuade their governments to value their children and improve the health of the world’s children.

“The rights of children to health care need to be at the centre of our health policies and investment in the health care of children is the most cost effective measure for any government to take.”

WMA to Conduct International Survey on Human Cloning

The WMA has decided to conduct an international investigation into human cloning to prepare comprehensive new guidelines for physicians. It has called on all its member national medical associations to participate in the survey and to consult experts and the public in their respective countries. Meanwhile the meeting reaffirmed its 1997 Resolution calling on doctors engaged in research to abstain from participating in the cloning of human beings until the scientific, ethical and legal issues had been fully considered.

Dr Anders Milton, chairman of the WMA Council, said he hoped the investigation would be completed in time for the WMA’s Council meeting in April 1999.

“Developments in this area are moving so fast that it is crucial for the WMA to produce early guidance for physicians around the world. The application of cloning technologies to human beings is an issue of such critical potential consequences affecting the future of medicine and society, that we need to make absolutely sure we have considered all the major ethical issues.

“What rights are in danger of being violated, for instance, if we proceed with the cloning of human beings? Does this justify banning a procedure which could provide therapeutic benefit to millions of people? Is a ban even possible or should the technique be legalised and regulated? These are the issues we need to consider urgently before decisions can be made.”

Working Party To Examine Doping in Sport

The Association has set up a working party to consider the issue of doping in sport. The group, under the chairmanship of the Danish Medical Association, will consider whether in the light of the recent spate of sports doping scandals across the world, the WMA should issue fresh advice to doctors. The Association last issued guidance in its 1981 Declaration on Principles of Health Care for Sports Medicines, which was amended in 1987 and 1993.

At the General Assembly meeting, Dr Torben Pedersen, president of the Danish Medical Association, said that doping could not take place without the participation of doctors and it was time for the medical profession to speak out on the issue. The WMA must give clear guidelines to all its members and must consider whether members who participated in doping should be expelled from the association and whether licences should not be revoked by their regulatory bodies.

A draft paper drawn up by the Danish Medical Association urged the medical profession to rally to oppose doping in sport and to censor any doctors involved in doping. It said that doping was now systematically being used in the professional sports world and significant abuse was also occurring on the amateur level, often with even more dangerous drugs.

The paper said that doctors who participated in doping were behaving unethically and in some cases in a criminal manner. The argument that if physicians did not involve themselves, athletes’ health would be in greater danger was spurious and unacceptable. Physicians and their professional associations must now take a leading role in publicising information about the dangers in doping in sport and assist in uncovering and prohibiting such misuse.

Human Rights in Kosova

The meeting approved a resolution expressing its grave concern over the situation in Kosova and urging its member national medical associations to press their governments to ensure the immediate provision of humanitarian assistance to thousands of displaced persons.

Governments should insist that authorities allowed impartial forensic investigations, under the auspices of international forensic experts and should insist that steps are taken immediately to monitor human rights violations, ensure respect for medical staff and facilities and facilitate unrestricted access to international humanitarian organisations. The resolution also called for an end to discrimination in the provision of health care in Kosova and to any distinction based on ethnicity between health care structures.

Medical Care for Refugees

Against the background of a steady increase in refugees throughout the world, the General Assembly passed a resolution stating that governments should not deny patients and physicians the right to receive and administer adequate treatment and that physicians had a duty to provide appropriate medical care regardless of the civil status of the patient. The resolution said that physicians cannot be compelled to participate in any punitive or judicial measures involving refugees or to administer any non medically justified diagnostic measure or treatment, such as sedatives, to facilitate easy deportation. Physicians must be allowed adequate time and sufficient resources to assess the physical and psychological condition of refugees who were seeking asylum.

Peace and Weapons

• A new Declaration was approved pledging the WMA to work for the elimination of nuclear weapons and urging all governments to refrain from the development, testing, production, deployment, threat and use of nuclear weapons.
• A further Resolution was passed supporting the International Committee of the Red Cross Sirus Project designed to achieve an international ban on weapons that cause superfluous injury or unnecessary suffering.
• The Assembly expressed its support for the Ottawa Convention, also known as the landmine ban convention, and approved a Resolution urging its member national medical associations to press their governments to sign and ratify the convention.
• The meeting also decided to support the Hague Appeal for Peace 1999 Campaign and its goals of strengthening human rights and humanitarian law and institutions, and of settling disputes peacefully.

Improved Investment in Health Care

The meeting approved a Resolution expressing concern about health care systems in all countries having adequate resources to meet the basic needs of their populations. The Resolution recommended member national medical associations to urge their governments to support improved investment in the social sector and called on international financial institutions to stop all interventions that lead to reduced access to essential health care and to improve the poor’s access to good quality health care.

New Members

Four medical associations were admitted as new members of the WMA – the Bolivian Medical Association, the Medical Association of the Dominican Republic, the Swiss Medical Federation and the Zimbabwe Medical Association.

New President and President Elect

Dr Daniel Johnson, former president of the American Medical Association, was inaugurated as president of the WMA for 1998/9.

Professor J. Blahos, president of the Czech Medical Association, was elected president for 1999/2000. Professor Blahos is Professor of Medicine at Charles University in Prague and will be the first WMA president from eastern Europe.