Declaration of Venice_v2006

Handbook of WMA Policies
World Medical Association ⏐ D-1983-01-2006
WMA DECLARATION OF VENICE
ON
TERMINAL ILLNESS
Adopted by the 35th
World Medical Assembly, Venice, Italy, October 1983
and revised by the 57th
WMA General Assembly, Pilanesberg, South Africa, October 2006
PREFACE
1. When addressing the ethical issues associated with end-of-life care, questions regard-
ing euthanasia and physician-assisted suicide inevitably arise. The World Medical
Association condemns as unethical both euthanasia and physician-assisted suicide. It
should be understood that WMA policy on these issues is fully applicable in the con-
text of this Statement on Terminal Illness.
PREAMBLE
1. When a patient’s medical diagnosis precludes the hope of health being restored or
maintained, and the death of the patient is inevitable, the physician and the patient are
often faced with a complex set of decisions regarding medical interventions. Ad-
vances in medical science have improved the ability of physicians to address many
issues associated with end-of-life care. However, it is an area of medicine that histori-
cally has not received the attention it deserves. While the priority of research to cure
disease should not be compromised, more attention must be paid to developing pallia-
tive treatments and improving the ability of physicians to assess and address the medi-
cal and psychological components of symptoms in terminal illness. The dying phase
must be recognized and respected as an important part of a person’s life. As public
pressure increases in many countries to consider physician assisted suicide and eutha-
nasia as acceptable options to end suffering in terminal patients, the ethical imperative
to improve palliative treatment in the terminal phase of life comes into sharp focus.
2. The World Medical Association recognizes that attitudes and beliefs toward death and
dying vary widely from culture to culture and among different religions. In addition,
many palliative and life-sustaining measures require technologies and/or financial
resources that are simply not available in many places. The approach to medical care
of the terminally ill will be influenced significantly by these factors, and thus at-
tempting to developing detailed guidelines on terminal care that can be universally
applied is neither practical nor wise. Therefore, the World Medical Association arti-
culates the following core principles to assist physicians and National Medical As-
sociations with decision-making related to terminal care.
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D-1983-01-2006 ⏐ Pilanesberg
Terminal Illness (Venice)
PRINCIPLES

1. The duty of physicians is to heal, where possible, to relieve suffering and to protect
the best interests of their patients. There shall be no exception to this principle even in
the case of incurable disease.
2. In the care of terminal patients, the primary responsibilities of the physician are to
assist the patient in maintaining an optimal quality of life through controlling symp-
toms and addressing psychosocial needs, and to enable the patient to die with dignity
and in comfort. Physicians should inform patients of the availability, benefits and
other potential effects of palliative care.
3. The patient’s right to autonomy in decision-making must be respected with regard to
decisions in the terminal phase of life. This includes the right to refuse treatment and
to request palliative measures to relieve suffering but which may have the additional
effect of accelerating the dying process. However, physicians are ethically prohibited
from actively assisting patients in suicide. This includes administering any treatments
whose palliative benefits, in the opinion of the physician, do not justify the additional
effects.
4. The physician must not employ any means that would provide no benefit for the pa-
tient.
5. Physicians should recognise the right of patients to develop written advance directives
that describe their wishes regarding care in the event that they are unable to commu-
nicate and that designate a substitute decision-maker to make decisions that are not
expressed in the advance directive. In particular, physicians should discuss the pa-
tient’s wishes regarding the approach to life-sustaining interventions as well as pal-
liative measures that might have the additional effect of accelerating death. When-
ever possible, the patient’s substitute decision-maker should be included in these con-
versations.
6. Physicians should endeavour to understand and address the psychosocial needs of
their patients, especially as they relate to patients’ physical symptoms. Physicians
should try to ensure that psychological and spiritual resources are available to patients
and their families to help them deal with the anxiety, fear and grief associated with
terminal illness.
7. The clinical management of pain in terminal patients is of paramount importance in
terms of alleviating suffering. Physicians and National Medical Associations should
promote the dissemination and sharing of information regarding pain management to
ensure that all physicians involved in terminal care have access to best practice guide-
lines and the most current treatments and methods available. Physicians should be
able to pursue clinically appropriate aggressive pain management without undue fear
of regulatory or legal repercussions.
8. National Medical Associations should encourage governments and research institu-
tions to invest additional resources in developing treatments to improve end-of-life
care. Medical school curricula should include the teaching of palliative medical care.
Where it does not exist, the establishment of palliative medicine as a medical special-
ty should be considered.
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Handbook of WMA Policies
World Medical Association ⏐ D-1983-01-2006
9. National Medical Associations should advocate for the development of networks
among institutions and organizations involved in palliative care in order to foster com-
munication and collaboration.
10. Physicians may, when the patient cannot reverse the final process of cessation of vital
functions, apply such artificial means as are necessary to keep organs active for trans-
plantation provided that they act in accordance with the ethical guidelines established
in the World Medical Association Declaration of Sydney on the Determination of Death
and the Recovery of Organs.
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