Adopted by the 49th WMA General Assembly, Hamburg, Germany, November 1997
reaffirmed by the 58th WMA General Assembly, Copenhagen, Denmark, October 2007,
reaffirmed with minor revisions by the 207th WMA Council Session, Chicago, United States, October 2017,
and by the 220th WMA Council Session, Paris, France, April 2022

 

RECOGNISING THAT:

all people have the right to the preservation of health; and,
the Geneva Convention (Article 23, Number IV, 1949) requires the free passage of medical supplies intended for civilians;

Recalling the standards of international human rights law, specifically the Universal Declaration of Human Rights and the International Covenant on Economic, Social and Cultural Rights guarantees in its article 12 “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health”;

The WMA urges national medical associations to ensure that Governments employing economic sanctions against other States respect the agreed exemptions for medicines, medical supplies and basic food items. Exemptions should not be exploited for inappropriate purposes.

Adopted by the 57th WMA General Assembly, Pilanesberg, South Africa, October 2006
and revised by the 68th WMA General Assembly, Chicago, United States, October 2017

 

INTRODUCTION

1.      HIV/AIDS, a chronic manageable disease, is a global pandemic that has created unprecedented challenges for physicians and health infrastructures.

In addition to representing a staggering public health crisis, HIV/AIDS is also fundamentally a human rights issue.

Many factors drive the spread of the disease, such as poverty, homelessness, illiteracy, prostitution, human trafficking, drug (substance) abuse, stigma, discrimination and gender-based inequality.

These social, economic, legal and human rights factors affect not only the public health dimension of HIV/AIDS but also individual physicians/health workers and patients, their decisions and relationships.

Efforts to tackle the disease are also constrained by the lack of human and financial resources available in health care systems.

2.      Discrimination against HIV / AIDS patients by physicians is unacceptable and must be eliminated completely from the practice of medicine.

2.1    All persons with HIV/AIDS are entitled to adequate and timely support, treatment and care with compassion and respect for human dignity.

2.2    It is unethical for a physician to refuse to treat a patient whose condition is within his or her current realm of competence, solely because the patient is seropositive.

2.3    National Medical Associations should work with respective governments, patient groups and relevant national and international organizations to ensure that national health policies clearly and explicitly prohibit discrimination against people infected with or affected by HIV/AIDS, including vulnerable groups such as males having sex with males and transgender persons.

2.4    Woman and man having sex with same sex partners are at a higher risk of discrimination at all levels. National Medical organizations shall work with Government, Non-Governmental Organizations, and Community based organizations to remove the discrimination for these under-privileged disadvantaged groups.

 

APPROPRIATE / COMPETENT MEDICAL CARE

3.      Patients with HIV/AIDS must be provided with competent and appropriate medical care at all stages of the disease.

4.      A physician who is not able to provide the care and services required by patients with HIV/AIDS must make an appropriate timely referral to those physicians or facilities that are equipped to provide such services. Unless or until the referral can be accomplished, the physician must take care for the patient.

5.      All physicians should be able to timely suspect and identify common opportunistic infections such as tuberculosis, fungal infections in HIV-AIDs patients and also suspect HIV-AIDS in presence of these infections especially in high risk individuals like IV drug users.

They must timely counsel these patient about the nexus of these infections with HIV infection.

6.      Physicians and other appropriate professional bodies must ensure that patients have accurate information regarding transmission of HIV/AIDS and strategies to protect themselves against infection.

Proactive measures should be taken to ensure that all members of the population, particularly at-risk groups, are educated to this effect.

Public information and related strategies should recognise that everyone is at risk, and attempt to spell out methods of risk reduction.

7.      Physicians must effectively counsel all seropositive patients regarding responsible behaviour to prevent the spread of the infection to their partners and prevention of opportunistic infections.

8.      Physicians must recognize that many people still believe HIV/AIDS to be an automatic and immediate death sentence and therefore will not seek testing.

Physicians must ensure that patients have accurate information regarding the treatment options available to them.

Patients should understand the potential and need of starting early antiretroviral treatment (ART) to improve not only their medical condition but also the quality of their lives. The new strategy is test and treat strategy.

Effective ART can greatly extend the period that patients are able to lead healthy productive lives, functioning socially and in the workplace and maintaining their independence.

HIV/AIDS is now manageable chronic condition.

For ART country – specific WHO evidence based practice guidelines should be followed and promoted by all NMAs.

9.      Physicians should be aware that misinformation regarding the negative aspects of ART has created resistance toward treatment by patients in some areas. Where misinformation is being spread about ART, physicians and medical associations must make it an immediate priority to publicly challenge the source of the misinformation and to work with the HIV/AIDS community to counteract the negative effects of the misinformation.

10.    Physicians should encourage the involvement of support networks to assist patients in adhering to ART regimens. With the patient’s consent, counselling and training should be available to family members to assist them in providing care.

11.    Physicians must be aware of the discriminatory attitudes toward HIV/AIDS that are prevalent in society and local culture. Because physicians are the first, and sometimes the only, people who are informed of their patients’ HIV status, physicians should be able to counsel them about their basic social and legal rights and responsibilities or should refer them to counsellors who specialize in the rights of persons living with HIV/AIDS.

12.    Physicians should be aware of the current availability and prescribing guidelines for pre-exposure and post-exposure prophylaxis for any patient and health care providers who may have been exposed to HIV.

 

TESTING

13.    Mandatory testing for HIV must be required of donated blood and blood fractions collected for donation or to be used in the manufacture of blood products; organs and other tissues intended for transplantation; and semen or ova collected for assisted reproduction procedures.

Newer technologies which are more sensitive, specific, and reduce the window period of HIV detection, such as nuclear acid testing (NAT), should be encouraged for such screening.

14.    Mandatory HIV testing of an individual against his or her will is a violation of medical ethics and human rights.

15.    Physicians must clearly explain the purpose of an HIV test, the reasons it is recommended and the implications of a positive test result.

Before a test is administered, the physician should have an action plan in place in case of a positive test result. Informed consent must be obtained from the patient prior to testing.

16.    While certain groups are labeled “high risk”, anyone who has had unprotected sex should be considered at risk.

Physicians must become increasingly proactive about recommending testing to patients, based on a mutual understanding of the level of risk and the potential to benefit from testing. Pregnant women and her partner should routinely be offered testing for HIV, and those pregnant women found to be HIV positive should be offered immediate counseling and offered timely ART (at diagnosis) in order to prevent transmission of the virus to the fetus and treatment of the fetus if seropositive.

17.    Counselling and voluntary anonymous testing for HIV should be available to all persons who request it, along with adequate post-testing support mechanisms.

 

PROTECTION FROM HIV IN THE HEALTH CARE ENVIRONMENT

18.    Physicians and all health care workers have the right to a safe work environment. Especially in developing countries, the problem of occupational exposure to HIV has contributed to high attrition rates of the health labour force. In some cases, employees become infected with HIV, and in other cases fear of infection causes health care workers to leave their jobs voluntarily. Fear of infection among health workers can also lead to refusal to treat HIV/AIDS patients. Likewise, patients have the right to be protected to the greatest degree possible from transmission of HIV from health professionals and in health care institutions.

18.1  Proper infection control procedures and universal precautions consistent with the most current national or international standards, as appropriate, should be implemented in all health care facilities. This includes procedures for the use of preventive and timely bART for health professionals who have been exposed to HIV.

18.2  If the appropriate safeguards for protecting physicians or patients against infection are not in place, physicians and National Medical Associations should take action to correct the situation.

18.3  Physicians who are infected with HIV should not engage in any activity that creates a risk of transmission of the disease to others.

In the context of possible exposure to HIV, the activity in which the physician wishes to engage will be the determining factor.

There may be nationally agreed standards but if not a determination should be made by a suitable expert panel or committee of health workers.

18.4  In the provision of medical care, if a risk of transmission of an infectious disease from a physician to a patient exists, disclosure of that risk to patients is not enough; patients are entitled to expect that their physicians will not increase their exposure to the risk of contracting an infectious disease.

18.5  If no risk exists, disclosure of the physician’s medical condition to his or her patients will serve no rational purpose.

18.6  Physicians should be aware of current professional guidelines for post-exposure prophylaxis of health care workers in case of any accidental exposure to HIV.

 

PROTECTING PATIENT PRIVACY AND ISSUES RELATED TO NOTIFICATION

19.    Fear of stigma and discrimination is a driving force behind the spread of HIV/AIDS. The social and economic repercussions of being identified as infected can be devastating and can include violence, rejection by family and community members, loss of housing and loss of employment.

Normalizing the presence of HIV/AIDS in society through public education is the only way to reduce discriminatory attitudes and practices. Until that can be universally achieved, or a cure is developed, potentially infected individuals may refuse testing to avoid these consequences.

The result of individuals not knowing their HIV status is not only disastrous on a personal level in terms of not receiving treatment, but may also lead to high rates of avoidable transmission of the disease. Fear of unauthorized disclosure of information also provides a disincentive to participate in HIV/AIDS research and generally thwarts the efficacy of prevention programs. Lack of confidence in protection of personal medical information regarding HIV status is a threat to public health globally and a core factor in the continued spread of HIV/AIDS. At the same time, in certain circumstances, the right to privacy must be balanced with the right of partners (sexual and injection drug) of persons with HIV/AIDS to be informed of their potential infection. Failure to inform partners not only violates their rights but also leads to the health problems of avoidable transmission and delay in treatment.

20.    All standard ethical principles and duties related to confidentiality and protection of patients’ health information, as articulated in the WMA Declaration of Lisbon on the Rights of the Patient, apply equally in the context of HIV/AIDS. In addition, National Medical Associations and physicians should take note of the special circumstances and obligations (outlined below) associated with the treatment of HIV/AIDS patients.

20.1  National Medical Associations and physicians must, as a matter of priority, ensure that HIV/AIDS public education, prevention and counselling programs contain explicit information related to protection of patient information as a matter not only of medical ethics but of their human right to privacy.

20.2  Special safeguards are required when HIV/AIDS care involves a physically dispersed care team that includes home-based service providers, family members, counsellors, case workers or others who require medical information to provide comprehensive care and assist in adherence to treatment regimens. In addition to implementing protection mechanisms regarding transfer of information, ethics training regarding patient privacy should be given to all team members.

Many countries have specific legislation to protect the privacy of those who are HIV positive. Others may consider the same.

20.3  Physicians must make all efforts to convince HIV/AIDS patients to take action to notify all partners (sexual and/or injection drug) about their exposure and potential infection. Physicians must be competent to counsel patients about the options for notifying partners. 
These options should include:

20.3.1    Notification of the partner(s) by the patient. In this case, the patient should receive counselling regarding the information that must be provided to the partner and strategies for delivering it with sensitivity and in a manner that is easily understood. A timetable for notification should be established and the physician should follow-up with the patient to ensure that notification has occurred.

20.3.2    Notification of the partner(s) by a third party. In this case, the third party must make every effort to protect the identity of the patient.

20.4  When all strategies to convince the patient to take such action have been exhausted, and if the physician knows the identity of the patient’s partner(s), the physician is compelled, either by law or by moral obligation, to take action to notify the partner(s) of their potential infection. Depending on the system in place, the physician will either notify directly the person at risk or report the information to a designated authority responsible for notification.

Physicians must be aware of the laws and regulations in the jurisdiction in which they are practicing. In cases where a physician must disclose the information regarding exposure, the physician must:

20.4.1    inform the patient of his or her intentions,

20.4.2    to the extent possible, ensure that the identity of the patient is protected,

20.4.3    take the appropriate measures to protect the safety of the patient, especially in the case of a female patient vulnerable to domestic violence.

20.5  Regardless of whether it is the patient, the physician or a third party who undertakes notification, the person learning of his or her potential infection should be offered support and assistance in order to access testing and treatment.

20.6  National Medical Associations should develop guidelines to assist physicians in decision-making related to notification. These guidelines should help physicians understand the legal requirements and consequences of notification decisions as well as the medical, psychological, social and ethical considerations.

20.7  As per local and national laws and guidelines requiring the reporting of new HIV infections, sexually transmitted diseases, and opportunistic infections, physicians must protect the privacy and confidentiality of all patients and maintain the highest ethical standards.

20.8  National Medical Associations should work with governments to ensure that physicians who carry out their ethical obligation to notify individuals at risk, and who take precautions to protect the identity of their patient, are afforded adequate legal protection.

 

MEDICAL EDUCATION

21.    National Medical Associations should assist in ensuring that there is training and education of physicians in the most current prevention strategies and medical treatments available for all stages of HIV/AIDS and associated infections, including prevention and support.

22.    National Medical Associations should, when appropriate, collaborate with NGOs and community based organizations, insist upon, and when possible assist with, the education of physicians in the relevant psychological, legal, cultural and social dimensions of HIV/AIDS.

23.    National Medical Associations should fully support the efforts of physicians wishing to concentrate their expertise in HIV/AIDS care, even where HIV/AIDS is not recognized as an official specialty or sub-specialty within the medical education system.

24.    The WMA encourages its national medical associations to promote the inclusion of designated, comprehensive courses on HIV/AIDS in undergraduate and postgraduate medical education programs, as well as continuing medical education.

INTEGRATION of HIV/AIDS SERVICES with other STDs MANAGEMENT ACTIVITES

25.    The National Medical Associations should support governments to integrate HIV/AIDS preventive and curative services with other STD management activities in a comprehensive manner.

 

Adopted by the 47th WMA General Assembly, Bali, Indonesia, September 1995
and revised by the 57th WMA General Assembly, Pilanesberg, South Africa, October 2006
and by the 66th WMA General Assembly, Moscow, Russia, October 2015 

 

PREAMBLE

Historically, many societies have regarded patients with mental illness as a threat to those around them rather than as people in need of support and care. In the absence of effective treatment, to prevent self-destructive behaviour or harm to others, many persons with mental illness were confined to asylums for all or part of their lives.

Today, progress in psychiatric treatment allows for better care of patients with mental illness. Efficacious drugs and psychosocial interventions offer outcomes ranging from complete recovery to remission for varying lengths of time.

The adoption in 2006 of the United Nations Convention on the Rights of Persons with Disabilities constituted a major step towards viewing them as full members of society with the same rights as everyone else. It is the first comprehensive human rights treaty of the 21st century. It aims to promote, protect and reinforce the human rights and dignity of all persons with disabilities, including those with mental impairments.

Persons with major mental illnesses and those with learning disability have the same right to preventive services and interventions to promote health as others members of the community, for which they often have greater need because they are more likely to live unhealthy lifestyles.

Patients with psychiatric morbidity may also experience non- psychiatric illness. Persons with mental illness have the same right to health care as any other patient. Psychiatrists and health care professionals who provide mental health services should refer patients to other appropriate professionals when patients need medical care. Health care professionals should never decline to provide needed medical care solely because the patient has a mental illness.

Physicians have the same obligations to all patients, including patients with mental illness. Psychiatrists or other physicians who treat patients with mental illness must adhere to the same ethical standards as any physician.

The physician’s primary obligation is to the patient and not to serve as agents of society, except in circumstances when a patient presents clear danger to himself/ herself or others due to mental illness.

PHYSICIANS’ ETHICAL RESPONSIBILITIES

The stigma and discrimination associated with psychiatry and the mentally ill should be eliminated. Stigma and discrimination may discourage people in need from seeking medical care, thereby aggravating their situation and placing them at risk of emotional or physical harm.

Physicians have a responsibility to respect the autonomy of all patients. When patients who are being treated for mental illness have decision-making capacity, they have the same right to make decisions about their care as any other patient. Because decision-making capacity is specific to the decision to be made and can vary over time, including as a result of treatment, physicians must continually evaluate the patient’s capacity. When a patient lacks decision-making capacity, physicians should seek consent from an appropriate surrogate in accordance with applicable law.

The therapeutic relationship between physician and patient is founded on mutual trust, and physicians have a responsibility to seek patients’ informed consent to treatment, including patients who are being treated for mental illness. Physicians should inform all patients of the nature of the psychiatric or other medical condition, and the expected benefits, outcomes and risks of treatment alternatives.

Physicians should always base treatment recommendations on their best professional judgment and treat all patients with solicitude and respect, regardless of the setting of care. Physicians who practice in mental health facilities, the military, or correctional institutions may have concurrent responsibilities to society that create conflicts with the physician’s primary obligation to the patient. In such situations, physicians should disclose the conflict of interest to minimize possible feelings of betrayal on the patient’s part.

Involuntary treatment or hospitalization of persons with mental illness is ethically controversial. While laws regarding involuntary hospitalization and treatment vary worldwide, it is generally acknowledged that this treatment decision without the patient’s informed consent or against the patient’s will is ethically justifiable only when: (a) a severe mental disorder prevents the individual from making autonomous treatment decisions; and/or (b) There is significant likelihood that the patient may harm him/her self or others. Involuntary treatment or hospitalization should be exceptional and physicians should utilize it only when there is good evidence that it is medically appropriate and necessary and should ensure that the individual is hospitalized for the shortest duration feasible under the circumstances. Wherever possible and in accordance with local laws, physicians should include an advocate for the rights of that patient in the decision process.

Physicians must protect the confidentiality and privacy of all patients.. When legally required to disclose patient information, the physician should disclose only the minimum relevant information necessary and only to an entity legally authorized to request or require the information. When databanks allow access to or transfer of information from one authority to another confidentiality must be respected and such access or transfer must comply fully with applicable law.

The participation of individuals with psychiatric illness in research needs to be in full accordance with the Declaration of Helsinki’s recommendations.

Physicians must never use their professional position to violate the dignity or human rights of any individual or group, and should never allow their personal desires, needs, feelings, prejudices or beliefs to interfere with a patient’s treatment. Physicians must never abuse their authority or take advantage of a patient’s vulnerability.

RECOMMENDATIONS

The World Medical Association and National Medical Associations are encouraged to:

  • Publicize this Statement and affirm the ethical foundations for treatment of patients with mental illness;
  • While doing so, call for full respect – at all times – of the dignity and human rights of patients with mental illness;
  • Raise awareness of physicians’ responsibilities to support the well-being and rights of patients with mental illness;
  • Promote recognition of the privileged relationship between patient and physician based on trust, professionalism and confidentiality;
  • Advocate for appropriate resources to meet the needs of persons with mental illness.

Adopted by the 40th World Medical Assembly, Vienna, Austria, September 1988
and revised by the 57th WMA General Assembly, Pilanesberg, South Africa, October 2006
and by the 68th WMA General Assembly, Chicago, United States, October 2017

 

PREAMBLE

1.      Health is not simply the absence of illness, but is also more than a state of physical, psychological and social flourishing, and includes an individual’s ability to adapt to physical, social and mental adversity. It is affected by many factors, including access to health care and especially the Social Determinants of Health (SDH), and its restoration is similarly multidimensional. Society has an obligation to make access to an adequate level of care available to all its members, regardless of ability to pay.

2.      Health care professionals regularly confront the effects of lack of access to adequate care and health inequality and have a corresponding responsibility to contribute their expertise to work with governments at local, regional and national levels to ensure they understand the Social Determinants of Health and integrate reduction of factors leading to inequality into all policies. Health care policies should suggest ways to eliminate health inequality.

3.      Access to health care is an important factor in reducing the short, medium and long term consequences of poor health, caused by adverse social and other conditions.  Access is itself multidimensional, and is constrained by factors including health human resources, training, finance, transportation, geographical availability, freedom of choice, public education, quality assurance and technology.

GUIDELINES

Health care workers

4.         The delivery of health care is highly dependent upon the availability of trained health care workers. The training should not only include socio-medical competencies, but particularly emphasize an understanding of how the social determinants of health affect people’s health outcomes.

The distribution of health care workers varies widely as do the demographics in most countries, where an ageing population forms a huge challenge for the years to come. There is global mal-distribution. While all countries train health care workers, global movement, especially from less to better developed countries, is leading to continuing shortages. The development of ethical recruitment codes may help to reduce inappropriate recruitment activities by states. Ethical recruitment codes should also be applied to commercial recruitment agencies.

5.      Research is needed to determine the best mix of different health care workers for different clinical settings to meet the needs of populations. Mal-distribution within countries should be addressed by seeking methods of attracting health care workers to rural and remote areas, or other underserved regions, at least for a part of their careers. Innovative concepts should be explored to make working in underserved areas interesting; punitive and coercive recruiting methods must not be used. Recruiting students who express a wish to return to their home area may help to alleviate this problem.

Training

6.      Primary training of health care workers has to be appropriate, accessible and of good quality, which makes the training costly, with the country of origin meeting this cost. Workers move to continue with secondary training, including higher professional training and specialisation for physicians, and also to earn more money that may be remitted home to support the family and community.

7.      The ambition for self-improvement is understandable; efforts to increase retention of health care workers should include consideration of encouraging a return to the home country, with use of the new skills and knowledge to improve health care access.

8.      Countries should not actively recruit from other states. Even when they do so passively, this recruitment should take place in accordance with ethical standards and the WMA Statement on Ethical Guidelines for the International Migration of Health Care workers.

Finance

9.      Access to care is essential for the whole population. Methods of financing care are for each country to decide, according to their own resources, health and social priorities, and health needs. Countries should develop revenue systems that reduce reliance on out-of-pocket payments and private health insurance as these increase inequalities between population groups.

10.    No single system of finance is ideal for every country; the exact balance needs to be locally decided. In making decision about financing systems governments must understand the essential nature of health care, the absolute requirement that it be available to all, based upon clinical need and not on the ability to pay, and that access can be constrained by financial fears. Eligibility for care does not ensure access, especially if co-payment schemes exclude those with the fewest financial resources.

11.    Innovative means should be used to provide comprehensive health care, including partnerships with private providers and commercial entities, who may be able to provide elements of specialised care. In doing so states must ensure that this does not limit specialised care to the wealthiest proportion of their population nor should this be seen as a preference for a private health care model.

12.    Decisions to limit access to elements of health care should be done on the basis of objective information, based on the best available scientific data about the efficacy and safety of health care services. It must include public debate about, and acceptance of, the concepts involved. Nothing should be introduced which discriminates against the elderly or vulnerable populations.

13.    The public should have access to clear information on the health care resources available to them and how they may be accessed. Specific processes should be established to ensure that poverty or illiteracy will never be a barrier to access care.

Vulnerable and hard to reach people

14.    There are groups of people in every country who are hard to reach with health care messages, and who often seek health care late in the progress of disease.

15.    A variety of methods should be used to ensure hard to reach people are aware of the availability of health care, without direct cost, including methods to reduce fear and other barriers to access.

16.    Where specific vulnerabilities such as learning disabilities or sensory impairments exist, solutions should include identifying and dealing with those vulnerabilities.

17.    Health care workers have a duty to provide care that is free from any form of unfair discrimination.

Transportation

18.    Health care facilities should be situated in locations that are easy to access. This may mean working with local transportation providers to ensure formal and informal public transport routes pass the facilities. Consideration should be made to making health care facilities more accessible by active transport methods. Especially in rural and remote locations, patients may travel considerable distances to attend the facilities.

19.    Patients who need referral to secondary and specialized care should be provided with access to transportation. Those needing help with accessing primary care should also receive support. Transportation should also be offered to isolated rural patients who require a level of care that can be found only in metropolitan medical centres. Telemedicine can sometimes be an acceptable substitute for transportation of patients.

Geographical availability

20.    Working with other health providers, including traditional birth attendants, may provide assistance. They should be integrated into the health care system, offered training, and be assisted to offer care that is safe and effective and that includes referral where necessary. This does not extend to the state health care system providing or funding care which is not evidence based, including so-called complementary therapies.

Freedom of choice

21.    The freedom to choose care providers, and the options of care they offer is an essential element of care in every system. It requires the ability to understand that choice, and the freedom to choose a provider from among alternatives.

22.    Barriers to freedom of choice may lie in access to financial resources, understanding of the options, and in cultural geographic, or other factors. Access to information about the available options is crucial in making an appropriately informed choice.

23.    The health authorities should ensure that all populations understand how to access care, and should seek to ensure that populations have access to objective information about the availability of different health care suppliers.

24.    Once individuals access care through a particular provider or physician they should be given opportunities to consider the clinical options open to them; access to systematically available information resources is an essential element supporting choice.

Public education

25.    General education is a determinant of health; the better educated a person is, generally the better their health likelihood.  When ill-health presents, prior education may be a determinant of the speed at which the person accesses health care. Education also aids individuals to make appropriate choices about the care options they access.

26.    Specific education about health matters can be an important adjunct to lifestyle planning. While education alone does not, for example, stop people from smoking, using drugs or alcohol, it can aid in decision making about risk behaviour.

27.    A general level of health literacy assists patients to make choices among different options for treatment, and to comply or co-operate with the requirements of that treatment. It will also improve self-care and the appropriateness of self-referral.

28.    Educational programs that assist people in making informed choices about their personal health and about the appropriate uses of both self-care and professional care should be established. These programs should include information about the costs and benefits associated with alternative courses of treatment within the context of modern medicine; the use of professional services that permit early detection and treatment or prevention of illnesses; personal responsibilities in preventing illnesses; and the effective use of the health care system. Physicians should actively participate, wherever appropriate, in such educational efforts and must be provided with adequate resources to enable them to undertake such education.

29.    Public education also assists governments by increasing understanding of public health measures, including taxation of tobacco, banning of human consumption of some products, and restrictions on individual freedoms because of health concerns. When legislative or other regulatory mechanisms are to be imposed by governments, a campaign of public education and explanation must be undertaken to gain public understanding and voluntary compliance.

Quality assurance

30.       Quality assurance mechanisms should be part of every system of health care delivery. Physicians share responsibility for assuring the quality of health care and must not allow other considerations to jeopardize the quality of care provided.

Technology

31.    Technology is playing an increasing role in the provision of health care services. Capital purchase prices are high because of the need for specific logistical services, including skilled technicians and adequate facilities.  Advanced technologies are not available in all locales; access to their benefits must be well planned to ensure they benefit all patients in need, not simply those local to advanced technology centres.

Extraordinary circumstances

32.    In extraordinary circumstances, including armed conflicts and major natural events such as earthquakes, physicians have a specific duty to ensure that policy makers protect access to care, especially for those most vulnerable and least able to move to more secure areas.

RECOMMENDATIONS

33.    Social Determinants of Health greatly affect access to health care as well as directly impacting on health. Physicians should work with governments to ensure they are able to take effective action on SDH.

34.    Access to health care requires systematic consideration to ensure appropriate conditions are met. These include:

34.1  Having an appropriate, universal, solidaristic and equitable health system, adequately resourced facilities, being available throughout a country, providing health centers and their professional staff with sufficient and sustainable financing, with individuals being treated on the basis of need and not on the ability to pay.

34.2  Patient choice should include which facility to access.

34.3  Access to adequate information for all is essential for making choices and for co-operating with health care providers.

34.4  Education is both a social determinant and a key factor in co-operation with health care provision, fostering responsible self-care with accessible support.

34.5  Health care professionals should be free to move around the world, especially to access educational and professional opportunities. This mobility must not damage resource availability, especially in resource poor countries.

34.6  Physicians must be provided with transparent and efficient ethical criteria for working in overcrowded or underserved areas.

34.7  Provision of health care requires action by government at all levels, working with populations to ensure that people understand the benefit of this care and are able to access it.

34.8  Physicians have an important role in ensuring that health care planning makes clinical sense, is communicated well to the population being served, and that patients are not endangered by inadequate resources, poor planning or other system flaws.

34.9  Physicians are aware of the health system and this forces them to play a socially conscious role regarding the social determinants of health and access to health care by themselves or through their representative medical associations.

34.10   Medical associations should work with their members to promote access to health care systems that equitably support the needs of populations.

 

Adopted by the 40th World Medical Assembly, Vienna, Austria, September 1988
and editorially revised by the 170th WMA Council Session, Divonne-les-Bains, France, May 2005
and reaffirmed by the 200th WMA Council Session, Oslo, Norway, April 2015 

WHEREAS academic sanctions or boycotts are discriminatory restrictions on academic, professional and scientific freedoms that deny or exclude physicians and others from educational, cultural and scientific meetings and other opportunities for the exchange of information and knowledge, the purpose of such restrictions being to protest the social and political policies of governments, and
WHEREAS such restrictions are in direct conflict with the major objectives of the WMA, viz., to achieve the highest international standards in medical education, medical science, medical art and medical ethics, and
WHEREAS such restrictions adversely affect health care, particularly of the disadvantaged, and therefore thwart the WMA’s objective of obtaining the best possible health care for all people of the world, and
WHEREAS such restrictions discriminate against physicians and patients on grounds of political persuasion or of political decisions taken by governments and are therefore in conflict with the WMA’s Declaration of Geneva, Statement on Non-Discrimination in Professional Membership and Activities of Physicians and Statement on Freedom to Attend Medical Meetings, and
WHEREAS a basic rule of medical practice is “primum non nocere”, i.e. first, do no harm,

THEREFORE BE IT RESOLVED, that the WMA regards the application of such restrictions as arbitrary political decisions designed to deny international scholarly exchange and to blacklist particular physicians or bodies of physicians because of their nationality or because of the political policies of their governments. The WMA is unalterably opposed to such restrictions and calls on all National Medical Associations to resist the imposition of such restrictions by every means at their disposal and to heed the WMA’s Statement on Non-Discrimination in Professional Membership and Activities of Physicians and the WMA Statement on Freedom to Attend Medical Meetings.

Adopted by the 53rd WMA General Assembly, Washington, DC, USA, October 2002
and rescinded at the 63rd WMA General Assembly, Bangkok, Thailand 2012

Whereas

Afghanistan is one of the world’s poorest countries with many millions of its population living below the poverty line. Before the beginning of the “War on Terror”, tens of millions were facing starvation. The war has further disrupted communications and transport links, increasing the risk of starvation especially within rural communities; and

Whereas

Health risks are increased by poverty, starvation and by civil unrest and military actions. Health care services in Afghanistan have suffered over a decade of serious neglect. Women have been excluded from education, including higher education and training in the health care professions. Medical schools and other institutions training health care workers have been destroyed and health care educators lost, leaving no effective resource for training new health care workers and for updating and retraining those who have been denied the ability to practice for long periods of time; and

Whereas

Some Afghani health care workers who left Afghanistan under previous regimes are now interested in returning home, at least for short periods of time, and if their safety can be guaranteed, to contribute to the development of sustainable health care provision, and;

Whereas

The international community is committing considerable resources to rebuilding the Afghan infrastructure.

Therefore

The WMA calls upon national governments and international agencies to commit funding to rebuilding the education and training system for health care workers so that Afghani doctors, nurses and others can return to providing health care to the Afghani population.

The WMA also calls upon national governments to enable Afghani refugees in their countries with refugee or equivalent status to return for short periods to Afghanistan to take part in infrastructure rebuilding programmes without jeopardising their refugee status.

Adopted by the 48th WMA General Assembly, Somerset West, South Africa, October 1996,
revised by the 58th WMA General Assembly, Copenhagen, Denmark, October 2007
And reaffirmed with minor revision by the 207th WMA Council session, Chicago, United States, October 2017

 

PREAMBLE

The WMA recognizes that unwanted pregnancies and pregnancies that are too closely spaced can have a serious adverse effect on the health of a woman and of her children. These adverse effects can include the premature deaths of women. Existing children in the family can also suffer starvation, neglect or abandonment resulting in their death or impaired health, when families are unable to provide for all their children. Social functioning and the ability to reach their full potential can also be impaired.

The WMA recalls its Declaration of Ottawa on Child Health, and supports the universal health rights of all children worldwide.

The WMA recognizes the benefits for women who are able to control their fertility. They should be helped to make such choices themselves, as well as in discussion with their partners. The ability to do so by choice and not chance is a principal component of women’s physical and mental health and social well-being.

Access to adequate fertility control methods is not universal; many of the poorest women in the world have the least access. Knowledge about how their bodies work, information on how to control their fertility and the materials necessary to make those choices are universal and basic human rights for all women.

The Sustainable Development Goals 5, target 6 calls for the “universal access to sexual and reproductive health and reproductive rights…”.

RECOMMENDATIONS

The WMA recommends that National Medical Associations:

  • Promote family planning education by working with governments, NGOs and others to provide secure and high-quality services and assistance;
  • Demand from governments to ensure that such information, materials, products and services are available without regard to nationality, creed, race, religion or socioeconomic status.