Access to Health Care – WMA – The World Medical Association

Adopted by the 49^th WMA General Assembly, Hamburg, Germany, November 1997
and amended by the 59^th WMA General Assembly, Seoul, Korea, October 2008,
by the 70^th WMA General Assembly, Tbilisi, Georgia, October 2019 and
by the 72^nd WMA General Assembly (online), London, United Kingdom, October 2021

PREAMBLE

For centuries, women and girls worldwide have suffered from gender inequality and an uneven balance of power between men and women. Historically based gender bias has led to women and girls being restricted in their access to, inter alia, employment, education and health care.

Gender inequality creates dangers in medical treatment. When both genders are not offered equal quality treatment and care for the same medical complaints or when different manifestations of disease are not considered based on sex, patient outcomes will suffer.

In addition, in some countries, female healthcare providers have been prevented from, or face barriers to practicing their profession or being promoted to leadership positions due to religious and/or cultural convictions, or discrimination based on the intersecting grounds of sex and religion/ethnicity. A lack of gender representation and diversity within the medical profession may lead to female patients and their children not having equitable access to health care.

Discrimination against girls and women damages their health expectation. It serves as a barrier to accessing health services, affects the quality of health services provided, and reinforces exclusion from society for women and girls. For example, the education of girls positively affects their health and well-being as adults. Education also improves the chances of their children surviving infancy and contributes to the overall well-being of their families. Conversely, secondary discrimination due to social, religious and cultural practices – which diminishes women’s freedom to make decisions for themselves and to access employment and healthcare opportunities – has a negative impact on health expectation.

National laws, policies and practices can also foster and perpetuate discrimination in health care settings, prohibiting or discouraging women and girls from seeking the broad range of health care services they may need. Evidence demonstrates the harmful health and human rights impacts of such laws. For example, in some countries and due to national laws, legislations or social norms, women and girls lack decision-making power about their own medical treatment, surgery, childbearing or contraception.

Addressing discrimination in health care settings will contribute to the achievement of many of the United Nations Sustainable Development Goads (SDGs), ensuring that no woman or girl is left behind. It is fundamental to securing progress towards SDG 3, Good health and wellbeing, including achieving universal health coverage and ending the AIDS and tuberculosis epidemics; SDG 4, Quality education; SDG 5, Gender equality and women’s empowerment; SDG 8, Decent work and inclusive economic growth; SDG 10, Reduced inequalities; and SDG 16, Peace, justice and strong institutions.

Gender is a social determinant of health and health problems may manifest themselves differently in men and women. There is a need to address the differences in health and unequal health care between men and women, including both the biological and socio-cultural dimensions.

Access to healthcare, including both therapeutic and preventative strategies, is a fundamental human right. This imposes an obligation on government to ensure that these human rights are fully respected and protected. Gender inequalities must be addressed and eradicated in all aspects of healthcare.

Machine learning, predictive algorithms and artificial intelligence (AI) in healthcare are expected to drastically change the way healthcare is practiced and managed. For example, AI could change the way in which diseases such as cancer are diagnosed and treated. However, even with the introduction of AI in healthcare, resource limitations may prevent most women globally from accessing such healthcare. In order not to amplify any gender inequalities, information being programmed into artificial intelligence algorithms being created to inform medical diagnoses and management must take into account the specific health considerations of women, for example women may present with different symptoms to men.

The WMA Declaration of Geneva establishes the physician’s respect for human dignity and that it should not allow considerations of gender to come between “my duties and my patients.”

RECOMMENDATIONS

Therefore, the World Medical Association urges its constituent members to:

Promote the equal human right of health for women and children;
Categorically condemn violations of the basic human rights of women and children, including violations stemming from social, political, religious, economic and cultural practices;
Insist on the rights of all women and children to full and adequate medical care, especially where religious, social, and cultural restrictions or discrimination may hinder access to such medical care, and promote women’s and children’s health and access to health as human rights;
Advocate for parity of health insurance premiums and coverage to ensure that women’s access to care is not impeded by prohibitively high expenses;
Governments have an obligation to ensure that the information being programmed into artificial intelligence algorithms being created to inform medical diagnoses and management must include a representative sample of data from women to ensure the gender inequality gap is not amplified further.
Ensure universal access to sexual and reproductive healthcare;
Promote the provision of pre-conception, prenatal and maternal care, and post-natal care including immunization, nutrition for proper growth and healthcare development for children.
Advocate for educational, employment and economic opportunities for women and for their access to information about healthcare and health services.
Work towards the achievement of the human right to gender equality of opportunity and gender equality of treatment.

Adopted by the 50^th World Medical Assembly, Ottawa, Canada, October 1998,
reaffirmed by the 59^th WMA General Assembly, Seoul, Korea, October 2008,
amended by the 61^st WMA General Assembly, Vancouver, Canada, October 2010,
and by the 72^nd WMA General Assembly (online), London, United Kingdom, October 2021

PREAMBLE

For the purpose of this Statement, in line with the International Organisation for Migration index, “migrant” is an umbrella term reflecting the common lay understanding of a person who moves away from his or her place of usual residence, whether within a country or across an international border, temporarily or permanently, and for a variety of reasons.

The WMA considers health to be a basic need, a human right, and one of the essential drivers of economic and social development.

According to the World Health Organisation, universal access to health implies that all people and communities have access to comprehensive health services, without barriers or discrimination, according to their needs, within the framework of equitable and supportive health systems.

Recalling the WMA Declaration of Geneva, the WMA underlines every physician’s duty to not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to interfere with the physician’s duty to his or her patient.

The WMA underlines that physicians should offer help in medical emergencies in accordance with the WMA International Code of Medical Ethics.

Taking into account the WMA Declaration of Ottawa on Child Health and the WMA Statement on Medical Age Assessment of Unaccompanied Minor Asylum Seekers, the WMA reiterates that children should enjoy special protection, including the right to adequate health care without discrimination.

These fundamental WMA principles also echo the principles laid down in the Universal Declaration of Human Rights, the United Nations Convention on the Rights of the Child and the International Covenant on Economic, Social and Cultural Rights.

The WMA Declaration of Lisbon on the Rights of the Patient declares that every person is entitled without discrimination to appropriate medical care. However, national legislation varies and is often not in accordance with this fundamental principle.

At any time, large numbers of migrants are seeking protection, fleeing from natural disasters, desperate poverty, violence and other injustices and abuses with potentially very harmful effects to mental and physical health.

Recalling the WMA statement on Armed Conflicts and the WMA declaration on Health and Climate Change, the WMA recognizes that climate change, natural disasters, warfare, armed conflicts and other emergencies, including continuous civil strife, unrest and violence, will inevitably lead to the displacement of people from their homes.

The WMA is concerned by the precarious situation of certain categories of migrants, such as refugees, asylum seekers, refused asylum seekers, undocumented migrants and displaced persons, whose access to health care is often undermined, and where physicians are required in some countries to intervene outside the scope of their medical duty, in contradiction with medical ethics.

Bearing in mind the above-mentioned principles, international conventions and WMA policies, the WMA advocates a strong and continued engagement of physicians in the defence of human rights and dignity of all people including migrants worldwide, while making the following recommendations for its constituent members and individual physicians:

RECOMMENDATIONS

WMA constituent members should:

Prioritize the medical care of human beings above any other personal, material, economic, or political interest.
Actively support and promote the right of all people to receive medical care on the basis of clinical need alone and speak out against legislation and practices that contradict this fundamental right.
Call for governments to reach political agreements that facilitate the availability of sufficient resources for the delivery of adequate and coordinated health services to migrant populations, including in refugee camps where the conditions of living make them more susceptible to the spread of disease and viruses.
Urge governments to ensure access to safe and adequate living conditions and essential services to all migrants, even with support from the donor agencies and/or philanthropists if needed.
Promote equality, solidarity and social justice, guaranteeing access of migrants and refugees to health and social services.
Implement policies, actions and commitments that promote the health of all, without discrimination, addressing the social determinants of health related to migrants and refugees.

Physicians:

Have a duty to provide appropriate medical care, based solely on clinical need, regardless of the civil or political status of the patient.
Should speak out against legislation and practices that prevent the fulfilment of this duty.
Cannot be compelled to participate in any punitive or judicial action against migrants, including refugees, asylum seekers, refused asylum seekers, undocumented migrants and or displaced persons, or to withhold medically necessary treatment, or to administer any non-medically justified diagnostic measure or treatment, such as sedatives to facilitate easy deportation from the country or relocation.
Must be allowed adequate time and be provided with sufficient resources, including interpretation services, to assess the physical and psychological condition of migrants, including refugees, asylum seekers, refused asylum seekers, undocumented migrants and displaced persons.

Adopted by the 60^th WMA General Assembly, New Delhi, India, October 2009,
And amended by the 72^nd WMA General Assembly (online), London, United Kingdom, October 2021

WHEREAS,

Physicians in the Islamic Republic of Iran have reported:

Deliberate denial of medical care in detention, withholding of essential and readily available medications by physicians and other health professionals;
Widespread use of torture and ill-treatments in detention;
Concern about the veracity of documentation related to the death of patients and physicians being forced to produce clinically incorrect documentation;
Lack of essential functioning medical equipment and supplies
Denial of the rights of hunger strikers; and
Physicians’ complicity in facilitating the death penalty for juveniles in violation of children’s rights.

THEREFORE, the World Medical Association

Reaffirms its Declaration of Lisbon on the Rights of the Patient, which states that whenever legislation, government action or any other administration or institution denies patients the right to medical care, physicians should pursue appropriate means to assure or to restore it.
Reaffirms its Declaration of Hamburg Concerning Support for Medical Doctors Refusing to Participate in, or to Condone, the Use of Torture or Other Forms of Cruel, Inhuman or Degrading Treatment, which encourages doctors to honor their commitment as physicians to serve humanity and to resist any pressure to act contrary to the ethical principles governing their dedication to this task.
Reaffirms its Declaration of Tokyo – Guidelines for Physicians Concerning Torture and other Cruel, Inhuman or Degrading Treatment or Punishment in Relation to Detention and Imprisonment, which:

Prohibits physicians from participating in, or even being present during the practice of torture or other forms of cruel or inhuman or degrading procedures;
requires that physicians maintain utmost respect for human life even under threat and prohibits them from using any medical knowledge contrary to the laws of humanity.

4. Reaffirms its Resolution on the Responsibility of Physicians in the Documentation and Denunciation of Acts of Torture or Cruel or Inhuman or Degrading Treatment, which states that physicians should attempt to:

ensure that detainees or victims of torture or cruelty or mistreatment have access to immediate and independent health care;
ensure that physicians include assessment and documentation of symptoms of torture or ill-treatment in the medical records using the necessary procedural safeguards to prevent endangering detainees.

5. Refers to the WMA International Code of Medical Ethics, which states that physicians shall be dedicated to providing competent medical service in full professional and moral independence, with compassion and respect for human dignity.

6. Reaffirms its Declaration of Malta on hunger strikers which prohibits force-feeding of hunger strikers as “degrading and inhuman,” even when this is the only way to save their lives.

7. Refers to the United Nations Nelson Mandela Rules, which emphasizes that the provision of health care for prisoners is a State responsibility, and that the relationship between health-care professionals and prisoners is governed by the same ethical and professional standards as those applicable to patients in the community.

8. Refers to the WMA Statement on Access of Women and Children to Health Care, which categorically condemns violations of the basic human right of women and children, including violations stemming from social, political, religious, economic and cultural practices.

9. Refers to the WMA Statement on Natural Variations of Human Sexuality, which condemns all forms of stigmatization, criminalization and discrimination of people based on their sexual orientation.

10. Urges the government of the Islamic Republic of Iran to respect the International Code of Medical Ethics and the standards included in the aforementioned declarations to which physicians are committed.

11. Stresses that physicians who adhere to the professional and ethical obligations outlined in the entire WMA policy apparatus, including the aforementioned declarations, must be protected