Policy Tag: Human Rights

Adopted by the 223rd WMA Council Session, Nairobi, Kenya, April 2023
Revised and adopted by the 74th WMA General Assembly, Kigali, Rwanda, October 2023
Revised as Council Resolution by the 226th WMA Council Session, Seoul, Korea, April 2024 and
adopted by the 75th WMA General Assembly, Helsinki, Finland, October 2024

 

PREAMBLE

The WMA is gravely concerned about the “Anti-Homosexuality law” that was passed in the Ugandan parliament on March 21, 2023, and signed into law by Ugandan President Yoweri Museveni in May 2023. The WMA originally condemned the bill in a press release issued on March 24, 2023.

While the Uganda Constitutional Court did strike down sections of the law that restricted healthcare access for LGBT people, criminalised renting premises to LGBT people, and an obligation to report alleged acts of homosexuality, on April 3, 2024, the court upheld the abusive and radical provisions of the Anti-Homosexuality Act, including sections which criminalise certain consensual same-sex acts and makes them punishable by death or life imprisonment. A provision on the “promotion” of homosexuality is also of grave concern, exposing anyone who “knowingly promotes homosexuality” to as much as twenty years in prison.

Similarly, an “Anti-Gay” bill was passed by the parliament of Ghana on February 28, 2024. The bill has its origins in British colonial law which criminalizes “unnatural sex”, and broadens the scope of criminal sanctions against lesbian, gay, bisexual, transgender, transsexual, and pansexual people, including their allies.

The so-called “Human Sexual Rights and Family Values” bill also allows for criminalizing medical professionals’ work. The bill prohibits the provision of or participation in the provision of surgical procedures for sex or gender reassignment, as punishable by fines or imprisonment. Distribution and other broadcast of any information that promote activities that are prohibited under bill, including teaching children any gender or sex beyond male and female, could result in 10 years imprisonment. The bill would also require anyone with knowledge of prohibited activities to report these activities to the police or other authorities.

In July 2024, the Ghana Supreme Court upheld the bill. Ugandan President Nana Akufo-Addo has not yet signed the bill into law.

Similar troubling legislation and laws have arisen in countries including but not limited to Georgia, the United States, Bulgaria and Iraq.

These kinds of laws and bills challenge the role of physicians to objectively provide information to patients and, where appropriate, those close to them. Physicians could face disciplinary action or retribution for pointing out in the context of treatment that homosexuality is a natural variation of human sexuality. This can impact the professional practice of a physician, as can be seen in other countries that have implemented similar legislation. It can also impact the health of individuals and the population as a whole if patients of the LGBTQ+ community are fearful of accessing healthcare or of being forthcoming with information when they require medical care.

As stated in its Statement on Natural Variations of Human Sexuality and supported in its Statement on Transgender People, the WMA condemns all forms of stigmatisation, criminalization of and discrimination against people based on their sexual orientation.

The WMA reasserts that being lesbian, gay, or bisexual are natural variations within the range of human sexuality and that discrimination, both interpersonally and at the institutional level, anti-homosexual or anti-bisexual legislation and human rights violations, stigmatisation, criminalization of same-sex partnerships, peer rejection and bullying continue to have a serious impact upon the psychological and physical health of lesbian, gay or bisexual people.

Further, the WMA emphasises that everyone has the right to determine one’s own gender, recognises the diversity of possibilities in this respect and calls for appropriate legal measures to protect the equal civil rights of transgender people.

 

RECOMMENDATIONS

Therefore, the WMA, reaffirming its statements on Natural Variations of Human Sexuality and Transgender People, calls on:

  • Ugandan authorities to immediately repeal the Anti-Homosexuality law in its entirety;
  • Ghanaian authorities to immediately veto or rescind the Human Sexual Rights and Family Values bill; and
  • WMA Constituent members to condemn the Ugandan law and Ghanaian bill, and advocate against any similar legislation that is proposed or enacted.

Adopted by the 74th WMA General Assembly, Kigali, Rwanda, October 2023

 

Preamble

In October 2020, the WMA passed a Resolution which formally condemned the treatment of the Uyghur population in the Xinjiang region of China. The resolution also repeated the July 2019 call of the UN Human Rights High Commissioner for independent international observers to be allowed into the region.

The Office of the High Commissioner for Human Rights (OHCHR) published a report on 31 august 2022 on the “Assessment of human rights concerns in the Xinjiang Uyghur Autonomous Region, People’s Republic of China”. The report’s assessments include findings that serious human rights violation have been committed in XUAR and that patterns of restrictions have a discriminatory component. The OHCHR furthermore inter alia finds that allegations of forced medical treatments and adverse conditions of detention are credible.

“The purpose of the WMA is to serve humanity by endeavouring to achieve the highest international standards in Medical Education, Medical Science, Medical Art and Medical Ethics, and Health Care for all people in the world”. Uyghur birth rates have been cut through involuntary IUDs, abortions and sterilisations [1]. All of these acts require the involvement of medical professionals.

The People´s Republic of China is continuing its campaign in a manner that is dependent upon continued and extensive medical involvement, engaging in the most egregious violations of human rights, which risk bringing the entire medical profession into disrepute. It is therefore morally incumbent on the WMA and its members to take a strong stand against such reprehensible actions.

In October 2020, the WMA recognised and condemned the treatment of the Uyghurs in China. As there is now incontrovertible evidence surrounding their abuse, it is incumbent on the Chinese Medical Association to join other constituent bodies of the WMA by acknowledging and condemning this abuse.

 

Recommendation

In light of the mounting body of evidence, including the report of 31 August 2022 from the OCHCR, of medical involvement in severe human rights violations against the Uyghur people and other minorities in China, the WMA asks the Chinese Medical Association to acknowledge the concerns set out in the report by the UN High Commissioner for Human Rights and comply with the 2020 WMA Resolution on human rights violations against Uyghur People in China.

 

[1] https://apnews.com/article/ap-top-news-international-news-weekend-reads-china-health-269b3de1af34e17c1941a514f78d764c

Adopted by the 74th WMA General Assembly, Kigali, Rwanda, October 2023

PREAMBLE

There are many countries in the world where torture and other cruel, inhumane or degrading treatment takes place. However, in some countries, physicians are unable to speak out against human rights violations, even if they witness them, due to the severe repression in the country. It is the WMA’s and the broader medical community’s responsibility to help draw attention to the fundamental changes that are urgently needed in order to guarantee physicians safe and sustainable working conditions, and to allow them to ethically practice their profession. One way of showing this recognition is to refrain from holding international events in such countries.

 

RECOMMENDATION

The WMA calls the medical community worldwide to carefully evaluate the suitability of holding international medical events in countries where physicians are persecuted and, where appropriate, to take a decision on whether to refrain from such events or to provide clear and explicit support for these physicians at such events.

 

Adopted by the 222nd WMA Council Session, Berlin, Germany, October 2022
and revised and adopted by the 74th WMA General Assembly, Kigali, Rwanda, October 2023

 

PREAMBLE

The WMA is deeply concerned by the violent repression of protesters against the Iranian regime.

In its report to the 52nd Human Rights Council (March 2023), the United Nations Special Rapporteur on the situation of human rights in the Islamic Republic of Iran, denounces the persistent violent response by the Iranian security forces leading to deaths of protesters, severe injuries and thousands arrestations and detentions, with life-imprisonment and death sentences. The report documents cases of solitary confinement, ill-treatments and inhumane conditions of detention, as well as denial of access to healthcare [1].

The WMA reaffirms its Resolution supporting the Rights of Patients and Physicians in the Islamic Republic of Iran, its statements on solitary confinement and in support of a moratorium on the use of the death penalty.

 

RECOMMENDATIONS

  1. The WMA condemns the persistent use of brutal and lethal force against protesters and calls on the Iranian authorities to:
    • immediately end all forms of violence, torture and ill-treatment of protesters and ensure that all perpetrators responsible for violence, torture and ill-treatment are held accountable;
    • fully adhere to its human rights obligations, including the right to peaceful demonstration and to the enjoyment of the highest attainable standard of physical and mental health;
    • respect the autonomy of physicians and in particular their ethical duty to provide care to anyone on the basis of medical need alone, and
    • ensure that healthcare equipment and facilities are used for health care purposes only.
  1. The WMA urges the international community to support efforts to promote accountability for recent and long-standing violations carried out with impunity in Iran.

 

[1] Report of the United Nations Special Rapporteur on the situation of human rights in the Islamic Republic of Iran, March 2023

 

Adopted as Council Resolution by the 220th WMA Council Session, Paris (hybrid), France, April 2022
and as Resolution by the 73rd WMA General Assembly, Berlin, Germany, October 2022 

 

PREAMBLE

Reminding that the World Medical Association was founded on the backdrop of the atrocities of war and how the medical profession was abused for violation of human rights and dignity;

Reaffirming the WMA Declaration of Geneva as a beacon of fundamental principles to which the world’s physicians are committed;

Deeply shocked by the Russian army’s bombing of Ukrainian civilians and hospitals, including maternity wards, thus infringing on medical neutrality in conflict zones. The WMA and its members express their solidarity with the Ukrainian people and provide their support for Ukrainian and international healthcare workers mobilized under extremely difficult conditions;

Recalling the WMA’s Statements on the Cooperation of National Medical Associations during or in the Aftermath of Conflicts, on Armed Conflicts, the Regulations in Times of Armed Conflict and Other Situations of Violence, the Statement on the Protection and Integrity of Medical Personnel in Armed Conflicts and Other Situations of Violence, the Declaration on the protection of healthcare workers in emergency situations and the Statement on Medical Care for Migrants;

Emphasizing the need to respect the Geneva Conventions and their protocols as the core of international humanitarian law, as well as the United Nations Security Council Resolution 2286;

Considering the suffering and human tragedy caused by the Russian invasion of Ukraine, including a refugee crisis on a massive scale;

 

RECOMMENDATIONS

  1. The Constituent Members of the WMA stand in solidarity with the Ukrainian Medical Association and all healthcare professionals.
  2. The WMA condemns Russia’s invasion of Ukraine and calls for an end to hostilities.
  3. The WMA considers that Russia’s political leadership and armed forces bear responsibility for the human suffering caused by the conflict.
  4. The WMA calls on Russian and Ukrainian doctors to hold high the principles in the WMA Declaration of Geneva and other documents that serve as guidance for medical personnel during times of conflict.
  5. The WMA demands that the parties to the conflict respect relevant Humanitarian Law and do not use health facilities as military quarters, nor target health institutions, workers and vehicles, or restrict the access of wounded persons and patients to healthcare, as set out in the WMA Declaration on the Protection of Health Workers in Situations of Violence.
  6. The WMA stresses that the parties to the conflict must strive to protect the most vulnerable populations.
  7. The WMA underlines that it is essential that access to medical care be guaranteed to all victims, civil or military, of this conflict, without distinction.
  8. Physicians and all other medical personnel, both Ukrainian and international, involved in NGOs, must not under any circumstances be hindered in the exercise of their unwavering duty, in accordance with the international recommendations provided in the WMA declaration on the protection of healthcare workers in emergency situations, the WMA’s position on the protection and integrity of medical personnel in armed conflicts and other violent situations and in the declaration of the United Nations General Assembly on the rights and responsibility of individuals, groups and organs of society to promote and protect human rights and universally recognized fundamental freedoms.
  9. The WMA calls on the parties to ensure that essential services are provided to those within areas damaged and disrupted by conflict.
  10. The WMA calls on the international community and governments to come to the aid of all persons displaced by this conflict who may choose their country as a destination following their departure from Ukraine.
  11. The WMA urges all nations receiving persons fleeing the conflict to ensure access to safe and adequate living conditions and essential services to all migrants, including appropriate medical care, as needed.
  12. The WMA calls on the parties to the conflict as well as the international community to ensure that when the conflict ends, priority must be given to rebuilding the essential infrastructure necessary for a healthy life, including shelter, sewerage, fresh water supplies, and food provision, followed by the restoration of educational and occupational opportunities.

Adopted by the 217th WMA Council Session, Seoul (online), April 2021
and by the 72nd WMA General Assembly (online), London, United Kingdom, October 2021

 

The World Medical Association notes with increasing alarm, the continuing actions of the current police and Myanmar security forces including arbitrary arrests and detention of health personnel and other citizens, attacks against physicians and other health personnel and facilities, and continuing harassment and intimidation of protesters, human rights defenders and journalists. The WMA and its members are seriously disturbed by their terrorizing, arresting, kidnapping and murdering health care workers for treating protesters.

With a collapsed health system, the Covid pandemic is devastating Myanmar with lack of medical equipment and personnel and increasing deaths. Recent reports of forcing hundreds of physicians to secretly treat Covid patients and ambushing and arresting physicians after luring them to a non-existent Covid patient’s home, are cause for further dismay.

These activities are in total opposition to the international recommendations in the WMA Declaration on the Protection of Health Care Workers in situation of Violence, the WMA Statement on the Protection and Integrity of Medical Personnel in Armed Conflicts and Other Situations of Violence as well as the United Nations Declaration on Human Rights Defenders.

Thus, the WMA and its members demand that the Myanmar security forces take immediate action to:

  • Guarantee, in all circumstances, the physical and psychological integrity of protesters, including health personnel who are arrested;
  • Release protesters and personnel immediately and unconditionally, and drop all charges against them since their detention is arbitrary as it only aims at preventing freedom of expression and their human rights activities;
  • Put an urgent end to attacks against health personnel and facilities and ensure their protection to provide adequate health care provisions to all.
  • Stop all acts of harassment, intimidation, and killing, against protesters, human rights defenders and journalists and comply with all the provisions of the United Nations Declaration on Human Rights Defenders;
  • Ensure in all circumstances respect for human rights and fundamental freedoms in accordance with international human rights standards and international instruments, including the International Covenant on Economic, Social and Cultural Rights.
  • Cooperate with international fact-finding commissions.

 

Adopted by the 217th WMA Council Session, Seoul (online), April 2021
and rescinded and archived by the 72nd WMA General Assembly (online), London, United Kingdom, October 2021
​

The World Medical Association notes with alarm the critical health condition of the Russian opposition activist Alexei Navalny detained in Moscow since January 2021.

Navalny has been on a hunger strike since 31 March and was transferred to a prison hospital on Monday 21st of April. Corroborating information indicates that he is facing denial of adequate medical care and threatened to be force-fed by the prison authorities.

The WMA recalls its Declaration of Malta on Hunger Strikers laying down the medical ethical principles governing hunger strikes, in particular the respect of the individual’s autonomy and dignity. Force-feeding and any other forms of coercion constitute a form of torture and is contrary to medical ethics.

The WMA recalls the standards of international human rights law, including the International Covenants on Civil and Political Rights and on Economic, Social and Cultural Rights, guaranteeing, amongst other matters, the freedom of expression, access to adequate healthcare as well as the prohibition of torture or cruel, inhuman or degrading treatment. The Russian Federation ratified the covenants in 1973 and is held accountable for its commitments.

Thus, the WMA and its members call on the Russian authorities to ensure full respect for its human rights obligations, and demand immediate action to ensure that Alexei Navalny be treated with humanity and with respect for the inherent dignity of the human person, in particular:

  • That he be urgently examined by independent and qualified medical experts,
  • That the Russian authorities take all the required measures to provide adequate conditions in line with the Malta Declaration to respect his decision to hunger strike and to ensure that he is not force-fed,
  • That he be released immediately as he is a prisoner of conscience deprived of his liberty for his peaceful political activism and exercising free speech.

Adopted by the 71st WMA General Assembly (online), Cordoba, Spain, October 2020
and reaffirmed by the 229th WMA Council Session, Montevideo, Uruguay, April 2025

 

PREAMBLE

It is incumbent upon health professionals to consider the health and human rights of people globally and denounce instances where these rights are being abused. The treatment of the Uighur people in the Xinjiang region of China is one such case.

Documented reports of physical and sexual abuse of Uighur people in China reveal unequivocal human rights violations. Reports note numerous violations of the Universal Declaration of Human Rights. The transgressions include, but are not limited to:

  • Article 5: No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment.
  • Article 9: No one shall be subjected to arbitrary arrest, detention or exile.
  • Article 25 (i): Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.[1]

Human rights organisations and sovereign states are increasingly drawing attention to the situation in Xinjiang, with over 20 United Nations ambassadors taking the rare step of issuing a joint letter to the UN Human Rights Council in 2019 expressing concerns about the treatment of the Uighurs in China and demanding that international independent observers be allowed into the region.

 

RECOMMENDATIONS

In the light of information and reports of systematic and repeated human rights violations against Uighur people in China, and its impact on the health of the Uighur people and health care supplies throughout the world, the WMA calls on its constituent members, physicians and the international health community to:

  1. formally condemn the treatment of the Uighurs in China’s Xinjiang region and call upon physicians to uphold the guidelines set out in the WMA Declaration of Tokyo and the WMA Resolution on the Responsibility of Physicians in the Documentation and Denunciation of Acts of Torture or Cruel or Inhuman or Degrading Treatment;
  2. support the requests made in the July 2019 letter to the UN Human Rights Council High Commissioner calling for international independent observers to be allowed into the Xinjiang region of China.
  3. Reaffirm its Statement on Forced and Coerced Sterilisation, asserting that no person, regardless of gender, ethnicity, socio-economic status, medical condition or disability, should be subjected to forced or coerced permanent sterilisation, and call on its members medical associations to advocate against forced and coerced sterilisation in their own countries and globally; and
  4. Reiterate support of its Declaration on Fair Trade in Medical Products and Devices and urge its medical association members to promote fair and ethical trade in the health sector, and insist that the goods they use are not produced at the expense of the health of workers in the global community. To do this, physicians should;
    • raise awareness of the issue of ethical trade and promote the development of fair and ethically produced medical goods amongst colleagues and those working within health systems.
    • play a leadership role in integrating considerations of labour standards into purchasing decisions within healthcare organisations.[1] https://www.un.org/en/universal-declaration-human-rights/

Adopted by the 210th WMA Council Session, Reykjavik, Iceland, October 2018* and
reaffirmed with minor revisions by the 224th WMA Council, Kigali, Rwanda, October 2023

 

PREAMBLE

There is universal agreement that physicians must not participate in executions because such participation is incompatible with the physician’s role as healer. The use of a physician’s knowledge and clinical skill for purposes other than promoting health, wellbeing and welfare undermines a basic ethical foundation of medicine. The WMA Declaration of Geneva states: “I will maintain the utmost respect for human life”, and “I will not use my medical knowledge to violate human rights and civil liberties, even under threat”.

As citizens, physicians have the right to form views about capital punishment based on their individual moral beliefs. As members of the medical profession, they must uphold the prohibition against participation in capital punishment.

 

RECOMMENDATIONS

Therefore, the World Medical Association

  1. AFFIRMS that it is unethical for physicians to participate in capital punishment, in any way, or during any step of the execution process, including its planning and the instruction and/or training of persons to perform executions.
  2. REQUESTS firmly its constituent members to advise all physicians that any participation in capital punishment as stated above is unethical.
  3. URGES its constituent members to lobby actively national governments and legislators against any participation of physicians in capital punishment.

 

*The WMA Resolution on Prohibition of Physician Participation in Capital Punishment is the result of a revision in 2018 merging two WMA policies: the Resolution on Physician Participation in Capital Punishment (2008) and the WMA Resolution to Reaffirm WMA’s Prohibition of Physician Participation in Capital Punishment (2012). These two policies have then been rescinded and archived.

Adopted by the 206th WMA Council Session, Livingstone, April 2017
and reaffirmed as a Resolution by the 71st WMA General Assembly (online), Cordoba, Spain, October 2020
and rescinded and archived by the 75th WMA General Assembly, Helsinki, Finland, October 2024

The World Medical Association notes with serious concerns that Dr Serdar Küni, the Human Rights Foundation of Turkey’s representative in Cizre and former president of the Şırnak medical chamber, is still imprisoned after 6 months of detention, on charges that he provided medical treatment to alleged members of Kurdish armed groups.

The case of Dr. Küni is one example amongst many of ongoing arrests, detentions, and dismissals of physicians and other health professionals in Turkey since July 2015, when unrest broke out in the southeast.

The WMA condemns such practices that threaten gravely the safety of physicians and the provision of health-care services. The protection of health professionals is fundamental, so that they can fulfil their duties to provide care for those in need, without regard to any element of identity, affiliation, or political opinion.

The WMA recalls the standards of international human rights law, specifically the Universal Declaration of Human Rights (1948) and the International Covenants on Civil and Political Rights and on Economic, Social and Cultural Rights (1966) ratified by Turkey. The 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”. This implies ensuring access to high quality healthcare, supported by a functioning healthcare system and safe conditions for the health workforce.

The WMA recalls as well the standards of international humanitarian law as well as the UN Security Council Resolution S/RES/2286 on Health Care in Armed Conflict that mandates that states should not punish medical personnel for carrying out medical activities compatible with medical ethics, or compel them to undertake actions that contravene these standards.

Furthermore, the WMA reaffirms the principles of medical ethics, including the WMA Regulations in Times of Armed Conflict and Other Situations of Violence as well as the Ethical Principles of Health Care in Times of Armed Conflict and Other Emergencies endorsed by the ICRC, civilian and military health-care organisations.

The WMA considers that punishing a physician for providing care to a patient constitutes a flagrant breach of international humanitarian and human rights standards as well as medical ethics. Ultimately it contravenes to the principle of humanity that includes the imperative to preserve human dignity.

Thus, in view of the next hearing on 24 April regarding Dr. Küni case at the Şırnak 2nd Heavy Penal Court, the WMA urges national medical associations and the international health community to mobilise in support of the immediate release of Dr. Serdar Küni and the charges based on his medical practice be dropped immediately and unconditionally.

The WMA calls as well national medical associations and the international health community to advocate for:

  • The full respect of Turkey’s humanitarian and human rights obligations, including the right to health, freedom of association and expression as well as the access to a fair trial;
  • The provision of effective remedy and reparation to victims of arbitrary arrests and detentions.

Adopted by the 42nd World Medical Assembly Rancho Mirage, California, USA, October 1990
and amended by the
45th World Medical Assembly, Budapest, Hungary, October 1993
46th General Assembly, Stockholm, Sweden, September 1994
47th General Assembly, Bali, Indonesia, September 1995
and rescinded at the WMA General Assembly, Santiago 2005

Having regard to the fact that:

  1. The World Medical Association and its member associations have always sought to advance the cause of human rights for all people, and have frequently taken actions endeavoring to alleviate violations of human rights.
  2. Members of the medical profession are often amongst the first to become aware of violations of human rights.
  3. Medical Associations have an essential role to play in calling attention to such violations in their countries.

The World Medical Association again calls upon its member associations

  1. To review the situation in their own countries so as to ensure that violations are not concealed as a result to fear of reprisals form the responsible authorities and to request strict observance of civil and human rights when violations are discovered.
  2. To provide clear ethical advice to doctors working in the prison system.
  3. To provide effective machinery for investigating unethical practices by physicians in the field of human rights.
  4. To use their best endeavours to ensure that adequate health care is available to all human beings without distinction.
  5. To protest alleged human rights violations through communications that urge the humane treatment of prisoners, and that seek the immediate release of those who are imprisoned without just cause.
  6. To support individual physicians who call attention to human rights violations in their own countries.

Adopted by the 67th WMA General Assembly, Taipei, Taiwan, October 2016
and reaffirmed with minor revisions by the 218th Council session (online), London, United Kingdom, October 2021 

 

The World Medical Association notes with great concern the repeated attacks on health care facilities, health personnel and patients since the beginning of the war in Syria in 2011. These attacks have killed and injured civilian people, and the most vulnerable among them, children and patients. The WMA recalls that health care facilities and personnel must, according to the international law, be protected by all parties of the conflict. 

Therefore, the WMA 

  • Deeply regrets and condemns the recurring attacks on health care facilities, health personnel and patients, considering these as a violation of human rights; 
  • Calls on all countries to fully implement the UN Resolution 2286 (2016) which demands all parties to armed conflicts to fully comply with their obligations under international law, to ensure the respect and protection of all health and humanitarian personnel exclusively engaged in medical duties, of their means of transport and equipment, as well as hospitals and other medical facilities; 
  • Demands an immediate and impartial enquiry into the attacks against health care facilities and personnel, and actions taken against those responsible in accordance with domestic and international law. 

 

Adopted by the 65th WMA General Assembly, Durban, South Africa, October 2014
and revised by the 70th WMA General Assembly, Tbilisi, Georgia, October 2019

 

PREAMBLE 

In many countries, a substantial number of prisoners are held in solitary confinement. Solitary confinement is a form of confinement used in detention settings where individuals are separated from the general detained population and held alone in a separate cell or room for upwards of 22 hours a day. Jurisdictions may use a range of different terms to refer to the process (such as segregation, separation, isolation or removal from association) and the conditions and environment can vary from place to place. However, it may be defined or implemented, solitary confinement is characterised by complete social isolation; a lack of meaningful contact; and reduced activity and environmental stimuli. Some countries have strict provisions on how long and how often prisoners can be kept in solitary confinement, but many countries lack clear rules on this.

Solitary confinement can be distinguished from other brief interventions when individuals must be separated as an immediate response to violent or disruptive behaviour or where a person must be isolated to protect themselves or others. These interventions should take place in a non-solitary confinement environment.

The reasons for the use of solitary confinement vary in different jurisdictions and it can be used at various stages of the criminal justice process. It may be used as a disciplinary measure for the maintenance of order or security; as an administrative measure, for the purposes of investigation or questioning; as a preventive measure against future harm (either to the individual or to others); or it may be the consequence of a restrictive regime that limits contact with others. It can be imposed for hours to days or even years. 

Medical impacts of solitary confinement

People react to isolation in different ways. For a significant number of prisoners, solitary confinement has been documented to cause serious psychological, psychiatric, and sometimes physiological effects. These include insomnia, confusion, hallucinations, psychosis, and aggravation of pre-existing health problems. Solitary confinement is also associated with a high rate of suicidal behaviour. Negative health effects can occur after only a few days and may in some cases persist when isolation ends.

Certain populations are particularly vulnerable to the negative health effects of solitary confinement. Persons with psychotic disorders, major depression, or post-traumatic stress disorder or people with severe personality disorders may find isolation unbearable and suffer considerable health harms. Solitary confinement may complicate treating such individuals and their associated health problems successfully later in the prison environment or when they are released back into the community. Prisoners with physical disabilities or other medical conditions often have their conditions aggravated, not only as a result of the physical conditions of isolation, but also as the particular health requirements linked to their disability or condition are often not accommodated.

For children and young people, who are in the crucial stages of developing socially, psychologically, and neurologically, there are serious risks of solitary confinement causing long-term mental and physical harm. A growing international consensus about the harms of solitary confinement on children and young people has resulted in some jurisdictions abolishing the practice completely.

International norms on solitary confinement

The increasing documentation on the harmful impact of solitary confinement on the health of prisoners led to the development of a range of international norms and recommendations seeking to mitigate the use and the harmful effect of solitary confinement.

The United Nations Standard Minimum Rules for the Treatment of Prisoners (SMR) were first adopted in 1957, and revised in 2015 as the Nelson Mandela Rules unanimously adopted by the United Nations Assembly. The SMR constitute the key international framework for the treatment of prisoners.

Other international standards and recommendations, such as the United Nations Rules for the Treatment of Women Prisoners and Non-Custodial Sanctions for Women Offenders (the Bangkok Rules), the United Nations Rules for the Protection of Juveniles Deprived of their Liberty and the observations of the Special Rapporteur on Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, support and complete the Nelson Mandela Rules.

The misuse of solitary confinement can include indefinite or prolonged solitary confinement (defined as a period of solitary confinement in excess of 15 days), but can also include corporal or collective punishment, the reduction of a prisoner’s diet or drinking water, or the placement of a prisoner in a dark or constantly lit cell. Misuse of solitary confinement in these ways can constitute a form of torture or ill-treatment and as such must be prohibited in line with international human rights law and medical ethics.

The WMA and its members reiterate their firm and long-standing position condemning any forms of torture and other cruel, inhuman or degrading treatment or punishment and reaffirm the basic principle that doctors should never participate in or condone torture or other cruel, inhuman or degrading treatment.

 

RECOMMENDATIONS

1. Given the harmful impact of solitary confinement, which can on occasion result in a form of torture or ill-treatment, the WMA and its members call for the implementation of the Nelson Mandela Rules and other associated international standards and recommendations, with a view to protect the human rights and the dignity of the prisoners.

2. The WMA and its members emphasize in particular the respect of the following principles:

  • In light of the serious consequences solitary confinement can have on physical and mental health (including an increased risk of suicide or self-harm), it should be imposed only in exceptional cases as a last resort and subject to independent review, and for the shortest period of time possible. The authority imposing the solitary confinement must be acting in line with clear rules and regulations as to its use.
  • All decisions on solitary confinement must be transparent and regulated by law. The use of solitary confinement should be time-limited by law. The detainee should be informed of the duration of the isolation, and the period of duration should be determined before the measure takes place. Prisoners subject to solitary confinement should have a right of appeal.
  • Solitary confinement should not exceed a time period of 15 consecutive days. Releasing the prisoner from solitary confinement for a very limited period of time, with the intention that the individual will be placed in solitary confinement immediately again to get around the rules on length of stay must also be prohibited.

Prohibitions of the use of solitary confinement

3. The indefinite or prolonged solitary confinement should be prohibited as amounting to torture or other cruel, inhuman or degrading treatment or punishment [1].

4. Solitary confinement should be prohibited for children and young people (as defined by domestic law), pregnant women, women up to six months post-partum, women with infants and breastfeeding mothers as well as for prisoners with mental health problems given that isolation often results in severe exacerbation of pre-existing mental health conditions.

5. The use of solitary confinement should be prohibited in the case of prisoners with physical disabilities or other medical conditions where their conditions would be exacerbated by such measures.

6. Where children and young people must be separated, in order to ensure their safety or the safety of others, this should be carried out in a non-solitary confinement setting with adequate resources to meet their needs, including ensuring regular human contact and purposeful activity.

Conditions of solitary confinement

7. The human dignity of prisoners confined in isolation must always be respected.

8. Prisoners in isolation should be allowed a reasonable amount of meaningful regular human contact, activity, and environmental stimuli, including daily outside exercise. As with all prisoners, they must not be subjected to extreme physically and/or mentally taxing conditions.

9. Prisoners who have been in solitary confinement should have an adjustment period, including a medical examination, before they are released from prison. This must never extend their period of incarceration.

Role of physician

10. The physician’s role is to protect, advocate for, and improve prisoners’ physical and mental health, not to inflict punishment. Therefore, physicians should never participate in any part of the decision-making process resulting in solitary confinement, which includes declaring an individual as “fit” to withstand solitary confinement or participating in any way in its administration. This does not prevent physicians from carrying out regular visits to those in solitary confinement to assess health and provide care and treatment where necessary, or from raising concerns where they identify a deterioration in an individual’s health.

11. The provision of medical care should take place upon medical need or the request of the prisoner. Physicians should be guaranteed daily access to prisoners in solitary confinement, upon their own initiative. More frequent access should be granted if physicians deem this to be necessary.

12. Physicians working in prisons must be able to practice with complete clinical independence from the prison administration. In order to maintain that independence, physicians working in prisons should be employed and managed by a body separate from the prison or criminal justice system.

13. Physicians should only provide drugs or treatment that are medically necessary and should never prescribe drugs or treatment with the intention of enabling a longer period of solitary confinement.

14. Healthcare should always be provided in a setting that respects the privacy and dignity of prisoners. Physicians working in the prison setting are bound by the same codes and principles of medical ethics as they would be in any other setting.

15. Physicians should report any concerns about the impact solitary confinement is having on the health and wellbeing of an individual prisoner to those responsible for reviewing solitary confinement decisions. If necessary, they should make a clear recommendation that the person be removed from solitary confinement, and this recommendation should be respected and acted upon by the prison authorities.

16. Physicians have a duty to consider the conditions in solitary confinement and to raise concerns with the authorities if they believe that they are unacceptable or might amount to inhumane or degrading treatment. There should be clear mechanisms in place in each system to allow physicians to report such concerns.

 

Reference

[1] Rule 43 SMR

Adopted by the 64th General Assembly, Fortaleza, Brazil, October 2013 and
revised by the 74th WMA General Assembly, Kigali, Rwanda, October 2023

 

PREAMBLE

Individuals who identify as LGBTQIA+ (Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and other identities beyond these) represent a broad and fluid spectrum of natural sexual orientations, gender identities, gender expressions, and sex characteristics. While LGBTQIA+ people may share common cultural and social experiences and shared goals of justice and equity in the face of detrimental, discriminatory treatment and even violence, these are diverse communities facing distinct challenges and with specific needs in healthcare and beyond.

This statement is specifically focused on lesbian, gay, and bisexual people.

Healthcare professionals encounter many aspects of human diversity when providing care, including different natural variations of human sexuality.

A large body of scientific research indicates that being lesbian, gay, or bisexual constitute natural variations of human sexuality without any intrinsically harmful health effects. They do not constitute a disorder or illness that requires treatment or cure and any efforts to do so are contrary to the ethical practice of medicine.

Homosexuality and bisexuality are consequently not included in the World Health Organization’s (WHO) International Classification of Diseases (ICD 11).

However, direct and indirect discrimination, both interpersonally and at the institutional level, anti-homosexual or anti-bisexual legislation and human rights violations, stigmatisation, criminalisation of same-sex partnerships, peer rejection, and bullying continue to have a serious impact upon the psychological and physical health of lesbian, gay, or bisexual people. These negative experiences are perpetuated by a lack of education in society on the different natural variations of human sexuality. They lead to poorer health outcomes, including higher prevalence rates of depression, anxiety disorders, substance misuse, and suicidal ideations and attempts. As a result, the suicide rate among lesbian, gay, or bisexual adolescents and young adults significantly higher than that of their heterosexual peers.

These negative outcomes can be exacerbated by other intersectional factors, including but not limited to national origin, race, ethnicity, gender, age, religion, gender identity, socioeconomic status, or disabilities.

In addition, false and baseless pathologisation of lesbian, gay, or bisexual identities leaves such individuals at risk of being coerced into so-called “conversion” or “reparative” procedures. These harmful and unethical practices, also sometimes referred to as sexual orientation and gender identity change efforts (SOGICE), are intended to suppress or change a person’s natural sexual orientation or gender identity. These methods have no medical indication, lack any evidence of effectiveness, and represent a serious threat to the health and human rights of those subjected to these practices. They can lead to anxiety, depression, low self-esteem, substance abuse, problems with intimacy, and suicide.

Negative experiences in healthcare may affect the patient-physician relationship, leading lesbian, gay, and bisexual individuals to avoid accessing care where it is available. They may also withhold their sexual orientation from physicians due to the resulting lack of confidence that they will receive the appropriate treatment and concerns about the safety and confidentiality of their healthcare environment. Without this information, it may be more challenging for physicians to provide targeted care that takes into account the specific health needs of lesbian, gay, or bisexual patients.

Lesbian, gay, or bisexual physicians, medical students, and other health professionals also face discrimination, disadvantages, marginalisation and bullying in the workplace, in schools, in professional organisations, and beyond. Harmful working and learning environments can lead to stress and burnout, especially among marginalised individuals.

 

RECOMMENDATIONS

  1. The WMA strongly asserts that being lesbian, gay, or bisexual does not represent a disease, but rather natural variations within the range of human sexuality.
  2. The WMA condemns all forms of stigmatisation, criminalisation of and discrimination against people based on their sexual orientation.
  3. The WMA asserts that psychiatric or psychotherapeutic support, when needed, must not focus upon the variations of sexuality itself, but rather upon conflicts which arise between those variations and religious, social and internalised norms and prejudices, as well as the health needs of the individual patient.
  4. The WMA unequivocally condemns so-called “conversion” or “reparative” methods. These constitute violations of human rights and are unjustifiable practices that should be denounced and subject to sanctions and penalties. It is unethical for physicians to participate during any step of any such procedures.
  1. The WMA calls upon all physicians to:
    • classify physical and psychological diseases on the basis of clinically relevant symptoms according to ICD 11 criteria regardless of sexual orientation, and to provide quality, evidence-based care in accordance with internationally recognised treatments and protocols and in keeping with the principles set forth in the WMA International Code of Medical Ethics;
    • provide a safe, respectful, and inclusive healthcare setting for lesbian, gay, and bisexual patients;
    • foster safe, respectful, and inclusive work and learning environments for lesbian, gay, and bisexual physicians, medical students, and other health professionals;
    • engage in continuing education and professional development to better understand the specific health needs of lesbian, gay, and bisexual patients and the benefits of certain treatments;
    • where appropriate, involve patients’ same-sex partners and same-sex parents in healthcare discussions in keeping with the patient’s preferences, respecting their consent, and with due regard for patient confidentiality;
    • speak out against legislation and practices violating the human rights of lesbian, gay, and bisexual people, which may also negatively impact the healthcare system at large;
    • reject and refuse to participate in any step of so-called “conversion” or “reparative” methods.
  1. The WMA calls upon constituent members and professional associations to:
    • advocate for safe and inclusive working and learning environments for lesbian, gay, and bisexual physicians, medical students, and other health professionals;
    • establish and enforce non-discriminatory policies in keeping with the WMA Statement on Non-Discrimination in Professional Membership and Activities of Physicians;
    • create guidelines for physicians outlining the specific physical and mental health challenges facing lesbian, gay, and bisexual patients, where appropriate;
    • Where possible, promote changes to medical education, specialty training and CME/CPD curricula to create sensitivity and awareness of the specific health needs of lesbian, gay, and bisexual patients;
    • establish channels for lesbian, gay, and bisexual physicians to report incidents of discrimination or bias against themselves or lesbian, gay, or bisexual patients;
    • in environments where confidentiality and patient safety are guaranteed and data cannot be abused, encourage voluntary data collection in the clinical setting and regular reporting on the health outcomes of lesbian, gay, and bisexual patient groups, while also taking intersectionality into account, to ensure and further improve targeted and appropriate healthcare provision;
    • actively condemn so-called “conversion” or “reparative” methods as unethical.
  1. The WMA calls upon governments to:
    • reject and repeal anti-homosexual or anti-bisexual legislation;
    • condemn and ban so-called “conversion” or “reparative” methods;
    • promote policies that counteract health-related and other inequities caused by overt and implicit discrimination against lesbian, gay, and bisexual people;
    • encourage education from an early age on diverse natural variations of human sexuality to increase acceptance and with the ultimate aim of promoting better physical and mental health for all individuals.

Adopted by the 64th General Assembly, Fortaleza, Brazil, October 2013 and
reaffirmed with minor revisions by the 224th WMA Council, Kigali, Rwanda, October 2023

 

PREAMBLE

The World Medical Association notes with grave concern the continued use of torture in many countries throughout the world.

The WMA reaffirms its total condemnation of all form of torture, and other cruel, inhuman or degrading treatment or punishment, as defined by the United Nations Convention Against Torture (CAT, 1984). Torture is one of the gravest violations of international human rights law and has devastating consequences for victims, their families and society as a whole. Torture causes severe physical and mental injuries and is a crime absolutely prohibited under international law.

The WMA reaffirms its policies adopted previously, namely:

The medical evaluation is an essential factor in pursuing the documentation of torture and the reparation of victims of torture. Physicians have a critical role to play in gathering information about torture, documenting evidence of torture for legal purposes, as well as supporting and rehabilitating victims.

The WMA recognizes the adoption, in December 2012, by the UN Committee Against Torture of the General Comment on the Implementation of article 14 of Convention against Torture relating to the right to reparation of victims of torture. The General Comment outlines the right of rehabilitation as an obligation on States and specifies the scope of these services. The WMA welcomes in particular:

  • The obligation of State parties to adopt a “long-term and integrated approach and ensure that specialized services for the victim of torture or ill treatment are available, appropriate and promptly accessible”, without making access to these services dependent on the victim pursuing judicial remedies [1].
  • The recognition of the right of victims to choose a rehabilitation service provider, be it a State institution, or a non-State service provider, which is funded by the State.
  • The recognition that State parties should provide torture victims with access to rehabilitation programs as soon as possible following an assessment by qualified independent healthcare professionals.
  • The references to measures aimed at protecting health and legal professionals who assist torture victims, developing specific training on the Istanbul Protocol for health professionals, and promoting the observance of international standards and codes of conduct by public servants, including medical, psychological and social service personnel [2].

The WMA notes that since the adoption of the General Comment on the Implementation of article 14, important developments have taken place in the practice of rehabilitation and in monitoring State compliance with their obligations:

 

RECOMMENDATIONS

  1. The WMA emphasizes the vital function of reparation for victims of torture and their families in rebuilding their lives and achieve redress and the important role of physicians in rehabilitation.
  2. The WMA encourages its member associations to work with relevant agencies – governmental and non-governmental – acting for the reparation of victims of torture, in particular in the areas of documentation and rehabilitation, as well as prevention, and to use the revised Istanbul Protocol and the global rehabilitations standards in doing so.
  3. The WMA encourages its members to support agencies that are under threat of – or subjected to – reprisals from state parties due to their involvement in the documentation of torture, rehabilitation and reparation of torture victims.
  4. The WMA calls on its members to use their medical experience to support torture victims in accordance with article 14 of the UN Convention against Torture, including by helping them to become active agents in their own rehabilitation process through survivor explicit programs.
  5. The WMA calls on its member associations to support and facilitate data collection at the national level, using established indicators for the right to rehabilitation, to monitor the implementation of the State’s obligation to provide rehabilitation services.

 

[1] Paragraph 13 of the General Comment
[2] Paragraph 18 of the General Comment
[3] Global Impact Data – IRCT

Adopted by the 63rd General Assembly of the World Medical Association, Bangkok, Thailand, October 2012
and rescinded at the 69th WMA General Assembly, Reykjavik, Iceland, October 2018

There is universal agreement that physicians must not participate in executions because such participation is incompatible with the physician’s role as healer. The use of a physician’s knowledge and clinical skill for purposes other than promoting health, wellbeing and welfare undermines a basic ethical foundation of medicine—first, do no harm.

The WMA Declaration of Geneva states: “I will maintain the utmost respect for human life”; and, “I will not use my medical knowledge to violate human rights and civil liberties, even under threat.”

As citizens, physicians have the right to form views about capital punishment based on their individual moral beliefs. As members of the medical profession, they must uphold the prohibition against participation in capital punishment.

Therefore, be it RESOLVED that:

  • Physicians will not facilitate the importation or prescription of drugs for execution.
  • The WMA reaffirms: “that it is unethical for physicians to participate in capital punishment, in any way, or during any step of the execution process, including its planning and the instruction and/or training of persons to perform executions”, and
  • The WMA reaffirms: that physicians “will maintain the utmost respect for human life and will not use [my] medical knowledge to violate human rights and civil liberties, even under threat.”

Adopted by the 62nd WMA General Assembly, Montevideo, Uruguay, October 2011
and reaffirmed with minor revisions by the 218th Council session (online), London, United Kingdom, October 2021 

 

Leprosy is a widespread public health problem, with approximately 200.000 new cases diagnosed annually worldwide. It is a curable disease and after starting treatment, the chain of transmission is interrupted. Leprosy is a disease that have been inadequately addressed from the point of view of investments in research and medical treatment. 

The World Medical Association recommends to all National Medical Associations to defend the right of the people affected with leprosy and members of their families, that they should be treated with dignity and free from any kind of prejudice or discrimination. Physicians, health professionals and civil society should be engaged in combating all forms of prejudice and discrimination. Research centers should acknowledge leprosy as a major public health problem and continue to research this disease since there are still gaps in understanding its patho-physiological mechanisms. These gaps in knowledge may be overcome through the allocation of resources to new research, which will contribute to more efficient control worldwide. Medical schools, especially in countries with high prevalence of leprosy, should enhance its importance in the curriculum. The public, private, and civil sectors should unify their best efforts in order to disseminate information that would counteract prejudice towards leprosy and that acknowledges its curability. 

Adopted by the 62nd WMA General Assembly, Montevideo, Uruguay, October 2011,
and reaffirmed with minor revisions by the 218th Council session (online), London, United Kingdom, October 2021 

 

The WMA reaffirms its Declaration of Tokyo establishing guidelines for physicians concerning torture and other cruel, inhuman or degrading treatment or punishment in relation to detention and imprisonment, and recommends that a monitoring and reporting mechanism be established to permit audit of adherence of States to the terms of the said declaration, in particular: 

  1. Where physicians are working in situations of dual loyalties, support must be offered to ensure they are not put in positions that might lead to violations of fundamental professional ethics, whether by active breaches of medical ethics or omission of ethical conduct, and/or of human rights, as laid out in the Declaration of Tokyo. 
  2. Its constituent members should offer support for physicians in difficult situations, including, as feasible and without endangering either patients or doctors, helping individuals to report violations of patients’ health rights and physicians’ professional ethics in custodial settings. The support given must adhere to the principles put forward in the WMA Resolution on the Responsibility of Physicians in the Documentation and Denunciation of Acts of Torture or Cruel or Inhuman or Degrading Treatment. 
  3. The WMA should review the evidence available of the violation of human rights codes by states and/or the forcing of physicians to violate the Declaration of Tokyo and refer as appropriate such cases to the relevant national and international authorities. 
  4. The WMA should encourage its member associations to investigate accusations of physician involvement in torture and similar abuses of human rights reported to it from reputable sources, and to report back in particular on whether physicians are at risk and in need of support.  
  5. The WMA should provide support to its constituent members and their individual physicians members to resist such violations, and as far as realistically possible, stand firm in their ethical convictions. The medical profession and governments should also protect physicians endangered because they adhere to their professional and ethical obligations. 
  6. The WMA shall encourage and support its member associations in their calls for investigations by the relevant United Nations special rapporteur or any other standard and reliable accountability mechanism in place when valid concerns are raised. 

Adopted by the 62nd WMA General Assembly, Montevideo, Uruguay, October 2011
and revised by the 73rd WMA General Assembly, Berlin, Germany, October 2022

PREAMBLE

The right to health and medical assistance is a basic human right that should be guaranteed at all times; ethical principles of healthcare remain the same in times of emergencies and in times of peace. Healthcare personnel must be duly protected.

Various international agreements, including the Geneva Conventions (1949), Additional Protocols to the Geneva Conventions (1977, 2005) and the Basic Principles on the Use of Force and Firearms by Law Enforcement Officials of the United Nations, must guarantee safe access to medical assistance as well as the protection of healthcare personnel.

The United Nations Security Council Resolution 2286 (2016) condemns attacks and threats against health care personnel, demands an end to impunity for those responsible, and that all parties to armed conflict comply fully with their obligations under international law.

Despite recognized international standards and the mobilization of humanitarian and human rights stakeholders over the last years denouncing the surge of violence against healthcare worldwide, the WMA notes with great concerns persistent attacks and misuses of hospitals and other medical facilities, as well as threats, killings and other violence against patients and healthcare personnel in emergency contexts.

The WMA condemns in the strongest terms this scourge of violence against healthcare personnel and facilities, which has disastrous humanitarian implications with critical impacts on the capacity of the health system to provide the care needed, resulting in unjustifiable suffering and death. Violence against healthcare personnel constitutes an international emergency, requiring urgent actions.

Recalling its Statement on Armed Conflicts, the WMA reaffirms that armed conflicts should always be a last resort and that States and other authorities who enter into armed conflict must accept responsibility for the consequences of their actions.

The safety and personal security of physicians and other healthcare personnel are essential in enabling them to provide care and save lives in situations of conflicts. They must always be respected as neutral and should never be prevented from fulfilling their duties. Healthcare personnel and facilities should never be instrumentalised as means of war.

Recalling its Regulations in Times of Armed Conflict and Other Situations of Violence, the WMA reaffirms that the primary obligation of physicians and other healthcare personnel is always to their patients; they have the same ethical responsibilities in situation of violence or armed conflicts as in peacetime, the same duty of preserving health and saving lives; they shall at all times act in accordance with the ethical principles of the profession, relevant international and national law, and their conscience.

 

RECOMMENDATIONS

The WMA calls upon all parties involved in situations of violence to:

1.Fully comply with their obligations under international law, including human rights law and international humanitarian law, in particular with their obligations under the Geneva Conventions of 1949 and the obligations applicable to them under the Additional Protocols of 1977 and 2005;

2. Ensure the safety, independence and personal security of healthcare personnel at all times, including during armed conflicts and other situations of violence, in accordance with the Geneva Conventions and their additional protocols;

3. Respect and promote the principles of international humanitarian and human rights law which safeguard medical neutrality in situations of conflict;

4. Protect medical facilities, medical transport and the people being treated in them, provide the safest possible working environment for healthcare personnel, and protect them from threats, interference and attack;

5. Never misuse hospitals and other health facilities for military purposes and dedicate them exclusively to health care;

6. Enable healthcare personnel to treat injured and sick patients, regardless of their role in a conflict, and to carry out their medical duties freely, independently and in accordance with the principles of their profession without fear of punishment or intimidation;

7. Ensure that safe access to adequate medical facilities for the injured and others in need of medical aid is not unduly impeded;

8. Ensure that the equipment, including personal protection equipment, necessary for the safety of healthcare workers, is available to them as needed, and that the staffing is adequate;

9. Support and strictly respect the ethical rules of the medical profession as defined, among other documents, in the Ethical Principles of Health Care in Times of Armed Conflict and Other Emergencies and in the WMA Regulations in Times of Armed Conflict and Other Situations of Violence, and to never require from physicians or force them to breach or renounce these rules, in particular:

  • privileges and facilities afforded to physicians and other health care professionals in times of armed conflict and other situations of violence must never be used for purposes other than health care;
  • physicians must at all times show appropriate respect for medical confidentiality;
  • physicians must never accept acts of torture or any other form of cruel, inhuman or degrading treatment under any circumstances; they must never be present at nor take part in such acts;
  • physicians have a duty to recognize and support vulnerable populations, including women, children, refugees, the disabled and displaced persons;
  • physicians and WMA constituent members should alert governments and non-state actors of the human consequences of warfare;
  • where conflict appears to be imminent and inevitable, physicians should ensure that authorities are planning for the protection of the public health infrastructure and for any necessary repair in the immediate post-conflict period.

The WMA calls upon governments to:

10. Establish efficient, secure and unbiased reporting mechanisms with sufficient resources to collect and disseminate data regarding assaults on physicians, other healthcare personnel and medical facilities;

11. Provide to the WHO the necessary support to fulfil its leadership role in documenting attacks on healthcare personnel and facilities[1];

12. Foster the mechanisms of investigating and bringing to justice those responsible for reported violations of the international agreements pertaining to the protection of healthcare personnel in armed conflicts and other situations of violence, and of enforcing the sanctions when such have been decided;

13. Develop and implement more efficient legal protection for medical and other healthcare personnel, so that whoever attacks a nurse, physician or another healthcare personnel knows that such actions will be severely penalised.

The WMA calls upon governments, its member organisations and the appropriate international bodies to:

14. Raise awareness of international norms on the protection of healthcare personnel and cooperate with different actors to identify strategies to tackle threats to healthcare and strengthen the mechanism of investigating the reported violations;

15. Raise awareness at both national and local level of the fundamental importance of protecting the healthcare personnel and of upholding their neutrality in times of conflict;

16. Support the development of pregraduate, postgraduate and continuous education for the healthcare personnel to ensure their competencies and their security and to minimize the psychological toll when confronted with armed conflicts and other situations of violence.

 

[1] The WMA recognizes that in some circumstances, documenting and denouncing acts of torture or other violence may put the physician, and those close to him or her, at great risk. Doing so may have excessive personal consequences. Physicians must avoid putting individuals in danger while assessing, documenting or reporting signs of torture and cruel, inhuman and degrading treatment and punishments.

Adopted by the 60th WMA General Assembly, New Delhi, India, October 2009,
And amended by the 72nd 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 

  1. 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.  
  2. 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. 
  3. 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 

Adopted by the 182nd WMA Council Session, Tel Aviv, Israel, May 2009

WHEREAS:

Reports worldwide have alluded to deeply unsettling practices by health professionals, including direct participation in the infliction of ill-treatment, monitoring specific methods of ill-treatment, and participation in interrogation processes;

THEREFORE, the WMA

  1. 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, inhuman or degrading procedures, and urges National Medical Associations to inform physicians and governments of the Declaration and its contents.
  2. Reaffirms its Declaration of Hamburg: Support for Medical Doctors Refusing to Participate in or to Condone the use of Torture or other Forms of Cruel, Inhuman or Degrading Treatment.
  3. Reaffirms its Resolution: Responsibility of Physicians in the Denunciation of Acts of Torture or Cruel or Inhuman or Degrading Treatment of Which they are Aware.
  4. Urges national medical associations to speak out in support of this fundamental principle of medical ethics and to investigate any breach of these principles by association members of which they are aware.

Adopted by the 58th WMA General Assembly, Copenhagen, Denmark, October 2007
reaffirmed by the 206th WMA Council Session, Livingstone, Zambia, April 2017
and rescinded and archived by the 73rd WMA General Assembly, Berlin, Germany, October 2022

PREAMBLE

Noting information and reports of systematic and repeated violations of human rights, interference with the right to health in Zimbabwe, failure to provide resources essential for provision of basic health care, declining health status of Zimbabweans, dual loyalties and threats to health care workers striving to maintain clinical independence, denial of access to health care for persons deemed to be associated with opposition political parties and escalating state torture, the WMA wishes to confirm its support of, and commitment to:

  • Attaining the World Health Organization principle that the “enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being”
  • Defending the fundamental purpose of physicians to alleviate distress of patients and not to let personal, collective or political will prevail against such purpose
  • Supporting the role of physicians in upholding the human rights of their patients as central to their professional obligations
  • Supporting physicians who are persecuted because of their adherence to medical ethics

RECOMMENDATION

Therefore, the World Medical Association, recognizing the collapsing health care system and public health crisis in Zimbabwe, calls on its affiliated national medical associations to:

  1. Publicly denounce all human rights abuses and violations of the right to health in Zimbabwe
  2. Actively protect physicians who are threatened or intimidated for actions which are part of their ethical and professional obligations
  3. Engage with the Zimbabwean Medical Association (ZiMA) to ensure the autonomy of the medical profession in Zimbabwe
  4. Urge and support ZiMA to invite an international fact finding mission to Zimbabwe as a means for urgent action to address the health and health needs of Zimbabweans

In addition, the WMA encourages ZiMA, as a member organization of the WMA, to:

  1. Uphold its commitment to the WMA Declarations of Tokyo, Hamburg and Madrid as well as the WMA Statement on Access to Health Care
  2. Facilitate an environment where all Zimbabweans have equal access to quality health care and medical treatment, irrespective of their political affiliations
  3. Commit to eradicating torture and inhumane, degrading treatment of citizens in Zimbabwe
  4. Reaffirm their support for the clinical independence of physicians treating any citizen of Zimbabwe
  5. Obtain and publicize accurate and necessary information on the state of health services in Zimbabwe
  6. Advocate for inclusion in medical curricula, teachings on human rights and the ethical obligations of physicians to maintain full and clinical independence when dealing with patients in vulnerable situations

The WMA encourages ZiMA to seek assistance in achieving the above by engaging with the WMA, the Commonwealth Medical Association and the NMAs of neighboring countries and to report on its progress from time to time.

Adopted by the 45th World Medical Assembly, Budapest, Hungary, October 1993
and editorially revised by the 170th WMA Council Session, Divonne-les-Bains, France, May 2005
and revised by the 67th WMA General Assembly, Taipei, Taiwan, October 2016 

 

PREAMBLE

The World Medical Association joins with other international agencies in condemning the practice of genital mutilation or cutting of women and girls, regardless of the level of mutilation, and opposes the participation of physicians in these practices.

Stopping female genital mutilations (FGM) requires action on strict enforcement of laws prohibiting the practice, medical and psychological care for women who are victims and prevention of FGM by education, risk assessment, early detection and engagement with community leaders.

FGM is a common practice in more than 30 countries of the world, including some in Africa, Asia and the Middle East. The phrase FGM is used to convey a number of different forms of surgery, mutilation or cutting of the female external genitalia. The term female circumcision is no longer used as it suggests equivalence with male circumcision, which is both inaccurate and counterproductive.  Most girls undergo FGM/C between the ages of 7 and 10.  There is no medical necessity for any such cutting, which is often performed by an unqualified individual in un-hygienic surroundings.

FGM of any type is a violation of the human rights of girls and women, as it is a harmful procedure performed on a child who cannot give valid consent.  As a result of migration a growing number of girls living outside countries where the practice is common are being affected.

Respecting the social norms of immigrants is increasingly posing problems for physicians and the wider community.

Because of its impact on the physical and mental health of women and children, and because it is a violation of human rights, FGM is a matter of concern to physicians.  Physicians worldwide are confronted with the effects of this traditional practice.  They may be asked to perform this mutilating procedure or to restore the result of mutilating “surgery” on women after childbirth has reopened the introitus.

There are various forms of FGM, classified by WHO.[1] It can be a primary procedure for young girls, usually between 5 and 12 years of age, or a secondary one, e.g., after childbirth. The extent of a primary procedure may vary: from an incision in the foreskin of the clitoris, up to the maximally mutilating so-called pharaonic infibulation which involves partly removing the clitoris and labia minora and stitching up of the labia majora so that only a small opening remains to allow the passage of urine and menstrual blood. The majority of procedures performed are somewhere in between these two extremes.

While the term female circumcision is no longer used it remains useful, familiar and readily accessible in the context of physician/patient consultations in some cases.

FGM has no health benefits and harms girls and women in many ways, regardless of which procedure is performed.  Research shows grave permanent damage to health, including: haemorrhage, infections, urinary retention, injury to adjacent organs, shock and very severe pain. Long-term complications include severe scarring, chronic bladder and urinary tract infections, urologic and obstetric complications, and psychological and social problems. FGM has serious consequences for sexuality and how it is experienced, including the loss of capacity for orgasm. There are also many complications during childbirth including expulsion disturbances, formation of fistulae, and traumatic tears of vulvar tissue.

There are a number of reasons given for the continuation of the practice of FGM: custom, community tradition (preserving the virginity of young girls and limiting the sexual expression of women) and as part of a girl’s initiation into womanhood. These reasons do not justify the considerable damages to physical and mental health.

None of the major religions supports this practice, which is otherwise often wrongly linked to religious beliefs.  FGM is a form of violence usually perpetuated on young women and girls and represents a lack of respect for their individuality, freedom and autonomy.

Physicians may be faced with parents seeking a physician to perform FGM, or they may become aware of parents who seek to take girls to places where the practice is commonly available.  They must be prepared to intervene to protect the girl.

Medical associations should prepare guidance on how to manage these requests which may include invoking local laws that protect children from harm and may include involving police and other agencies.

When patients who have undergone FGM give birth, physicians may receive requests to restore the results of the FGM. They should be confident in handling such requests and supported with appropriate educational material that will enable them to discuss with the patient the medically approved option of repairing the damage done by FGM and by childbirth. Physicians also have a responsibility to have a discussion with the spouse of the patient, with the consent of the patient, who might otherwise seek “restoration” of the FGM, if not given a full explanation of the harm that is done by FGM.

There is a growing tendency for physicians and other health care professionals in some countries to perform FGM because of a wish to reduce the risks involved. Some practitioners may believe that medicalization of the procedure is a step towards its eradication.  Performing FGM is a breach of medical ethics and human rights, and involvement by physicians may give it credibility.  In most countries performing this procedure is a violation of the law.

Governments in several countries have developed legislation, such as prohibiting FGM in their criminal codes.

RECOMMENDATIONS

  1. Taking into account the psychological needs and ‘cultural identity’ of the people involved, physicians should explain the dangers and consequences of FGM and discourage performing or promoting FGM. Physicians should integrate women’s health promotion and counselling against FGM into their work.
  2. Physicians should assist in educating health professionals and work with local community, cultural and social leaders to educate them about the adverse consequences of FGM. They should support persons who want to end FGM and the establishment of community programmes designed to outlaw the practice, offering medical information about its damaging effects as necessary.
  3. There are active campaigns against FGM that are led by women leaders and heads of state in Africa and elsewhere.  These campaigns have issued strong statements against the practice.
  4. Physicians should work with groups such as these and others who manage pregnant women including midwives, nurses and traditional birth attendants, to ensure all practitioners have standardized and sensitive information about FGM.
  5. Physicians should cooperate with any preventive legal strategy when a child is at risk of undergoing FGM.
  6. National Medical Associations should stimulate public and professional awareness of the damaging effects of FGM.
  7. National Medical Associations should ensure that FGM education and awareness are part of its advocacy to prevent violence against women and girls.
  8. National Medical Associations should work with opinion leaders, encouraging them to become active advocates against FGM.
  9. National Medical Associations should stimulate government action in preventing the practice of FGM. This should include sustained advocacy programmes and the development of legislation prohibiting FGM.
  10. NMAs must prohibit involvement by physicians in the practice of FGM, including re-infibulation after childbirth. Physicians should be encouraged to perform reconstructive surgery on women who have undergone FGM. Physicians should seek to ensure the provision of adequate (and non-judgemental) medical and psychological care for women who have undergone FGM.
  11. Physicians should be aware that the risk of FGM might be a justification for overriding patient confidentiality, and allow disclosure to social or other relevant services to protect a child from serious harm.

[1] FGM can be classified into four types: clitoridectomy, excision, infibulation and other harmful procedures such as pricking, piercing, incising, scraping and cauterizing the genital area.

Adopted by the 54th WMA General Assembly, Helsinki, Finland, September 2003,
revised by the 58th WMA General Assembly, Copenhagen, Denmark, October 2007,
editorially revised by the 179th WMA Council Session, Divonne-les-Bains, France, May 2008
and by the 71st WMA General Assembly (online), Cordoba, Spain, October 2020

 

PREAMBLE

The dignity and value of every human being are acknowledged globally and expressed in numerous distinguished ethical codes and codifications of human rights, including the Universal Declaration of Human Rights. Any act of torture or cruel, inhuman or degrading treatment constitutes a violation of these codes and is irreconcilable with the ethical principles that lie at their core. These codes are listed at the end of this Statement (1).

However, in the medical professional codes and legal texts, there is no consistent and explicit reference to an obligation upon physicians to document cases and denounce acts of torture or cruel, inhuman or degrading treatment of which they become aware or witness.

The careful and consistent documentation and denunciation of torture or cruel, inhuman or degrading treatment by physicians contributes to the human rights of the victims and to the protection of their physical and mental integrity. The absence of documentation and denunciation of these acts may be considered as a form of tolerance thereof.

Because of the psychological sequelae from which they suffer, or the pressures brought upon them, victims are often unable or unwilling to formulate by themselves complaints against those responsible for the torture or cruel, inhuman and degrading treatment and punishments they have undergone.

By ascertaining the sequelae and treating the victims of torture, either early or late after the event, physicians witness the effects of these violations of human rights.

The WMA recognizes that in some circumstances, documenting and denouncing acts of torture may put the physician, and those close to him or her, at great risk. Consequently, doing so may have excessive personal consequences.

This statement relates to torture and other cruel, inhuman and degrading treatment and punishments as referred by the United Nations Convention against torture, excluding purposely the role of physicians in detention appraisal addressed in particular by the UN Standard Minimum Rules for the Treatment of Prisoners (Mandela rules).

 

RECOMMENDATIONS

The WMA recommends that its constituent members:

  1. Promote awareness among physicians of The Istanbul Protocol, including its Principles on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment. This should be done at the national level.
  2. Promote training of physicians on the identification of different methods of torture and cruel, inhuman and degrading treatment and punishments, to enable them to provide high quality medical documentation that can be used as evidence in legal or administrative proceedings.
  3. Encourage professional training to ensure that physicians include assessment and documentation of signs and symptoms of torture or cruel, inhuman and degrading treatment and punishments in the medical records, including the correlation between the allegations given and the clinical findings.
  4. Work to ensure that physicians carefully balance potential conflicts between their ethical obligation to document and denounce acts of torture or cruel, inhuman and degrading treatment and punishments and a patient’s right to informed consent before documenting torture cases.
  5. Work to ensure that physicians avoid putting individuals in danger while assessing, documenting or reporting signs of torture and cruel, inhuman and degrading treatment and punishments.
  6. Promote access to immediate and independent health care for victims of torture or cruel, inhuman and degrading treatment and punishments.
  7. Support the adoption of ethical rules and legislative provisions:
  • Aimed at affirming the ethical obligation on physicians to report and denounce acts of torture or cruel, inhuman and degrading treatment and punishments of which they become aware; depending on the circumstances, the report or denunciation should be addressed to the competent national or international authorities for further investigation.
  • Addressing that a physician’s obligation to document and denounce instances of torture and cruel, inhuman and degrading treatment and punishments may conflict with their obligations to respect patient confidentiality and autonomy.
  • Physicians should use their discretion in this matter, bearing in mind paragraph 69 of the Istanbul Protocol (2).
  • cautioning physicians to avoid putting in danger victims who are deprived of freedom, subjected to constraint or threat or in a compromised psychological situation when disclosing information that can identify them.
  • Work to ensure protection of physicians, who risk reprisals or sanctions of any kind due to the compliance with these guidelines.
  • Provide physicians with all relevant information on procedures and requirements for reporting torture or cruel, inhuman and degrading treatment and punishments, particularly to national authorities, non-governmental organizations and the International Criminal Court.
  1. The WMA recommends that the constituent members’ codes of ethics include the physician’s obligations concerning documentation and denunciation of acts of torture and cruel, inhuman and degrading treatment and punishments as they are stated in this document.

 

(1) Codes and codifications:

  1. The Preamble to the United Nations Charter of 26 June 1945 solemnly proclaiming the faith of the people of the United Nations in the fundamental human rights, the dignity and value of the human person.
  2. The Preamble to the Universal Declaration of Human Rights of 10 December 1948 which states that disregard and contempt for human rights have resulted in barbarous acts which have outraged the conscience of mankind.
  3. Article 5 of the Universal Declaration of Human Rights which proclaims that no one shall be subjected to torture or cruel, inhuman or degrading treatment.
  4. The United Nations Standard Minimum Rules for the Treatment of Prisoners (the Nelson Mandela Rules), Adopted by the First United Nations Congress on the Prevention of Crime and the Treatment of Offenders, held at Geneva in 1955, and approved by the Economic and Social Council by its resolutions 663 C (XXIV) of 31 July 1957 and 2076 (LXII) of 13 May 1977, revised and adopted by the General Assembly on 17 December 2015.
  5. The American Convention on Human Rights, which was adopted by the Organization of American States on 22 November 1969 and entered into force on 18 July 1978, and the Inter-American Convention to Prevent and Punish Torture, which entered into force on 28 February 1987.
  6. The Declaration of Tokyo, Adopted by the 29th World Medical Assembly, Tokyo, Japan, October 1975 Editorially revised by the 170thWMA Council Session, Divonne-les-Bains, France, May 2005 and the 173rdWMA Council Session, Divonne-les-Bains, France, May 2006.
    Revised by the 67th WMA General Assembly, Taipei, Taiwan, October 2017.
  7. The Declaration of Hawaii, adopted by the World Psychiatric Association in 1977.
  8. The Principles of Medical Ethics Relevant to the Role of Health Personnel, Particularly Physicians, in the Protection of Prisoners and Detainees Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, adopted by the United Nations General Assembly on 18 December 1982, and particularly Principle 2, which states: “It is a gross contravention of medical ethics… for health personnel, particularly physicians, to engage, actively or passively, in acts which constitute participation in, complicity in, incitement to or attempts to commit torture or other cruel, inhuman or degrading treatment…”.
  9. The Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, which was adopted by the United Nations General Assembly on December 1984 and entered into force on 26 June,1987.
  10. The European Convention for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment, which was adopted by the Council of Europe on 26 June 1987 and entered into force on 1 February 1989.
  11. The WMA Declaration of Hamburg, adopted by the World Medical Association in November 1997 during the 49th General Assembly, and reaffirmed with minor revision by the 207th WMA Council session, Chicago, United States, October 2017 calling on physicians to protest individually against ill-treatment and on national and international medical organizations to support physicians in such actions.
  12. The Istanbul Protocol (Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment), adopted by the United Nations General Assembly on 4 December 2000.
  13. The Convention on the Rights of the Child, which was adopted by the United Nations on 20 November 1989 and entered into force on 2 September 1990.
  14. The World Medical Association Declaration of Malta on Hunger Strikers, adopted by the 43rd World Medical Assembly Malta, November 1991and amended by the WMA General Assembly, Pilanesberg, South Africa, October 2006, and revised by the 68th WMA General Assembly, Chicago, United States, October 2017.

(2) Istanbul Protocol, paragraph 69: “In some cases, two ethical obligations are in conflict. International codes and ethical principles require the reporting of information concerning torture or maltreatment to a responsible body. In some jurisdictions, this is also a legal requirement. In some cases, however, patients may refuse to give consent to being examined for such purposes or to having the information gained from examination disclosed to others. They may be fearful of the risks of reprisals for themselves or their families. In such situations, health professionals have dual responsibilities: to the patient and to society at large, which has an interest in ensuring that justice is done and perpetrators of abuse are brought to justice. The fundamental principle of avoiding harm must feature prominently in consideration of such dilemmas. Health professionals should seek solutions that promote justice without breaking the individual’s right to confidentiality. Advice should be sought from reliable agencies; in some cases, this may be the national medical association or non-governmental agencies. Alternatively, with supportive encouragement, some reluctant patients may agree to disclosure within agreed parameters.”

Adopted by the 53rd WMA General Assembly, Washington, DC, USA, October 2002,
revised by the 64th WMA General Assembly, Fortaleza, Brazil, October 2013
and by the 72nd WMA General Assembly (online), London, United Kingdom, October 2021

 

PREAMBLE

 Since the start of the global HIV epidemic, women and girls in many regions have been disproportionately affected by HIV. Young women (aged 15-24), and adolescent girls (aged 10-19) in particular, account for a disproportionate number of new HIV infections.

Gender inequality contributes to the spread of HIV. It can increase infection rates and reduce the ability of women and girls to cope with the illness. Often, they have less information about HIV and fewer resources to take preventive measures. Sexual violence, a widespread violation of women’s rights, exacerbates the risk of HIV transmission.

Many women and girls living with HIV struggle with stigma and exclusion, aggravated by their lack of rights. Women widowed by AIDS or living with HIV may face property disputes with in-laws, complicated by limited access to justice to uphold their rights. Regardless of whether they themselves are living with HIV, women generally assume a disproportionate burden of care for others who are sick from or dying of AIDS, along with the orphans left behind. This, in turn, can reduce prospects for education and employment. It can also significantly reduce prevention of mother-to-child transmission (PMTCT) efforts and strategies.

Access to healthcare, including both preventative and therapeutic 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.  This should impact every aspect of healthcare.

The promotion and protection of the reproductive rights of women are critical to the ultimate success of confronting and resolving the HIV/AIDS pandemic.

 

RECOMMENDATIONS

The WMA requests all national member associations to encourage their governments to undertake and promote the following actions:

  1. Develop empowerment programs for women of all ages to ensure that women are better supported and free from discrimination. Such programs should include universal and free access to reproductive health education and life skills training,
  2. Develop programme to provide HIV testing and post-exposure prophylaxis in the form of antiretrovirals to all survivors of assault.
  3. Governments must provide universal access to antiviral therapy and treatment to all HIV infected women, protecting their health, and in the case of pregnant women, preventing mother to child transmission.
  4. Provide universal HIV testing of all pregnant women, with patient notification of the right of refusal, as a routine component of perinatal care, and such testing should be accompanied by privacy protection, basic counseling and awareness of appropriate treatment, if necessary.
  5. Patient notification should be consistent with the principles of informed consent. Universal and free access to antiretroviral therapy must also be provided to all HIV-positive pregnant women in order to prevent mother to child transmission of HIV.

 

 

Adopted by the 51st World Medical Assembly, Tel Aviv, Israel, October 1999,
revised by the 66th WMA General Assembly, Moscow, Russia, October 2015
and reaffirmed by the 217th WMA Council Session, Seoul (online), April 2021

Preamble

Medical School curricula are designed to prepare medical students to enter the profession of medicine.  Increasingly, in addition to core biomedical and clinical knowledge, they teach skills including critical appraisal and reflective practice.  These additional skills help to enable future doctors to understand and assess the importance of published research evidence, and how to evaluate their own practice against norms and standards set nationally and internationally.

In much the way same that anatomy, physiology and biochemistry are a solid base for understanding the human body, how it works, how it can fail or otherwise go wrong, and how different mechanisms can be used to repair damaged structure and functions, there is a clear need for physicians in training to understand the social, cultural and environmental contexts within which they will practice.  This includes a solid understanding of the social determinants of health.

Medical ethics includes the social contract made between the health care professions and the societies they serve, based upon established principles, on the limits that apply to medical practice It also establishes a system or set of principles through which new treatments or other clinical interventions will be sieved before decisions are made on whether elements are acceptable within medical practice.   There is a complex intermingling of medical ethics and the duties of physicians to patients, and the rights patients enjoy as citizens.

At the same time physicians face challenges and opportunities in relation to the human rights of their patients and of populations, for example occasions for imposing  treatments without consent, and will also often be the first to observe and to itemize the infringement of these rights by others, including the state.  This places very specific responsibilities upon the observing physician.

Physicians have a duty to use their knowledge to improve the wellbeing and health of patients and the population.  This will mean considering social and societal change, including legislation and regulation, and can only be done well if doctors can take a holistic view within clinical and ethical parameters.

Physicians should press government to ensure legislation supports principled medical practice.

Given the core nature of health care ethics in establishing medical practice in a manner that is acceptable to society and that does not violate civil, political and other human rights, it is essential that all physicians are trained to perform an ethics evaluation of every clinical scenario they may encounter, while simultaneously understanding their role in protecting the rights of individuals.  

Physicians’ ability to act and communicate in a way that respects the values of the individual patient is a prerequisite for successful treatment.  Physicians must also be able to work effectively in teams with other health c are professionals including other physicians.

Failures of individual physicians to recognize the ethical obligations they owe patients and communities can damage the reputation of doctors both locally and globally. Therefore it is essential that all doctors are taught to understand and respect medical ethics and human rights from the beginning of their medical school careers.

In many countries ethics and human rights are an integral part of the medical curriculum, but this is not universal.  Too often teaching is undertaken by volunteers, and can fail if those volunteers are unable or unavailable to teach, or if that teaching is unduly idiosyncratic or inadequately based upon clinical scenarios.

The teaching of medical ethics should become an obligatory and examined part of the medical curriculum within every medical school.

Recommendations

  1. The WMA urges that medical ethics and human rights be taught at every medical school as obligatory and examined parts of the curriculum, and should continue at all stages of post graduate medical education and continuing professional development. 
  2. The WMA believes that medical schools should seek to ensure that they have sufficient faculty skilled at teaching ethical enquiry and human rights to make these courses sustainable.
  3. The WMA commends the inclusion of medical ethics and human rights within post graduate and continuing medical education.

Adopted by the 50th World Medical Assembly Ottawa, Canada, October 1998
and rescinded and archived by the 59th WMA General Assembly, Seoul, Korea, October 2008

The World Medical Association expresses grave concern over the situation in Kosova and urges its member National Medical Associations to call upon their Governments as a matter of urgency:

  1. to ensure the immediate provision of humanitarian assistance to the thousands of displaced persons;
  2. to insist that the authorities permit impartial forensic investigations, under the auspices of international forensic experts;
  3. to insist that steps be taken immediately to:
    1. monitor human rights violations;
    2. ensure respect for medical staff and facilities; and
    3. facilitate unrestricted access of international humanitarian organizations.
  4. to insist upon an end to discrimination in the provision of health care in Kosova and to any distinction, based on ethnicity, between health care structures.