Patient Rights – WMA – The World Medical Association

Adopted by the 71^st WMA General Assembly (online), Cordoba, Spain, October 2020

PREAMBLE

The patient-physician relationship is part of a human relationship model that dates back to the origins of medicine. It represents a privileged bond between a patient and a physician based on trust. It is a space of creativity where information, feelings, visions, help and support are exchanged.

The patient-physician relationship is a moral activity that arises from the obligation of the physician to alleviate suffering and respect the patient’s beliefs and autonomy. It is usually initiated by mutual consent – expressed or implied – to provide quality medical care.

The patient-physician relationship is the fundamental core of medical practice. It has a universal scope and aims at improving a person’s health and wellbeing. This is made possible by knowledge sharing, common decision making, patient and physician autonomy, help, comfort and companionship in an atmosphere of trust. Trust is an inherent component of the relationship that can be therapeutic in and of itself.

The patient-physician relationship is essential to patient-centred care. It requires both the physician and the patient to be active participants in the healing process. While the relationship encourages and supports collaboration in medical care, competent patients make decisions that direct their care. The relationship may be terminated by either party. The physician must then assist the patient in securing transfer of care and refer the patient to another physician with the necessary ability to continue the care.

The patient-physician relationship is a complex issue subject to myriad cultural, technological, political, social, economic or professional influences. It has evolved throughout history, according to culture and civilisation, in the pursuit of what is most appropriate based on scientific evidence for patients by improving their mental and physical health and well-being and alleviating pain. The relationship underwent deep changes as a result of momentous milestones such as the Universal Declaration of Human Rights (1948), the WMA declarations of Geneva (1948), Helsinki (1964), and the Lisbon (1981).The relationship has slowly progressed towards the empowerment of the patient.

Today, the patient-physician relationship is frequently under threat from influences both within and outside health care systems. In some countries and health care systems, these influences risk alienating physicians from their patients and potentially harming patients. Amongst those challenges likely to undermine the therapeutic efficacy of the relationship, we note a growing trend to:

A technologization of medicine, sometimes leading to a mechanistic view of health care, neglecting human considerations;
The dilution of trustworthy relationships between people in our societies, which negatively influences healthcare relationships;
A primary focus on economic aspects of medical care to the detriment of other factors, posing sometimes difficulties to establish genuine relationships of trust between the physician and the patient.

It is of the utmost importance that the patient-physician relationship addresses these factors of influence in such a way that the relationship is enriched, and that its specificity is warranted. The relationship should never be subject to undue administrative, economic, or political interferences.

RECOMMENDATIONS

Reiterating its Declaration of Geneva, the International Code of Medical Ethics and its Lisbon Declaration on Patient Rights and given the vital importance of the relationship between physician and patient in history and in the current and future context of medicine, the WMA and its Constituent Members:

Reaffirm that professional autonomy and clinical independence are essential components of high-quality medical care and medical professionalism, protecting the right of the patients to receive the health care they need.
Urge all actors involved in the regulation of the patient-physician relationship (governments and health authorities, medical associations, physicians, and patients) to defend, protect and strengthen the patient-physician relationship, based of high-quality care, as a scientific, health, cultural and social heritage.
Call on Constituent Members and individual physicians to preserve this relationship as the fundamental core of any medical action centred on a person, to defend the medical profession and its ethical values, including compassion, competence, mutual respect, and professional autonomy, and to support patient-centred care.
Reaffirm its opposition to interference from governments, other agents and institutional administrations in the practice of medicine and in the Patient-physician
Reaffirm its dedication to providing competent medical service in full professional and moral independence, with compassion and respect for human dignity.
Commit to address emerging factors which could pose a threat to the patient-physician relationship and to take action to mitigate against those factors.

Portuguese translation

Adopted by the 53^rd WMA General Assembly, Washington, DC, USA, October 2002
and revised by the 67^th WMA General Assembly, Taipei, Taiwan, October 2016

PREAMBLE

1. The Declaration of Helsinki lays down ethical principles for medical research involving human subjects, including the importance of protecting the dignity, autonomy, privacy and confidentiality of research subjects, and obtaining informed consent for using identifiable human biological material and data.

2. In health care provision, health information is gathered by physicians or other members of the medical team to record health care events and to aid physicians in the on-going care of their patient.

3. This Declaration is intended to cover the collection, storage and use of identifiable data and biological material beyond the individual care of patients. In concordance with the Declaration of Helsinki, it provides additional ethical principles for their use in Health Databases and Biobanks.

This Declaration should be read as a whole and each of its constituent paragraphs should be applied with consideration of all other relevant paragraphs.

4. A Health Database is a system for collecting, organizing and storing health information. A Biobank is a collection of biological material and associated data. Biological material refers to a sample obtained from an individual human being, living or deceased, which can provide biological information, including genetic information, about that individual. Health Databases and Biobanks are both collections on individuals and population, and both give rise to the similar concerns about dignity, autonomy, privacy, confidentiality and discrimination.

5. Research using Health Databases and Biobanks can often significantly accelerate the improvement in the understanding of health, diseases, and the effectiveness, efficiency, safety and quality of preventive, diagnostic and therapeutic interventions. Health research represents a common good that is in the interest of individual patients, as well as the population and the society.

6. Physicians must consider the ethical, legal and regulatory norms and standards for Health Database and Biobanks in their own countries as well as applicable international norms and standards. No national or international ethical, legal or regulatory requirement should reduce or eliminate any of the protections for individuals and population set forth in this Declaration.

When authorized by a national law adopted through a democratic process in respect of human rights, other procedures could be adopted to protect the dignity, autonomy and privacy of the individuals. Such procedures are only acceptable when strict rules on data protection are implemented.

7. Consistent with the mandate of WMA, the Declaration is addressed primarily to physicians. The WMA encourages others who are involved in using data or biological material in Health Databases and Biobanks to adopt these principles.

ETHICAL PRINCIPLES

8. Research and other Health Databases and Biobanks related activities should contribute to the benefit of society, in particular public health objectives.

9. Respecting the dignity, autonomy, privacy and confidentiality of individuals, physicians have specific obligations, both ethical and legal, as stewards protecting information provided by their patients. The rights to autonomy, privacy and confidentiality also entitle individuals to exercise control over the use of their personal data and biological material.

10. Confidentiality is essential for maintaining trust and integrity in Health Databases and Biobanks. Knowing that their privacy will be respected gives patients and donors the confidence to share sensitive personal data. Their privacy is protected by the duty of confidentiality of all who are involved in handling data and biological material.

11. The collection, storage and use of data and biological material from individuals capable of giving consent must be voluntary. If the data and biological material are collected for a given research project, the specific, free and informed consent of the participants must be obtained in accordance with the Declaration of Helsinki.

12. If the data or biological material are collected and stored in a Health Database or a Biobank for multiple and indefinite uses, consent is only valid if the concerned individuals have been adequately informed about:

The purpose of the Health Database or Biobank;
The risks and burdens associated with collection, storage and use of data and material;
The nature of the data or material to be collected;
The procedures for return of results including incidental findings;
The rules of access to the Health Database or Biobank;
How privacy is protected;
The governance arrangements as stipulated in paragraph 21;
That in case the data and material are made non-identifiable the individual may not be able to know what is done with their data/material and that they will not have the option of withdrawing their consent;
Their fundamental rights and safeguards established in this Declaration; and
When applicable, commercial use and benefit sharing, intellectual property issues and the transfer of data or material to other institutions or third countries.

13. In addition to the requirements set forth in the Declaration of Helsinki, when persons who were not able to consent, whose data and biological materials have been stored for future research, attain or regain the capacity to consent, reasonable efforts should be made to seek the consent of those persons for continued storage and research use of their data and biological materials.

14. Individuals have the right to request for and be provided with information about their data and its use as well as to request corrections of mistakes or omissions. Health Databases and Biobanks should adopt adequate measures to inform the concerned individuals about their activities.

15. Individuals have the right, at any time and without reprisal, to alter their consent or to ask for their identifiable data to be withdrawn from the Health Database and their biological material to be withdrawn from a Biobank. This applies to future use of the data and biological materials.

16. In the event of a clearly identified, serious and immediate threat where anonymous data will not suffice, the requirements for consent may be waived to protect the health of the population. An independent ethics committee should confirm that each exceptional case is justifiable.

17. The interests and rights of the communities concerned, in particular when vulnerable, must be protected, especially in terms of benefit sharing.

18. Special considerations should be given to the possible exploitation of intellectual property. Protections for ownership of materials, rights and privileges must be considered and contractually defined before collecting and sharing the material. Intellectual property issues should be addressed in a policy, which covers the rights of all stakeholders and communicated in a transparent manner.

19. An independent ethics committee must approve the establishment of Health Databases and Biobanks used for research and other purposes. In addition the ethics committee must approve use of data and biological material and check whether the consent given at the time of collection is sufficient for the planned use or if other measures have to be taken to protect the donor. The committee must have the right to monitor on-going activities. Other ethical review mechanisms that are in accordance to par 6 can be established.

GOVERNANCE

20. In order to foster trustworthiness, Health Databases and Biobanks must be governed by internal and external mechanisms based on the following principles:

Protection of individuals: Governance should be designed so the rights of individuals prevail over the interests of other stakeholders and science;
Transparency: any relevant information on Health Databases and Biobanks must be made available to the public;
Participation and inclusion: Custodians of Health Databases and Biobanks must consult and engage with individuals and their communities.
Accountability: Custodians of Health Databases and Biobanks must be accessible and responsive to all stakeholders.

21. Governance arrangements must include the following elements:

The purpose of the Health Database or Biobank;
The nature of health data and biological material that will be contained in the Health Database or Biobank;
Arrangements for the length of time for which the data or material will be stored;
Arrangements for regulations of the disposal and destruction of data or material;
Arrangement for how the data and material will be documented and traceable in accordance with the consent of the concerned persons;
Arrangement for how the data and material will be dealt with in the event of change of ownership or closure;
Arrangement for obtaining appropriate consent or other legal basis for data or material collection;
Arrangements for protecting dignity, autonomy, privacy and preventing discrimination;
Criteria and procedures concerning the access to and the sharing of the health data or biological material including the systematic use of Material Transfer Agreement (MTA) when necessary;
The person or persons who are responsible for the governance;
The security measures to prevent unauthorized access or inappropriate sharing;
The procedures for re-contacting participants where relevant;
The procedures for receiving and addressing enquiries and complaints.

22. Those professionals contributing to or working with Health Databases and Biobanks must comply with the appropriate governance arrangements.

23. Health Databases and Biobanks must be operated under the responsibility of an appropriately qualified professional assuring compliance with this Declaration.

24. The WMA urges relevant authorities to formulate policies and law that protect health data and biological material on the basis of the principles set forth in this document.

Adopted by the 62^nd WMA General Assembly, Montevideo, Uruguay, October 2011,
and reaffirmed with minor revisions by the 218^th 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:

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

WHEREAS,

Physicians in the Islamic Republic of Iran have reported:

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

THEREFORE, the World Medical Association

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

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

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

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

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

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

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

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

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

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

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

Adopted by the 60^th WMA General Assembly, New Delhi, India, October 2009
and revised by the 70^th WMA General Assembly, Tbilisi, Georgia, October 2019

The WMA reaffirms the Declaration of Seoul on professional autonomy and clinical independence of physicians.

The medical profession must play a central role in regulating the conduct and professional activities of its members, ensuring that their professional practice is in the best interests of citizens.

The regulation of the medical profession plays an essential role in ensuring and maintaining public confidence in the standards of care and of behaviour that they can expect from medical professionals. That regulation requires very strong independent professional involvement.

Physicians aspire to the development or maintenance of systems of regulation that will best protect the highest possible standards of care for all patients. Professionally led models can provide an environment that enhances and assures the individual physician’s right to treat patients without interference, based on his or her best clinical judgment. Therefore, the WMA urges its constituent members and all physicians to work with regulatory bodies and take appropriate actions to ensure effective systems are in place. These actions should be informed by the following principles:

Physicians are accorded a high degree of professional autonomy and clinical independence, whereby they are able to make recommendations based on their knowledge and experience, clinical evidence and their holistic understanding of the patient including his/her best interests without undue or inappropriate outside influence. This is expounded in more detail in the Declaration of Seoul.
The regulation of the profession must be proportionate and facilitative and not be burdensome, and be based on a model that applies to every physician equally and that protects and benefits patients and is based upon an ethical code. The planning and delivery of all types of health care is based upon an ethical model and current evidence-based medical knowledge by which all physicians are governed. This is a core element of professionalism and protects patients. Physicians are best qualified to judge the actions of their peers against such normative standards, bearing in mind relevant local circumstances.
The medical profession has a continuing responsibility to be strongly involved in regulation or self-regulating. Ultimate control and decision-making authority must include physicians, based on their specific medical training, knowledge, experience and expertise. In countries where Professionally led regulation is in place physicians must ensure that this retains the confidence of the public. In countries that have a mixed regulation system physicians must seek to ensure that it maintains professional and public confidence.
Physicians in each country are urged to consider establishing, maintaining and actively participating in a proportionate, fair, rigorous and transparent system of professionally-led regulation. Such systems are intended to balance physicians’ rights to exercise medical judgment freely with the obligation to do so wisely and temperately.
National Medical Associations must do their utmost to promote and support the concept of well-informed and effective regulation amongst their membership and the public. To ensure that any potential conflicts of interest between their representative and regulatory roles are avoided they must ensure separation of the two processes and pay rigorous attention to a transparent and fair system of regulation that will assure the public of its independence and fairness.
Any system of professionally-led regulation must enhance and ensure:
- the delivery of high quality safe and competent healthcare to patients
- the competence of the physician providing that care the professional, including ethical, conduct of all physicians
- the protection of society and the rights of patients
- the promotion of trust and confidence of patients, their families and the public
- the quality assurance of the regulation system
- the maintenance of trust by patients and society
- the development of solutions to potential conflicts of interest
- a commitment to wide professional responsibilities
To ensure that the patient is offered quality continuing care, physicians should participate actively in the process of Continuing Professional Development, including reflective practice, in order to update and maintain their clinical knowledge, skills and competence. Employers and management have a responsibility to enable physicians to meet this requirement.
The professional conduct of physicians must always be within the bounds of the Code of Ethics governing physicians in each country. National Medical Associations must promote professional and ethical conduct among physicians for the benefit of patients, and ethical violations must be promptly recognized, reported to the relevant regulatory authority and acted upon. Physicians are obligated to intervene in a timely manner to ensure that impaired colleagues do not put patients or colleagues at risk and receive appropriate assistance from a physician health program or appropriate training enabling a return to active practice.
The regulatory body should, when the judicial or quasi-judicial processes are complete, and assuming that a case is found against the physician, publish their findings and include details of the remedial action taken. Lessons learned from every case should, to the extent possible, be extracted and used in professional education processes.
The regulation process should ensure that the incorporation of such lessons is, as far as possible, seamless.
National Medical Associations are urged to assist each other in coping with new and developing challenges including potential threats to professionally-led regulation. The ongoing exchange of information and experiences between National Medical Associations is essential for the benefit of patients.
Whatever judicial or regulatory process a country has established, any judgment on a physician’s professional conduct or performance must incorporate evaluation by the physician’s professional peers who, by their training, knowledge and experience, understand the complexity of the medical issues involved.
An effective and responsible system of professionally-led regulation must not be self-serving or internally protective of the profession. National Medical Associations should assist their members in understanding that professionally-led regulation, in countries where that system exists, must maintain the safety, support and confidence of the general public, including their health-related rights, as well as the honour of the profession itself.

Adopted by the 65^th WMA General Assembly, Durban, South Africa, October 2014
and reaffirmed by the 217^th WMA Council Session, Seoul (online), April 2021

PREAMBLE

Reliable reports indicate that migrant workers in Qatar suffer from exploitation and violation of their rights. Workers basic needs, e.g. access to sufficient water and food, are not met. Less than half of the workers are entitled to health care. Hundreds of workers have already died in the construction sites since 2010 as the country prepares to host the 2022 FIFA[1] World Cup. Workers are not free to leave when they see their situation hopeless or health endangered since their passports are confiscated.

Despite the pleas of international labour and human rights organizations, such as ITUC (International Trade Union Confederation) and Amnesty International, the response of the Qatar government to solve the situation has not been adequate. FIFA has been inefficient and has not taken the full responsibility to facilitate the improvements to the worker´s living and working conditions.

The World Medical Association reminds that health is a human right that should be safeguarded in all situations.

The World Medical Association is concerned that migrant workers are continuously put at risk in construction sites in Qatar, and their right to freedom of movement and right to health care and safe working conditions are not respected.

RECOMMENDATIONS

The WMA calls upon the Qatar government and construction companies to ensure the health and safety of migrant workers;
The WMA demands the FIFA as the responsible organization of the World Cup to take immediate action by changing the venue as soon as possible;
The WMA calls upon its members to approach local governments in order to facilitate international cooperation with the aim of ensuring the health and safety of migrant workers in Qatar.

[1] Fédération Internationale de Football Association

Adopted by the 34^th World Medical Assembly, Lisbon, Portugal, September/October 1981
and amended by the 47^th WMA General Assembly, Bali, Indonesia, September 1995
and editorially revised by the 171^st WMA Council Session, Santiago, Chile, October 2005
and reaffirmed by the 200^th WMA Council Session, Oslo, Norway, April 2015

PREAMBLE

The relationship between physicians, their patients and broader society has undergone significant changes in recent times. While a physician should always act according to his/her conscience, and always in the best interests of the patient, equal effort must be made to guarantee patient autonomy and justice. The following Declaration represents some of the principal rights of the patient that the medical profession endorses and promotes. Physicians and other persons or bodies involved in the provision of health care have a joint responsibility to recognize and uphold these rights. Whenever legislation, government action or any other administration or institution denies patients these rights, physicians should pursue appropriate means to assure or to restore them.

PRINCIPLES

Right to medical care of good quality
1. Every person is entitled without discrimination to appropriate medical care.
2. Every patient has the right to be cared for by a physician whom he/she knows to be free to make clinical and ethical judgements without any outside interference.
3. The patient shall always be treated in accordance with his/her best interests. The treatment applied shall be in accordance with generally approved medical principles.
4. Quality assurance should always be a part of health care. Physicians, in particular, should accept responsibility for being guardians of the quality of medical services.
5. In circumstances where a choice must be made between potential patients for a particular treatment that is in limited supply, all such patients are entitled to a fair selection procedure for that treatment. That choice must be based on medical criteria and made without discrimination.
6. The patient has the right to continuity of health care. The physician has an obligation to cooperate in the coordination of medically indicated care with other health care providers treating the patient. The physician may not discontinue treatment of a patient as long as further treatment is medically indicated, without giving the patient reasonable assistance and sufficient opportunity to make alternative arrangements for care.
Right to freedom of choice
1. The patient has the right to choose freely and change his/her physician and hospital or health service institution, regardless of whether they are based in the private or public sector.
2. The patient has the right to ask for the opinion of another physician at any stage.
Right to self-determination
1. The patient has the right to self-determination, to make free decisions regarding himself/herself. The physician will inform the patient of the consequences of his/her decisions.
2. A mentally competent adult patient has the right to give or withhold consent to any diagnostic procedure or therapy. The patient has the right to the information necessary to make his/her decisions. The patient should understand clearly what is the purpose of any test or treatment, what the results would imply, and what would be the implications of withholding consent.
3. The patient has the right to refuse to participate in research or the teaching of medicine.
The unconscious patient
1. If the patient is unconscious or otherwise unable to express his/her will, informed consent must be obtained whenever possible, from a legally entitled representative.
2. If a legally entitled representative is not available, but a medical intervention is urgently needed, consent of the patient may be presumed, unless it is obvious and beyond any doubt on the basis of the patient’s previous firm expression or conviction that he/she would refuse consent to the intervention in that situation.
3. However, physicians should always try to save the life of a patient unconscious due to a suicide attempt.
The legally incompetent patient
1. If a patient is a minor or otherwise legally incompetent, the consent of a legally entitled representative is required in some jurisdictions. Nevertheless the patient must be involved in the decision-making to the fullest extent allowed by his/her capacity.
2. If the legally incompetent patient can make rational decisions, his/her decisions must be respected, and he/she has the right to forbid the disclosure of information to his/her legally entitled representative.
3. If the patient’s legally entitled representative, or a person authorized by the patient, forbids treatment which is, in the opinion of the physician, in the patient’s best interest, the physician should challenge this decision in the relevant legal or other institution. In case of emergency, the physician will act in the patient’s best interest.
Procedures against the patient’s will
Diagnostic procedures or treatment against the patient’s will can be carried out only in exceptional cases, if specifically permitted by law and conforming to the principles of medical ethics.
Right to information
1. The patient has the right to receive information about himself/herself recorded in any of his/her medical records, and to be fully informed about his/her health status including the medical facts about his/her condition. However, confidential information in the patient’s records about a third party should not be given to the patient without the consent of that third party.
2. Exceptionally, information may be withheld from the patient when there is good reason to believe that this information would create a serious hazard to his/her life or health.
3. Information should be given in a way appropriate to the patient’s culture and in such a way that the patient can understand.
4. The patient has the right not to be informed on his/her explicit request, unless required for the protection of another person’s life.
5. The patient has the right to choose who, if anyone, should be informed on his/her behalf.
Right to confidentiality
1. All identifiable information about a patient’s health status, medical condition, diagnosis, prognosis and treatment and all other information of a personal kind must be kept confidential, even after death. Exceptionally, descendants may have a right of access to information that would inform them of their health risks.
2. Confidential information can only be disclosed if the patient gives explicit consent or if expressly provided for in the law. Information can be disclosed to other health care providers only on a strictly “need to know” basis unless the patient has given explicit consent.
3. All identifiable patient data must be protected. The protection of the data must be appropriate to the manner of its storage. Human substances from which identifiable data can be derived must be likewise protected.
Right to Health Education
Every person has the right to health education that will assist him/her in making informed choices about personal health and about the available health services. The education should include information about healthy lifestyles and about methods of prevention and early detection of illnesses. The personal responsibility of everybody for his/her own health should be stressed. Physicians have an obligation to participate actively in educational efforts.
Right to dignity
1. The patient’s dignity and right to privacy shall be respected at all times in medical care and teaching, as shall his/her culture and values.
2. The patient is entitled to relief of his/her suffering according to the current state of knowledge.
3. The patient is entitled to humane terminal care and to be provided with all available assistance in making dying as dignified and comfortable as possible.
Right to religious assistanceThe patient has the right to receive or to decline spiritual and moral comfort including the help of a minister of his/her chosen religion.

Portuguese translation

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

PREAMBLE

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

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

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

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

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

RECOMMENDATIONS

The WMA recommends that National Medical Associations:

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