Privacy – WMA – The World Medical Association

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

DEFINITION

Social media is a collective term for the different interactive platforms, websites and applications intended for digital networking, that allow individuals and organizations to create and share user-generated content digitally.

The objectives of this policy are to:

Examine the professional and ethical challenges related to the increasing usage of social media by physicians, medical students, and patients.
Establish a framework that protects their respective interests.
Ensure trust and reputation by maintaining high professional and ethical standards.
Promote the availability of quality information across social media.
Stand against misinformation and disinformation on social media.

The use of social media has become a fact of life for billions of people worldwide including physicians, medical students, and patients.

Interactive, collaborative tools such as wikis, social networking platforms, chat applications and blogs have transformed passive Internet users into active participants. These tools are means for gathering, sharing and disseminating information, including healthcare and science information, socializing and connecting with friends, relatives, professionals etc. They can be used to seek medical advice, and patients share their health and healthcare experiences. They can also be used in research, public health, and education.

The positive aspects of social media should be recognized such as in promoting a healthy lifestyle, the dissemination of medical knowledge to society and in reducing patients’ isolation.

Areas, which may require special attention include:

Sensitive content, photographs, videos, other personal materials posted on online social forums often exist in the public domain and have the capacity to remain on the internet permanently. Individuals may not have control over the ultimate distribution of material they post on-line.
Patient portal, blogs and tweets are not a substitute for one on one consultation with physicians but may widen engagement with health services amongst certain groups. Online “friendships” with patients may also alter the patient-physician relationship, and may result in unnecessary, possibly problematic physician and patient self-disclosure.
Each party’s privacy may be compromised in the absence of adequate and conservative privacy settings or by their inappropriate use. Privacy settings are not absolute; social media sites may change default privacy settings unilaterally, without the user’s knowledge. Social media sites may also make communications available to third parties.
Misinformation and disinformation often spread more rapidly through social media than fact-based accurate information. It may cause harm to the health of individuals as well as to public health and foster doubt and distrust towards professionals seeking to promote truth and science-based evidence.
Appropriate disclaimers to include in biographical information (e.g., “my opinions are my own”, “posts are not personalized medical advice”, etc).

The dissemination of medical knowledge, best practices and treatment options on social media can increase and expedite access to new and valid information among medical professionals. However, individuals or companies can take advantage of these channels in misleading ways, including to market or promote their medical products or treatments.

RECOMMENDATIONS

The WMA urges National Medical Associations (NMA) to establish social media guidelines for their members addressing the following objectives:

To maintain appropriate boundaries of the patient-physician relationship in accordance with professional ethical guidelines just as they would in any other context.
To ensure that no identifiable patient information is posted in any social media by their physician, by increasing the understanding of privacy provisions of social networking sites and their limitations while considering intended audience and the technical feasibility to restrict access to the content to predefined individuals or groups.
To exercise care when using applications that might compromise the security of the data, including when consulting with colleagues.
To promote and apply the principles in the WMA Guidelines on Promotional Mass Media Appearances by Physicians to all social media activities by physicians.
To encourage physicians to routinely monitor their own Internet presence to ensure that the personal and professional information on their own sites and, to the extent possible, content posted about them by others is accurate and appropriate.
To prevent the use of technological devices from diverting our attention during direct consultation with the patient.
To provide factual, concise, understandable information, declare any conflicts of interest and adopt a sober tone when discussing professional matters.
To avoid inappropriate use of the networks, frivolous, insensitive attitudes or light-hearted opinions on medical matters.
To draw the attention of physicians to the fact that social media content posted by health professionals may contribute to the public perception of the profession and should be done in accordance with the principles in the WMA Declaration of Geneva and the International Code of Medical Ethics.
To include education on the use of social media in medical curricula and continuing medical education.
To behave in the media and on social networks with the same scientific rigor and the same approach as in a consultation and show the same respect to patients and colleagues.
To create mechanisms for accountability in professional settings when inappropriate behavior on social media is observed and reported.
To promote health literacy and knowledge among populations and with individual patients by using objective and evidence based messages in accordance with the principles in the WMA Declaration of Geneva, the WMA International Code of Medical Ethics, and the WMA Statement on Healthcare Information for All.
To combat misinformation, disinformation, and the promotion of pseudoscience and pseudotherapy on social media, all of which can result in negative health outcomes for patients and communities.
To counsel fellow physicians who engage in misinformation, disinformation, or violation of patient trust on social media and/or report to relevant authorities for ongoing deliberate acts of the same.
To raise awareness among physicians and medical students about the possibility that information shared on social media could be used in misleading ways by individuals or companies.

Adopted by the 50^th World Medical Assembly, Ottawa, Canada, October 1998,
revised by the 60^th WMA General Assembly, New Delhi, India, October 2009
and by the 71^st WMA General Assembly (online), Cordoba, Spain, October 2020

PREAMBLE

Science has now proven that to reach their potential, children need to grow up in an environment where they can thrive – spiritually, emotionally, mentally, physically and intellectually. That place must be characterized by four fundamental elements:

A healthy, safe and sustainable physical and emotional environment.
the opportunity for optimal growth and development;
adequate health services for healthy child development; and
monitoring and research for evidence-based continual improvement into the future

Physicians know that the future of our world depends on our children. Early childhood experiences strongly influence future development, including basic learning, school success, economic participation, social citizenry, and health. In most situations, parents and caregivers are only able to provide nurturing environments with help from local, regional, national and international organizations.

The principles of this Declaration apply to all children in the world from birth to 18 years of age, regardless of race, age, ethnicity, nationality, political affiliation, creed, language, gender, sex, disease or disability, physical ability, mental ability, sexual orientation, cultural history, life experience or the socioeconomic status of the child or her/his parents or legal guardian. In all countries of the world, regardless of resources, meeting these principles should be a priority for parents, communities and governments. The United Nations Convention on the Rights of Children (1989) and National Children’s rights Charters, set out the broader rights of all children and young people, but those rights cannot exist without health. Furthermore, the United Nations Sustainable and Development Goals, especially SDG3, SDG4, SDG5, and SDG6, apply directly to the health of children and the social determinants of health. Responsibility for giving effect to the principles herein lies with the government of the region where the child is primarily domiciled.

All children should be treated with dignity, tolerance and respect and be taught the same.

All children have the right to the highest attainable standard of physical and mental health and wellbeing.

Addressing the social determinants of health is essential to achieving equity in health and healthcare in children.

While children are generally regarded as the vulnerable groups, the most vulnerable groups of children include children with special needs, orphans, the homeless, refugees and asylum seekers, disabled, children from low-income homes and conflict zones. These groups require special consideration in all areas.

A healthy, safe and sustainable physical and emotional environment comprises the following elements:

A safe and sustainable physical environment with minimum climate change, optimum ecosystem free from water, air and soil pollution and degradation;
Urgent implementation of climate change adaptation and mitigation strategies, and age-appropriate education on climate change to achieve a better and more sustainable environment for all children;
A safe home, a family setting, available parental care and a community that cares;
Healthy, safe and stable families, homes, schools and communities;
Protection from bullying and an environment that promotes positive mental health;
Protection from discrimination based on age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor;
Access to a safe infrastructure, including safe sanitation, transportation, and places to play;
Protection from natural and man-made disasters;
Protection from physical, sexual, emotional and verbal abuse and neglect;
Prevention of exploitation in the form of child labour;
Protection from harmful traditional practices;
Freedom from witnessing and participating in violence and armed conflict including forced recruitment as child soldiers or into gangs;
Protection from the harms associated with alcohol, tobacco and substance abuse, including the right to age-appropriate information.

All infants should be officially registered within one month of birth or as soon as possible to enable them to have an official identity, access to health care, social security and any other resources where identification is mandatory.

Asylum seeking children, whether accompanied or unaccompanied, should not be detained, separated from the parents and families sent back to a place where they are at risk of human rights violations.

The opportunity for optimal growth and development entails:

Access to adequate healthy and nutritious food to promote long-term health development. This includes the promotion of exclusive breastfeeding, where possible, for the first six months of life as long as the mother and baby are comfortable, access to adequate safe food that satisfies dietary diversity, and protection from obesogenic environments through regulation of unhealthy and processed food and beverages;
Promotion and encouragement of nutritional literacy, physical activity and physical education from an early age;
Access to education from early childhood through secondary education with provisions for those without access;
Access to age-appropriate information as it pertains to health, including the provision of evidence-based comprehensive sexuality education;
Access to social assistance.

Access to the full range or appropriate and high-quality healthcare services for all stages of childhood development entails:

The best interests of the child shall be the primary consideration in the provision of health care. The following principles of child health care must be ensured:

Appropriate preventive, curative, rehabilitative and emergency care for mother and child;
Prenatal and maternal care for the best possible health at birth and good postnatal care to ensure the best possible outcomes for mother and child;
Respect for the privacy of children;
Medical care for all children of asylum seekers and refugees;
Specialized training necessary to enable caregivers to respond appropriately to the specific medical, physical, emotional and developmental needs of children & their families;
Basic health care including developmental assessment, health promotion, recommended immunization, early detection of disease, access to medicines, oral and eye-health;
Multidisciplinary (i.e. consisting of physicians, social workers, psychologists, therapists, occupational therapists, education specialists and others) and community-based mental health prevention, care and prompt referral for intervention when problems are identified;
Priority access to emergency medical care for life-threatening conditions;
Hospitalization when appropriate. Hospitals should provide access to parental facilities and policies for continuous parental care;
Specialist diagnosis, care and treatment when needed;
Rehabilitation services and supports within the community;
Pain management and care and prevention (or minimization) of suffering;
End of life care / Palliative care;
Informed consent is necessary before initiating any diagnostic, therapeutic, rehabilitative, or research procedure on a child.  In the majority of cases, the consent shall be obtained from the parent(s) or legal guardian, or, in some cases, by extended family, although the wishes of a competent child should be taken into account before consent is given.  Where a child lacks competence and is able to express a view, his/her wishes should still be taken into account before consent is given. Where appropriate (e.g. reproductive health services), competent children should be allowed to consent to treatment without parental consent. In case of a life-threatening, and when competent children cannot give consent and parents/caregivers are not accessible, for treatment, consent should be presumed for life-saving treatment;
The full range of sexual and reproductive health services for adolescents including access to abortion according to national legislation;
Respect for the sexual and gender identity of the child. Harmful practices like genital mutilation or so-called conversion therapies must be forbidden;
Social assistance and mechanisms to provide for universal access to health care are ensured for all particularly vulnerable children;
The homeless, orphaned, asylum seeker, refugees and children from conflict zones should be provided with essential and emergency medical care without discrimination.

Monitoring & and research for evidence-based continual improvement into the future includes:

The principles of the Declaration of Helsinki must be observed in any research study involving children as research subjects.