Policy Type: Resolution

Adopted by the 42nd World Medical Assembly Rancho Mirage, CA., USA, October 1990
and rescinded at the WMA General Assembly, Santiago 2005

  • WHEREAS: Therapeutic Substitution is one form of drug substitution. Therapeutic substitution occurs when a pharmacist substitutes a chemically different drug for the drug that the physician actually prescribed. The drug substituted by the pharmacist belongs to the same pharmacologic class and or to the same therapeutic class. However since the two drugs have different chemical structures, potentially adverse outcomes for the patient can occur.
  • WHEREAS: Genetic substitution is entirely different from therapeutic substitution. In generic substitution, a generic drug is substituted for a brand name drug. However, both drugs have the same active chemical ingredient, same dosage strength, and same dosage form.
  • WHEREAS: The prescription of a drug represents the culmination of a careful deliberative process between physician and patient aimed at the prevention, amelioration or cure of a disease or problem. This deliberative process requires that the physician evaluate a variety of scientific and psychological data including costs and make an individualized choice of therapy for the patient.
  • WHEREAS: Physicians have the responsibility for diagnosing the patient’s condition and for the development of a treatment plan, including the prescribing of appropriate drugs and medications.

BE IT RESOLVED that the World Medical Association supports:

  1. Individualization of therapy for patients based on a complete clinical database compiled from a comprehensive history, current physical findings, all relevant laboratory data, and psychosocial factors.
  2. Maintaining the prescription authority of the physician so that the patient will receive organized, effective care.
  3. Requiring the pharmacist to dispense the exact chemical, dose, and dosage form prescribed by the physician.

BE IT FURTHER RESOLVED that the World Medical Association opposes:

  1. The concept of therapeutic substitution because it results in prescribing based on incomplete information and, thus may be harmful to patient welfare.
  2. Any governmental law or regulation that permits therapeutic substitution.

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 40th World Medical Assembly Vienna, Austria, September 1988
and rescinded at the WMA General Assembly, Santiago 2005

  • WHEREAS medical care is organized throughout the world in many different ways, from absolute freedom to practice medicine to medical services organized exclusively and completely by the State and
  • WHEREAS examination of the economic and social contexts within which these health care systems exist reveals a diversity of medical need and community objectives, and
  • WHEREAS a pluralism of structure for the provision of medical care is needed to fulfill those needs and objectives,

THEREFORE BE IT RESOLVED, hat the World Medical Association supports the concept of medical group practice as one method for providing continuous quality medical care within the context of medical ethics.

Adopted by the 147th Council Session Paris, France, May 1997,
endorsed by the 49th WMA General Assembly Hamburg, Germany, November 1997
and rescinded at the WMA General Assembly, Santiago 2005

Recognising that there have been recent developments in science leading to the cloning of a mammal, namely a sheep, and

because this raises the possibility of such cloning techniques being used in humans, in turn raising concern for the dignity of the human being and protection for the security of human genetic material,

the World Medical Association hereby calls on doctors engaged in research and other researchers to abstain voluntarily from participating in the cloning of human beings until the scientific, ethical and legal issues have been fully considered by doctors and scientists, and any necessary controls put in place.

Adopted by the WMA General Assembly, Santiago 2005
and rescinded at the WMA General Assembly, Pilanesberg, South Africa, 2006

The World Medical Association recognizes the potential global morbidity and mortality as a result of the H5N1 strain of avian flu. This possibility increases with every passing day as more countries find infected birds in their territories. The WMA will work with member NMAs, the WHO and other stakeholders to track the progress of the disease and propose the necessary measures to minimize its impact on the global human population. The WMA also urges governments to engage with NMAs to prepare for the possibility of a pandemic.

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 as a Council Resolution by the 203rd  WMA Council Session, Buenos Aires, Argentina, April 2016 and adopted by the 67th WMA General Assembly, Taipei, Taiwan, October 2016

Recognizing that the WHO has designated the Zika virus infection a global health emergency, the WMA provides the following recommendations:

  • WHO should work with ECDC, CDC and other disease control organisations to better understand the natural history and current epidemiology of Zika virus infection.
  • Information should be disseminated widely to advise and protect all women and men who live in or must travel to Zika-affected areas and who are considering becoming parents. Advice should also include recommendations for women who are already pregnant who may have been directly exposed to the Zika virus or whose partners live in or have travelled to Zika-affected areas.
  • Relevant agencies, including WHO, should gather data on the efficacy of different mosquito control methodologies, including the potentially harmful or teratogenic effects of the use of various insecticides.
  • Work on diagnostic tests, antivirals, and vaccines should continue with an emphasis on producing a product that is safe for use in pregnant women and public funding should be assured for this research.  When such products are developed states should ensure that they are available to, and affordable by, those most at risk.
  • States which have witnessed the delivery of a number of babies with microcephaly and other fetal brain abnormalities must ensure that these infants are properly followed up by health and other services, and provide support to families seeking to cope with a child with developmental abnormalities.  Wherever possible research on the consequences of microcephaly should be published, to better inform future parents, and to allow the development of optimal service provision.

Adopted as a Council Resolution by the 203rd WMA Council Session, Buenos Aires, April 2016,
adopted by the 67th World Medical Assembly, Taipei, Taiwan, October 2016,
and rescinded and archived by the 72nd WMA General Assembly (online), London, United Kingdom, October 2021

PREAMBLE

Currently, a very large number of people are seeking refuge and/or asylum; some are fleeing war zones or other conflicts, others are fleeing from desperate poverty, violence, and other injustices and abuses with potentially very harmful effects to mental and physical health.

The global community has been ill prepared for handling the refugee crisis, including addressing the health needs of those seeking refuge.

The WMA recognizes that mass migration will continue unless people are content to stay in their birth countries because they see opportunities to live their lives in relative peace and security and to offer themselves and their families the ability to live lives with opportunities for fulfilment of various sorts, including economic improvement.  The global community has a responsibility to seek to improve the lot of all populations, including those in countries currently with the poorest economies and other key factors.  Sustainable development will give all populations improved security, and economic options.

The WMA recognizes that warfare and other armed conflict, including continuous civil strife, unrest and violence, will inevitably lead to people movement.  The worse the conflict the higher the percentage of people who will want to leave the conflict zone.  There is a responsibility for the global community, especially its political leaders, to seek to support peace making and conflict resolution.

The WMA recognizes and condemns the phenomenon of forced migration, which is inhumane and must be stopped.  Such cases should be considered for referral to the International Criminal Court.

PRINCIPLES

1. The WMA reiterates the WMA Statement on Medical Care for Refugees originally adopted in Ottawa, Canada in 1998 which states:

  • Physicians have a duty to provide appropriate medical care regardless of the civil or political status of the patient, and governments should not deny patients the right to receive such care, nor should they interfere with physicians’ obligation to administer treatment on the basis of clinical need alone.
  • Physicians cannot be compelled to participate in any punitive or judicial action involving refugees, including asylum seekers, refused asylum seekers and undocumented migrants, or Internally Displaced Persons or to administer any non-medically justified diagnostic measure or treatment, such as sedatives to facilitate easy deportation from the country or relocation.
  • Physicians must be allowed adequate time and sufficient resources to assess the physical and psychological condition of refugees who are seeking asylum.
  • National Medical Associations and physicians should actively support and promote the right of all people to receive medical care on the basis of clinical need alone and speak out against legislation and practices that are in opposition to this fundamental right.

2. WMA urges governments and local authorities to ensure access to adequate healthcare as well as safe and adequate living conditions for all regardless of their legal status.

Adopted by the 170th WMA Council Session, Divonne-les-Bains, France, May 2005
And amended 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: 

  1. Acknowledges the essential role of health professionals in tobacco control and urges its constituent members and other representatives of the medical community to use World No Tobacco Day each year to advocate for tobacco control measures; 
  2. Recognises the importance of the WHO Framework Convention on Tobacco Control (FCTC) as a mechanism to protect people from exposure and addiction to tobacco; 
  3. Encourages Member States to the Convention to recognize (ratify, accept, approve, confirm or accede) the Protocol to Eliminate Trade in Tobacco Products; 
  4. Encourages its constituent members to work assiduously and energetically to get their governments to implement the measures set out in the FCTC as a minimum; 
  5. In line with its Statement on Electronic Cigarettes, calls on Member States to include e-cigarettes and other electronic nicotine delivery systems in the scope of application of the WHO Framework Convention and to ensure that that these products be subjected to local regulatory approval and be entrenched in smoke free laws. 
  6. Urges governments to introduce regulations and other control measures as described in the FCTC including regulation of smokeless tobacco products. Governments should ban smoking and vaping in public places and workplaces as an urgent public health intervention and also consider additional measures, especially those tobacco control measures that have been proven to be successful in other countries; 
  7. Urges governments to introduce initiatives that break brand recognition, including plain packaging of cigarettes and other smoking products, as stated in its Resolution on Plain Packaging of Cigarettes, e-Cigarettes and Other Smoking Product 
  8. Strongly encourages governments to set a distinct method to ensure adequate funding for tobacco control and research; 
  9. Urges governments to promote ready access to smoking cessation advice and services to all smokers, including children; 
  10. Recognises the vital role of health professionals in public health education and in promoting smoking cessation; 
  11. Combats the tobacco industry’s predatory marketing tactics by adopting comprehensive bans on advertising, promotion and sponsorship, as set forth in the WHO FCTC, in order to protect the health of individuals and communities; 
  12. Contributes to the improvements and updating of international tobacco control regulations as needed. 

Adopted by the 66th General Assembly, Moscow, Russia, October 2015
and rescinded and archived by the 75th WMA General Assembly, Helsinki, Finland, October 2024

After the events of October 3 in Kunduz (Afghanistan), the WMA:

  • Extends its deepest condolences to families, colleagues and friends of doctors, healthcare workers and patients killed in the bombing
  • Deeply regrets and condemns the bombing of the Hospital of MSF , considering it a violation of human rights.
  • Reaffirms its positional statements on “Healthcare in Danger” and calls on all countries to respect healthcare personnel in conflict situations
  • Demands an immediate enquiry into the attack by an independent body and the assumption of responsibilities.

Adopted by the 66th General Assembly, Moscow, Russia, October 2015
and rescinded and archived by the 75th WMA General Assembly, Helsinki, Finland, October 2024

PREAMBLE 

Several media report that over the last two months of conflict in Turkey, healthcare workers have been killed, wounded or threatened with guns. Some physicians have been taken out of ambulances and beaten. Access to wounded people is prevented by security forces, and ambulances as well as health facilities are regularly targeted. A rather comprehensive study conducted by the Turkish Medical Association confirms these facts.

There are indications that attacks on healthcare workers and the obstructions of service delivery are used as a deliberate political instrument to intimidate people, depriving them of their democratic rights.

Parties in armed conflict have the obligation to protect health care provision to wounded and sick and to prevent attack on or threat to medical activities, healthcare workers and facilities. Physicians and other healthcare workers should not be impeded to perform their duties. Such attacks constitute blatant violation of international human rights law, in particular the inherent right to life that shall be protected by law, and the right to enjoy the highest attainable standard of health[1].

These attacks undermine gravely as well fundamental medical ethics principles, in particular WMA international Code of Medical Ethics and the Ethical Principles of Health Care in Times of Armed Conflict and Other Emergencies endorsed by civilian and military health-care organisations[2], stating that: “Health-care personnel, as well as health-care facilities and medical transports, whether military or civilian, must be respected by all. They are protected while performing their duties and the safest possible working environment shall be provided to them » (article 10).

Recommendations

The WMA urges all parties to:

  1. Stop attacks on healthcare workers and patients, health care facilities, and ambulances and ensure their safety,
  2. Respect the professional autonomy and impartiality of healthcare workers,
  3. Comply fully with international human rights law as well as other relevant international regulations that Turkey is a State Party to, and
  4. Document and record all violations and duly prosecute their perpetrators.

[1] International Covenant on Economic, Social and Cultural Rights, article 12 – December 1966

[2] Adopted by the ICRC, the WMA, the International Committee of Military Medicine (ICMM), the International Council of Nurses (ICN) and the International Pharmaceutical Federation (FIP)  – June 2015

Adopted by the 66th General Assembly, Moscow, Russia, October 2015
and rescinded and archived by the 72nd WMA General Assembly (online), London, United Kingdom, October 2021

The WMA recognises that mass movement of people often follows disasters that flow from armed conflict or natural phenomena as populations seek to escape danger and deprivation.  The current mass movement of the populations, to escape the effects of armed conflict including bombing, lack of access to utilities, clean water, and the destruction of homes, schools and hospitals, has been numerically larger than any mass movement of populations in over 70 years.

While the WMA recognises that countries may have concerns about their ability to absorb significant numbers of new migrants, we recognise that people fleeing warfare, or natural phenomena are doing so because they are desperate and often face life-threatening conditions.  They are afraid for their health, safety and welfare, and that of the family members who accompany them.

Most countries have signed international treaties giving them binding obligations to offer aid and assistance to refugees and asylum seekers.  The WMA believes that, when there are events, including on-going events such as conflict, which generate refugee crises, governments must increase their efforts to provide assistance to those in need.

This should include ensuring safe passage for refugees, and appropriate support after they enter countries offering refuge.  Recognising that the disaster from which they have fled, and the vicissitudes of the journey, may have led to health problems it is essential that receiving countries establish systems to provide health care to refugees.

Governments should seek to ensure that refugees and asylum seekers are able to live in dignity within their country of refuge and make all efforts to enable their integration into their new society. The international community should seek to obtain a peaceful solution in Syria under which the population can either stay at home safely or, if they have already left, safely return home.

The WMA recognises that mass population movement cause significant stress on existing populations of countries as well on those who become refugees.  We believe that governments and international agencies including the United Nations must make more concerted efforts to reduce the pressures that lead to such movements, including rapidly providing extensive relief after natural phenomena, and making more efforts to avert or stop armed conflict. Re-establishing security of food, water, housing, sewerage, education and health care, and improving public safety, should make a significant impact and reduce the numbers of refugees.

The WMA:

  • Recognises that the process of becoming a refugee is damaging to physical and mental health;
  • Commends those countries that have welcomed and cared for refugees, especially those currently fleeing Syria;
  • Calls on other countries to improve their willingness to receive refugees and asylum seekers;
  • Calls on national governments to ensure that refugees and asylum seekers are enabled to live in dignity by providing access to essential services;
  • Calls on all governments to work together to seek to end local, regional, and international conflicts, and to protect the health, safety and welfare of populations;
  • Calls on all governments to cooperate in providing immediate help to countries facing the effects of natural phenomena, remembering that those already the most socio-economically disadvantaged will face the most challenges;
  • Calls upon global media to report on the refugee crisis in a manner that respects the dignity of refugees and displaced persons, and to avoid bigotry and racial or other bias in reporting.

Adopted by the 65th WMA General Assembly, Durban, South Africa, October 2014
and rescinded and archived by the 74th WMA General Assembly, Kigali, Rwanda, October 2023

In the case of Ebola virus, the WMA strongly supports the intention of Paragraph 37 of the 2013 revision of the Declaration of Helsinki, which reads:

In the treatment of an individual patient, where proven interventions do not exist or other known interventions have been ineffective, the physician, after seeking expert advice, with informed consent from the patient or a legally authorized representative, may use an unproven intervention if in the physician’s judgement it offers hope of saving life, re-establishing health or alleviating suffering. This intervention should subsequently be made the object of research, designed to evaluate its safety and efficacy. In all cases, new information must be recorded and, where appropriate, made publicly available.

Adopted as a Council Resolution by the 198th WMA Council Session, Durban, October 2014 and
adopted by the 65th WMA General Assembly, Durban, South Africa, October 2014
and rescinded and archived by the 74th WMA General Assembly, Kigali, Rwanda, October 2023

 

BACKGROUND

A number of viral diseases have caused occasional health emergencies in parts of Africa, with local or wider spread epidemics.  These include Lassa, Marburg and Ebola Viral Diseases (EVD).  The 2013-14 outbreak of EVD in West Africa has proven far more difficult to control than previous epidemics and is now present in Sierra Leone, Liberia and Guinea with more than 2000 deaths.  This epidemic appears to have a case related mortality of approximately 55% against a range for EVD of 50-95%.

Following infection, patients remain asymptomatic for a period of 2-21 days, and during this time tests for the virus will be negative, and patients are not infectious, posing no public health risk. Once the patient becomes symptomatic, EVD is spread through contact with body fluids including blood.  Symptoms include diarrhea, vomiting and bleeding, and all these body fluids are potentially sources of infection.

Management is primarily through infection control, the use of personal protective equipment (PPE) by health care workers and those disposing of body fluids and of bodies, and supportive care for sick patients including using IV fluids and inotropes. Contact tracing is also important but may be difficult in many of the communities currently affected.  Vaccines are in development as are some antivirals, but they will arrive late in this epidemic if they are proven successful.

Evidence from those treating patients in affected communities is that a shortage of resources, including health care workers and PPE, as well as poor infection control training of health care workers, caregivers and others at risk are making epidemic control difficult.

Some governments have indicated that they will build new treatment centres in affected areas as a matter of urgency, while others are directly providing personal protective equipment and other supplies.

RECOMMENDATIONS

  1. The WMA honours those working in these exceptional circumstances, and strongly recommends that national governments and international agencies work with health care providers on the ground and offer stakeholders training and support to reduce the risks that they face in treating patients and in seeking to control the epidemic.
  2. The WMA commends those countries that have committed resources for the urgent establishment of new treatment and isolation centres in the most heavily burdened countries and regions.  The WMA calls upon all nations to commit enhanced support for combatting the EVD epidemic.
  3. The WMA calls on the international community, acting through the United Nations and its agencies as well as aid agencies, to immediately provide the necessary supplies of PPE to protect health care workers and ancillary staff and reduce the risk of cross infection.  This must include adequate supplies of gloves, masks and gowns, and distribution must include treatment centres at all levels.
  4. The WMA calls on all those managing the epidemic, including local and national governments and agencies such as WHO, to commit to adequate training in infection control measures, including PPE for all staff and caregivers who might come into contact with infective materials.
  5. The WMA calls on national and local governments to increase public communication about basic infection control practices.
  6. The WMA calls upon WHO to facilitate research into the timeliness and effectiveness of international interventions, so that planning and interventions in future health emergencies can be better informed.
  7. The WMA strongly urges all countries, especially those not yet affected, to educate health care providers about the current case definition in addition to strengthening infection control methodologies and contact tracing in order to prevent transmission within their countries.
  8. The WMA calls for NMAs to contact their national governments to act as described in this document.

Adopted by the 64th General Assembly, Fortaleza, Brazil, October 2013
And reaffirmed with minor revisions by the 215th Council session (online), Cordoba, Spain, October 2020

  

PREAMBLE

It has been recognised for centuries that certain chemical agents can affect consciousness, or other factors influencing the ability of an individual to take part in fighting, predominantly during warfare. More recently some agents have been used to temporarily disable participants in civil unrest, protests or riots. In warfare such agents have, historically, had a significant morbidity and mortality and included nerve gases and related agents.

Despite widespread condemnation such weapons were extensively used in the early 20th century. A global movement to outlaw the use of such weapons led to the development of the Chemical Weapons Convention (CWC), which entered into force in 1997 having been opened to signature in 1993.  As of October 2020, only three countries have not ratified or acceded to the CWC.

The production, stockpiling and use of CW is prohibited.  Despite this, such weapons have been used by state forces and by non-state actors in a number of countries. By their nature such weapons are indiscriminate.  This use has led to deaths, injuries and human suffering in those countries.

Chemical agents used in policing actions, including by the military acting in a policing role, are allowed under the CWC.  There is a significant international dialogue underway on the definition of such agents and the situations in which they can be used. It should be noted that the CWC appears to assume such agents will not be lethal, but the use of any agent might have fatal consequences.  Those using them, or authorising their use, must seek to ensure that they are not used in a manner which risks death or serious injury to targeted persons.

RECOMMENDATIONS

  1. The WMA notes that the development, production, stockpiling and use of Chemical Weapons is banned under the CWC, and that use of such weapons is regarded by some to be a crime against humanity, regardless of whether the target populations are civilian or military.
  2. The WMA urges all relevant parties to make active efforts to abide by the CWC ban on the development, production, stockpiling and use of Chemical Weapons.
  3. The WMA urges support from all states party to the CWC for the safe destruction of all stockpiles of Chemical weapons.
  4. The WMA calls for efficient independent accountabiliy measures bringing to justice those responsible for the use of Chemical Weapons.
  5. The WMA urges states using chemical agents in riot control and related situations to carefully consider and minimise the risks and to, wherever possible, refrain from such use.  Any use must follow the establishment of the necessary procedures to reduce the risk of death or serious injury. They should not be used in a manner, which deliberately increases the risk of injury, harm or death to their targets.
  6. Reaffirming its Statement on the Protection and Integrity of Medical Personnel in Situations of Violence and its Declaration on the Protection of Health Care Workers in Situation of Violence, the WMA emphasizes the serious risk of exposing health professionals to chemical agents while performing their medical duties to provide first-aid to injured people in unrest contexts.

Adopted by the 64th General Assembly, Fortaleza, Brazil, October 2013
And reaffirmed with minor revisions by the 215th Council session (online), Cordoba, Spain, October 2020

PREAMBLE

During wars and armed conflicts, hospitals and other medical facilities have often been attacked and misused and patients and medical personnel have been killed or wounded. Such attacks are a violation of the Geneva Conventions (1949), Additional Protocols to the Geneva Conventions (1977) and WMA policies, in particular, the WMA Statement on the Protection and Integrity of Medical Personnel in Armed Conflicts and Other Situations of Violence (Montevideo 2011) as well as WMA Regulations in Times of Armed Conflicts and Other Situations of Violence (Bangkok 2012).

The World Medical Association (WMA) has been active in condemning documented attacks on medical personnel and facilities in armed conflicts, including civil wars. The Geneva Conventions and their Additional Protocols are designed to protect medical personnel, medical facilities and their patients in international and non-international armed conflicts. The parties on both sides of the conflict have legal and moral duties not to interfere with medical care for wounded or sick combatants and civilians, and to not attack, threaten or impede medical functions. Physicians and other health care personnel must act as and be considered neutral and must not be prevented from fulfilling their duties.

RECOMMENDATIONS

  1. The WMA recalls the United Nations Security Council Resolution 2286 adopted in 2016 condemning attacks and threats against medical personnel and facilities in conflict situations and demanding an end to impunity for those responsible.
  2. The WMA calls upon all parties in the Syrian conflict to ensure the safety of healthcare personnel and their patients, as well as medical facilities and medical transport, and to respect the ethical obligation of health personnel to treat all patients, irrespective of who they are in line with the Ethical Principles of Health Care in Times of Armed Conflict and other Emergencies endorsed by civilian and military health-care organizations in 2015.
  3. The WMA calls upon its members to approach local governments in order to facilitate international cooperation in the United Nations, the European Union or other international body with the aim of ensuring the safe provision of health care to the Syrian people.

 

Adopted by the 64th General Assembly, Fortaleza, Brazil, October 2013
and rescinded and archived by the 75th WMA General Assembly, Helsinki, Finland, October 2024

 

There are credible reports that the Brazilian Government program “Mais Médicos” to create more medical schools, extend the duration of the medical course, compulsorily place last years medical students to work in public services and attract foreign physicians to work in remote areas of the country and in the poorest outskirts of big cities, was proposed without the appropriate consultation to the medical community and medical schools, and departs from a wrong diagnosis about the causes of the insufficient health care provided to the Brazilian population. The program as proposed bypass systems established to verify physicians’ credentials, medical competence and language skills in order to protect patients.

The World Medical Association is concerned that patients are put at risk by unregulated medical license, inadequate medical competence and potential misunderstanding of patient communication and of drugs and medical supplies labels.

Therefore, the WMA:

  • Condemns any policy and practice that disrupt the accepted standards of medical credentialing and medical care;
  • Calls upon the Brazilian government to work with the medical community and medical schools on all matters related to medical education, physician certification and the practice of medicine, and to respect the role of the Brazilian Medical Association on behalf of the Brazilian physicians and population;
  • Urges, as a matter of utmost concern, that the Brazilian government respect the WMA International Code of Medical Ethics that guides the medical practice of physicians all over the world.

Adopted by the 194th WMA Council Session, Bali, April 2013 as Council Resolution,
adopted by the 64th WMA General Assembly, Fortaleza, Brazil, October 2013
and reaffirmed by the 217th WMA Council Session, Seoul (online), April 2021

Preamble

Doctors who commit criminal acts which are not part of patient care must remain as liable to sanctions as all other members of society. Serious abuses of medical practice must be subject to sanctions, usually through professional regulatory processes.

Numerous attempts are made by governments to control physicians’ practice of medicine at local, regional and national levels worldwide.  Physicians have seen attempts to:

  • Prevent medically indicated procedures;
  • Mandate medical procedures that are not indicated; and
  • Mandate certain drug prescribing practices.

Criminal penalties have been imposed on physicians for various aspects of medical practice, including medical errors, despite the availability of adequate non-criminal redress. Criminalizing medical decision making is a disservice to patients.

In times of war and civil strife, there have also been attempts to criminalize compassionate medical care to those injured as a result of these conflicts.

Recommendations

Therefore, the WMA recommends that its members:

  1. Oppose government intrusions into the practice of medicine and in healthcare decision making, including the government’s ability to define appropriate medical practice through imposition of criminal penalties.
  2. Oppose criminalizing medical judgment.
  3. Oppose criminalizing healthcare decisions, including physician variance from guidelines and standards.
  4. Oppose criminalizing medical care provided to patients injured in civil conflicts.
  5. Implement action plans to alert opinion leaders, elected officials and the media about the detrimental effects on healthcare that result from criminalizing healthcare decision making.
  6. Support the principles set forth in the WMA’s Declaration of Madrid on Professional Autonomy and Self-Regulation.
  7. Support the guidance set forth in the WMA’s Regulations in Times of Armed Conflict and Other Situations of Violence.

Adopted as a Council Resolution by the 194th WMA Council Session, Bali, Indonesia, April 2013,
adopted by the 64th WMA General Assembly, Fortaleza, Brazil, October 2013
and reaffirmed by the 217th WMA Council Session, Seoul (online), April 2021
and by the 229th WMA Council Session, Montevideo, Uruguay, April 2025

 

Ensuring patient safety and quality of care is at the core of medical practice. For patients, a high level of performance can be a matter of life or death. Therefore, guidance and standardisation in healthcare must be based on solid medical evidence and has to take ethical considerations into account.

Currently, trends in the European Union can be observed to introduce standards in clinical, medical care developed by non-medical standardisation bodies, which neither have the necessary professional ethical and technical competencies nor a public mandate.

The WMA has major concerns about such tendencies which are likely to reduce the quality of care offered, and calls upon governments and other institutions not to leave standardisation of medical care up to non-medical self selected bodies.

Adopted by the 194th WMA Council Session, Bali, April 2013

The World Medical Association is extremely concerned that Professor Cyril Karabus, a retired paediatric oncologist remains remanded on bail in the UAE despite a long and slow judicial process, which has absolved him of all the charges against him.

The WMA notes that the expert medical panel, appointed by the court to advise it whether there was any evidence against Professor Karabus, has advised the judge that Professor Karabus has no case to answer.  Consequently the judge dismissed all charges and a ruling of not guilty was given.  It also notes with concern that the prosecutors have indicated they will appeal the courts ruling meaning that Professor Karabus needs to remain in the UAE indefinitely.

Given the findings of the medical panel, the WMA believes that Professor Karabus is being treated in a manner, which fails to meet international fair trial standards and should be allowed to return home immediately.

In light of the above experience, the WMA will publish an advisory notice in the WMJ and on the WMA website to advise doctors thinking of working in the UAE to note the working conditions and the legal risks of employment there. The WMA will encourage member NMAs to publish similar advisory notices in their national publications.

Adopted by the 63rd WMA General Assembly, Bangkok, Thailand, October 2012
And rescinded at the 68th WMA General Assembly, Chicago, USA, October 2017

Evidence from epidemiological and other research demonstrates a clear link between the price of alcohol and levels of consumption, especially amongst young drinkers and those who are heavy alcohol users.

Setting a minimum unit price at a level that will reduce alcohol consumption is a strong public health measure, which will both reduce average alcohol consumption throughout the population and be especially effective in heavy drinkers and young drinkers.

Some states are intending to set a minimum unit price in order to reduce the medical and social effects of excessive alcohol consumption.

The WMA supports states seeking to use such innovative measures to combat the serious public and individual health effects of excessive and problem drinking.

Adopted by the 63rd WMA General Assembly, Bangkok, Thailand, October 2012,
reaffirmed with minor revision by the 217th WMA Council Session (online), Seoul, South Korea, April 2021

 

The WMA reaffirms its Resolution on Implementation of the WHO Framework Convention on Tobacco Control and emphasizes the importance of this global mechanism to protect people from exposure and addiction to tobacco and tobacco products such as nicotine. 

The WMA also reaffirms its statement on e-cigarettes and the recommendation that these products be subjected to local regulatory approval and be entrenched in smoke free laws. 

The WMA recognises that : 

  • Cigarettes offer a serious threat to the life and health of individuals that use them, and a considerable cost to the health care services of every country; 
  • Those who smoke predominantly start to do so while adolescents; 
  • There is mounting evidence that e-cigarette use predicts initiation of the use of traditional tobacco products among young people and/or non-smokers, and of additional health risks from the use of e-cigarette products.
  • There is a proven link between brand recognition and likelihood of starting to smoke; 
  • Brand recognition is strongly linked to cigarette packaging; 
  • Plain packaging reduces the impact of branding, promotion and marketing of cigarettes and e-cigarette products. 

The WMA strongly encourages national governments to support the introduction of initiatives that break brand recognition, including plain packaging of cigarettes, other tobacco products, and e-cigarettes and deplores strategies from the tobacco industry to oppose the adoption and implementation of such policy. 

 

Adopted by the 63rd WMA General Assembly, Bangkok, Thailand, October 2012
and rescinded and archived by the 75th WMA General Assembly, Helsinki, Finland, October 2024

The WMA welcomes the bail granted on the 11th of October to the retired South African paediatric haematologist, 78-year-old Professor Cyril Karabus, as a positive step given his state of health; he has cardiac disease. Dr Karabus had been detained in an Abu Dhabi, UAE prison since August 18th 2012.  He was arrested in Dubai, whilst in transit to South Africa, owing to alleged charges emanating from a brief period that he worked in the UAE in 2002.

Professor Karabus was neither informed of the charges leveled against him nor the subsequent trial that was held in absentia relating to the unfortunate death of a child with acute leukemia under his care during his tenure in the UAE in 2002.  His defense lawyer has also been unable to access any documents or files relating to the case that may assist in providing a fair defense.

Therefore,

The WMA General Assembly urgently calls on the authorities of the United Arab Emirates to ensure that Professor Karabus:

  • Is guaranteed a fair trial according to international standards;
  • Has access to the relevant documents or information he may require to prepare his defense.

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 191st WMA Council Session, Prague, April 2012
and rescinded and archived by the 71st WMA General Assembly (online), Cordoba, Spain, October 2020

Introduction

The WMA is extremely concerned about recent actions by the Turkish government that drastically reduce the self-governing authority and professional autonomy of the medical profession in Turkey. In particular, the newly enacted Government Decree 663 on the Organization and Duties of the Ministry of Health and its Associated Organizations establishes a Health Professions Board, controlled by the Ministry of Health, and delegates authority to this Board for certain critical functions that should remain with the Turkish Medical Association in keeping with the principles of professional autonomy and physician self governance. The Turkish Medical Association was established by the Turkish Parliament in 1953, while Decree 663 was passed by the government ministers of Turkey in an extraordinary process that bypassed the Parliament.

Of grave concern is the fact that the Turkish Medical Association no longer has the authority to:

  • Establish and issue ethical guidelines concerning physician conduct
  • Conduct investigations regarding alleged malpractice by physicians
  • Determine disciplinary sanctions against physicians in cases of malpractice
  • Develop core curricula for medical education, post-graduate medical specialty curricula, and content and accreditation for continuing medical education (all of which were previously done in partnership between the TMA and universities)

In addition, Decree 663 amends Article 1 of the Constituting Law of the Turkish Medical Association (originally drafted and adopted by the Parliament) by removing the following language in the TMA’s mandate: “ensuring that medical profession is practiced and promoted in line with public and individual well-being and benefit”. As a result of this restriction of its mandate, the TMA no longer has the right to legally challenge actions and regulations that adversely affect the right to health, the provision of health care, public health, and individual patient well-being. Examples might include, for instance, efforts against restrictions on which medical procedures would be reimbursed under the national health system or initiation of action to address public health hazards such as the use of cyanide in silver and gold mining and processing. The narrowing of the TMA’s mandate in this regard not only diminishes the independence of physicians, but also jeopardizes the health of their patients.

THEREFORE:

Reaffirming its unequivocal commitment to the independence and professional self-governance of the medical profession, as defined in the WMA Declaration of Madrid on Professional Autonomy and Self-Regulation, and the WMA Resolution on the Independence of National Medical Associations, the WMA Council:

  1. Urges the Turkish government to rescind Decree 663 and restore to the Turkish Medical Association its duties and responsibilities for professional autonomy and self regulation, properly established by the Parliament in 1953 through the legitimate and transparent national democratic process.
  2. Urges all physician members of Parliament, regardless of political affiliation, to recall their duties as physician leaders and support the right of the medical profession to autonomy and self-regulation.
  3. Supports and commends the Turkish Medical Association and those members of the Turkish Parliament who have challenged these recent actions and requested a legal review of this Decree by the Constitutional Court.
  4. Calls on all physicians in Turkey and around the world to join actively in advocacy efforts to promote and support professional independence, the right to health, and the health of the people of Turkey.

Adopted by the 191st WMA Council Session, Prague, April 2012

The WMA recognises that attacks on health care facilities, health care workers and patients are an increasingly common problem and the WMA Council denounces all such attacks in any country.

These often occur during armed conflict and also in other situations of violence, including protests against the state.  Patients, including those injured during protests, often come from the poorest and most marginalised parts of the community and suffer a higher proportion of serious health problems than those from wealthier backgrounds.

Governments have an obligation to ensure that health care facilities and those working in them can operate in safety and without interference either from state or non-state actors, and to protect those receiving care.

Where services are not available to patients due to government action or inaction, the government, not the health practitioners, should be held responsible.

Noting that recent and ongoing conflicts in Bahrain and Syria have seen physicians, other health care personnel and their patients attacked while in health care facilities, the WMA demands:

That states fulfill their obligations to all their citizens and residents, including political protestors, patients and health care workers, and protect health care facilities and their occupants from interference, intimidation or attack.
That governments enter into meaningful negotiations wherever such attacks are possible, likely or already occurring to stop the attacks and protect the institutions and their occupants, and
That governments consider how they can contribute positively to the work of the International Committee of the Red Cross on promoting the safety of health care provision through awareness of the concepts within their project Health Care in Danger.

Adopted by the 191st WMA Council Session, Prague, April 2012

PREAMBLE

The Economic and Monetary Union of West Africa (Union Economique et Monétaire Ouest Africaine; UEMOA) brings together eight countries of West Africa using CFA Franc as a currency. This tool of integration advocates for the free circulation and settlement of physicians in the countries of UEMOA.

There is a College of the Orders of Physicians, bringing together the Orders of member countries of the Union. The Orders are often under the supervision of the health ministries. This situation often confines the technical and administrative autonomy and impedes the good management of the medical mapping of the region, undermining access to health care for the populations.

RECOMMENDATION

Reiterating its Declaration of Madrid on Professional Autonomy and Self-Regulation and its Resolution on the Independence of National Medical Associations, the WMA requests that the independence, professional autonomy and self-regulation be guaranteed within the countries of the Economic and Monetary Union of West Africa.

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

 

RECOGNISING THAT:

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

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

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

Adopted as a Council Resolution by the 189th WMA Council Session, Montevideo, Uruguay, October 2011 and
adopted by the 62nd WMA General Assembly, Montevideo, Uruguay, October 2011
and rescinded and archived by the 75th WMA General Assembly, Helsinki, Finland, October 2024

The WMA General Assembly notes that

A number of doctors, nurses and other health care professionals in the Kingdom of Bahrain were arrested in March 2011 after the civil unrest in that country and tried under emergency powers before a special court, led by a military judge.  Twenty of this group were found guilty of a number of charges, on 29 September 2011 and sentenced to fifteen, ten or five years imprisonment.

These trials failed to meet international standards for fair trials, including the accused not being allowed to make statements in their own defence, and their lawyers not being allowed to question all the witnesses.  Allegations from the accused and their lawyers of mistreatment, abuse and other human right violations during arrest and while in detention have not been investigated.

While various criminal charges were brought it appears that the major offence was treating all the patients who presented for care, including leaders and members of the rebellion. Other charges appear to be closely related to providing such treatment and were, in any case, not proven to the standard expected in court proceedings. In treating patients without considering the circumstances of their injury these health care professionals were honouring their ethical duty as set out in the Declaration of Geneva.

The WMA welcomes the announcement by the government of Bahrain of 6 October 2011 that all twenty will be re-tried before a full civil court.

Therefore, the WMA requires that no doctor or other health care professional be arrested, accused or tried for treating patients, regardless of the origins of the patient’s injury or illness.

The WMA demands that all states understand, respect and honour the concept of medical neutrality. This includes providing working conditions which are as safe as possible, even under difficult circumstances, including armed conflict or civil unrest.

The WMA expects that if any individual, including health care professionals, are subject to trial that there is due process of law including during arrest, questioning and trial in accordance with the highest standards of international law.

The WMA demands that states investigate any allegations of torture or cruel and inhumane treatment by prisoners against its agents, and act quickly to stop such abuses.

The WMA recommends that independent international assessors are allowed to observe the trials and meet privately with the accused, so that the state of Bahrain can prove to the watching world that the future legal proceedings follow fair process.

The WMA recognises that health care workers and health care facilities are increasingly under attack during wars, conflicts and civil unrest.  We demand that states throughout the world recognise, respect and honour principles of medical neutrality and their duty to protect health care institutions and facilities for humanitarian reasons.

Adopted by the 62nd WMA General Assembly, Montevideo, Uruguay, October 2011
And amended by the 71st WMA General Assembly (online), Cordoba, Spain, October 2020

 

PREAMBLE

Around the world, tens of millions of people with cancer and other diseases and conditions experience moderate to severe pain without access to adequate treatment. These people face severe suffering, often for months on end, and many eventually die in pain. Those who may not be able to adequately express their pain – such as children, people with intellectual disabilities and those with altered consciousness– and individuals and populations that have historically been undertreated for pain and pain management due to bias, are especially at risk of receiving inadequate pain treatment.

Inadequate pain treatment contributes to individual suffering physically and emotionally, but also causes huge care burdens and negative economic impact on a national level.

However, most of the suffering is unnecessary and is almost always preventable and treatable.

In most cases, pain can be stopped or relieved with inexpensive and relatively simple treatment interventions, which can dramatically improve the quality of life for patients. Sometimes, especially in severe chronic pain, psycho-emotional factors are even more significant than physiologic factors.

Pain treatment in these cases may require a multi-faceted approach to care by multidisciplinary teams.

Over the years, the use of opioids has seen significant growth in some countries. In many other areas around the world, however, access to essential pain treatment remains limited for patients in pain. Even in countries with a high volume of use, it can be difficult for specific populations to receive adequate treatment for their pain. Incomplete pain assessment or improper use of pain medication can bring about adverse drug reactions. All of these are very important and urgent issues need to be addressed.

Governments should adopt effective measures, wherever possible, for adequate pain treatment. For this goal, governments shall ensure that healthcare professionals across fields are entitled to educational training on pain evaluation and management; that the right of all patients in pain to pain treatment is not compromised due to unnecessary regulations; and that policies on the management of controlled drugs help with effective monitoring of and prevention against risks associated with controlled drugs.

 

RECOMMENDATIONS

  1. Access to adequate pain treatment is a human right. Physicians, medical professionals and health care workers must offer pain assessment and pain treatment to patients with pain. Governments must provide sufficient resources and proper pain treatment regulations.
  2. Pain is a complex perception consisting of physical, psychological, social, cultural and spiritual sufferings. Physicians, medical professionals and health care workers must offer holistic pain assessment and appropriate pain treatment, such as pharmacological and/or non-pharmacological interventions to patients with pain. All healthcare professionals should seek to fulfill the goal of effectively evaluating the pain of all patients, including pain suffered by children, cognitively impaired patients and those unable to properly express themselves.  Healthcare professionals should also seek to effectively evaluate and treat pain in patients and populations who have historically been undertreated for pain due to implicit and explicit biases.
  3. Pain treatment and control education shall be provided to healthcare professionals including physicians, other medical professionals, and other health care workers.

Education should include pain assessment, evidence-based pain control, and the efficacy and risks of painkillers. Education should include pain medicine, including the action of opioids, preventing adverse reactions, and the adjustment and conversion of the dosage of opioids. Patient-centered care should be taught to fulfill the goal of adequately stopping pain and reducing the incidence of adverse reactions. The curriculum shall be highly competence-based in design enhancing the knowledge, the attitude, and the skills of healthcare professionals while treating pain.

Education should support the development of pain and palliative specialists, in order for them to effectively support first-line physicians and other medical professionals.

Pain treatment education for medical professionals shall include the non-medicinal treatment options. Education should equip medical professionals with proper interpersonal communication skills, cultural sensitivity, and the ability to evaluate the overall pain suffered by patients at the physiological, psychological, and spiritual levels and to empower them in inter-professional practice so that professionals can work together to alleviate the pain felt by patients with and without medication.

  1. Governments, regulators and healthcare administrators must acknowledge the consequences of pain in terms of health, productivity, and economic burden. Governments should provide ample resources and have suitable regulations governing controlled drugs.

For policies on the control of drugs, governments shall periodically review and adequately revise them to ensure the availability and accessibility of controlled drugs such as opioids. In addition, abuse and illicit use must be prevented.

  • Patients in pain shall be given access to effective pain medication, including opioids. Depriving them of such right is a violation of their right to health and is medically unethical.
  • Governments must ensure that controlled drugs, including opioids, are made available and accessible to help relieve the suffering. Relief of suffering and prevention against abuse shall be balanced in the management of controlled drugs.

Government shall provide abundant resources and create a national pain management research institute to explore issues in pain treatment and to come up with solutions, in particular:

  • Explore issues that become barriers to pain treatment, such as financial condition, socioeconomic status, patient race and ethnicity, urban and rural differences, logistics, insufficient training, and culture (the misunderstanding that people have about opioids, for example)
  • Promote the use of validated pain assessment tools.
  • Conduct studies of emerging therapies or non-medicinal therapies.
  • Establish a system and a standard procedure to record and collect pain-related data for correct statistics and monitoring. Pain-related data includes the incidence and prevalence of pain, cause of pain, burden of pain, pain treatment status, reason for pain not properly treated, and number of people with drug abuse, etc.
  1. Governments shall prepare a national pain treatment plan to be followed in pain prevention, pain treatment, pain education, and policies on the management of controlled drugs.
  • The national pain treatment plan shall be evidence-based.
  • Governments must take into consideration opinions of policymakers, medical professionals, and the general public in order to prepare a national pain treatment plan that is extensive, practical, and forward-looking, contributing to enhanced nationwide pain treatment efficacy.