Policy Type: Resolution

Adopted as a Council Resolution by the 188th WMA Council Session, Sydney, Australia, April 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and rescinded and archived by the 75th WMA General Assembly, Helsinki, Finland, October 2024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 World Medical Association is deeply concerned about reports of potential serious health impacts resulting from economic sanctions imposed by the European Union against Ivory Coast leader, Laurent Gbagbo, and numerous individuals and entities associated with his regime, including two major ports linked to Gbagbo’s government.  The sanctions aim to severely restrict EU-registered vessels from transacting business with these ports, which could inhibit the delivery of necessary and life-saving medicines.

The WMA General Assembly reiterates the following position from the WMA Resolution on Economic Embargoes and Health:

  • 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;

The WMA therefore urges the European Union to take steps immediately to ensure the delivery of medical supplies to the Ivory Coast, in order to protect the life and health of the population.

Adopted as a Council Resolution by the 189th WMA Council Session, Montevideo, Uruguay, October 2011, adopted by the 62nd WMA General Assembly, Montevideo, Uruguay, October 2011
and reaffirmed by the 217th WMA Council Session, Seoul (online), April 2021

 

National medical associations are established to act as representatives of their physicians, and to negotiate on their behalf, sometimes as a trade union or regulatory body but also as a professional association, representing the expertise of medical doctors in relation to matters of public health and wellbeing.

They represent the views of the medical profession, including attempting to ensure the practice of ethical medicine, the provision of good quality medical care, and the adherence to high standards by all practitioners.

These associations may also campaign or advocate on behalf of their members, often in the field of public health.  Such advocacy is not always welcomed by governments who may consider the advocacy to have oppositional politics attached, when in reality it is based upon an understanding of the medical evidence and the needs of patients and populations.

The WMA is aware that because of those advocacy efforts some governments attempt to silence the medical association by placing it’s own nominated representatives into positions of authority, to subvert the message into one they are better able to tolerate.

The WMA denounces such action and demands that no government interferes with the independent functioning of national medical associations.  It encourages governments to understand better the reasons behind the work of their national medical association, to consider the medical evidence and to work with physicians to improve the health and well being of their populations.

Adopted by the 61st WMA General Assembly, Vancouver, Canada, October 2010 and
reaffirmed with minor revisions by the 215th Council session (on line), Cordoba, Spain, October 2020

PREAMBLE

From the beginning of their studies and throughout their professional careers, physicians acquire the knowledge, training and competence required to treat their patients with the utmost skill and care.

Physicians determine the most accurate diagnosis and the most effective treatment to cure illness, or alleviate its effects, taking into consideration the overall condition of the patient.

Pharmaceutical products are often an essential part of the treatment approach. In order to make the right decisions in accordance with the ethical and professional principles of medical practice, the physician must have a thorough knowledge and understanding of the principles of pharmacology and possible interactions among different drugs and their effects on the health of the patient.

The prescribing of medication is a significant clinical intervention, which should be preceded by multiple, integrated processes to assess the patient and determine the correct clinical diagnosis. These processes include:

  • Taking a history of the current condition and past medical history;
  • The ability to make differential diagnosis;
  • Understanding any multiple chronic and complex illnesses involved;
  • Taking a history of the medications currently being administered successfully or previously withdrawn and also being aware of possible interactions.

Inappropriate drug prescription without proper knowledge and accurate diagnosis may cause serious adverse effects on the patient’s health. In view of the possible serious consequences that may result from an inappropriate therapeutic decision, the WMA affirms the following principles on high quality treatment and ensuring patient safety.

The WMA reiterates its support to its statements on the Relationship between Physicians and Pharmacists in Medicinal Therapy and on Biosimilar Medicinal Products.

PRINCIPLES

  1. Prescription of drugs should be based on a correct diagnosis of the patient’s condition and should be performed by those who have successfully completed a curriculum on disease mechanisms, diagnostic methods and medical treatment of the condition in question.
  2. Prescriptions issued by physicians are vital for ensuring patient safety, which in turn is critical for maintaining the relationship of trust between patients and their physicians.
  3. Although nurses and other healthcare workers cooperate in the overall treatment of patients, the physician is the best qualified individuals to prescribe independently. In some countries, laws may allow for other professionals to prescribe drugs under specific circumstances, generally with extra training and education and most often under medical supervision. In all cases, the responsibility for the patient’s treatment must remain with the physician. Each country’s medical system should ensure the protection of public interest and safety in the diagnosis and treatment of patients. If a system fails to comply with this basic framework due to social, economical or other compelling reasons, it should make every effort to improve the situation and to protect the safety of the patients.

Adopted by the 60th WMA General Assembly, New Delhi, India, October 2009
and reaffirmed by the 212th WMA Council Session, Santiago, Chile, April 2019

 

In health care, the term “Task Shifting” is used to describe a situation where a task normally performed by a physician is transferred to a health professional with a different or lower level of education and training, or to a person specifically trained to perform a limited task only, without having a formal health education. Task shifting occurs both in countries facing shortages of physicians and those not facing shortages.

A major factor leading to task shifting is the shortage of qualified workers resulting from migration or other factors. In countries facing a critical shortage of physicians, task shifting may be used to train alternate health care workers or laypersons to perform tasks generally considered to be within the purview of the medical profession. The rationale behind the transferring of these tasks is that the alternative would be no service to those in need. In such countries, task shifting is aimed at improving the health of extremely vulnerable populations, mostly to address current shortages of healthcare professionals or tackle specific health issues such as HIV. In countries with the most extreme shortage of physicians, new cadres of health care workers have been established. However, those persons taking over physicians’ tasks lack the broad education and training of physicians and must perform their tasks according to protocols, but without the knowledge, experience and professional judgement required to make proper decisions when complications arise or other deviations occur. This may be appropriate in countries where the alternative to task shifting is no care at all but should not be extended to countries with different circumstances.

In countries not facing a critical shortage of physicians, task shifting may occur for various reasons: social, economic, and professional, sometimes under the guise of efficiency, savings or other unproven claims. It may be spurred, or, conversely, impeded, by professions seeking to expand or protect their traditional domain. It may be initiated by health authorities, by alternate health care workers and sometimes by physicians themselves. It may be facilitated by the advancement of medical technology, which standardizes the performance and interpretation of certain tasks, therefore allowing them to be performed by non-physicians or technical assistants instead of physicians. This has typically been done in close collaboration with the medical profession. However, it must be recognized that medicine can never be viewed solely as a technical discipline.

Task shifting may occur within an already existing medical team, resulting in a reshuffling of the roles and functions performed by the members of such a team. It may also create new types of personnel whose function is to assist other health professionals, specifically physicians, as well as personnel trained to independently perform specific tasks.

Although task shifting may be useful in certain situations, and may sometimes improve the level of patient care, it carries with it significant risks. First and foremost among these is the risk of decreased quality of patient care, particularly if medical judgment and decision making is transferred. In addition to the fact that the patient may be cared for by a lesser trained health care worker, there are specific quality issues involved, including reduced patient-physician contact, fragmented and inefficient service, lack of proper follow up, incorrect diagnosis and treatment and inability to deal with complications.

In addition, task shifting which deploys assistive personnel may actually increase the demand on physicians. Physicians will have increasing responsibilities as trainers and supervisors, diverting scarce time from their many other tasks such as direct patient care. They may also have increased professional and/or legal responsibility for the care given by health care workers under their supervision.

The World Medical Association expresses particular apprehension over the fact that task shifting is often initiated by health authorities, without consultation with physicians and their professional representative associations.

 

RECOMMENDATIONS

Therefore, the World Medical Association recommends the following guidelines:

  1. Quality and continuity of care and patient safety must never be compromised and should be the basis for all reforms and legislation dealing with task shifting.
  2. When tasks are shifted away from physicians, physicians and their professional representative associations should be consulted and closely involved from the beginning in all aspects concerning the implementation of task shifting, especially in the reform of legislations and regulations. Physicians might themselves consider initiating and training a new cadre of assistants under their supervision and in accordance with principles of safety and proper patient care.
  3. Quality assurance standards and treatment protocols must be defined, developed and supervised by physicians. Credentialing systems should be devised and implemented alongside the implementation of task shifting in order to ensure quality of care. Tasks that should be performed only by physicians must be clearly defined.  Specifically, the role of diagnosis and prescribing should be carefully studied.
  4. In countries with a critical shortage of physicians, task shifting should be viewed as an interim strategy with a clearly formulated exit strategy. However, where conditions in a specific country make it likely that it will be implemented for the longer term, a strategy of sustainability must be implemented.
  5. Task shifting should not replace the development of sustainable, fully functioning health care systems. Assistive workers should not be employed at the expense of unemployed and underemployed health care professionals. Task shifting also should not replace the education and training of physicians and other health care professionals. The aspiration should be to train and employ more skilled workers rather than shifting tasks to less skilled workers.
  6. Task shifting should not be undertaken or viewed solely as a cost saving measure as the economic benefits of task shifting remain unsubstantiated and because cost driven measures are unlikely to produce quality results in the best interest of patients. Credible analysis of the economic benefits of task shifting should be conducted in order to measure health outcomes, cost effectiveness and productivity.
  7. Task shifting should be complemented with incentives for the retention of health professionals such as an increase of health professionals’ salaries and improvement of working conditions.
  8. The reasons underlying the need for task shifting differ from country to country and therefore solutions appropriate for one country cannot be automatically adopted by others.
  9. The effect of task shifting on the overall functioning of health systems remains unclear. Assessments should be made of the impact of task shifting on patient and health outcomes as well as on efficiency and effectiveness of health care delivery. In particular, when task shifting occurs in response to specific health issues, such as HIV, regular assessment and monitoring should be conducted of the entire health system. Such work is essential in order to ensure that these programs are improving the health of patients.
  10. Task shifting must be studied and assessed independently and not under the auspices of those designated to perform or finance task shifting measures.
  11. Task shifting is only one response to the health workforce shortage. Other methods, such as collaborative practice or a team/partner approach, should be developed in parallel and viewed as the gold standard. Task shifting should not replace the development of mutually supportive, interactive health care teams, coordinated by a physician, where each member can make his or her unique contribution to the care being provided.
  12. In order for collaborative practice to succeed, training in leadership and teamwork must be improved. There must also be a clear understanding of what each person is trained for and capable of doing, clear understanding of responsibilities and a defined, uniformly accepted use of terminology.
  13. Task shifting should be preceded by a systematic review, analysis and discussion of the potential needs, costs and benefits. It should not be instituted solely as a reaction to other developments in the health care system.
  14. Research must be conducted in order to identify successful training models. Work will need to be aligned to various models currently in existence. Research should also focus on the collection and sharing of information, evidence and outcomes. Research and analysis must be comprehensive and physicians must be part of the process.
  15. When appropriate, National Medical Associations should collaborate with associations of other health care professionals in setting the framework for task shifting. The WMA shall consider establishing a framework for the sharing of information on this topic where members can discuss developments in their countries and their effects on patient care and outcomes.

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

 

WHEREAS,

In 2006, Nicaragua adopted a penal code that criminalises abortion in all circumstances, including any medical treatment of a pregnant woman which results in the death of or injury to an embryo or fetus.

According to the UN Population Fund (UNFPA), despite improvement of national sexual and reproductive health indicators, Nicaragua continues to have one of the highest teenage pregnancy and maternal mortality rates in the Americas region, in particular in lower income rural population groups.

This legislation:

  • Has a negative impact on the health of women in Nicaragua resulting in preventable deaths of women and the embryo or fetus they are carrying.
  • Places physicians at risk of imprisonment if they carry out abortions, even to save a pregnant woman’s life, unless they follow the Nicaraguan Ministry of Health’s (MINSA) 2006 Obstetric Protocols designed for high emergency care alone.
  • Requires physicians to report to police, women and girls for suspected abortions, in breach of their duty of confidentiality towards patients and placing them in a conflict between the law and medical ethics.

The WMA Statement on Medically-Indicated Termination of Pregnancy (October 2018) provides that: “National laws, norms, standards, and clinical practice related to termination of pregnancy should promote and protect women’s health, dignity and their human rights, voluntary informed consent, and autonomy in decision-making, confidentiality and privacy. National medical associations should advocate that national health policy upholds these principles.”

The WMA reiterates its Resolution on Criminalisation of Medical Practice (October 2013) recommending that its members “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.”

THEREFORE, the World Medical Association and its constituent members urge the Nicaraguan government to repeal its penal code criminalizing abortion and develop in its place a legislation that promotes and protects women’s human rights, dignity and health, including adequate access to reproductive healthcare, and that allows physicians to perform their duties in line with medical ethics and particularly medical confidentiality.

Adopted by the 50th World Medical Assembly, Ottawa, Canada, October 1998
revised by the 60th WMA General Assembly, New Delhi, India, October 2009 and
the 74th WMA General Assembly, Kigali, Rwanda, October 2023

 

PREAMBLE 

The medical workforce is essential to healthcare systems. To meet the present and future health needs of the global populations, adequate healthcare services in all fields of medicine should be provided. This requires ensuring sufficient numbers of trained physicians in all countries taking into consideration evolving populational healthcare needs as well as physicians’ right to international mobility, while preserving the well-being and safety of both patients and physicians.

Population growth in many parts of the world, combined with ageing populations in other regions point toward an increasing shortage of physicians. Comprehensive and extensive medical workforce planning on both the national level and the international levels is therefore essential, within an ethical coordinated global framework, as recommended in WHO Global Code of Practice on the international Recruitment of Health Personnel. In this regard, the WMA reaffirms its Statement on Ethical Guidelines for the International Migration of Health Workers, and its Resolution on Task shifting in dealing with the significant global shortages of medical workforce [1].

Inadequate working conditions and the lack of support to the medical workforce has exacerbated the workforce shortage situation causing physicians to leave their home countries. This phenomenon occurred especially during the COVID-19 pandemic, which has renewed focus on physicians’ well-being and safety.

In this regard the WMA reaffirms its policies on Bullying and Harassment within the Profession, Physician well-being, Protection and Integrity of Medical Personnel in Armed Conflicts and Other Situations of Violence, Workplace Violence in the Health Sector, Epidemics and Pandemics, the Medical Profession and COVID-19, Digital Health, as well as Augmented Intelligence in Healthcare, Gender Equality in Medicine and Medical Education.

Thriving both professionally and personally is critical for the medical workforce to carry out their vital responsibilities, and to ensure quality healthcare services.

The World Health Organization (WHO) has developed several instruments that support the medical workforce, and acknowledge the global urgency to support and protect health personnel, in particular:

 

RECOMMENDATIONS

The WMA stresses the need for comprehensive and gender equal measures to guarantee physicians’ well-being and safety via an adequate working environment, including in emergency contexts, and emphasizes on the employer’s responsibility to ensure it.

The WMA calls on the following stakeholders to:

WHO and other relevant international entities

  1. strengthen the management of the medical workforce through international cooperation and consensus;
  2. provide timely data and information to guide the international and national efforts on medical workforce recruitment and retention;
  3. identify the skills, knowledge and ways of working that the evolving workforce will require in the future.

Academic institutions

  1. ensure that the education, training and development of the medical workforce meets the highest possible standards, including student support, and that they are carried out with solidarity, consideration and mutual respect;
  2. conduct and publish research on the impact of working conditions of physicians on the quality of healthcare services provided, and on the effectiveness of interventions aimed at ensuring workplace safety;
  3. include clinical informatics and digital health literacy in medical training and education to ensure the workforce is equipped with the skills and knowledge to harness existing and emerging technologies, in accordance with the principle of confidentiality, to improve health outcomes.

Governments / Health authorities

  1. guarantee the ethical international recruitment of health personnel, considering the rights, obligations and expectations of source countries, destination countries and migrant health personnel, in reference to WHO Global Code of Practice on the International Recruitment of Health Personnel;
  2. develop and implement Positive Practice Environments in health care settings in line with the World Health Professions Alliance (WHPA) campaign in order to increase physician retention;
  3. establish an appropriate monitoring and reporting mechanisms at institutional and system level, to document deviations from best practices for healthcare workplaces, e.g. unacceptable working conditions, shortage of staff and equipment. Such a database should be made available to professional organizations and other relevant stakeholders;
  4. ensure that appropriate and safe patient to physicians’ ratios are maintained between the populations and the medical workforce at all levels, including mechanisms to align supply with population healthcare need, and address access to care in rural and remote areas, based on evidence-based workforce planning, accepted international norms and standards where these are available, and in accordance with the WMA Statement on Access to Healthcare;
  5. directly address the obligations of hospitals’ commercial management and/or representative organizations to ensure safe and healthy working conditions;
  6. allocate sufficient financial resources for the education, training and development of the medical workforce to meet the health needs of the entire population in the country in reference to the WMA Statement on Medical Education;
  7. combat discrimination and foster inclusive policies for physicians and personnel from foreign countries;
  8. adequately engage and collaborate with medical professional bodies on the development and implementation of policies impacting on medical practice, such as policies around Universal Health Coverage, reimbursement, and allocation/distribution of medical personnel, in accordance with the WMA Declaration of Seoul on Professional Autonomy and Clinical Independence;
  9. adequately invest in the recruitment and retention of the needed medical workforce via the improvement of working conditions, including:
    • provision of fatigue management and safe rostering practices, including consideration of a maximum of weekly working hours for physicians in all health care establishments to prevent burnout and sustain motivation,
    • access to appropriate facilities, equipment, treatment modalities, etc.
    • adequate support from other trained healthcare professionals,
    • protection from harassment, violence, workplace stress, stigma and forced labour,
    • access to career development opportunities at all professional levels, including promotion of equity, inclusion and diversity,
    • adequate professional support and fair remuneration.
  1. in partnership with health professions’ organisations, timely anticipate potential imbalances between the supply and demand of medical workforce in order to assess future needs in human resources and design plans to meet those needs;
  2. address telemedicine in the contractual responsibilities of recruited physicians while recognizing the diverse needs of the medical workforce by enabling greater work-life balance, through flexible and remote working where clinically appropriate;
  3. develop transparent memoranda of understanding between countries where migration of physicians is an issue of concern.

WMA constituent members

  1. promote WHPA Positive Practice Environments campaign to create health care settings that are high quality and supportive workplaces;
  2. advocate for governments to develop policies to support the recruitment of physician candidates from within their own countries;
  3. actively advocate for the protection of physicians from harm, while promoting adequate working and living conditions;
  4. work with the government to devise appropriate policies addressing multidisciplinary practice;
  5. promote regular evaluation and improvement of the workforce planning solutions’ impact and effectiveness.

 

[1]Terminology:
– The term “medical workforce” in the text refers to physicians.
– According to WHO Health Workforce-related terminology:
“Health workforce” refers to health workers considered collectively.
“Health workers” are all people primarily engaged in actions with the primary intent of enhancing health.

 

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

 

WHEREAS, 

Physicians in the Islamic Republic of Iran have reported: 

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

THEREFORE, the World Medical Association 

  1. Reaffirms its Declaration of Lisbon on the Rights of the Patient, which states that whenever legislation, government action or any other administration or institution denies patients the right to medical care, physicians should pursue appropriate means to assure or to restore it.  
  2. Reaffirms its Declaration of Hamburg Concerning Support for Medical Doctors Refusing to Participate in, or to Condone, the Use of Torture or Other Forms of Cruel, Inhuman or Degrading Treatment, which encourages doctors to honor their commitment as physicians to serve humanity and to resist any pressure to act contrary to the ethical principles governing their dedication to this task. 
  3. Reaffirms its Declaration of Tokyo – Guidelines for Physicians Concerning Torture and other Cruel, Inhuman or Degrading Treatment or Punishment in Relation to Detention and Imprisonment, which: 
  • Prohibits physicians from participating in, or even being present during the practice of torture or other forms of cruel or inhuman or degrading procedures; 
  • requires that physicians maintain utmost respect for human life even under threat and prohibits them from using any medical knowledge contrary to the laws of humanity. 

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

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

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

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

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

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

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

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

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

Adopted by the 50th World Medical Assembly, Ottawa, Canada, October 1998
and amended by the 60th WMA General Assembly, New Delhi, India, October 2009 and
rescinded and archived by the 70th WMA General Assembly, Tbilisi, October 2019

INTRODUCTION

Each country should have a health system with enough resources to attend to the needs of its population. However today, many countries across the world are suffering wide inequities and inequalities in health care and this is causing problems of access to health services for the poorer segments of society [the weak or underprivileged]. The situation is especially serious in low-income countries.

The international community has attempted to improve the situation. The 20/20 initiative of 1995, the 1996 Initiative for Heavily Indebted Poor Countries (HIPC), and Objectives for Millennium 2000 Development (MDGs) are all initiatives aimed at reducing poverty and dealing with poor health, inequities and inequalities between the sexes, education, insufficient access to drinking water and environmental contamination.

The objectives are formed as an agreement with acknowledgement of the contributions which developed countries can make, in the shape of trade relations, development assistance, reduction of the burden of debt, improving access to essential medication and the transfer of technology. Three of the eight objectives are directly related to health, which has a considerable influence on various other objectives that interact to support each of the others within a structural framework, these are designed to increase human development globally. The eight Millennium Development Objectives (MDO) foresee a development vision based on health and education, thus affirming that development does not only refer (allude) to economic growth.

Various reports from the World Health Organization have underlined the opportunities and skills [or techniques] which are currently involved in bringing about significant improvements in health, as well as helping to reduce poverty and encourage growth. Additionally, the reports highlight the fact that it is of fundamental importance to reduce limitations on human resources, in order to increase the achievements of the public health system, a situation which requires urgent attention. These limitations are related to work, training and payment conditions, and play a substantial role in determining capacity for sustained growth of access to health services.

RECOMMENDATIONS

The World Medical Association urges National Medical Associations to:

1. Advocate that their governments should adhere to and promote the proposals to increase investment in the health sector; and to adhere to and promote initiatives to reduce the debt burden for the poorest countries on the planet.

2. Advocate [defend] the inclusion of public health factors in all fields of policy provision, since health is mostly determined by factors that are external to the area of healthcare, for example, housing and education. [Health is not only medicine, it also depends on living standards].

3. Encourage and support countries in the planning and implementation of investment plans, which invest in health for the poor; guarantee that more resources be used for health in general, with greater efficiency and impact; and reduce limitations for the most effective use of the additional investments.

4. Maintain vigilance to ensure that the investment plans focus maximum attention on generating capacity, that they promote leadership skills and promote incentives to retain and place qualified personnel, whilst it is taken into consideration that the limitations in relation to the previous matter currently constitute the greatest obstacle for progress.

5. Urge international financial institutions and other important donors to: i) Adopt the necessary measures to help the countries that have already organised mechanisms to prepare their investment plans, and provide assistance to those countries that have begun to take the necessary steps, with the support and participation of the international community; ii) Help countries to obtain funds to develop and implement their investment plans; iii) Continue providing technical assistance to the countries for their plans.

6. Exchange information in order to coordinate efforts to change policies in these areas.

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

WHEREAS:

Recent international conflicts, including the Israeli-Palestinian conflict in Gaza, the conflict in Sri Lanka, the conflict in Darfur, and the conflict in the Democratic Republic of Congo, have led to loss of life and the impairment of living conditions; and International standards of medical neutrality must be upheld throughout such conflicts;

THEREFORE, the WMA

  1. Reaffirms its policy, “Regulations in Time of Armed Conflict” and the obligations of physicians stated in this document. The WMA calls on its members to act in accordance with all internationally accepted principles of healthcare delivery in times of conflict.
  2. Reiterates its commitment to the universal right to health, and access to the highest attainable standard of health care. This universal right is not conditional on peaceful existence, although a peaceful existence accommodates greater ability to provide health to all.
  3. Reaffirms the obligation incumbent on all parties involved in conflict situations to abide by the rules of international medical ethics, a swell as the provisions of international humanitarian law, as expressed in the Geneva Conventions, particularly their common article 3, and, specifically, to assure the provision of medical care and/or evacuation of the trapped and wounded and to refrain from targeting medical personnel and medical facilities.

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

WHEREAS:

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

THEREFORE, the WMA

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

Adopted by the 59th WMA General Assembly, Seoul, Korea, October 2008,
reaffirmed with minor revision by the 210th WMA Council Session, Reykjavik, Iceland, October 2018
and by the 224th WMA Council, Kigali, Rwanda, October 2023

PREAMBLE

The majority of the existing human infectious diseases, including the bioterrorism agents, are zoonoses. Zoonoses can, by definition, infect both animals and humans. By their very nature, the fields of human medicine and veterinary medicine are complementary and synergistic in confronting, controlling and preventing zoonotic diseases from infecting across species.

Collaboration and communication between human medicine and veterinary medicine have been limited in recent decades, yet the challenges of the 21st Century demand that these two professions work together in times when there is an increased risk of zoonotic diseases due to globalization and climate change, in addition to changes in human behavior.

An initiative, often called the “One Health” initiative, is being developed to improve the lives of all species through the integration of human and veterinary medicine. “One Health” aims to promote and implement close meaningful collaboration and communication between human medicine, veterinary medicine and all allied health scientists with the goal of hastening human public health efficacy as well as advanced health care options for humans (and animals) via comparative biomedical research.

To foster such collaboration and communication, the WMA works with other health professions though the World Health Professions Alliance, as well as with the World Veterinary Association.

The WMA recognizes the ways in which animals and animal care may affect human health and disease through its own current policies, particularly its statements on Animal Use in Biomedical Research, Antimicrobial Resistance and on Avian and Pandemic Influenza. The WMA also recognized the impact that climate change has on health, through its Declaration on Health and Climate Change.

RECOMMENDATIONS

That the World Medical Association:

  1. Support collaboration between human and veterinary medicine.
  2. Support the concept of joint educational efforts between human medical and veterinary medical schools.
  3. Encourage joint efforts in clinical care through the assessment, treatment, and prevention of cross-species disease transmission.
  4. Support cross-species disease surveillance and control efforts in public health, particularly the identification of early disease and outbreak trends.
  5. Recalling its Statement on Antimicrobial Resistance, urge joint commitment to the prevention and control of antimicrobial resistance by avoiding overuse and misuse of antimicrobials in human and veterinary medicine, as well as in food production.
  6. Support the need for joint efforts in the development, integration and evaluation of screening tools, diagnostic methods, medicines, vaccines, surveillance systems and policies for the prevention, management and control of zoonotic diseases.
  7. Pursue and consolidate its dialogue with the World Veterinary Association to discuss strategies for enhancing collaboration between human and veterinary medical professions in medical education, clinical care, public health, and biomedical research.
  8. Encourage its Constituent Members to engage in a dialogue with their veterinary counterparts to discuss strategies for enhancing collaboration between human and veterinary medical professions within their own countries.

Adopted by the 59th WMA General Assembly, Seoul, Korea, October 2008
and rescinded at the 69th WMA General Assembly, Reykjavik, Iceland, October 2018

Whereas the World Health Organization (WHO) has indicated that a small number of countries in the world consume 80% of the opiates legally available worldwide, leaving significant unmet needs in the rest of the world, especially in developing countries;

Whereas morphine and diamorphine play an essential role in the treatment of moderate and severe pain, especially in meeting the pain needs of the growing number of end-stage HIV/AIDS and cancer patients;

Whereas the International Narcotics Control Board (INCB) has asked the international community to promote the prescription of painkillers, especially in poor countries, as severe under-treatment is reported in more than 150 countries where hardly anyone in need of treatment is being treated, and in another 30 countries, where under-treatment is even more prevalent or where no data are available;

Whereas there exists an illegal opium crisis in Afghanistan, with growing poppy cultivation and opium production;

Therefore, the World Medical Association:

  • Supports the investigation of possibilities for the controlled production of opium for medical purposes in Afghanistan through a scientific pilot project in Afghanistan; and
  • Urges governments to support a scientific pilot project to investigate whether certain areas of Afghanistan could provide the right conditions for the strictly controlled production of morphine and diamorphine for medical purposes.

Adopted by the 65th WMA General Assembly, Durban, South Africa, October 2014
and reaffirmed by the 217th WMA Council Session, Seoul (online), April 2021
and rescinded and archived by the 75th WMA General Assembly, Helsinki, Finland, October 2024

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

  1. The WMA calls upon the Qatar government and construction companies to ensure the health and safety of migrant workers;
  2. 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;
  3. 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 59th WMA General Assembly, Seoul, Korea, October 2008
and rescinded at the 69th WMA General Assembly, Reykjavik, Iceland, October 2018

The current global economic crisis is affecting individuals as well as national and global economies and will have implications for health. Individuals face uncertainties about their future and psychological consequences are beginning to emerge. Governments facing economic downturns have to respond by cutting down national expenses. There is a risk that expenditure on health care will decrease nominally and proportionally in the coming years. Experience has shown that this response can have serious consequences on the health of individuals and on their contribution to the national economy. Any savings will therefore be reduced.

The WMA therefore urges NMAs to work with their governments to:

  • Initiate programs for families and individuals needing medical and psychological support because of the current economic crisis.
  • Preserve at least the current expenditure on health.

Adopted by the 50th World Medical Assembly, Ottawa, Canada, October 1998,
revised by the 59th WMA General Assembly, Seoul, Korea, October 2008,
reaffirmed by the 209th WMA Council Session, Riga, April 2018, and
reaffirmed with minor revisions by the 224th WMA Council, Kigali, Rwanda, October 2023

 

PREAMBLE

Anti-personnel mines are designed to injure or kill indiscriminately any person coming into contact with them or within their proximity. They have a long-term devastating impact with civilian deaths and injuries, even after the war is over. The harmful effects on health care services and other essential services to the populations, such as electricity or water, can also be critical.

The WMA is firmly opposed to the use of anti-personnel landmines and expresses its support to the Convention on the Prohibition of the Use, Stockpiling, Production and Transfer of Anti-Personnel Mines and on their Destruction, usually referred to as the Ottawa Convention or the Anti-Personnel Mine Ban Treaty.

 

RECOMMENDATIONS

The World Medical Association:

  1. urges its constituent members to press their governments to sign and ratify the Convention, and to ensure its implementation in all its provisions;
  2. urges its constituent members to press their governments to cease manufacture, sale, deployment and use of landmines.

Adopted by the 58th WMA General Assembly, Copenhagen, Denmark, October 2007,
reaffirmed with minor revision by the 207th WMA Council session, Chicago, United States, October 2017
and revised by the 74th WMA General Assembly, Kigali, Rwanda, October 2023

 

PREAMBLE

A lack of physicians, especially in vulnerable and peri-urban areas, is a worldwide phenomenon that has serious implications for health systems, demanding policies to assure the provision and retention of health personnel. The implementation of programs, such as the More Doctors Program (PMM), in deprived areas in Latin America and the Caribbean has provided doctors to support primary health care which would otherwise not be carried out due to the shortage of doctors.

In particular, the PMM has provided a great number of foreign doctors, predominantly from Cuba, to work in the primary health care systems where the distribution of primary care physicians was insufficient.

Specifically, during the COVID-19 pandemic, Cuba has sent thousands of Cuban doctors abroad, to meet the demands of many countries. In addition, international health establishments, such as the Pan American Health Organization, have facilitated the placement of Cuban doctors.

However, programs like the PMM also give cause for concern:

  • Potential health benefits are undermined due to the widespread allocation of doctors to non-priority areas and local substitution effects.
  • The Cuban government keeps three-quarters of the health personnel’s salaries, and many doctors complain of dreadful working conditions.
  • Documented reports reveal arrangements between the Cuban government and certain Latin American and Caribbean governments to bypass credentialing systems established, to verify physicians’ credentials and competence and protect patients. As a result, patients may be put at risk by unregulated medical practices and unqualified physicians.

 

RECOMMENDATIONS

Recalling its Statement on Ethical Guidelines for the International Migration of Health workers, whereby “Physicians who are working, either permanently or temporarily, in a country other than their home country should be treated fairly in relation to other physicians in that country” and that bilateral agreements require “due cognizance of international human rights law, so as to effect meaningful co-operation on health care delivery”, the WMA:

  1. condemns any policies or actions by governments that subvert or bypass the accepted standards of medical credentialing and medical care;
  2. calls on the governments to work with medical associations within the region on all matters related to physician certification and the practice of medicine and to respect the role and rights of these medical associations and the autonomy of the medical profession;
  3. urges, as a matter of utmost concern, governments to respect the WMA International Code of Medical Ethics, the Declaration of Madrid on Professionally-led Regulation, the Declaration of Seoul on Professional Autonomy and Clinical Independence and the Statement on Ethical Guidelines for the International Migration of Health workers;
  4. calls for adequate and sustainable investment in national health care systems and medical education as a matter of priority to ensure that the highest standard of care is available to the entire population.

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

PREAMBLE

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

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

RECOMMENDATION

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

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

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

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

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

Adopted by the 57th WMA General Assembly, Pilanesberg, South Africa, October 2006
and reaffirmed by the 203rd WMA Council Session, Buenos Aires, Argentina, April 2016 
and reaffirmed with minor revisions by the 218th Council session (online), London, United Kingdom, October 2021 

 

Recalling its Statement on Nuclear Weapons, the WMA: 

  • Denounces North Korean nuclear testing conducted at a time of heightened global vigilance on nuclear testing and arsenals; 
  • Calls for the immediate abandonment of the testing of nuclear weapons by any nation;  
  • Requests its constituent members and other representatives of the medical profession across the world to urge their governments to understand the adverse health and environmental consequences of the testing and use of nuclear weapons; and 

 

Adopted by the 57th WMA General Assembly, Pilanesberg, South Africa, October 2006
and rescinded by the 67th WMA General Assembly, Taipei, Taiwan, October 2016 

MINDFUL that the WMA Statement on HIV/AIDS and the Medical Profession was adopted at the 57th WMA General Assembly in Pilanesberg, Republic of South Africa, on 14 October 2006; and RECOGNIZING the alarming statistic from UNAIDS that some 37-38 million people worldwide are infected with HIV, with the number increasing daily, and that 60% percent of them live in sub-Saharan Africa; and

NOTING that there exist evidence-based methods for preventing the spread of the infection and also for life-prolonging treatment; therefore

The WMA urges governments to work closely with health professionals and their representative organizations to identify and implement the critical steps to ensure

  1. that all efforts are made to prevent the spread of HIV/AIDS;
  2. that the diagnosis, counselling and treatment of patients for HIV/AIDS is undertaken only by appropriately trained physicians and other healthcare personnel, according to established evidence-based principles;
  3. that patients be given accurate, relevant and comprehensive information to enable them to make informed decisions about their health care treatment; and
  4. that barriers preventing people from coming forward for testing and treatment be identified and eliminated.

The WMA calls on National Medical Associations to use this resolution in their advocacy efforts to their governments, their patients and the public.

Adopted by the 174th WMA Council Session, Pilanesberg, South Africa, October 2006
and rescinded at the 67th WMA General Assembly, Taipei, Taiwan, October 2016

There are credible reports that arrangements between the Cuban government and the Bolivian government to supply Cuban physicians to Bolivia are bypassing systems, established to protect patients, that have been set up to verify physicians’ credentials and competence.

The World Medical Association is significantly concerned that patients are put at risk by unregulated medical practices, including the provision of drugs and medical supplies that are improperly labeled and of uncertain origin.

There exists already a duly constituted and legally authorized Bolivian Medical Association, which is charged with the registration of physicians and which is required to be consulted by the Bolivian Ministry of Health.
Therefore, the WMA:

  1. Condemns any collusion of two countries in policies and practices that disrupt the accepted standards of medical credentialing and medical care;
  2. Calls upon the Bolivian government to work with the Bolivian Medical Association on all matters related to physician certification and the practice of medicine and to respect the role and rights of the Bolivian Medical Association;
  3. Urges, as a matter of utmost concern, that the Bolivian government respect the WMA International Code of Medical Ethics that guides the medical practice of physicians all over the world.

Adopted by the 57th WMA General Assembly, Pilanesberg, South Africa, October 2006
Revised by the 68th WMA General Assembly, Chicago, United States, October 2017
and reaffirmed with minor revisions by the 221st WMA Council Session, Berlin, Germany, October 2022

 

PREAMBLE

 According to the World Health Organization, tuberculosis is a significant global public health problem. South East Asian and African countries are most affected.

In developing countries, the incidence of tuberculosis (TB) has risen dramatically because of high prevalence of HIV/AIDS, increasing migration of populations, urbanisation and over-crowding. The incidence and severity of the disease are closely associated with the social and economic living conditions within a population as well as the availability of resources within a health system.

Tuberculosis is also a significant threat to patients with cancers, organ transplants, and those receiving immunologic therapies for various diseases.

The emergence of strains of tuberculosis bacteria resistant to first line drugs have become a major public and global health threat in the forms of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB). MDR-TB and XDR-TB are indicators of the growing antimicrobial resistance whose drivers are multifactorial and complex and require a multisectoral approach.

Community awareness and public health education and promotion are essential elements of tuberculosis prevention.

Screening of high-risk groups including PLHIV (people living with HIV), health personnel from endemic countries as well as vulnerable populations including migrants, prisoners, and the homeless should be considered within each national epidemiological context as a component of tuberculosis prevention. Systematic screening of contacts of infected persons is also recommended.

Rapid diagnosis with molecular tests and starting supervised daily treatment early should help arrest the spread of disease.

BCG (Bacille Calmette-Guérin) vaccination as early as possible after birth should continue, in line with International Union against Tuberculosis and Lung Disease (IUATLD) criteria, until a new more effective vaccine is available.

Intensified research and innovation are also considered imperative if attempts to address the epidemic and emerging resistance are to be successful.

 

RECOMMANDATIONS

In line with its “Declaration of Oslo on Social Determinants of Health” and its “Declaration of Edinburgh on Prison Conditions and the Spread of Tuberculosis and Other Communicable Diseases”, the World Medical Association emphasizes that tuberculosis is a disease associated with socioeconomic factors such as poverty, poor housing, malnutrition and stigma, and recommends that these factors are fully considered and integrated in policies to end TB.

The WMA supports WHO “End TB Strategy” and calls upon all governments, communities, civil societies and the private sectors to act together to end tuberculosis world-wide.

The WMA, in consultation with WHO and national and international health authorities and organizations, will therefore continue advocating to generate community awareness about symptoms of TB and increase capacity building of health personnel in early identification and diagnosis of TB cases and to ensure complete treatment utilizing patient-centered treatment support, including Directly Observed Treatment Short course or other appropriate therapy.

The WMA further calls:

Member States

1.To ensure equitable access to existing tuberculosis interventions;

2. To allocate adequate financial, material and human resources for tuberculosis and HIV/AIDS research and prevention, including adequately educated health care providers and adequate public health infrastructure;

3. To ensure to health care professionals full access to all required medical and protective equipment to guard against the risk of infection and spread of the disease;

4. To foster efforts to build up the capacity of health care professionals in the use of rapid diagnostics methods, the availability of these methods in the public and private sector and in the management of all forms of TB, including MDR and XDR.

5. To address the burden of MDR and XDR TB in prison populations by ensuring drug susceptibility tests on isolates from patients with active TB are performed as soon as possible, and when patient compliance is a problem, implementing programs of directly observed therapy.

Constituent Members

6. To support their National TB Programmes by generating awareness among healthcare professionals about TB management and early reporting of cases in the community.

7. To promote methods of TB prevention including respiratory hygiene, cough etiquettes, and safe sputum disposal.

8. To encourage their members to notify to relevant authorities, about all patients diagnosed with TB or put on TB treatment in a timely manner for initiation of contact screening and adequate follow up till the completion of treatment.

9. To encourage the development of strong pharmacovigilance and active TB drug-safety monitoring and management, to detect, manage and report suspected or confirmed drug toxicities, and encourage all their members to contribute actively to these systems.

10. To co-ordinate with their TB National Programme and promote the adopted guidelines to all members.

Adopted by the 57th WMA General Assembly, Pilanesberg, South Africa, October 2006,
and reaffirmed by the 203rd WMA Council Session, Buenos Aires, Argentina, April 2016,
and reaffirmed with minor revisions by the 218th Council session (online), London, United Kingdom, October 2021 

 

PREAMBLE 

Air travel is a common mode of transportation and is used by people of all ages every day. The WMA notes that high standards of safety for adult passengers in air travel have been achieved, with strict safety procedures increasing greatly the chance of survival during emergency situations in aircraft.  

Restraint and safety systems for infants and children have been successfully tested to reduce the risk of suffering injuries in case of emergency. Those systems have been approved for usage in standard passenger aircrafts and successfully introduced by several airlines. However, the practice of holding an infant or child in a lap or using a “loop belt” continues and is not a sufficient safety measure. 

 

RECOMMENDATIONS 

 Therefore, the World Medical Association and its constituent members 

  1. Express grave concern regarding the fact that adequate safety systems for infants and children have not been generally implemented; 
  2. Call on all airline companies to take immediate steps to introduce safe, thoroughly tested and standardized child restraint systems; 
  3. Call on all airline companies to train their staff in the appropriate handling and usage of child restraint systems; 
  4. Call for the establishment of a universal standard or specification for the testing and manufacturing of child restraint systems, and 
  5. Call on national legislators and air transportation safety authorities to: 
  • require for infants and children, as a matter of law, safe individual child restraint systems that are approved for use in standard passenger aircraft; 
  • ensure that airlines provide child restraint systems or welcome passengers using their own systems, if the equipment is qualified and approved for the specific aircraft; 
  • ban the usage of inappropriate “loop belts” frequently used to secure infants and children in passenger aircraft; 
  • provide appropriate information about infant and child safety on board of aircraft to all airline passengers. 

 

 

 

Adopted by the 170th WMA Council Session, Divonne-les-Bains, France, May 2005
and reaffirmed by the 176th WMA Council Session, Berlin, Germany, May 2007
and rescinded at the 66th WMA General Assembly, Moscow, Russia, October 2015 

WHEREAS, a reported 300,000 Darfurians have been killed and one million refugees displaced since early 2003, on the basis of racial or ethnic origins; and

WHEREAS, there have been official reports of savage killing, torture, rape and mutilation of men, women and children by the Government of Sudan and its allied militia; and

WHEREAS, many of these reports, including that of the UN Commission of Inquiry on Darfur, have only recently been publicized; and

WHEREAS, genocide, as defined by the 1948 UN Convention on the Prevention and Punishment of the Crime of Genocide, is the killing or destroying of populations on the basis of their racial or ethnic identity; and

WHEREAS, the WMA, as an international medical organization committed to the protection of health and human rights for all, has expressed its support for human rights in statements and resolutions, among them the Resolution on Human Rights, adopted by the WMA in Rancho Mirage during the 42nd General Assembly and amended by the 45th, 46th and 47th General Assemblies,

THEREFORE, BE IT RESOLVED, that the WMA condemns the genocide in Darfur and calls upon its member NMAs to urge their governments and the international community to take immediate action to stop the mass killings, expulsions, rape and destruction in Darfur and to protect the health and safety of refugees in the region.

Adopted by the 171st WMA Council Session, Santiago, Chile, October 2005
and rescinded at the 66th WMA General Assembly, Moscow, Russia, October 2015 

Chronic non-communicable diseases are a rapidly growing problem worldwide. They have major adverse health, social and economic effects especially in poor nations.

The WMA Council welcomes the work of the WHO on “Preventing Chronic Diseases, a vital investment” and recommends that all NMAs work with health professional organizations, interested stakeholders and their governments to prevent and relieve the increasing burden of chronic disease.

Adopted by the 170th WMA Council Session, Divonne-les-Bains, France, May 2005
and rescinded at the 66th WMA General Assembly, Moscow, Russia, October 2015 

Recognising that the lack of healthcare workers in developing countries, particularly those in sub-Saharan Africa, is one of the most serious global problems of today and that the impact of healthcare worker migration from developing to developed countries is a significant component in the crisis,

Therefore, be it resolved:

  1. That the WMA reaffirms its 2003 Statement on Ethical Guidelines for the International Recruitment of Physicians, particularly para. 14: “Every country should do its utmost to educate an adequate number of physicians, taking into account its needs and resources. A country should not rely on immigration from other countries to meet its need for physicians”; and para. 15: “Every country should do its utmost to retain its physicians in the profession as well as in the country by providing them with the support they need to meet their personal and professional goals, taking into account the country’s needs and resources.”
  2. That developed countries must assist developing countries to expand their capacity to train and retain physicians and nurses, to enable developing countries to become self-sufficient.
  3. That action to combat the skills drain in this area must balance the right to health of populations (Universal Declaration of Human Rights (1948), Article 25.1; International Covenant on Economic, Social, and Cultural Rights (1976), Article 12.1.) and other individual human rights.
  4. That the WMA reconvene the expert working group on physician resources to coordinate development of WMA input to WHO preparations for the decade on human resources for health.
  5. That the WMA commend WHO for taking a leadership role in the global challenges of human resources for health; commend to WHO the afore-mentioned principles (1, 2 and 3); and call upon WHO to convene a global roundtable to discuss HHR issues.

Adopted by the 40th World Medical Assembly, Vienna, Austria, September 1988
and editorially revised by the 170th WMA Council Session, Divonne-les-Bains, France, May 2005
and reaffirmed by the 200th WMA Council Session, Oslo, Norway, April 2015 

WHEREAS academic sanctions or boycotts are discriminatory restrictions on academic, professional and scientific freedoms that deny or exclude physicians and others from educational, cultural and scientific meetings and other opportunities for the exchange of information and knowledge, the purpose of such restrictions being to protest the social and political policies of governments, and
WHEREAS such restrictions are in direct conflict with the major objectives of the WMA, viz., to achieve the highest international standards in medical education, medical science, medical art and medical ethics, and
WHEREAS such restrictions adversely affect health care, particularly of the disadvantaged, and therefore thwart the WMA’s objective of obtaining the best possible health care for all people of the world, and
WHEREAS such restrictions discriminate against physicians and patients on grounds of political persuasion or of political decisions taken by governments and are therefore in conflict with the WMA’s Declaration of Geneva, Statement on Non-Discrimination in Professional Membership and Activities of Physicians and Statement on Freedom to Attend Medical Meetings, and
WHEREAS a basic rule of medical practice is “primum non nocere”, i.e. first, do no harm,

THEREFORE BE IT RESOLVED, that the WMA regards the application of such restrictions as arbitrary political decisions designed to deny international scholarly exchange and to blacklist particular physicians or bodies of physicians because of their nationality or because of the political policies of their governments. The WMA is unalterably opposed to such restrictions and calls on all National Medical Associations to resist the imposition of such restrictions by every means at their disposal and to heed the WMA’s Statement on Non-Discrimination in Professional Membership and Activities of Physicians and the WMA Statement on Freedom to Attend Medical Meetings.

Approved by the 55th WMA General Assembly, Tokyo, Japan, October 2004,
reaffirmed by the 197th WMA Council Session, Tokyo, Japan, April 2014
and by the 217th WMA Council Session, Seoul (online), April 2021
and revised by the 74th WMA General Assembly, Kigali, Rwanda, October 2023

 

Whereas the WMA:

  1. Recognizes the need and importance for sound global standards for quality improvement of medical education;
  2. Acknowledges the WMA's special relationship with the World Federation for Medical Education (WFME) as one of the founders of the Federation;
  3. Recognizes that it is represented in the WFME Executive Council and in this capacity is co-responsible for the WFME Project on International Standards in Medical Education, conducted since 19971;
  4. Acknowledges the development of the WFME Trilogy of Documents of Global Standards in Medical Education for Quality Improvement, covering Basic Medical Education2, Postgraduate Medical Education3 and the Continuing Professional Development (CPD) of Medical Doctors4;
  5. Recognizes the endorsement5 of the WFME Global Standards at the World Conference in Medical Education: Global Standards in Medical Education for Better Health Care, in Copenhagen, Denmark, March 20036;

It hereby:

  1. Expresses its encouragement and support of the ongoing work of implementing the Trilogy of WFME Documents on Global Standards in Medical Education.

 

References:

  1. The Executive Council, The World Federation for Medical Education: International standards in medical education: assessment and accreditation of medical schools´ educational programmes. A WFME position paper. Med Ed 1998; 32: 549-558.
  2. World Federation for Medical Education: Basic Medical Education. WFME Global Standards for Quality Improvement. WFME, Copenhagen 2003. http://www.wfme.org
  3. World Federation for Medical Education. WFME Standards for Postgraduate Medical Education 2023
  4. World Federation for Medical Education: Continuing Professional Development (CPD) of Medical Doctors. WFME Global Standards for Quality Improvement. WFME Copenhagen 2003. http://www.wfme.org
  5. J.P. de V. van Niekerk. WFME Global Standards receive ringing endorsement. Med Ed, 2003; 37: 586-587.
  6. WFME website: http://www.wfme.org

Adopted by the 54th WMA General Assembly, Helsinki, Finland, September 2003
and reaffirmed by the 194th WMA Council Session, Bali, Indonesia, April 2013 and reaffirmed by the 215th WMA Council Session (online), Cordoba, Spain, October 2020

Whereas the World Medical Association has a specific focus and function in the field of medical ethics, and came into being on 18 September 1947 during the first General Assembly, it is resolved that NMAs are encouraged to annually observe the 18th September as “Medical Ethics Day”.

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

 

PREAMBLE

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

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

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

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

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

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

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

 

RECOMMENDATIONS

The WMA recommends that its constituent members:

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

 

(1) Codes and codifications:

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

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

Adopted by the 54thWMA General Assembly, Helsinki, Finland, September 2003,
revised by 65th WMA General Assembly, Durban, South Africa 2014
and reaffirmed by the 217th WMA Council Session, Seoul (online), April 2021

PREAMBLE

The rapid advances in biomedical technologies have led to growth of the reproductive assistance industry, which tends to be poorly regulated. Despite the fact that many governments have laws prohibiting commercial transactions of reproductive material, most have not been successful in universally preventing the sale of human ova, sperm and embryos on the internet and elsewhere. The market value of human material, including cells, tissues, and cellular tissue can be lucrative, creating a potential conflict for physicians and others between economic interests and professional ethical obligations.

For the purposes of this resolution human reproductive material is defined as human gametes and embryos.

According to the WHO, transplant commercialism “is a policy or practice in which cells, tissues or organs are treated as a commodity, including by being bought or sold or used for material gain.” [1]

The principle that the “human body and its parts shall not, as such, give rise to financial gain”[2] is laid down in numerous international declarations and recommendations.[3]   The 2006 WMA Statement on Human Organ Donation and Transplantation and the 2012 WMA Statement on Organ and Tissue Donation call for the prohibition of the sale of organs and tissues for transplantation.  The WMA Statement on Assisted Reproductive Technologies (2006) also states that it is inappropriate to offer financial benefits to encourage donation of human reproductive material.

The same principles should be in place for the use of human reproductive material in the area of medical research.  The International Bioethics Committee of the United Nations Educational, Scientific and Cultural Organization (UNESCO IBC) in its report on the ethical aspects of human embryonic stem cell research states that the transfer of human embryos must not be a commercial transaction and that measures should be taken to discourage any financial incentive.

It is important to distinguish between the sale of clinical assisted reproductive services, which is legal, and the sale of the human reproductive materials, which is usually illegal.  Due to the special nature of human embryos, the commercialization of gametes is unlike that of other cells and tissues as sperm and eggs may develop into a child if fertilization is successful.

Before human reproductive material is donated, the donor must give informed consent that is free of duress.  This requires that the individual donor is deemed fully competent and has been given all the available information regarding the procedure and its outcome. If research is to be conducted on the material, it is subject to a separate consent process that must be consistent with the provisions in the WMA’s Declaration of Helsinki. There must not be any inducement or other undue pressure to donate or offers of compensation.

Monetary compensation given to individuals for economic losses, expenses or inconveniences associated with the retrieval of donated reproductive materials should be distinguished from payment for the purchase of reproductive materials.

RECOMMENDATIONS

  1. National Medical Associations (NMAs) should urge their governments to prohibit commercial transactions in human ova, sperm and embryos and any human material for reproductive purpose.
  2. Physicians involved in the procurement and use of human ova, sperm, and embryos should implement protocol to ensure that materials have been acquired appropriately with the consent and authorization of the source individuals. In doing so, they can uphold the ethical principle of non-commercialization of human reproductive material.
  3. Physicians should consult with potential donors prior to donation in order to ensure free and informed consent.
  4. Physicians should adhere to the WMA Statement on Conflict of Interest when treating patients who seek reproductive services.

[1]  Global Glossary of Terms and Definitions on Donation and Transplantation, WHO, November 2009

[2] European convention of human rights and biomedicine – Article 21 – Prohibition of financial gain

[3] Declaration of Istanbul guiding principle 5