Policy Type: Statement

Adopted by the 66th WMA General Assembly, Moscow, Russia, October 2015
and revised by the 76th WMA General Assembly, Porto, Portugal, October 2025

 

PREAMBLE

  1. People who are LGBTQIA+ (Lesbian, Gay, Bisexual, Trans, Queer, Intersex, Asexual, and other identities beyond these) represent a spectrum of natural sexual orientations, gender identities, gender expressions, and sex characteristics. While LGBTQIA+ people may share common experiences and shared goals of justice and equity in the face of detrimental, discriminatory treatment and even violence, these are diverse communities facing distinct challenges and with specific needs in healthcare and beyond.
  2. This statement is specifically focused on the challenges and needs of trans(-gender) people. The term “trans” is used throughout this document in keeping with its increasingly prevalent use in scientific literature, advocacy work, and social spaces. Children and adolescents experiencing gender incongruence require a sensitive and supportive approach, as well as individualized, evidence-based care that considers their unique needs.
  3. In most cultures, an individual’s sex is assigned at birth according to primary physical sex characteristics. Gender identity is a person’s individual experience of gender, which may or may not align with the sex they were assigned at birth. This along with gender expression, the way in which individuals outwardly present their gender identity to the world, contribute to the concept of gender itself.
  4. Individuals who experience gender incongruence, or a marked and persistent incongruence between their experienced gender and assigned sex, are referred to by the umbrella term “trans”. Gender incongruence can be expressed in very different ways.
  5. Under the umbrella term of “trans” (or “transgender”), there are people who, despite having a distinct anatomically identifiable sex, seek to change their primary and secondary sex characteristics to affirm their gender identity (formerly referred to as “transsexual”)[1]. Some experience their gender as falling outside the sex/gender binary of either male or female or do not exclusively see themselves as male or female (genderqueer or non-binary). The umbrella term “trans” represents an attempt to describe these groups without pathological characterisation and instead as a term of positive self-identification. This statement does not explicitly address individuals who dress in a style or manner traditionally associated with a sex/gender different from the sex assigned at birth or individuals who are born with variations of sex characteristics (e.g., intersex individuals); however, there are such individuals who are trans. Additionally, some cultures have historically recognised three or more gender identities embodying distinct sociocultural beliefs and traditions. It is important to point out that trans identity, as well as non-binary identity, relate to gender identity, which must be considered separately from an individual’s sexual orientation.
  6. Being trans does not constitute a disorder or illness. At the same time, trans people may require interdisciplinary gender-affirming care (e.g., gender-affirming hormones, surgeries, mental healthcare) and counselling to help them navigate their gender and to address the complex social and relational issues that are affected by it.
  7. The World Health Organization’s (WHO) International Classification of Diseases (ICD 11) moved the terms “Gender incongruence of adolescence and adulthood” and “Gender incongruence of childhood” from the “Mental and behavioural disorders” chapter into a newly added chapter entitled “Conditions related to sexual health” to reflect that gender diverse identities should no longer be classified as mental health disorders.
  8. Because this is a complex ethical and socially relevant issue, the WMA would like to acknowledge the crucial role played by physicians in a wide range of medical specialties in advising and consulting with trans people and their families about the risks and benefits of desired care, especially in a time of widely propagated misinformation and disinformation on the topic. As a potential first point of contact, physicians need to understand the social and political challenges facing trans people and be aware of the health consequences of discrimination and the importance of providing support to people experiencing gender incongruence on the basis of their needs. The WMA intends for this statement to serve as a guideline for patient-physician relations and to foster better training, enabling physicians to increase their knowledge of and understanding toward trans people and the specific health issues they face.
  9. Interdisciplinary gender-affirming care, including pharmacologic therapy or surgical interventions, can be beneficial to people with gender incongruence who seek medical interventions. However, trans people are often denied access to or forgo appropriate and affordable gender-affirming healthcare due to, among other things, the policies of health insurers and national social security benefit schemes, a lack of relevant clinical and social competence among healthcare providers, and the fear of discrimination concerning one or multiple facets of their identity. These situations show how physicians and health professionals play an important role in creating a safe, respectful, and inclusive healthcare environment for trans people seeking care.
  10. Trans people are often put at a professional and social disadvantage and experience a relatively higher rate of direct and indirect discrimination, as well as physical violence. In addition to being denied equal civil rights, anti-discrimination legislation, which protects other marginalised communities, may not extend to trans people. Being disadvantaged or discriminated against can have a negative impact upon physical and mental health. These negative outcomes can be exacerbated by other intersectional factors, including but not limited to national origin, race, ethnicity, gender, sexual orientation, age, religion, socioeconomic status, or disabilities.
  11. In addition, the psychopathologisation of trans people leaves such individuals at risk of being forced or coerced into so-called “conversion” or “reparative” procedures. These harmful and unethical practices, also sometimes referred to as Sexual Orientation and Gender Identity Change Efforts (SOGICE), are intended to suppress or change a person’s natural sexual orientation or gender identity. These practices have no evidence-based background, no medical indication of effectiveness, and represent a serious threat to the health and human rights of those subjected to them. Such practices can lead to anxiety, depression, low self-esteem, substance abuse, suicide, worsened cardiovascular health, and other somatic health issues.
  12. Negative experiences in healthcare affect the patient-physician relationship, leading trans people to avoid accessing care even when it is available. When trans people feel secure and confident that their gender identity will be affirmed in a respectful, confidential environment, they are more likely to share their personal experiences openly. This transparency enables physicians to provide targeted care that addresses the specific health needs of trans patients.
  13. Trans physicians, medical students, and other health professionals also face discrimination, disadvantages, marginalisation and bullying in the workplace, in schools, in professional organisations, and beyond. Harmful working and learning environments can lead to stress, social isolation, and burnout, especially among marginalised individuals.

General principles

  1. The WMA emphasises the right of all people to determine and live out their own gender and recognises diversity of gender.
  2. The WMA strongly asserts that gender incongruence (ICD 11) does not represent a disease or a mental disorder; however, it can lead to discomfort, distress, or the desire to transition in order to live, and be accepted, as a person of the experienced gender.
  3. The WMA condemns all forms of discrimination, stigmatisation, and violence against trans people and calls for appropriate legal measures to protect their equal civil rights.
  4. The WMA affirms that, in general, any health-related procedure or gender-affirming care related to an individual’s trans identity, (e.g. surgical interventions, hormone therapy or mental health care), requires the provision of accurate scientific information regarding the consequences of gender-affirming care and the freely given informed consent of the patient.
  5. The WMA unequivocally condemns so-called “conversion” or “reparative” practices or SOGICE. These constitute violations of human rights and are unjustifiable practices that should be denounced and subject to sanctions and penalties. It is unethical for physicians to participate in any step of such procedures. Healthcare systems must aim to enable trans people to have the best possible quality of life.
  6. The WMA affirms its position that no person, regardless of age, medical condition, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, culture, sexual orientation, social standing, or any other factor should be subjected to forced or coerced sterilisation of any kind (in line with the WMA Statement on Forced or Coerced Sterilisation). This also includes sterilisation as a condition for rectifying the recorded sex on legal documents independent of gender reassignment.

 

RECOMMENDATIONS

  1. The WMA urges that every effort be made to make individualised, multi-professional, interdisciplinary and affordable gender-affirming care (including, as appropriate, counselling, hair removal, speech therapy, hormonal treatment, surgical interventions, reproductive and mental healthcare) available to all people who experience gender incongruence. In order to reduce potentially negative health consequences, this care should be guided by due consideration of the available scientific evidence and tailored to the individual’s needs and goals.
  2. The WMA calls upon all physicians to:
  • respect each individual’s right to self-identification with regards to gender;
  • ensure that children and adolescents receive special consideration and individual assessment recognising their specific vulnerability before any potential form of medical care is initiated;
  • classify physical diseases and mental health issues on the basis of clinically relevant symptoms according to ICD 11 criteria regardless of gender identity, and to provide quality care in accordance with internationally recognised treatments and protocols and in keeping with the principles set forth in the WMA International Code of Medical Ethics;
  • provide a safe, respectful, and inclusive healthcare environment for trans patients;
  • where appropriate, refer trans patients to physicians with more knowledge of and experience with trans health issues to ensure the highest standard of care is provided;
  • foster safe, respectful, and inclusive work and learning environments for trans physicians, medical students, and other health professionals;
  • engage in continuing medical education and professional development in an attempt to encourage the further study and understanding of the specific health needs of trans patients and the benefits or risks of certain treatments;
  • where appropriate, involve those close to the patient in healthcare discussions in keeping with the patient’s preferences, respecting their consent, and with due regard for patient confidentiality;
  • speak out against legislation and practices violating the human rights of trans people;
  • reject and refuse to participate in any step of so-called “conversion” or “reparative”
  1. The WMA calls upon its Constituent Members and professional associations to:
  • take action to identify and combat barriers to healthcare faced by trans people;
  • advocate for safe and inclusive working and learning environments for trans physicians, medical students, and other health professionals;
  • establish and enforce non-discriminatory policies in keeping with the WMA Statement on Non-Discrimination in Professional Membership and Activities of Physicians;
  • create guidelines for physicians outlining the specific physical and mental health challenges facing trans patients, where appropriate;
  • where possible, promote changes to medical education, specialty training and CME/CPD curricula to support the provision of gender-affirming care and to help physicians provide appropriate care to meet the specific health needs of trans patients and to recognise and avoid discriminatory practices;
  • promote the establishment of channels for physicians to report incidents of discrimination or bias against trans physicians or trans patients;
  • in environments where confidentiality and patient safety are guaranteed and data cannot be abused, encourage voluntary data collection in the clinical setting and regular reporting on the health outcomes of trans patient groups, while also taking intersectionality into account, to ensure and further improve targeted and appropriate healthcare provision;
  • actively condemn so-called “conversion” or “reparative” practices as unethical.
  1. The WMA calls upon governments to:
  • adopt and implement a comprehensive legal framework to protect trans people from discrimination and violence, and to support their full participation in society, including access to affordable and quality gender-affirming care;
  • strive to ensure that administrative processes, medical records, and care pathways respect and reflect the patient’s self-identified name and gender, avoiding practices that undermine their dignity or safety;
  • maintain continued interest in the healthcare rights of trans people by conducting health services research at the national level and using these results in the development of health and medical policies. The objective should be a responsive healthcare system adapted to each patient;
  • reject and repeal anti-trans legislation;
  • condemn and ban so-called “conversion” or “reparative” practices;
  • promote policies that counteract health-related and other inequities caused by overt and implicit discrimination against trans people;
  • encourage education on the many manifestations of gender identity and gender expression to increase acceptance and with the ultimate aim of promoting better physical and mental health for all individuals;
  • promote and fund more research in this area to enable the best, evidence-based standard of care for trans people, and combat censorship of research regarding trans people;
  • safeguard physicians and other health professionals providing gender-affirming care, and offer additional protections against discrimination and violence;
  • involve organizations representing trans people as valuable stakeholders and expert contributors in the development of health policies, clinical protocols, educational materials, and models of care.

 

[1] Although the term “transsexual” is outdated and inappropriate, and its usage has been discontinued in the medical field, it is referred to here because it is still sometimes used in legal provisions relating to trans people.

Adopted by the 67th  General Assembly of the World Medical Association, Taipei, Taiwan, October 2016
and revised by the 76th WMA General Assembly, Porto, Portugal, October 2025

PREAMBLE

Visiting medical students or residents are increasingly participating in global educational and service experiences, commonly referred to as Global Clinical Electives, Global Health Electives or Short Term Global Health Experiences.

Although Global Clinical Electives can provide valuable learning experiences, this must be weighed against the potential risks to the host community, the sponsor organization and the visiting medical student or resident. Successful placements help to ensure that there are mutual benefits for all parties and are built upon an agreed understanding of concepts including non-maleficence and justice in keeping the WMA International Code for Medical Ethics.

Published ethical guidelines, such as the Ethics and Best Practice Guidelines for Training Experiences in Global Health by the Working Group on Ethics Guidelines for Global Health Training (WEIGHT) and the Brocher Declaration, call on sponsor institutions (i.e., universities and organizations facilitating electives) to commit to sustainable partnerships with host institutions and local communities. All parties are also called upon to work collaboratively in creating professional guidelines and standards for clinical electives.

In turn, visiting medical students or residents undertaking Global Clinical Electives must adhere to relevant ethical principles outlined in WMA ethical documents.

RECOMMENDATIONS

Therefore the WMA recommends that:

  1. Sponsor institutions work closely with host institutions and local communities to create professional and ethical guidelines on best practices for Global Clinical Electives. Both parties should be actively engaged in guideline development and update. The sponsor organization should evaluate the proposed elective using such standards prior to approval.
  2. Sponsor institutions and host institutions should strive to facilitate two-way exchanges.
  3. Guidelines must hold patient and community safety as paramount, and outline processes to ensure informed consent, patient confidentiality, privacy, and continuity of care as outlined in the WMA International Code of Medical Ethics.
  4. Guidelines should also outline processes to protect the safety and health of visiting medical students and residents, their scope of practice according and highlight the obligations of the sponsor and host institutions to ensure appropriate supervision of these students and residents at all times. The Scope of Practice of medical students and residents during Global Clinical Electives should be commensurate to their education and should not exceed their scope of practice in their home country.
  5. Sponsor and host institutions have a responsibility to ensure that Global Clinical Electives are well planned, including at a minimum: appropriate pre-departure briefings, which should include training in culture and language competency, explicit avoidance of any activity which could be exploitative, provision of language services as required, and sufficient introduction and guidance at the host institution. Post-departure debriefing should be planned on return of the visiting medical student or resident, including reviewing ethical situations encountered and providing the appropriate emotional and medical support needed.
  6. The visiting medical student or resident should receive feedback and assessment of the experience so that academic credit can be received. The visiting medical student or resident should also have the opportunity to evaluate the quality of the experience.
  7. Visiting medical students or residents must be fully informed of their responsibility to follow instructions given by local supervisors, and to treat local host staff and patients with respect.
  8. WMA constituent members should support the development of best practices for Global Clinical Electives and encourage their adoption as standards by national or regional accrediting bodies, as feasible, and their implementation by sponsor and host institutions.

 

Adopted by the 60th WMA General Assembly, New Delhi, India, October 2009
Reaffirmed with minor revision by the 201st WMA Council Session, Moscow, Russia, October 2015,
and revised by the 76th WMA General Assembly, Porto, Portugal, October 2025

 

PREAMBLE

This policy is intended to identify areas where a conflict of interest might occur during the day-to-day practice of medicine, and to assist physicians in resolving such conflicts in the best interests of their patients. A conflict of interest arises when professional judgement concerning direct patient care might be unduly influenced by secondary interests. Factors such as mandatory institutional requirements or career advancement pressures could represent conflicts of interest.

As stated in the WMA’s International Code of Medical Ethics, the physician must recognize and avoid real or potential conflicts of interest.

In some cases, it may be enough for a physician to acknowledge that a potential or perceived conflict exists. In others, specific steps to resolve the conflict may be required. Some conflicts of interest are inevitable and there is nothing inherently unethical in the occurrence of conflicts of interest in medicine, but it is the manner in which they are addressed that is crucial.

In addition to practicing medicine and providing direct patient care, physicians serve in additional roles and pursue various other interests, such as participating in research, contributing to seminars and conferences, training and educating future physicians and occupying administrative or managerial positions. As private interests within medicine have expanded in many locales, physicians have occasionally provided their expertise to these endeavors as well, acting as consultants (and sometimes employees) for private enterprises, including those involved in the development of new technologies and digital solutions.

The growing interaction between physicians and private sector stakeholders reflects the broader systemic influence of these private interests on healthcare markets, clinical practice, research priorities, and medical education. These factors are also referred to as commercial determinants of health.

Although the participation of physicians in such activities can ultimately serve the greater public good, it can also give rise to conflicts with their primary obligation to the health and well-being of their individual patients, as well as broader public health needs. Other interests must not be allowed to influence clinical decision-making or even have the potential to do so.

Physicians have a moral duty to scrutinize their own individual behavior for any potential conflicts of interest. If unacknowledged, conflicts of interest can seriously undermine patient trust in the medical profession as well as in the individual practitioner and therefore negatively impact the patient-physician relationship. Any conflict of interest, be it real or potential, financial or personal, including relational conflicts of interest, should be disclosed. Depending on the circumstances, additional remediation may be necessary.

Physicians may also wish to consult additional resources such as specialty societies, medical associations or regulatory authorities on issues relating to conflicts of interest, and they should be aware of applicable national regulations and laws.

The WMA unambiguously addresses the issue of conflicts of interest in its fundamental ethical policies, including the Declaration of Geneva: The Physician’s Pledge, the International Code of Medical Ethics, and the Declaration of Helsinki. These core documents make it clear that the health and well-being of the patient or research participant must always be the physician’s first consideration.

 

RECOMMENDATIONS

Research

1. The interests of the clinician and the researcher may not be the same. If the same individual is assuming both roles, as is often the case, the potential conflict should be addressed by ensuring that appropriate steps are put in place to protect the patient, including disclosure of the potential conflict to the patient.

2. Medical research must be conducted ultimately for the advancement of individual and public health. A physician-researcher may never place financial interests above the welfare of patients. Patient health and well-being and scientific integrity must be paramount.

3. All relevant and material physician-researcher relationships, sources of funding, institutional affiliations, and conflicts of interests must be disclosed to potential research participants, research ethics committees, appropriate regulatory oversight bodies, medical journals, conference participants and the medical centre where the research is conducted.

4. Prior to commencement of any research, all parties involved in the research including trial sponsors, the physician-researcher and research participants, should agree to key terms and conditions relating to, at a minimum:

• financial compensation for the physician-researcher,
• control of and access to research results,
• the right and obligation of the physician-researcher to publish negative results,
• the right of the physician-researcher to release relevant information to trial participants at any point during the study,
• funding for participants’ medical care in the event of complications associated with the research,
• data protection and incidental findings.

5. Physician-researchers should retain control of and should have full access to all trial data and should decline non-disclosure clauses.

6. Physician-researchers should ensure that, regardless of the trial results, the presentation or publication of the results will not be unduly delayed or otherwise obstructed.

7. Physicians should not accept payment or other benefits solely for referring patients to research studies or for sharing patient data. Patient information should only be shared with due regard for patient confidentiality and data safety.

8. Any compensation received by physician-researchers from trial sponsors should approximately replace lost clinical income and should be commensurate with the efforts and responsibilities of the physician performing the research. When enrolment is particularly challenging and time-consuming, reasonable additional payments may be made to compensate physician-researcher or institution specifically for time and effort spent on extra recruiting efforts to enroll appropriate research participants. Escalating bonuses designed to increase trial enrolment should not be accepted.

9. Payments or compensation of any sort may never be tied to the outcome of clinical trials. Physician-researchers should not have a financial interest in a company sponsoring a trial or a product being studied in a clinical trial if this financial interest could be affected positively or negatively by the results of the trial; they should have no direct financial stake in the results of the trial. They should not purchase, buy or sell stock (shares) in the company while the trial is ongoing and until the results have been made public. This might not apply for those physicians who have developed a medication but are not part of the enrolment process.

10. Physician-researchers should decline requests to review grant applications or research paper submissions from colleagues or competitors if their relationship poses a risk to impartiality.

11. Physician-researchers should only participate in clinical trials when they relate to their area of medical expertise, and they should have the appropriate ethical and scientific education, training and qualifications in the conduct of research and the principles of research ethics.

12. Authorship should be determined prior to the start of the trial and should be based on substantive scientific contribution.

13. Physician-researchers should be aware of broader commercial determinants of health that may influence research priorities, study design, and the interpretation or dissemination of results, and should actively seek to mitigate such influences to preserve scientific integrity and public trust.

Education and training

14. The educational needs of students and physicians in specialty training and the quality of their education and training experience must be balanced with the best interests of patients. Where these are in conflict, the interests of patients will take precedence.

15. Basic medical education, specialty training, and continuing professional development (CME/CPD) should include specific training on recognizing and managing conflicts of interest, as well as understanding commercial determinants of health, to support critical appraisal of information and uphold professional integrity in the best interests of patients.

Self-referrals , kickbacks, and fee-splitting

16. All referrals to other physicians or providers, and prescriptions for specific goods or services, should be based on the objective assessment of the referring or prescribing physician. Any form of collaboration among health professionals must prioritize the interests of the patient.

17. Physician self-referral occurs when a physician refers a patient to a service, practice, or health care facility (such as a laboratory) where they do not engage in professional activities but in which they have a financial interest. This practice has the potential to significantly influence clinical decision-making and is not generally considered acceptable unless there are appropriate safeguards in place and the referral is based on objective, medically relevant criteria. (For example, there is a need for the facility in a small rural community and other ownership is not a possibility. The physician in this situation should receive no more financial interest than would an ordinary investor.)

18. Kickbacks or fee-splitting occur when a physician receives financial consideration for referring a patient to a specific practitioner or for a specific service for which a fee is charged. These practices are not acceptable.

Product sales

19. Physician sale of medical products (health-related products), or of non-medical products (products not related to patient health or the practice of medicine), from their office or website may raises ethical concerns about financial conflict of interest and may risks placing undue pressure on the patient. Non-medical products and scientifically non-validated medical products should not be sold from physicians’ offices or websites. Sales of scientifically validated medical products are acceptable only in limited circumstances with appropriate safeguards, including appropriate disclosure to the patient.

Organizational/institutional conflicts

20. Health care institutions, in particular, are increasingly subject to a number of pressures that threaten several of their roles, and many medical centers have begun to identify alternate sources of revenue. Policies should be in place to ensure that these new sources are not in conflict with the values and mission of the institution and with medical ethical principles (for example, funding from the tobacco, food, or pharmaceutical industries in medical schools or clinics).

21. Individual medical organisations and institutions (including, but not limited to, medical schools, hospitals, medical associations, official/state regulators and research institutions) should develop and enforce conflict of interest guidelines which also apply to their employees and members, and which also address the broader commercial determinants of health. Such guidelines should be structured to assist physicians in making appropriate disclosures and identifying situations where a conflict of interest would preclude their participation in a given activity.

22. Health care institutions should have a clear demarcation between investment decision-making committees, technology transfer and the research arm of the institution.

23. Written policies should provide guidelines for disclosure requirements, or for discontinuing participation in the decision-making process, for those individuals who are conflicted due to sponsored research, consulting agreements, private holdings or licensing agreements.

Adopted by the 76th WMA General Assembly, Porto, Portugal, October 2025

 

PREAMBLE

Dementia is a syndrome caused by many different diseases, which collectively form an increasing part of non-communicable conditions globally. According to the World Health Organization (WHO), “Dementia is an umbrella term for several diseases affecting memory, other cognitive abilities and behavior that interfere significantly with a person’s ability to maintain their activities of daily living. Although age is the strongest known risk factor for dementia, it is not a normal part of ageing.”

Dementia is primarily a condition of older people but one in ten affected individuals show signs before the age of 65. As the actual number of older people is increasing steadily around the globe, there is a rising number of cases of dementia. In 2023 the WHO estimated the number of individuals with dementia to be 55 million worldwide and this is expected to rise to 139 million by 2050. Currently, 60% of people with dementia live in low and middle-income countries, but by 2050 this is predicted to rise to 71%.

Dementia incidence and outcome are influenced not only by biological factors but also by social determinants such as education, socioeconomic status, and access to healthcare, which vary widely across regions and populations.

The annual global cost of dementia was estimated in 2019 to be more than 1.3 trillion US$ and is expected to rise to 2.8 trillion US$ by 2030. This figure includes costs attributed to informal care (unpaid care provided by family and other informal caregivers) and direct costs of social and medical care.

Non-communicable diseases (NCDs), including heart disease, stroke, cancer, diabetes and chronic lung disease, are collectively responsible for 74% of all deaths worldwide according to the WHO. Dementia is not listed as a major NCD despite its major effects on individuals and families as well as its rising contribution to societal cost. However, dementia risk increases with the five major risk factors on the NCD list of WHO: tobacco use, physical inactivity, harmful use of alcohol, unhealthy diets and air pollution.

Alzheimer´s disease, the most common disease causing dementia, is the seventh most common causes of death globally, but the fourth in high-income countries. Alzheimer´s disease is the only one of the ten most prevalent causes of death with no effective prevention or cure and only limited treatment possibilities.

Women are disproportionately affected by dementia, with greater prevalence rates than men in all age groups and a higher proportion of deaths. Women are also responsible for providing roughly 70% of informal care hours globally, with the highest proportions being in low- and middle-income countries.

Dementia leads to increasing dependency in daily life and decreasing quality of life. As the burden of care increases, the quality of life of the caregiver, typically a close family member decreases as well. Individuals with moderate and severe dementia ultimately need to move to a service or nursing home but in many countries, particularly low- and middle-income countries, this possibility is not available. Nursing home costs are putting an increasing strain on economies, whether inside or outside a national health service.

There is increasing evidence that up to 45% of cases of dementia might be preventable to some extent. This has been supported by the actual decrease in dementia prevalence in the last three decades, but due to the rising number of older individuals, the total number of cases of dementia continues to rise.

Dementia does not generally belong to any one specialty of medicine but is most often the responsibility of either neurology, psychiatry (often senior psychiatry), geriatrics or family medicine. It involves a multidisciplinary approach requiring collaboration across various healthcare fields. However, individuals with dementia are more frequently admitted to hospital than those without dementia independent of physical comorbidities with generally poorer prognosis than non-demented individuals.

Research into treatment options for diseases causing dementia has been lagging compared to other major NCDs and has been mostly futile. New biological treatments for Alzheimer’s disease are very costly and most societies, even the wealthiest, are having difficulties handling the financial burden. In addition, these medications have a limited effects as they are not halting the process of increasing cognitive impairment but only slowing it.

The WHO global actions plan for dementia 2017-2025 states that countries need to develop practical and ambitious national strategies. The plan includes a set of seven global targets such as viewing dementia as a public health priority to improve diagnosis, support for dementia carers and increased funding for research.

 

RECOMMENDATIONS

The World Medical Association (WMA) calls on the following stakeholders to:

The World Health Organization (WHO) 

  1. List dementia as one of the major NCDs globally.
  2. Increase its focus on dementia and its causes, particularly in low and middle-income countries since they are expected to face the greatest increase in the number of dementia cases in coming decades.
  3. Collaborate with governments, international Alzheimer´s disease bodies as well as the WMA in enhancing global awareness of dementia.

National Governments

  1. View dementia as a public health priority.
  2. Work along the lines of the WHO global action plan for dementia.
  3. Develop comprehensive national dementia strategies including clear targets and measurable indicators, with allocated funding and a clear monitoring and evaluation process.
  4. Support risk reduction programs, especially through public health initiatives. Such programs will also help countering other major NCDs.
  5. Increase awareness of dementia and support dementia friendly initiatives.
  6. Develop programs to support caregivers, including access to respite care, financial support, and mental health services, recognizing their critical role in dementia care.
  7. Increase funding for dementia research nationally and through international partnerships with a focus on effective, accessible treatments and care.

Medical Associations and the Scientific Community

  1. Promote initiatives to increase physicians´ knowledge about dementia, in order to promote early identification and accurate diagnosis of cognitive impairment, thereby enabling appropriate treatment and care to be provided.
  2. Increase awareness that individuals with dementia have special needs when seeking health care for other ailments.
  3. Work with other stakeholders to promote high quality care and good quality of life for individuals with dementia.
  4. Increase enrollment in clinical trials of appropriate patients with Alzheimer’s disease and related dementias, and their families, to better identify sex-differences in incidence and progression and to advance a treatment and cure of Alzheimer’s disease and related dementias.
  5. Encourage studies to determine how best to provide stable funding for the long-term care of patients with Alzheimer’s disease and other dementing disorders.
  6. Make available information about community resources to facilitate appropriate and timely referral to supportive caregiver services.

 

Adopted by the 67th WMA General Assembly, Taipei, Taiwan, October 2016
and revised by the 76th WMA General Assembly, Porto, Portugal, October 2025

PREAMBLE

The world is experiencing an unprecedented increase in life expectancy. Over the last century, some 30 years have been added to global average life expectancy at birth (LEB). However, these improvements are very variable; many of the poorest communities in all countries and a larger percentage of the population in the poorest countries have gained less in terms of life expectancy over this period of time.

The increase in longevity has coincided with a decreasing number of children, adolescents and younger adults as some countries experience total fertility rates below replacement level, raising the average age in these countries.

The challenges of ageing, particularly in developing countries, are complicated by the fact that essential resources and infrastructure are seldom in place. In most cases, populations are ageing more rapidly than resources and infrastructure are being developed.

Unpaid carers, in particular for older people requiring long-term and/or palliative care, should be supported and encouraged to balance their caring role with their professional and social lives, while maintaining their own health and well-being.

The World Health Organization (WHO) defines healthy ageing as “the process of developing and maintaining the functional ability that enables wellbeing in older age”[1]. The term “functional ability” is used to describe “the capabilities that enable all people to be and do what they have reason to value”. Relatedly, AGE Platform Europe defines age equity as “an inclusive society, based on well-being for all, solidarity between generations and full entitlement to enjoy life, participate in and contribute to society. At the same time, each person’s rights and responsibilities throughout their life course have to be fully respected”[2]. Healthy ageing presupposes a life course perspective as the social, behavioral, personal, economical and environment determinants that influence healthy ageing operate throughout the life course of an individual.

It is essential to rethink the way in which society and physicians value age and to promote an active role for the older people in the community without discrimination, as outlined in the WMA Declaration on discrimination against Elderly Individuals within Healthcare Settings.

 

GENERAL PRINCIPLES

Medical Expenses Associated with Ageing

  1. There is strong evidence that chronic diseases, rather than age per se, increase the use (and costs) of health services. However, chronic conditions and disabilities become more prevalent with advancing age. Therefore, health care use and spending rise in tandem with age.
  2. In many countries, health care spending for older persons has increased over the years as more interventions and new technologies have become available for problems common in older age.
  3. Awareness should be raised about the potential unintended impact of overtreatment as some investigative or treatment options do not necessarily contribute beneficially to the patient’s overall health.

Effect of Ageing on Health Systems

  1. Health care systems face two major challenges as longevity increases: preventing chronic disease and disability, and delivering high quality and cost-effective care that is appropriate for individuals of all ages. In less developed regions the disease burden in old age is higher than in more developed regions.

Special Health Care Considerations

  1. Compared to the general population, older adults are more likely to experience social isolation and loneliness. These risk factors contribute to chronic diseases common in older adults, such as cognitive decline and dementia, by adversely affecting their physical and mental health. Approximately 1 in 4 older people experience social isolation, and research proves that the impact of social isolation and loneliness on mortality is similar to that of smoking, obesity, and physical inactivity[3].
  2. The leading causes of disability worldwide are cardiovascular disease, cancer, chronic respiratory disease, musculoskeletal disorders, and neurological and mental diseases, including dementia. Some common conditions in older age are especially disabling and benefit from early detection and management.
  3. Chronic diseases, particularly cardiovascular disease, diabetes, chronic obstructive pulmonary disease and many types of cancer, are common among older people and include diseases preventable through healthy behaviors and/or lifestyle interventions, effective preventive health services, and policy interventions.
  4. While research may eventually lead to effective disability prevention or treatment, early management is key to controlling disability and/or maintaining quality of life.
  5. Older persons may be more vulnerable to the effects of accidents within and outside the home. As older people continue to work, these risks must be assessed and managed. Those who suffer injuries may have their recovery complicated by other medical vulnerabilities and comorbidities.

Considerations for Health Care Policy Makers and Professionals

  1. At a societal level, achieving age equity requires action across multiple sectors. For example, design solutions can help make environments more age-friendly and often benefit the general population.
  2. Similarly, achieving healthy ageing also often requires a variety of professionals working as an articulated team.
  3. Older people come from diverse backgrounds. The policies, systems, environments, care, and medical education and training may need to be tailored to optimally care for every individual.

Continuum of Care

  1. A comprehensive continuum of health services needs to be adopted urgently as populations age. It should include health promotion, disease prevention, curative treatments, rehabilitation, management and prevention of decline, and palliative care.
  2. Different types of health care providers should be utilized to offer these services, from self and family/informal care – sometimes in a voluntary capacity – to community-based providers and institutions.

Establishing Optimal Health Care Systems

  1. Universal Health Coverage should be provided to all, including older people.
  2. The vast majority of health problems can and should be dealt with at the community level. In order to provide optimal community care and ensure care coordination over time, it is critical to strengthen Primary Health Care (PHC) within health systems, by addressing workforce shortages and by planning and ensuring adequate financial resources and equipment provision in PHC facilities, as outlined in the WMA Statement on Primary Health Care. This includes empowering community health workers and interdisciplinary care teams to deliver age-friendly services, particularly in resource-limited settings.
  3. In order to strengthen PHC to promote healthy ageing, WHO advanced evidence-based principles for age-friendly PHC in three areas which should be considered: information/education/communication/ training, health care management systems and the physical environment of PHC centers.
  4. The health sector should encourage health care systems to support and facilitate access to all such dimensions of care to individuals as they age.
  5. Health systems must adapt to ageing in order to guarantee their financial sustainability and avoid imbalances.
  6. Health systems and communities should implement evidence-based interventions such as social prescribing, community engagement programs, and digital inclusion initiatives to reduce social isolation and its health impacts.
  7. Preventative consultations should be encouraged, particularly to identify age-related risks and preserve independence.
  8. Communication during winter vaccination campaigns targeting older people must be strengthened. Access to vaccination must be facilitated and encouraged.

Specificities of Health Care

  1. Many formal systems of health care have been developed with an emphasis on “acute or catastrophic care” of a much younger population, often focused on communicable diseases and/or injuries. Health systems should emphasise other needs, especially prevention, chronic diseases management, cognitive decline, palliative care and long-term care when treating older people. While acute care services are essential for people of all ages, they are not focused on keeping people healthy or providing the ongoing support and care required to manage geriatric conditions. A geriatric evaluation and handling of elderly patients should be available in every acute care facility.
  2. Medical conditions in older age often occur simultaneously with social problems and both need to be considered by health professionals when providing health care. Physicians, particularly specialists, should bear in mind that older patients may have other concurrent chronic diseases or comorbidities that interact with each other and that their treatment should not lead to inadvertent and preventable induction of complications.
  3. When initiating a pharmacologic treatment for chronic disease in an older patient, the principles of geriatric pharmacology should be observed.
  4. Older patients´ right to self-determination must be respected. If the patient cannot decide for him/herself, due to memory and cognitive problems, physicians treating older patients should actively communicate with the family, unpaid carers, and frequently with formal caretakers, to provide support and educate them about the patient’s health condition and medication administration.
  5. When considering different therapeutic options, physicians should always seek to find out the wishes of the patient and recognise that, for some patients, quality of life will be more important than the potential results of more aggressive treatment options.
  6. Development of appropriate digital and technical solutions and tools that can improve care, and access to care, for older people should be promoted. International cooperation and technical assistance should be mobilized to support developing countries in building sustainable infrastructure and services that address the needs of ageing populations.

Education and Training for Physicians

  1. All physicians should be appropriately educated and trained to diagnose and treat the health problems of older people, which means integrating ageing into medical curricula., including geriatrics, gerontology, and palliative care. In particular, general practitioners should have access to information and undergo education and training to identify and prevent polypharmacy and potentially adverse drugs interactions and be educated in geriatric pharmacological therapy.
  2. Secondary health care for older people should be provided as necessary. It should be holistic, including taking into consideration psychosocial as well as environmental aspects, in line with the approach of comprehensive geriatric assessment. As outlined in the WMA Declaration of Hong Kong, physicians should also be aware of the risks of abuse and measures to be taken when abuse is identified or suspected.
  3. Continuing medical education on topics relevant to the ageing patient should be emphasised in order to help physicians adequately diagnose, treat, and manage the complexities of caring for an ageing population.

 

[1] https://www.who.int/news-room/questions-and-answers/item/healthy-ageing-and-functional-ability
[2] A society for all ages (AGE Platform Europe)
[3] Social Isolation and Loneliness (who.int) / New details about loneliness and dementia risk – Harvard Health

Adopted by the 65th World Medical Assembly, Durban, South Africa, October 2014
and revised by the 76th WMA General Assembly, Porto, Portugal, October 2025

PREAMBLE

For the purpose of this statement, aesthetic treatment is defined as an intervention that is performed not to treat an injury, a disease or a deformity, but for non-therapeutic reasons, with the sole purpose of enhancing or changing the physical appearance of the individual concerned. In this statement, the individual undergoing treatment is referred to as the patient.

The treatments available include a great variety of interventions, ranging from surgical procedures to injections and different kinds of skin treatments. This statement focuses on interventions that are methodologically similar to those performed in conventional health care. Tattooing, scarring and similar interventions are therefore not considered in this statement.

Aesthetic treatments are performed by practitioners with widely differing clinical and educational backgrounds.

Body image affects a person’s self-esteem and mental health and is an integral part of a person’s overall health and well-being. However, media portrayals of “perfect bodies” cause some people, especially children and adolescents, to develop unrealistic and unhealthy body images. Social media in particular has the potential to impact the physical and mental health of individuals.

Some aesthetic treatments can also be motivated by cultural stigma and colorism.

Many aesthetic treatments involve risks and may potentially harm the health of the patient. Minors [1] are particularly vulnerable, as their bodies are often not fully developed. The WMA has developed the following basic recommendations to protect persons considering or undergoing aesthetic treatment.

Reaffirming the medical ethics principles laid out in the WMA Declaration of Geneva, the WMA Declaration of Lisbon on the Rights of the Patient and the WMA International Code of Medical Ethics, and consistent with the mandate of the WMA, this statement is addressed primarily to physicians. However, the WMA encourages other practitioners performing aesthetic treatments to adopt these principles.

RECOMMENDATIONS

1. The patient´s dignity, autonomy, integrity and confidentiality must always be respected.

2. Physicians have a role in helping to identify unhealthy body images, including those motivated by gender norms, cultural stigma and colorism, to address and treat disorders when these exist, and to refer the patient to a psychiatrist or other mental health professional and/or other relevant health professionals as needed.

3. Aesthetic treatments must only be performed by practitioners with sufficient knowledge, skills and experience of the interventions performed. Aesthetic treatments that involve the practice of medicine must be performed by or appropriately supervised by a physician.

4. All practitioners providing aesthetic treatments should hold a specific degree and must be registered with and/or licensed by the appropriate regulatory authority, and act only within the scope authorized.

5. All aesthetic treatments must be preceded by a thorough examination of the patient. The practitioner must consider all circumstances, physical and psychological, that may cause an increased risk of harm for the patient and should refuse to perform the treatment if the risk is unacceptable. This is especially true in the case of minors. Practitioners should always choose the most appropriate treatment option, rather than the most lucrative one.

6. Minors may need or benefit from plastic medical treatments, but purely aesthetic procedures should not be performed on minors. If, in exceptional cases, aesthetic treatment is performed on a minor, it must be done with special care and consideration and only if the aim of the treatment is to avoid negative attention rather than gain positive attention. All relevant medical factors, such as whether the minor is still growing or whether the treatment will need to be repeated at a later date, must be considered.

7. The patient must consent explicitly to any aesthetic treatment, preferably in writing. Before seeking consent, the practitioner must inform the patient of all relevant aspects of the treatment, including different treatment options, how the procedures are performed, possible risks and harms and the fact that many of these treatments may be irreversible. The patient must be given sufficient time to understand and consider the information before the treatment starts. Where the patient requesting the treatment is a minor, the informed consent of the minor’s parents or legally authorized representative should be obtained.

8. All aesthetic treatments performed must be carefully documented by the practitioner. The documentation must include a detailed description of the treatment performed, information on medications and medical equipment used, and all other relevant aspects of the treatment.

9. Aesthetic treatments must only be performed under strictly hygienic and medically safe conditions on premises that are adequately staffed and equipped. This includes expertise and equipment for treating life-threatening allergic reactions and other potential acute and, ideally, late complications.

10. The WMA discourages the use of social media to promote unrealistic and unhealthy expectations of appropriate body images and encourages physicians, in keeping with the WMA Statement on the Professional and Ethical Use of Social Media, to promote health literacy among patients and combat misinformation and disinformation on social media.

11. Advertising and marketing of aesthetic treatments must be conducted professionally and responsibly, be based on factual and not misleading information, and must never be targeted to minors or foster unrealistic expectations of treatment results. Unrealistic or altered photographs showing patients before and after treatments must not be used in advertising and marketing.

12. Practitioners should never offer or promote financial loans as a means of paying for aesthetic treatment.

13. Products and devices used for aesthetic treatments should be subject to legal frameworks ensuring their traceability and safety.

14. Further research is encouraged into the long-term consequences of aesthetic treatments on individuals and society, including its role in reshaping ideals and views of normality.

 

[1] For the purpose of this statement minor is defined as a person who, according to applicable national legislation, is not an adult.

Adopted by the 76th WMA General Assembly, Porto, Portugal, October 2025

 

PREAMBLE

  1. The World Medical Association (WMA) recognizes that artificial intelligence (AI) is rapidly transforming all sectors, including healthcare. In this statement, the WMA reaffirms its commitment to patient-centered, physician-led care by emphasizing the concept of augmented intelligence – a framing that highlights AI’s role in augmenting human judgment – by strengthening rather than supplanting it, while recognizing that in specific, well-defined tasks AI may perform independently but always under human accountability. Through augmentation, AI is supporting rather than replacing human judgment, empathy, and accountability.
  2. Building on lessons learned from early deployments, the WMA sets out principles that maximize AI’s benefits while mitigating its risks, ensuring that its development, regulation and use remain consistent with medical ethics, international human-rights standards and the public’s trust in the profession.

DEFINITIONS AND SCOPE

  1. To promote clarity across jurisdictions while embedding the augmented intelligence perspective, the WMA uses the following working definitions in the healthcare ecosystem:
  • Artificial Intelligence (AI): Computer systems designed to perform tasks that normally require human intelligence – such as learning, problem-solving, understanding language, and recognizing patterns.
  • Augmented Intelligence: Use of artificial intelligence designed to support—not replace—human capabilities in healthcare.
  • Physician-in-the-Loop (PITL): an extension of the general “human-in-the-loop” principle whereby a licensed physician—rather than any user—must review and retain final authority over all AI outputs before they shape clinical care. Where clinical care involves multidisciplinary teams, PITL implementation should ensure that all relevant licensed professionals are adequately consulted, while the physician retains ultimate clinical responsibility.
  1. Emphasis on “augmented”
  • The term signals a human-centered approach to AI—one that reinforces the physician’s role as the final decision-maker. Rather than viewing AI as a replacement, augmented intelligence frames these tools as extensions of clinical expertise, designed to support – not replace – professional judgment, empathy, and responsibility.
  • While “AI” is widely understood as artificial intelligence, emphasizing the augmented perspective helps ensure that systems are designed, validated, regulated, and trusted with the right ethical priorities.
  • For the medical profession, this framing also enables more effective advocacy—especially when engaging with policymakers, regulators, and stakeholders who default to the broader term AI. It equips physicians to promote technologies that truly align with the goals of ethical, patient-centered care.
  1. Scope and audience
  • This statement aims to apply to all uses of AI in medicine, including clinical care and research, where AI primarily augments human decision-making. AI systems in administrative and educational contexts should be applied responsibly and with appropriate human oversight.
  • Its principles address physicians, other healthcare professionals, healthcare organizations, developers, regulators, payers, academic institutions, and industry partners, each of whom shares responsibility for ensuring that AI remains a safe, equitable, transparent, and ethically-governed tool in the delivery of healthcare worldwide.

GUIDING PRINCIPLES FOR AI IN HEALTHCARE

  1. Human-centricity: Human-centricity in AI prioritizes human needs, values, and wellbeing above technological capabilities or performance metrics. This principle includes:
  • Maintaining and respecting patient dignity, autonomy, and rights through meaningful consent for AI use.
  • Preserving patient health and well-being, and the human connection as the paramount considerations.
  • Embedding cultural competence to ensure AI systems respect diverse patient values, clinical needs, languages, and health beliefs.
  1. Physician well-being: The well-being of physicians and other clinicians must be safeguarded, recognizing that reducing administrative burden and avoiding unnecessary cognitive load are essential not only for supporting healthcare professionals but also for ensuring the quality and safety of patient care.
  2. AI is a Tool: AI should serve as a means to support healthcare goals rather than an end in itself. Unlike traditional medical tools, AI systems may appear to learn and adapt without continuous human input, making it essential to pair their use with strong human oversight and ethical governance.
  3. Accountability: AI integration does not diminish physician responsibility for patient welfare and advocacy. Consistent with the PITL principle, physicians must continue exercising professional judgment, and the final responsibility and accountability for diagnosis, indication, and therapy must always lie with the physician. At the same time, the growing prevalence of these tools necessitates clearly distributed accountability. Responsibility should be appropriately allocated among all stakeholders, including but not limited to developers, healthcare organizations, regulators, researchers and clinicians.
  4. Transparency, Explainability, and Trustworthiness:
  • AI systems must be designed and developed in ways that ensure their outputs and recommendations can be meaningfully understood by their intended end users—whether physicians, other healthcare professionals, or patients—within the relevant clinical context. Transparency extends beyond the “black box” paradigm, while explainability provides insight into the basis for specific outputs, thereby fostering trust and enabling responsible use. Transparency requirements and disclosures must be tailored to the needs of physicians and patients without adding paperwork or extra administrative tasks. Ensuring these qualities is a shared responsibility across all stakeholders, including developers, healthcare organizations, regulators, researchers, and clinicians.
  • Mechanisms should exist for meaningful challenges of healthcare AI outputs, enabling patients and clinicians – including physicians – to question, review, or override AI recommendations when appropriate. This capacity is essential for building clinical trust, without which clinicians may reject valuable AI tools or overly rely on opaque systems.
  • Explainability exists on a spectrum, with some complex models functioning as “black boxes” where only input/output relationships can be observed. The level of explainability required should generally be proportional to the clinical risk involved and the degree of autonomy granted to the system. In high-stakes contexts such as life-and-death decision-making, additional safeguards and oversight must be in place whenever full explainability cannot be achieved.
  1. Safe deployment: Safe deployment of AI in healthcare requires real-world validation demonstrating consistent performance, clinical efficacy, and usability before widespread adoption. Before clinical deployment, AI systems must also undergo rigorous ethical and health equity impact assessments that are context-sensitive and adapted to the specific healthcare setting and population, with particular attention to vulnerable and underrepresented groups. Implementation must include continuous performance monitoring, feedback mechanisms, and iterative improvement protocols to ensure sustained benefit and global accessibility. Risks and harmful consequences, including bias, must be properly understood, anticipated, and mitigated.
  2. Equitable implementation: New and beneficial AI healthcare tools must be developed and deployed equitably, with the goal of being accessible worldwide. Equitable implementation should ultimately bridge gaps in healthcare access, treatment, and outcomes., while expanding access to technology across disparate health care facilities.
  3. Data governance: All stakeholders must maintain the highest standards of data collection, storage, processing, and sharing to protect patient privacy, and institutional trust. This principle is foundational because healthcare AI depends on data access. Transparency around data provenance – including the origin, diversity, and quality of datasets used to train AI systems – must also be ensured to build trust and verify that data appropriately represents the patients being served.
  4. Environmental impact: Effective implementation of AI in healthcare requires careful consideration of its environmental impact and a strong commitment to sustainability. Environmental responsibility must be integrated alongside clinical validation to ensure that new technologies improve care while minimizing harm to the planet.

PHYSICIAN ROLES AND RESPONSIBILITIES

  1. Clinical Judgment and Accountability: As emphasized in the PITL principle, physician judgment remains essential when using AI in healthcare, serving as both an ethical imperative and a practical necessity. Physicians must maintain professional autonomy and clinical independence to act in the best interests of patients, consistent with the WMA Declaration of Seoul.
  2. Patient Advocacy: Physicians must safeguard patient health, well-being, and safety, ensuring that AI tools are only used in ways that genuinely benefit patients. Patient safety must remain a fundamental priority, whether or not augmented intelligence is applied.
  3. AI tool development: Physicians should be involved throughout the development and implementation of AI technologies in healthcare. They must participate in decision-making processes about technology and its use from the outset and be empowered to scrutinize new innovations, including for usability.
  4. Maintenance of competencies: Physicians must maintain core clinical expertise while also being educated and trained to work responsibly with AI systems. Delegation of tasks to AI must not erode the human capability required for safe, safety-critical care or for continuity when AI systems are unavailable or unreliable. Healthcare organizations should support this through ongoing education, simulation-based refreshers, periodic skills maintenance, and documented failover procedures that enable clinicians to critically appraise, override, and – when necessary – perform essential tasks independently.
  5. Incident reporting: Physicians must be empowered to report incidents and question outcomes resulting from the use of AI in healthcare.

PATIENT RIGHTS AND ENGAGEMENT

  1. While core patient rights are covered in existing WMA policies, AI introduces new risks – especially due to its reliance on data – that require focused ethical attention.
  2. Informed consent: Given AI systems’ reliance on patient health information, appropriate safeguards for data use are crucial. The principles of informed consent and transparency, building upon the WMA Declaration of Lisbon’s affirmation of patients’ rights to information and self-determination, must be rigorously applied in healthcare involving AI. Where possible, patients should be informed about the role AI plays in their care in ways that are understandable and meaningful, while physicians retain responsibility for ensuring safe and appropriate use of AI. In circumstances where full technical comprehension is impractical, informed consent may reasonably extend to a ‘consent for governance’ model, whereby patients place justified trust in physicians, healthcare institutions, and regulatory oversight to uphold their rights, safety, and welfare.
  3. Data rights: Patients must be informed about AI systems’ limitations and potential for error, as well as how physician oversight helps to ensures their protection. Patients should retain the right to request removal of their data from AI systems where feasible and legally permissible, and the right to understand how their data contributes to their care.
  4. Patient autonomy and explanation rights: Patient autonomy must be preserved through meaningful consent processes. Patients should retain the right, where feasible, to refuse AI-mediated interventions and request human-only assessment. Where such refusal is not possible due to systemic integration of AI, safeguards must ensure that patients’ data remain anonymous and non-traceable. Patients must have access to understandable and non-biased explanations of how AI contributes to their care, tailored to their information needs and preferences. They must also retain the right to dispute AI-generated recommendations they believe to be erroneous and to seek appropriate redress. This must extend to health insurer use of AI to determine patient care, payment, and coverage.
  5. Vulnerable patient population: Vulnerable patient cohorts, such as those with reduced decision-making capabilities, must not be disadvantaged or harmed through the use of AI in healthcare. Safeguards must include proactive bias mitigation, inclusive dataset development, and tailored consent or governance procedures to protect those unable to fully exercise autonomy. Particular attention must be given to ensuring that informed consent and data rights principles are applied in ways that do not reinforce structural inequities or exclude vulnerable groups from fair access to care.

GOVERNANCE, REGULATION, AND LIABILITY

  1. Up-to-date standards: Regulation, standards, and guidance must be suitably robust to safeguard patient safety and to ensure that the ethical rules of the medical profession are considered, with regulators empowered to stay up to date with developments and enforce legislation. Health care AI policies should be coordinated and consistent across government entities.
  2. Liability: Clear lines of legal liability must be established, including the AI developers, as well as physicians, and healthcare organisations. Accountability should be shared and proportional, reflecting each actor’s role in design, deployment, and use, rather than defaulting to a single actor alone.
  3. Continuous audit: There should be regular reviews and audits of regulatory processes and bodies surrounding AI in healthcare, including bias audits, ethical reviews, and participatory governance with physician input.

CLINICAL INTEGRATION AND IMPLEMENTATION OF HEALTH AI

  1. Tool evaluation and governance support: AI systems implemented in clinical settings must be validated for clinical relevance, safety, and effectiveness. Regular updates must be implemented to maintain security and ensure systems remain compatible with evolving clinical practices. In complex delivery environments, AI adoption must also be supported by appropriate governance structures that align clinical teams, leadership, and technology teams to ensure safe and responsible implementation.
  2. Workflow integration: AI tool implementation requires seamless integration within existing workflows to enhance usability and function as supportive additions rather than disruptive elements that impede efficient care delivery. Mechanisms should be established for tracking AI recommendations and their relationship to final clinical decisions.
  3. Post-deployment monitoring: Robust post-deployment monitoring is critical to ensure AI systems continue performing as intended. AI systems can drift from initial performance parameters when encountering new patient populations not represented in training data, as clinical practices evolve, or even within the same populations over time. Special attention should be directed toward monitoring outcomes in patient groups not adequately represented in training datasets.

DATA GOVERNANCE IMPLEMENTATION

  1. Patient data: All patient-identifiable information used or generated by AI systems must be collected, stored, and processed in strict accordance with the WMA Declaration of Taipei on Ethical Considerations Regarding Health Databases and Biobanks, as well as all applicable laws and regulations. Security safeguards are mandatory to preserve confidentiality, prevent unauthorised access, and uphold the therapeutic trust that underpins the patient–physician relationship. Additionally, patient data use must follow the same ethical safeguards applied to clinician data, including purpose limitation, transparency and consent, protection against misuse, and, where feasible, anonymisation and minimisation of data collected.
  2. Clinician data: AI systems are increasingly capturing granular data about clinicians (e.g., keystrokes, voice recordings, workflow metrics, prescribing patterns). Such information can support quality improvement and safety, but it also carries a risk of surveillance, punitive misuse, or erosion of professional autonomy. Therefore:
  • Purpose limitation: Clinician-identifiable data may be used only for clearly defined clinical, educational, or quality-improvement objectives that have been disclosed to—and agreed by—those clinicians.
  • Transparency and consent: Physicians must be informed, in advance and in comprehensible terms, what data are collected, how they will be analyzed, and who will have access. Explicit consent is required for uses beyond direct patient care or clinician-requested feedback.
  • Protection against misuse: Data must not be repurposed to penalize clinicians, set unrealistic performance quotas, or otherwise undermine the patient-physician relationship. Any secondary use (e.g. commercial analytics, administrative oversight) requires separate ethical review and consent.
  • Anonymization and minimization: Where feasible, clinician data should be de-identified or aggregated, and collection limited to the minimum necessary to achieve the stated purpose.
  1. Governance and oversight: Healthcare organisations must establish independent oversight mechanisms – such as, and not limited to, data protection officers, ethics committees, and periodic external audits – to verify compliance with safeguards for both patient and clinician data. Breaches or unauthorised uses must trigger transparent disclosure, remediation, and, where appropriate, sanctions. In addition, AI system developers must implement and support robust cybersecurity policies and controls to protect the confidentiality, integrity, and availability of health data throughout the AI system’s lifecycle.

MEDICAL EDUCATION AND CAPACITY BUILDING

  1. AI literacy requirements: Physicians must maintain appropriate AI literacy in the rapidly evolving AI landscape, including the knowledge and skills to use AI tools properly and the ability to critically understand and assess AI literacy must be systematically integrated into undergraduate medical curricula to ensure all physicians acquire a foundational understanding of these technologies. In addition, AI literacy should be reinforced through mandatory continuing professional development programs, enabling physicians to keep pace with evolving tools and to ensure their safe, ethical, and informed use in practice.
  2. Global equity: Focused attention must be directed toward bridging AI education gaps between regions, with particular emphasis on enhancing capacity in low- and middle-income countries (LMICs). Equitable distribution of educational resources and opportunities is essential to prevent widening disparities in AI implementation and ensure global benefit from these technological advances.

RESEARCH, INNOVATION AND EVALUATION

  1. Medical research standards: Any medical research involving AI, whether as the tool or object of study, must abide by accepted international standards of medical research, including, but not limited to, Good Clinical Practice, the WMA Declaration of Helsinki, and the WMA Declaration of Taipei.

GLOBAL CONSIDERATIONS AND COLLABORATION

  1. Cross-jurisdiction applicability: AI policies and infrastructures should, as far as possible, be aligned to have applicability across jurisdictions.
  2. Diverse healthcare environments: Appropriate AI solutions must be pursued across diverse healthcare environments, including low-resource settings. This requires supporting locally developed, context-sensitive innovations to ensure AI systems are responsive to local needs, realities, and resource constraints.
  3. Cultural Sensitivity: AI policies should respect varied cultural approaches while ensuring alignment with fundamental ethical principles, such as respect for human dignity, rights, and wellbeing.

RECOMMENDATIONS

  1. For physicians and medical associations: Medical professionals and their representative organizations should promote the development of comprehensive AI literacy programs, actively engage in AI governance structures – including contributing to the development of best practices for AI use in medicine – and uphold rigorous ethical standards to ensure quality patient care in an AI-enhanced healthcare environment. They should also consider creating educational materials for patients to support transparency and informed understanding of AI in healthcare.
  2. For healthcare facilities: Healthcare institutions must establish robust governance frameworks for the safe adoption of AI technologies and implement continuous monitoring processes. Organizations should balance innovation with safety considerations and maintain respect for clinical judgment when deploying AI systems. Importantly, AI implementation should be pursued when it demonstrably serves patients’ interests, without mandating AI use as a condition for licensure, participation, or reimbursement.
  3. For technology developers: Technology companies and AI developers must prioritize co-design approaches with practicing physicians and provide transparency in system development, deployment and use. Sustained collaboration between clinical and technical experts throughout the entire development lifecycle is essential to create tools that enhance healthcare quality and equity and that effectively support clinical activity.
  4. For regulators and policymakers: In consultation with medical associations (and other health professions organisations), craft physician-informed regulations and foster international cooperation.
  5. For educational institutions: Embed AI training in curricula and support global capacity building.
  6. For researchers and innovators: Pursue ethical, equitable, and evidence-based AI advancements.

 

Appendix

Narrow AI:
Domain-specific applications confined to clearly defined clinical or administrative objectives.

Generative AI:
Models, often large-language models, that create new clinical content—such as documentation drafts or treatment-plan suggestions—based on training data.

Foundational Models:
Broad, continuously trained models that underpin multiple healthcare applications and therefore require ongoing domain-specific oversight.

Machine learning:
A subset of artificial intelligence in which computer algorithms autonomously improve their performance at a specific task by learning complex relationships or identifying patterns in data, rather than by following explicit, pre-programmed instructions.

Patient-Physician Relationship:
Trust can be enhanced in the patient-physician relationship when:

-Physicians transparently discuss the role of AI in patient care
-AI systems demonstrably improve quality or safety outcomes
-Patients clearly understand how their data is used and protected and how data governance is organized.
-Patients are offered more time with their physician

 

Adopted by the 66th WMA General Assembly, Moscow, Russia, October 2015,
and revised by the 76th WMA General Assembly, Porto, Portugal, October 2025

PREAMBLE

The WMA believes that in the 21st century, life on the streets for children left to their own devices, to poverty, or to any form of exploitation or crime, is unacceptable. It is concerned about this phenomenon, which is becoming increasingly prevalent in many countries around the world, with UNICEF currently estimating that several tens of millions of children are affected.

The concept of “children in street situations”, developed by the United Nations[1], includes children or individuals under the age of 18 who depend on the street to live or work, whether this be alone, with peers, or with their families; it also refers to a wider population of children who have forged strong ties with public places and for whom the street is an essential part of their identity and daily life.

The health of these children remains critical and has been exacerbated by global economic inequalities, the geopolitical situation due to the development of numerous conflict zones around the world, as well as the climate and environmental crisis, which contribute to family break-ups, social upheavals, violence, and rising school drop-out rates; all of which seriously hamper access to healthcare.

Children in street situations, even more than other children, may be victims of discrimination. They are also particularly exposed and vulnerable to abuse of all kinds, violence and to the risk of exploitation for commercial or sexual purposes, or recruitment into armed forces or armed groups.

The WMA firmly believes that the minimum conditions for a child’s development and education cannot be met in such circumstances and that physicians must work to address situations that could seriously compromise a child’s future by hindering their development, safety, and health, which is defined by the WHO as a state of complete physical, mental and social well-being.

The WMA emphasizes that life on the streets carries many additional health risks (barriers to prevention and access to care, difficulties in follow-up, vulnerability to serious pathologies and trauma).

This is a complex, multi-factorial issue that requires strong commitment from all societies and relevant stakeholders, including healthcare professionals, and in particular physicians.

Facilitating contact between children in street situations and caretakers should be seen as a first step towards preserving or restoring these children’s health and re-socialising them through an established bond of trust. Once achieved, a more multidisciplinary and multidimensional approach can then be put in place to provide more comprehensive care and support, particularly educational and social.

The WMA emphasizes that the health of young people shapes the health of tomorrow’s population, and that young people play a part in social cohesion and are an asset to any country.

 

RECOMMENDATIONS

The WMA:

  1. strongly condemns any infringement of the rights of children in street situations, in particular through discrimination, stigmatisation, and exposure to abuse, violence, and all forms of exploitation.
  2. calls on governments to intensify their research into the factors that result in children living on the streets, and to work to minimise the impact of these situations on children’s overall health. National authorities have an imperative duty to take charge for all these children and to support their return to a living environment appropriate for a child. National authorities must also do everything in their power to protect children living on the streets from the health risks associated with various addictions and drug abuse (tobacco, alcohol, medicines and drugs), and those associated with transmissible diseases, particularly sexually transmitted ones.
  3. calls on the national authorities to carry out more research and collect data to assess more accurately the number of children in street situations. States must ensure that the collection and use of such data does not stigmatize and is beneficial to these children.
  4. calls on governments, medical associations and healthcare professionals to become more aware of the scale of the phenomenon, and to organise targeted prevention and awareness campaigns so that these children have access to the full range of necessary health and social protection.
  5. urges all medical associations to collaborate with governments and public authorities, and with other professionals in the health and social sectors, to ensure that the fundamental rights of children in street situations, in particular the right to health and education, are respected at all times. Every effort must be made to provide these children with housing, healthcare, and access to clean drinking water and nutritious food. Prevention policies, and in particular vaccination programmes as defined by the WHO, must be supported and implemented effectively. Appropriate information on health and the specific risks associated with precarious living conditions must be provided to the children concerned and to all relevant stakeholders and decision-makers.
  6. calls on physicians to advocate for the rights of children, especially the most vulnerable ones, and to commit fully to their protection.
  7. encourages physicians and local health providers to get involved in health and risk screening, information and prevention initiatives, and particularly in vaccination campaigns directed at children in street situations.
  8. urges physicians to exercise caution and express appropriate reservations when asked, through clinical or paraclinical methods, to estimate the age of young individuals for legal or administrative purposes, given the importance of ensuring that adolescents benefit from their status as minors until they reach adulthood, as recognized by the UN International Convention on the Rights of the Child. In particular, the physician must state the scientific uncertainties and specify the margin of error of the age estimation techniques used. These methods should only be used as a last resort.

[1] General comment No. 21 (2017) on children in street situations – United Nations Committee on the Rights of the Child

Adopted by the 60th WMA General Assembly, New Delhi, India, October 2009
and reaffirmed by the 212th WMA Council Session, Santiago, Chile, April 2019
and revised by the 76th WMA General Assembly, Porto, Portugal, October 2025 

PREAMBLE

In response to the global health workforce shortages and the increasing health expenditures, different measures have been developed to fill the unmet needs in health care delivery.

During the HIV/AIDS crisis, the WHO, the Joint United Nations Programme on HIV/AIDS (UNAIDS), and President´s Emergency Plan for AIDS Relief (PEPFAR) recommended task shifting with the aim to provide care to all individuals in need. Task shifting was defined as specific tasks that are moved from highly qualified health personnel to health personnel with shorter training and fewer qualifications. However, there are significant risks associated with task shifting, most notably the risk of decreasing the quality of patient care and contributing to the creation of a two-tier system in medicine.

In 2021, the WHO published health workforce-related terminology1. It discouraged the use of the word task shifting as it implies simply shifting tasks in isolation, without any accompanying support measures. Instead, the WHO encouraged task sharing, which it defines as ‘the rational redistribution of responsibilities among health workforce teams. Specific tasks or roles are shared, where appropriate, to less specialised health workers to use the available personnel efficiently. It should be accompanied by appropriate measures in terms of education, supervision, management support, licensing, regulation and remuneration.’

The term scope of practice (or SOP) refers to the limits of a health professional’s knowledge, skills and experience. A scope of practice reflects all tasks and activities undertaken within the context of a health professional’s role.

In multi-disciplinary health care teams physicians and other health personnel (like nurses, physiotherapists, physician assistants or community workers) cooperate to make their unique contribution to the best care of the patient. Such teamwork is to be coordinated by a physician, as the most highly trained team member and the one who generally bears the responsibility for diagnostic and therapeutic decisions. In such teams, it is important that each health personnel works within their scope of practice.

Multi-disciplinary healthcare teams should not be understood as interprofessional collaboration. as described in the World Health Professional Alliance statement on Interprofessional Collaborative Practice. This statement refers to collaboration between health professionals, who are licensed and/or regulated, highly educated and adhere to strict codes of ethics.

Some health care settings or jurisdictions have created new cohorts of healthcare personnel whose function is to assist other health professionals, specifically physicians, as well as new groups trained to independently perform specific tasks with or without physician supervision. If these new cohorts are allowed to perform physicians’ tasks on their own without supervision of a physician, this may decrease the quality of care. There are several risks such as, delayed, incorrect or overdiagnosis, incorrect treatment and inability to deal with complications, fragmented and inefficient service and lack of proper follow up. It may also increase the overall cost of care, as non-physician health personnel are more likely to rely on consultations and diagnostic and other tests to compensate for their lesser education and training compared to physicians. Also, the upholding of the specific ethical rules of the medical profession may be compromised.

All these measures are often implemented as counter measures to the critical shortage of physicians, or for social or economic reasons or by request of other health professionals or as means of lowering cost, under the guise of efficiency, or other unproven claims. In some cases, studies indicate that non-physician practitioners actually increase cost and inefficiency. Cost savings and efficiencies may also be facilitated by other interventions, such as the advancement of medical technology, which can standardize the performance and interpretation of certain tasks and augment the skills and knowledge of physicians and other health care professionals, and efforts to incentivize physicians to practice in rural or underserved areas. Data also shows that non-physicians tend to practice in the same locations as physicians, thus negating the notion that these proposals will solve concerns around access to care. It must also be noted that workforce shortages are not limited to physicians but indeed impact many health care professionals.

It must be recognized that medicine can never be viewed solely as a technical discipline. Patients’ health, rights, quality of care and medical ethics, must be the top priorities.

RECOMMENDATIONS

Therefore, the World Medical Association recommends the following guidelines:

  1. Multi-disciplinary team approaches, led and coordinated by a physician, should be viewed as the gold standard. This should involve the development of mutually supportive, interactive health care teams, where each member can make his or her unique contribution to the care being provided, based on their education, competence, area of expertise and scope of practice (as agreed upon by the physician leader).
  2. Quality and continuity of care, patient safety and medical ethics must never be compromised and should be the basis for all health workforce reforms and legislation.
  3. Respect for the physician’s competence, professional independence and clinical autonomy must be guaranteed in any health workforce reform. Diagnosis, as the basis for any action relating to the patient’s health, and prescribing treatments must remain the sole responsibility of the physician.
  4. It is imperative to consult and involve physicians and their professional representative organizations when considering whether to shift tasks away from physicians or opening them to other health professionals or new cohorts. This involvement should be explicit and cover all aspects of ensuring high quality care, particularly in relation to reforms in legislation and regulations. In some health care systems, physicians might themselves consider initiating and training a new cohort of assistants under their supervision and in accordance with principles of safety and proper patient care and with clear regulatory frameworks, to be created if necessary.
  5. When tasks are shifted from physicians to other health professionals, the respective clinical responsibility and legal liability must be clearly defined before implementation. These definitions should be included in official policies and made accessible to all relevant stakeholders. In particular, patients should be made aware of which health personnel are treating them. Terms such as ‘doctor’ or ‘physician’ must not be used in ways that confuse patients or imply greater training.’
  6. Quality assurance standards and treatment protocols must be defined, developed and supervised by physicians. Credentialing systems should be devised and implemented in order to ensure quality of care. The roles and responsibilities of different health personnel must be clarified. Tasks that can only be performed by physicians, such as responsibility for diagnosis and prescribing treatments, must be clearly defined, and non-physician staff must not be allowed or pressured into operate beyond the bounds of their scope of practice.
  7. All health workforce reforms should aim for the development of sustainable, fully functioning health care systems, which promote the quality of professional practice. The aspiration should be to educate and employ as many skilled health personnel as required, including physicians, rather than shifting tasks to less skilled health personnel.
  8. Assessments (including structured evaluations) should be made of the impact of the health workforce reforms on patient and health outcomes as well as on efficiency and effectiveness of health care delivery.
  9. Healthcare reforms, where tasks are shifted to non-physician health professionals without supervision, should not be undertaken or viewed as a viable cost-saving measure, as the economic benefits of such reforms are unsubstantiated. Cost driven measures are unlikely to produce quality results in the best interest of patients. Credible analysis of the economic benefits of such reforms should be conducted to measure public health outcomes, cost effectiveness and productivity, and should be studied and assessed independently and not under the auspices of those designated to perform or finance these reforms.
  10. Health care reforms that change scopes of practice or implement new groups of healthcare personnel should be complemented with incentives for the retention of physicians through means such as increasing salaries and improving working conditions.
  11. Such health care reforms 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, and in order for collaborative practice to succeed, training in physician leadership and teamwork must be improved. There must also be a clear understanding of the scope of practice of each healthcare team member, meaning what each person is educated for and capable of doing, a clear understanding of responsibilities and a defined, uniformly accepted use of terminology.
  12. The reasons underlying the need for health workforce reforms differ from country to country and therefore solutions appropriate for one country cannot be automatically adopted by others.
  13. Research must be conducted to identify training models that have been proven effective for less skilled health personnel. Work should 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.
  14. 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.
  15. When developing relevant law and policy, governments and health bodies should ensure that definitions of scope of practice for healthcare professionals are consistent, safe and facilitate the highest quality care, and clearly define which roles and tasks should only be undertaken by physicians and which tasks non-physician healthcare professionals may perform with physician supervision.

Adopted by the 76th WMA General Assembly, Porto, Portugal, October 2025

 

PREAMBLE

Good mental health of physicians and other health and care professionals is a prerequisite for high quality medical care and patient safety.

The WHO Working for Health Action Plan 2022-2030 emphasizes that many challenges faced by health and care professionals around the world, including i.a. labor market failures and substantial underinvestment that have a “direct effect on physical and mental health and worker well-being as they undermine their health, social and economic contribution to society.”

Physicians and other health and care professionals may experience mental health conditions that are linked to burnout, long working hours, high-stakes decision-making, and emotional burdens specific to their profession. If not addressed in time, mental health conditions can become chronic and have serious consequences in all areas of life. They can even lead to an increased risk of suicidal ideation among physicians.

The prevalence of mental health conditions among physicians and other health and care professionals worldwide highlights the need for greater attention to their psychosocial well-being.

Pressure from employers, extended working hours, or experiences of violence, combined with access to drugs and medication, can also give rise to situations in which physicians require help and support. These and other factors can also contribute to an increased risk of substance abuse among medical professionals. Since the mental health of physicians impacts on the quality of health care and patient safety, ensuring the well-being of physicians is essential.

Promoting physician mental health requires comprehensive action that ensures appropriate treatment and rehabilitation without stigmatization.

Several countries have implemented specific programs that have demonstrated effectiveness in providing comprehensive care to physicians affected by mental health conditions.

A history of mental health conditions does not inherently preclude a physician from providing valuable, high-quality patient care. Physicians should be supported through return-to-work programs and reasonable workplace accommodations to ensure their successful reintegration and continued contribution to patient care.

Further research regarding mental health of physicians is needed to better understand the problem and identify best practices in terms of mental health promotion and treatment, including attention to diversity and equity among physician populations.

 

RECOMMENDATIONS

The World Medical Association reaffirms its Statement on Physician Well-being, calls on the relevant authorities to collaborate with healthcare professional organisations on the issue of physician mental health and urges its constituent members and physicians to:

  1. Advocate for the development of effective policies that protect the mental health of physicians and ensure sufficient resources to enable appropriate care.
  2. Encourage concerted efforts for the prevention and early detection of mental health conditions among physicians, ensuring confidential access to evaluation, treatment, and follow-up without fear of professional repercussions. Promote physicians’ physical and mental well-being through specific strategies, including during higher education and postgraduate training. These strategies should provide support for those experiencing mental conditions and ensure that resources to promote positive mental health are available to all clinicians, including those at risk.
  3. Promote the development of specific mental health intervention programs and protocols for physicians that address the problem from a healthcare, social and professional point of view, with confidentiality and without stigma and encouraging physical and psychological rehabilitation. This should include programs to support physicians to overcome addictions, which could be caused by occupational psychosocial risk factors. Medical associations should promote programs helping physicians return to practice after treatment and recovery.
  4. Ensure the destigmatization of mental health and substance use disorders in physicians by ensuring access to treatment and follow-up without disproportionate risk of adverse licensure or certification actions. Any restrictions on medical practice should be based on an objective, case-by-case assessment involving relevant regulatory bodies, with full consideration of patient safety, clinical recovery, and the rights of the physician.
  5. Duly consider the experience acquired by physicians recovered from mental health disorders in efforts to overcome stigmatization, discrimination and to reduce inequalities.
  6. Support and expand physicians’ mental health research and education to identify and implement best practices.
  7. Increase awareness and promote comprehensive training on physician mental health across healthcare, academic, and institutional settings and at all stages of medical education.
  8. Encourage research on the prevalence and impact of psychosocial risks factors in the medical profession.
  9. National medical associations should promote the establishment of mechanisms such as observatories or dedicated monitoring initiatives to recognize, assess, and track mental health challenges among physicians, and to develop evidence-based proposals for their prevention and resolution.
  10. Consider and promote measures to create positive and supportive workplace cultures that foster open communication, teamwork and a sense of belonging where physicians feel valued and respected, including leadership training, peer support initiatives, and confidential channels for raising concerns without fear of retribution.

 

Adopted by the 76th WMA General Assembly, Porto, Portugal, October 2025

 

PREAMBLE

The WMA notes with concern that reproductive health[1] is underprioritized in many regions of the world.

The WMA recognizes that access to reproductive health services may be influenced by local moral, cultural and religious beliefs, traditions and practices.

The WMA affirms that such beliefs, traditions and practices should not constitute a barrier to access to health services.

The WMA opposes laws, policies, and juridical practices that unreasonably restrict or criminalize the termination of pregnancy.

The WMA underlines that physicians are responsible for protecting their patients’ privacy and maintaining physician-patient confidentiality.

The sexual and reproductive rights of women and girls are human rights that must be respected to ensure their full development in all spheres of life.

The WMA reaffirms its Statement on medically-indicated termination of pregnancy.

 

RECOMMENDATIONS

The WMA recommends its constituent members to:

  1. Address reproductive health in public debate in order to promote greater societal knowledge and understanding of the issues at stake.
  2. Consider reproductive health as an individual and public health issue in the same way as other health needs.
  3. Promote universal accessibility, with a focus on affordability to health services, including reproductive health services.
  4. Oppose criminal and civil penalties for the provision of reproductive health services, including access to contraception.
  5. Advocate for legal protection for physicians and patients who provide and receive reproductive health services, including contraception.
  6. Oppose criminal and civil penalties for the provision of voluntary termination of pregnancy and advocate for legal protection for physicians who provide voluntary termination of pregnancy and for their patients.
  7. Facilitate development of and access to knowledge related to reproductive health.
  8. Promote health and sexual information and education for girls and women in order to develop adequate and healthy reproductive health.

The WMA recommends physicians to:

  1. Ensure that patients’ health and well-being are prioritized without discrimination.
  2. Treat all patients with respect for their autonomy and dignity.
  3. Ensure that where conflicts of conscience prevent the physician from providing reproductive health services, sufficient information is provided about alternative care givers and timely access to care is ensured for every patient.
  4. Assist patients with information and products that support their autonomy with regard to family planning.
  5. In obstetric care, always facilitate safe childbirth and post-partum care.

 

[1] The term “reproductive health” in this statement includes maternal and neonatal care, contraception, fertility treatments and family planning.

Adopted by the 76th WMA General Assembly, Porto, Portugal, October 2025

 

PREAMBLE

The World Medical Association recognizes obesity as a widespread, long-term chronic disease and a global concern. The WMA notes that obesity is increasing among all age groups. Still, the rise in children including adolescents is of particular concern as earlier onset leads to worsened chronic disease burden over the life course. Obesity can affect both mental and physical health and can lead to discrimination, stigma, and bullying.

Obesity is a major health problem affecting all countries and all social and economic groups. It puts much pressure on healthcare resources. It is not an aesthetic problem, it is a medical problem that increases the risk of many other illnesses and health problems and, due to its scale and consequences, it is a public health problem of the highest priority.

Obesity’s causes are complicated and relate to changes in society and the economy, including the environment that encourages obesity. The causes of obesity may be multifaceted, encompassing various factors such as environmental influences on physical activity, biological and medical conditions, psychological factors, maternal and developmental aspects, dietary habits, and economic and social elements.

The WMA acknowledges that social determinants of health significantly contribute to obesity. These determinants partially account for the disparities observed in racial and ethnic minority groups.

Physicians can be instrumental in both preventing and treating obesity. However, their potential may be hindered by insufficient education regarding obesity or subconscious and conscious biases toward patients with obesity. This may subsequently affect the quality of care offered to patients with obesity.

The WMA emphasizes the need to stimulate and support multisectoral country-level action on obesity across the globe.

The prescription of drugs for the treatment of obesity should be based on a medical diagnosis with strictly scientific criteria.

The WMA recalls its policies on Free Sugar Consumption and Sugar-sweetened Beverages, the Global Burden of Chronic Non-Communicable Disease, and Primary Health Care. These policies provide important context and guidance for addressing the obesity epidemic.

 

RECOMMENDATIONS

  1. The WMA recommends all Medical Associations to call for policies that reduce the incidence of obesity, including:
  • Learning about healthy diets in school curricula;
  • Facilitating access to physical activity and sports for all parts of the population;
  • Actively using consumer protection regulations to restrict marketing and raise prices of unhealthy products.
  1. The WMA urges all Medical Associations to advocate for the recognition of obesity as a chronic disease requiring medical care and appropriate support, and the integration of obesity prevention, management, and treatment into national health services. All stakeholders must work together to address this global health concern.
  2. The WMA calls for integrating obesity prevention, management, and treatment into Universal Health Coverage as an ‘essential health service.’ This includes access to evidence-based therapies and treatments for obesity, ensuring these services are universally available, accessible, affordable, and sustainable.
  3. The WMA encourages physicians to use their leadership roles to push for obesity reduction to be a priority for national health authorities and to advocate for policies suitable for different cultures and ages, involving physicians and other key stakeholders.
  4. The WMA acknowledges that there are various treatment options for patients with obesity. These range from lifestyle and behavioral changes to pharmacotherapy, medical devices, and metabolic and bariatric surgery.
  5. Primary prevention is a crucial objective for physicians in addressing obesity, but only limited effective methods to achieve it are currently available. While progression of and complications associated with obesity can be prevented and treated, there is a need to develop and support additional effective strategies to reduce its incidence. We must promote health information and education based on sound scientific criteria that inform, help and support the population in the prevention and management of this disease.
  6. Physicians need thorough education on obesity to fully understand the disease. This will enable them to treat it effectively, minimize prejudice and stigma, advocate for relevant policies, and lead treatment teams efficiently.
  7. Physicians attending to pediatric patients should understand the specific details associated with childhood and adolescent obesity, especially the necessity for prevention and early intervention. They should be able to identify rare types of obesity, as failure to do so can result in detrimental health consequences.
  8. The WMA recommends a multisectoral approach, based on the principles of primary health care, to prevent, treat, and manage obesity. This approach involves various sectors, including health, education, and social services, with physicians playing a crucial role in this multisectoral approach.
  9. The WMA encourages its Constituent Members and physicians to advocate for healthy diet, to promote regular physical exercise and to combat diet and nutrition misinformation spread particularly on social networks.
  10. The WMA calls for firm action against self-proclaimed therapists and unproven therapies.

 

 

Adopted by the 76th WMA General Assembly, Porto, Portugal, October 2025

 

PREAMBLE

The increasing number of physicians at or near retirement age plays a great role in contemporary medical practice. They provide competent care as well as improve patient access to medical care. This resolution supports professional autonomy, and addresses the matter of continued competency evaluation, to preserve patients’ access to care, patients’ right to freedom of choice, as well as patient safety and medical care standards.

The number of physicians at or near retirement age is increasing in many parts of the world, and many of these physicians still play an active and leading role in their respective fields.

Ageing physicians can play a valuable role contributing their experience and knowledge of the healthcare environment, of their patients, and of the interpersonal dynamics and the patient-physician relationship.

The World Medical Association believes that when there is concern about a physician’s competence, the physician’s colleagues and internal management should examine whether the concern is well-founded and if so, whether the issue can be resolved quickly and through internal processes without risk to patient safety. If such efforts do not resolve the problem, it may be necessary to report the physician to the relevant authorities in good faith and in the best interests of the physician and of their patients. It is imperative that this approach be marked by the utmost benevolence and collegiality. Appropriate personal support to the physician should be ensured.

  

RECOMMENDATIONS

  1. The World Medical Association urges avoidance of policies that mandate age-specific retirement for physicians.
  2. The World Medical Association invites its Constituent Members to:
  • Foster the principles of evidence-based competency evaluation of the individual physicians and strive for professional autonomy in this matter.
  • Seek to ensure appropriate and balanced evaluation of the working ability of ageing physicians that wish to continue their medical practice.
  • Promote tailored continuing professional development activities to support ageing physicians and the maintenance of their professional aptitude, for them to provide high quality care throughout their practice careers.
  • Promote ways for ageing physicians to remain active after retirement, including through volunteer opportunities.
  1. Physicians should report to the appropriate authorities conditions or circumstances which impede a physicians from providing care of the highest standards, as set forth in the WMA’s International Code of Medical Ethics.
  2. The World Medical Association invites its members and health authorities to secure appropriate pathways when there is concern about a physician’s competence or circumstances which impede a physician from providing care of the highest standards, as set forth in the WMA’s International Code of Medical Ethics.
  3. In these circumstances, the physician’s colleagues and internal management should examine whether the concern is well-founded and if so, whether the issue can be resolved quickly and through internal processes without risk to patient safety.
  4. If such efforts do not resolve the problem, it may be necessary to report the physician to the relevant authorities in good faith and in the best interests of the physician and of the patients. It is imperative that this approach be marked by the utmost benevolence and collegiality. Appropriate personal support to the physician should be ensured.
  5. The World Medical Association recommends physicians to:
  • Have their health and work ability regularly evaluated by another physician.
  • Maintain professional skills with appropriate continuing professional development activities, in order also to adapt to new technologies, treatments and healthcare protocols and ensure up-to-date and safe medical care.

 

Adopted by the 66th WMA General Assembly, Moscow, Russia, October 2015
and revised by the 76th WMA General Assembly, Porto, Portugal, October 2025

 

PREAMBLE

The World Health Organization defines “health” as “a state of complete physical, mental and social well-being” and defines “well-being” as “a positive state experienced by individuals and societies. Similar to health, it is a resource for daily life and is determined by social, economic and environmental conditions.” Physicians, like all human beings, experience personal, institutional, and systemic challenges to their well-being. For physicians, these challenges can include, mental illness, disabilities and injuries resulting from work hazards, occupational stress and burnout often caused by shortages of human and other resources, and performance-oriented policy pressures.

In the WMA Declaration of Geneva, physicians promise to attend to their own “health, well-being, and abilities in order to provide care of the highest standard,” recognizing that physician well-being can positively impact patient care and public health. Conversely, challenges to physician well-being can put patients at risk, compromise physicians’ relationships with patients as well as colleagues, and undermine public trust in the profession.

The relationship between physician well-being, patient care and public health is also recognized by the International Labour Organisation/World Health Organisation’s Guide for the Development and Implementation of Occupational Health and Safety Programmes for Health Workers, an important document presenting key elements and deliverables of national occupational safety programmes that help promote physician well-being, decrease work-related risks and prevent occupational diseases in health care workers, including physicians.

Risks and Barriers for Physicians Well-being

Professional Roles and Expectations

  1. The medical profession often attracts highly driven individuals with a strong sense of duty. Successfully completing the long and intense educational requirements often confers upon physicians a high degree of respect and responsibility in their communities.
  2. With these high levels of respect and responsibility, physicians are subject to high expectations from patients and the public. These expectations can contribute to prioritizing the care of others over care of self and feelings of guilt and selfishness for managing their own well-being.
  3. A reason physicians may delay seeking care or help is their concern about confidentiality and professional repercussions, compounded by stigma and a prevailing culture in medicine that discourages vulnerability.

Factors that affect physician wellbeing

  1. Working conditions, including workload and working hours, affect physicians’ motivation, job satisfaction, personal life and physical and psychological health during their careers.
  2. Physicians may be exposed to a variety of occupational risks including physical (radiation, noise, chemicals), infections, or related to non-ergonomic working conditions (particularly for surgical disciplines and other specialties with extended periods of standing and musculoskeletal system exertion). Physicians who are employed by small organizations or who are self-employed may be at even higher risk for occupational exposures and may not have access to health and safety programs provided by large health care establishments.
  3. Medical students, physicians and physicians in postgraduate education often confront emotionally stressful and traumatic situations in the exercise of their profession. They may also be victims of violence.
  4. Medical students and physicians in postgraduate education can be victims of bullying, harassment and discrimination during their medical education. Due to their position within the medical hierarchy, they may feel powerless to confront these behaviours.
  5. Physician autonomy is one of the strongest predictors of physician satisfaction, and provision of high-quality healthcare services. Increasing external regulatory pressures such as excessive emphasis on cost efficiencies, administrative and technical aggravations, concerns about consequences of reporting medical errors, and malpractice actions may unduly influence medical decision-making and diminish a physician’s autonomy.
  6. In extreme cases, emotional and physical challenges in the health care environment during national or global emergency situations such as work actions, natural disasters, pandemics and armed conflicts can occur. Difficult practice situations, lack of human and material resources and the pressure of the fast-paced decision making required all contribute to an elevated risk of physician burnout and a challenging work environment.

Mental health risks, prevention strategies and treatment for physicians

  1. Physicians face a heightened risk of developing mental disorders due to various factors. Despite their awareness of the importance of early diagnosis and treatment, some physicians may conceal their illnesses and delay seeking help until they can no longer fulfill their professional duties. Barriers such as denial, desensitization to issues, concerns about confidentiality, reluctance to assume the patient role, fear of disciplinary actions, potential loss of practice privileges, reliance on self-care, and lack of systemic support contribute to this reluctance. Mental and behavioral health issues, including but not limited to depression, anxiety, burnout and substance use disorders, often overlap with physical and cognitive problems throughout a physician’s career, impacting both personal well-being and patient care. The mental aspect of physician well-being is addressed in greater detail by the WMA Statement on Physician Mental Health.

 

RECOMMENDATIONS

The World Medical Association recommends that constituent members and their members should recognize and, where possible, actively address the following:

Systems-level Advocacy

  1. Constituent members should support the right of physicians to have working conditions that help limit the risk of burnout and empower them to care for their personal health by balancing their professional medical commitments and their private lives and responsibilities.
  2. Constituent members should emphasize the importance of optimal working conditions. Optimal working conditions include a safe and reasonable maximum number of consecutive and total working hours, adequate rest between shifts, an appropriate number of non-working days, including paid non-working days, and targeted system-wide efforts to reduce non-clinical work burdens. Working conditions must not put the safety of patients or physicians at risk. Physicians should be engaged in establishing safe conditions within medical workplaces.
  3. Professional autonomy is an essential factor of well-being; relevant organizations should actively and constructively address professional autonomy and work-life balance problems and involve physicians in making decisions about their work lives.
  4. It is essential that regulating bodies, health care systems and other key parties to protect and uphold the privacy and confidentiality of physician-patients. It is also essential that physicians can seek help without fear of punitive action, including through the decriminalization of help-seeking behaviour where such barriers exist.

Workplace Standards and Best Practices

  1. Workplaces should promote conditions conducive to healthy lifestyles, including access to healthy food choices, regular physical activity, including through the provision of exercise areas and rest areas, nutrition counselling and support to combat addictions.
  2. Workplaces should also strive to support physicians in their family responsibilities by offering options such as flexible working hours, postpartum support, childcare facilities, and family care leave.
  3. Physicians, physicians in postgraduate education and medical students must be able to practice in an environment free from harassment, violence, and all forms of discrimination. They should be protected from verbal, cyber, physical and sexual aggression and abuse.
  4. Physicians, physicians in postgraduate education and medical students deeply need safe and stimulating collaboration in the workplace. Workplaces should promote interdisciplinary teamwork, and communication between physicians and all other professionals in the workplace should be offered in a spirit of cooperation and respect. Education about communications skills, self-awareness and team-work should be considered.
  5. Institutions must take active responsibility for creating and maintaining psychologically safe and inclusive learning environments.
  6. Constituent members should act to implement the recommendations in the WMA Statement on Workplace Violence in the Health Sector. Medical staff members should undergo training to identify potentially violent people, adopt an appropriate approach and communicate effectively with them. Health care facilities should safeguard against violence including routine violence risk audits, especially in mental health treatment facilities and emergency departments. Staff members who are victims of violence or who report violence should be supported by management and offered medical, psychological and legal counselling. Reporting of violence should be made practical, confidential and safe.
  7. Medical consultations should be offered in the workplace and at the outset of physician postgraduate education to identify any health issues.
  8. Medical schools and teaching hospitals should also develop and maintain independent, confidential, and easily accessible health services for physicians in postgraduate education and for medical students and raise awareness of and access to such programs.
  9. Health systems, regulators, administrators and technology vendors should be aware that the increasing burden of documentation and reporting in healthcare increases physicians’ cognitive load. Improving the user-friendliness of electronic systems, reducing and simplifying documents and forms, and providing adequate personal support for data management can enhance physician well being.

Education, resources and programmes

  1. Constituent members should recognize their obligation to promote or provide education about physician well-being. Constituent members should collaboratively encourage and promote research to establish best practices that promote physician health and to determine the impact of physician well-being on patient care. Constituent members should encourage dissemination of research results and implementation of demonstrated best practices.
  2. Constituent members should also support interprofessional collaboration and inclusive leadership development as essential to promoting healthy workplace cultures. In addition, medical education should include education on physician work hazards.
  3. Physician well-being should be supported within and outside the workplace. Support may include, but is not limited to, referral to medical treatment, counselling, peer networks, telehealth-based mental health services, and digital tools designed to promote resilience and coping. Physician health programs can assist physicians to proactively help themselves via prevention strategies and can aid physicians who are ill via assessment, referral to treatment and follow-up. Constituent members should promote the availability of culturally-adapted physician health programs for all physicians.
  4. Resources for the early identification, intervention and special arrangements for the care of physician-patients should be available to protect the health of physicians, especially during national and global emergency situations. Prevention, early assistance and intervention should be available and separate from any disciplinary process.

Physicians and the Physician Community

  1. To preserve the quality of their performance, physicians have a responsibility to maintain personal health and wellness, broadly construed as preventing or treating acute or chronic diseases, including mental illness, disabilities, and occupational stress. Collectively, physicians have an obligation to ensure that colleagues are able to provide safe and effective care, which includes promoting health and wellness amongst physicians.
  2. Physicians evaluating and treating their medical colleagues should not be required to report any aspects of their physician-patient’s care in any manner not required for their non-physician patients.

 

Adopted by the 54th WMA General Assembly, Helsinki, Finland, September 2003
Revised by the 65th WMA General Assembly, Durban, South Africa, October 2014
and by the 76th WMA General Assembly, Porto, Portugal, October 2025

PREAMBLE

The medical workforce is essential to global health care systems. Population growth in some parts of the world, combined with ageing populations in other regions have contributed to shortages in the health personnel workforce. While comprehensive and extensive workforce planning at a national and international level is required, this hasn’t always been a priority, leaving a global shortage of physicians, even in the wealthiest countries. A major reason for the shortage is a failure to educate and train enough physicians to meet the needs of the country. Other reasons for the net loss of physicians are the recruitment of physicians to other professions, early retirement and emigration, illness (including mental health problems), and the problems of combining professional and family responsibilities, all of which are often due to poor working conditions for physicians.

Physicians do have valid reasons for migrating, for example, to seek better career opportunities and to escape poor working and living conditions, which may include the pursuit of more political and personal freedoms and other benefits. The WMA acknowledges that temporary stays of physicians in other countries where they can work and train in other healthcare systems help both the receiving and the sending countries to exchange medical knowledge, skills and attitudes. The exchange of medical professionals is therefore beneficial for the development of medicine and healthcare systems and in general deserves the support of Constituent Members as well as governments.

The WMA Resolution on the Medical Workforce (2023) has stressed the need for comprehensive and gender equal measures to guarantee physicians’ well-being and safety via an adequate working environment, including in emergency contexts, with a strong emphasis made to the employer’s responsibility in ensuring this. The WMA also reaffirms its policies on WMA Statement on Non-Discrimination In Professional Membership and Activities of Physicians, WMA Resolution on Task Shifting from the Medical Profession, and WMA Resolution of Criminalisation of Medical Practice.

The WMA emphasizes the WHO Global Code of Practice on the International Recruitment of Health Personnel, established to promote voluntary principles and practices for the ethical international recruitment of health personnel and to facilitate the strengthening of health systems and that takes into account the “rights, obligations and expectations of source countries, destination countries and migrant health personnel”.

The Global health and care worker compact[1] provides Member States, stakeholders and other organizations with technical guidance on how to “protect health and care workers and safeguard their rights, and to promote and ensure decent work, free from racial and all other forms of discrimination and a safe and enabling practice environment”, in line with the WHO Global Code of Practice on the International Recruitment of Health Personnel.

 

RECOMMENDATIONS

The WMA makes the following recommendations to ensure physicians’ well-being and safety via an adequate working environment in the source and destination countries:

  1. Constituent Members, governments and employers should exercise diligence in collecting global health workforce data. This data can be used to establish, strengthen and maintain a health personnel information system; ideally it should be available in real time, for better reactivity. The setting up of observatories on medical demography should be encouraged.
  2. Every country should do its utmost to educate and train 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. Countries should explore strategies to mitigate negative effects of physician migration on “source” countries.
  3. Every country should put resources into retaining its physicians in the profession as well as in the country (including those nationals who have studied medicine elsewhere) by providing them with the support they need to meet their personal and professional goals, taking into account the country’s priorities. This includes providing comprehensive induction to those new to the country and the system of working. All countries need to ensure adequate working conditions for physicians, including, but not limited to safe working conditions, manageable working hours, access to essential resources, including well-being support, and opportunities for professional advancement.
  4. Physicians should not be prevented from leaving their home or adopted country to pursue career opportunities in another country.
  5. Countries that recruit or receive physicians from other countries should ensure that recruiters provide timely, comprehensive and accurate information to potential recruits on the nature and requirements of the position to be filled on immigration, administrative and contractual requirements, and on the legal and regulatory conditions for the practice of medicine in the recruiting country, including language skills.
  6. Physicians who are working, either permanently or temporarily, in a country other than their country of birth, adopted country or country of education, should be treated fairly and without discrimination in all aspects of the recruitment and employment process in relation to other physicians in that country (for example, equal access to career development and equal payment for the same work); grievance mechanisms should be considered.
  7. Fair and equitable remuneration for physicians and all health and care personnel should be ensured as an important element of providing them with safe, healthy, supportive and dignified conditions of work.
  8. Countries that wish to recruit physicians from another country should only do so in terms of and in accordance with the provisions of a Memorandum of Understanding entered between the countries. Further the international recruitment should be “conducted in accordance with the principles of transparency, fairness and promotion of sustainability of health systems in developing countries”[2].
  9. Nothing should prevent countries or medical institutions from entering into fair bilateral agreements and agreements of understanding, as provided for in international law and with due cognizance of international human rights law, so as to effect meaningful co-operation on health care delivery, including the exchange of physicians.
  10. The monitoring and information-sharing system established by the WHO should be robustly supported with the goal of international cooperation. Stakeholders should regularly collate and share data, which should be monitored and analyzed by the WHO. The WHO should provide substantive critical feedback to governments. Information should be shared about how to overcome challenges encountered.

 

[1] Friedman EA, Bickford R, Bjork C, et al
The global health and care worker compact: evidence base and policy considerations
BMJ Global Health 2023;8:e012337.
[2] Para. 3.5 of WHO Global Code of Practice on the International Recruitment of health Personnel

Adopted by the 50th World Medical Assembly, Ottawa, Canada, October 1998
Revised by the 59th WMA General Assembly, Seoul, Korea, October 2008,
by the 66th WMA General Assembly, Moscow, Russia, October 2015,
by the 69th WMA General Assembly, Reykjavik, Iceland, October 2018,
and by the 76th WMA General Assembly, Porto, Portugal, October 2025

 

Preamble

The WMA Declarations of Geneva, Helsinki and Tokyo make clear the duties and responsibilities of the medical profession to preserve and safeguard the health of the patient and to dedicate itself to the service of humanity. Therefore, and in light of the persistent availability of nuclear weapons, the catastrophic medical and environmental consequences of nuclear weapon use, and the impossibility of a meaningful health and humanitarian response, the WMA considers that it has a duty to work toward the elimination of nuclear weapons. To achieve a world free of nuclear weapons is a necessity.

 

Recommendations

Therefore, the WMA:

  1. Condemns the development, testing, production, stockpiling, transfer and deployment of nuclear weapons, as well as the threat or use of nuclear weapons for any reason and at any time.
  2. Requests all governments to refrain from the development, testing, production, stockpiling, transfer, deployment, threat and use of nuclear weapons and to work in good faith towards the elimination of nuclear weapons.
  3. Advises all governments that even a limited nuclear war would bring about immense human suffering and health damage, and a substantial death toll, together with catastrophic effects on the earth’s climate and ecosystem, which could cause a “nuclear winter” effect, subsequently decreasing the worlds food supply and putting a significant portion of the world’s population at risk of famine.
  4. Is deeply concerned by plans to retain indefinitely and modernize nuclear arsenals, including increasing use of artificial intelligence in the military; by the absence of progress in nuclear disarmament by nuclear-armed states; and by the growing dangers of nuclear war, whether by intent, including cyberattack, inadvertence or accident.
  5. Welcomes the entry into force of the Treaty on the Prohibition of Nuclear Weapons, and joins with others in the international community, and nearly 100 UN member states, in calling, as a mission of physicians, on all states to promptly sign, ratify or accede to, and faithfully implement the Treaty on the Prohibition of Nuclear Weapons.
  6. Urges the World Health Assembly to empower the World Health Organization to review and renew its 1987 report “Effects of Nuclear War on Health and Health Services,” and its 1993 report “Health and Environmental Effects of Nuclear Weapons” and to publicize its findings widely, continuing to update this report regularly and on an ongoing basis and,
  7. Requests that all Medical Associations at all levels join the WMA in supporting this Statement, use available educational resources to educate the general public and urge their respective governments to work urgently to prohibit and eliminate nuclear weapons, including by joining and implementing the UN Treaty on the Prohibition of Nuclear Weapons.

Adopted by the 57th WMA General Assembly, Pilanesberg, South Africa, October 2006,
revised by the 73rd WMA General Assembly, Berlin, Germany, October 2022,
and revised in its recommendation 14 by the 75th WMA General Assembly, Helsinki, Finland, October 2024

 

PREAMBLE

Assisted Reproductive Technology [ART] encompasses a wide range of techniques designed primarily to aid individuals unable to conceive without medical assistance.

ART is defined as any fertility treatment in which either gametes or embryos are handled.

Assisted reproductive technologies may raise profound ethical and legal issues. Views and beliefs on assisted reproductive technologies vary both within and among countries  and are subject to different regulations in different countries.

Central to much of the debate in this area are issues around the moral status of the embryo, the way in which ART is viewed morally, societally and religiously, the child/ren born from ART, and the rights of all participants involved, i.e. donors, surrogates, the child/ren and the intended parents are just some of the issues central to the debate in ART. Whilst consensus can be reached on some issues, there remain fundamental differences of opinion that are more difficult to resolve.

Assisted conception differs from the treatment of illness in that the inability to become a parent without medical intervention is not always regarded as an illness. Notwithstanding, the inability to conceive may also be a result of prior illness.

In many jurisdictions, the process of obtaining consent must follow a process of information giving and the offer of counselling and might also include a formal assessment of the patient in terms of the welfare of the potential child.

Faced with the progress of new technologies of assisted reproduction, physicians should keep in mind that not everything that is technically feasible is ethically acceptable. Genetic manipulation that does not have a therapeutic purpose is not ethical, nor is the manipulation on the embryo or foetus without a clear and beneficial diagnostic or therapeutic purpose.

 

RECOMMENDATIONS

1.Physicians involved in providing assisted reproductive technologies should always consider their ethical responsibilities towards all parties involved in a reproductive plan, which may include the future child/ren, donor, surrogate or parents. If there is compelling evidence that a future child, donor, surrogate or parent would be exposed to serious harm, treatment should not be provided.

2. As with all other medical procedures, physicians have an ethical obligation to limit their practice to areas in which they have relevant expertise, skill, and experience and to respect the autonomy and rights of patients.

3. In practice this means that informed consent is required as with other medical procedures; the validity of such consent is dependent upon the adequacy of the information offered to the patient and their freedom to make a decision, including freedom from coercion or other pressures or influences to decide in a particular way.

4. The consent process should include providing the participant/s with understandable, accurate and adequate information about the following:

  • The purpose, nature, procedure, and benefits of the assisted reproductive technology that will be used.
  • The risks, burdens and limitations of the assisted reproductive technology that will be used.
  • The success rates of the treatment and possible alternatives, such as adoption.
  • The availability of psychological support for the duration of the treatment and, in particular, if a treatment is unsuccessful.
  • The measures protecting confidentiality, privacy and autonomy, including data security measures.

5. The following should be discussed during the informed consent process:

  • Detailed medical risks;
  • whether or not all biological samples involved in ART, including but not limited to donor eggs, sperm, gametes and genetic information, may be used for research purposes;
  • The risks of multiple donations and donating at multiple clinics;
  • Confidentiality and privacy issues;
  • Compensation issues.

6. Donors, surrogates and any resulting child/ren seeking assisted reproductive technologies are entitled to the same level of confidentiality and privacy as for any other medical treatment.

7. Assisted reproductive technology involves handling and manipulation of human gametes and embryos. There are different levels of concern with the handling of such material, yet there is general agreement that such material should be subject to specific safeguards to protect from inappropriate, unethical, or illegal use.

8. Physicians should uphold the principles in the WMA Statement on Stem Cell Research, WMA Statement on Human Genome Editing, the WMA Declaration of Helsinki, and the WMA Declaration of Reykjavik – Ethical Considerations Regarding the Use of Genetics in Health Care.

9. Physicians should, where appropriate, provide ART in a non-discriminatory manner. Physicians should not withhold services based on nonclinical considerations such as marital status.

Multiple pregnancies

10. Replacement of more than one embryo will raise the likelihood of more than one embryo implanting. This is offset by the increased risk of premature labour and other complications in multiple pregnancies, which can endanger the health of both the mother and child/ren. Practitioners should follow professional guidance on the maximum number of embryos to be transferred per treatment cycle.

11. If multiple pregnancies occur, selective termination or fetus reduction will only be considered on medical grounds and with the consent of all participants involved to increase the chances of the pregnancy proceeding to term, provided this is compatible with applicable laws and codes of ethics.

Donation

12. Donation should follow counselling and be carefully controlled to avoid abuses, including coercion or undue influence of potential donors. Explicit instructions should be provided about what will be done with any donated samples if the donor is known to have died prior to implantation.

13. The WMA holds the view that gamete donation should at best not be commodified, thus serving a humanitarian benefit.

14. Appropriate controls and limits on methods used to encourage donations should be ensured. All donations must comply with national legislation and appropriate ethical guidance, including the maximum amount of gamete donations per person. Guidance on the maximum number of children allowed through donation from a single donor should be developed and adhered to, to avoid unintended incest, inbreeding and psychological harm to those involved. Physicians should advocate for and contribute to the development of such ethical guidance, if such guidance does not exist.

15. Due to the widespread use of genetic technology and registries, it has become possible to identify donors, despite clinics and donors’ attempts to maintain strict confidentiality.A child/ren born as a result of donation may in future contact donors. Potential donors must be made aware of this possibility as part of the consent process.

16. Where a child is born following donation, families should be encouraged and supported to be open with the child about this, irrespective of whether or not domestic law entitles the child to information about the donor. This may require the development of supportive materials, which should be produced to a national normative standard.

Surrogacy

17. Where a woman is unable, for medical reasons, to carry a child to term, surrogate pregnancy may be used to overcome childlessness unless prohibited by national law or the ethical rules of the National Medical Association or other relevant organizations. Where surrogacy is legally practiced, great care must be taken to protect the interests of all parties involved.

18. Prospective parents and surrogates should receive independent and appropriate legal counsel.

19. Medical tourism for surrogacy purposes should be discouraged.

20. Commercial surrogacy should be condemned. However, this must not preclude compensating the surrogate mother for necessary expenses.

21. The rights of surrogate mothers must be upheld, and great care must be taken to ensure that they are not exploited. The rights of surrogate mothers include, but are not limited to:

  • Having her autonomy respected;
  • Where appropriate, having health insurance;
  • Being informed about any medical procedure and the potential side effects;
  • Where possible, choosing her medical team if side effects develop;
  • Having psychological help at any point during the pregnancy;
  • Having medical expenses such as doctor visits, the actual birthing process, fertilization and any examinations related to the surrogacy covered by the intended parent/s;
  • Loss if income covered if unable to work during the pregnancy;
  • Receiving the compensation and/or reimbursements agreed to in any legal agreement

Pre-implantation Genetic Diagnosis (PGD)

22. Pre-implantation genetic diagnosis (PGD) and pre-implantation genetic screening (PGS) may be performed on early embryos to search for the presence of genetic or chromosomal abnormalities, especially those associated with severe illness and very premature death, and for other ethically acceptable reasons, including identifying those embryos most likely to implant successfully in women who have had multiple spontaneous abortions.

23. It is recommended to encourage screening for infectious diseases in sperm donors and to determine whether to inform donors of positive tests.

24. Physicians must never be involved with sex selection unless it is used to avoid a serious sex-chromosome related condition, such as Duchenne’s Muscular Dystrophy.

Research

25. Physicians have an ethical duty to comply with such regulation and to help inform public debate and understanding of these issues.

26. Research on human gametes and embryos should be carefully controlled and monitored and in accordance with all applicable national laws and ethical guidelines.

27. Views and legislation differ on whether embryos may be created specifically for, or in the course of, research. Physicians should act in accordance with the declarations of Taipei and Helsinki, as well as all applicable local laws and ethical and professional standards advice.

28. The principles of the Convention on Human Rights and Biomedicine should be followed.

 

Adopted by the 43rd World Medical Assembly, Malta, November 1991,
revised by the 57th WMA General Assembly, Pilanesberg, South Africa, October 2006
by the 67th WMA General Assembly, Taipei, Taiwan, October 2016 and
 reaffirmed with minor revisions by the 227th WMA Council, Helsinki, Finland, October 2024

 

PREAMBLE

The past several decades have witnessed a dramatic change in causes of adolescent mortality. Previously, adolescents mostly died of natural causes, whereas now they are more likely to die from preventable causes. The suicide rate among adolescents has risen in all regions of the world. In the adolescent population, suicide is currently one of the leading causes of death. Suicides are probably under-reported due to cultural and religious stigma attached to self-destruction and to an unwillingness to recognize certain traumas, such as some automobile accidents, as self-inflicted.

Adolescent suicide is a tragedy that affects not only the individual but also the family, peers and larger community in which the adolescent lived. Suicide is often experienced as a personal failure by parents, friends and physicians who blame themselves for not detecting warning signs. It is also viewed as a failure by the community, serving as a vivid reminder that modern society often does not provide a nurturing, supportive and healthy environment in which children can grow and develop.

Factors contributing to adolescent suicide are varied and include: affective disorders, trauma, emotional isolation, low self-esteem, excessive emotional stress, eating disorders, physical disease, discrimination and harassment (school bullying, cyber bullying and sexual harassment), romantic fantasies, thrill-seeking, drug and alcohol abuse, the availability of firearms and other agents of self-destruction, and media reports of other adolescent suicides, which may inspire imitation acts. In addition, the prolonged exposure to electronic media, which predominantly affects adolescents through their use of computer games and social media, can contribute to social isolation, school failure and malaise amongst young people.

Youth within correctional facilities are at a higher risk for suicide than the general population, yet they have fewer resources available to them. The lack of resources makes it difficult to identify those at risk for suicide.

The incidence of adolescent suicide is observed to be greater in the “first peoples” of some nations. The reasons for this are complex.

The health care of adolescents is best achieved when physicians provide comprehensive services, including both medical and psychosocial evaluation and treatment. Continuous, comprehensive care provides the physician the opportunity to obtain the information necessary to detect adolescents at risk for suicide or other self-destructive behaviour. This service model also helps to build a socially supportive patient-physician relationship that may moderate adverse influences adolescents experience in their environment.

In working to prevent adolescent suicide, the World Medical Association recognizes the complex nature of adolescent bio-psycho-social development; the changing social world faced by adolescents; and the introduction of new, more lethal, agents of self-destruction.

In response to these concerns, the World Medical Association recommends that its constituent members adopt the following guidelines for physicians. In doing so, we recognise that many other players – parents, governmental agencies, schools, communities, social services – also have important roles in this area.

 

RECOMMENDATIONS

  1. All physicians should receive, during medical school and postgraduate training, education in child psychiatry and adolescent bio-psycho-social development, including education in the risk factors for suicide.
  2. Physicians should be educated to identify early signs and symptoms of physical, emotional, and social distress of adolescent patients. They should also be educated to identify the signs and symptoms of psychiatric disorders, like depression, bipolar disorder and substance use disorders, that may contribute to suicide as well as other self-destructive behaviours.
  3. Physicians should be taught how and when to assess suicidal risk in their adolescent patients, taking into account the adolescent’s environment, including the potential availability of firearms.
  4. Physicians should be taught and keep up-to-date on the treatment and referral options appropriate for all levels of self-destructive behaviours of their adolescent patients. The physicians with the most significant education in adolescent suicide are child and adolescent psychiatrists, so the patient should be referred to one if available.
  5. Physicians should collaborate with the families or guardians of the adolescents as well as other relevant stakeholders, such as social workers, school officials, and psychologists who bear expertise in child and adolescent behavior.
  6. When caring for adolescents with any type of trauma, physicians should consider the possibility that the injuries might have been self-inflicted.
  7. When caring for adolescents who demonstrate deterioration in thinking, feeling or behaviour, the possibility of substance abuse and addiction should be considered, and the threshold should be lower, with reference to adequate scientific evidence, for urine toxicology assessment.
  8. Health care systems should facilitate the establishment of mental health consultation services aimed at preventing suicide and should pay for the socio-medical care given to patients who have attempted suicide. Services should be tailored to the specific needs of adolescent patients. A medical consultation for adolescents is highly recommended to enable doctors to detect any disorders in their patients.
  9. Epidemiological studies on suicide, its risk factors and methods of prevention should be conducted, and physicians should keep up-to-date with such studies.
  10. When caring for adolescents with psychiatric disorders or risk factors for suicide, physicians should educate parents or guardians to watch for the signs of suicide and about the options for evaluation, and encourage them to seek support for themselves.
  11. Physicians should advocate for the identification of at-risk groups of adolescents with the mobilization of specifically targeted resources directed at prevention and risk reduction.

 

 

Adopted by the 66th WMA General Assembly, Moscow, Russia, October 2015
and reaffirmed with minor revisions by the 227th WMA Council, Helsinki, Finland, October 2024

 

PREAMBLE

Mass media, including social media, can effectively play diverse roles in medical communication. Physicians, as professionals and experts, can contribute to improved public health by providing the public with accurate health related information. Mass media provides a channel through which physicians may contribute to society by leveraging mass media appearances in positive ways.

However, the increase in instances of physicians’ frequent appearances on mass media to recommend unproven treatments or products and to use such appearances for marketing purposes is posing a serious concern. The public may readily accept groundless recommendations by physicians and may develop unrealistic expectations. The subsequent confusion and disappointment can damage the patient-physician relationship.

This issue is more serious in some countries where there are different systems of medicine, including alternative medicine.

 

GUIDELINES

  1. The WMA recalls its Statement on the Professional and Ethical Use of Social Media and recommends the following guidelines regarding mass media appearances by physicians to prevent them from being involved in commercial activities that may compromise professional ethics and to contribute to patient safety by ensuring physicians providing accurate, timely, and objective information.

Accurate and Objective Delivery of Scientifically Proven Medical Information

  1. When appearing in media, physicians shall provide objective and evidence-based information and shall not recommend medical procedures or products that are not medically proven or justified.
  2. A physician shall not use expressions that may promote unrealistic patient expectations or mislead viewers about the function and effect of medical procedures, drugs or other products.
  3. Physicians shall include important information, such as possible adverse effects and risks, when explaining medical procedures, drugs, or other products.

Not Abusing Mass Media as a Means of Advertisement

  1. Physicians should not recommend specific products by either specifically introducing or intentionally highlighting the name or trademark of a product.
  2. Physicians shall practice prudence regarding personal appearances on home shopping programs. The physician should have no financial stake in the products being sold.
  3. Physicians shall not be a part of mass media advertisement on any product which is harmful to humans and/or the environment.

Maintaining Professional Integrity

  1. Physicians shall not require or receive economic benefits for mass media appearances other than a customary appearance fee.
  2. Physicians shall not provide economic benefits to broadcasting personnel in order to secure mass media appearances.
  3. Physicians shall not engage in the promotion, sale or advertising of commercial products and shall not introduce false or exaggerated statements regarding their qualifications, such as academic background, professional experience, medical specialty and licensure as a specialist, for the benefit of the economic interests of any commercial entity.

 

Adopted by the 68th General Assembly, Chicago, October 2017
and revised by the 75th WMA General Assembly, Helsinki, Finland, October 2024

 

PREAMBLE

History demonstrates that new diseases will emerge, and old diseases re-emerge unpredictably and pose significant threats to global health.

Epidemics and pandemics highlight deep-rooted inequalities, hitting less-resourced regions hardest due to their constrained resources, fragile health systems, and significant disease burdens. The common but differentiated responsibilities (CBDR) principle can be applied to pandemic prevention, preparedness and response (PPPR) in order to bring equity and justice in cooperation between states.

The accelerating pace of epidemic-prone diseases, compounded by the repercussions of geopolitical conflicts, environmental degradation, climate change, increased human encroachment into natural ecosystems, antimicrobial resistance, widening socio-economic disparities, global travel, and the intrinsic link between the health of humans, animals, and our shared environment, underscores the vulnerability of global health security.

Integrating the One Health approach acknowledges the critical interdependence of all living organisms and their habitats, essential for understanding the emergence and spread of diseases and highlighting the need for a multisectoral, interdisciplinary and evidence-based approach to global health threats.

Robust and effective global surveillance is pivotal for improving the prevention and response to infectious diseases, enabling earlier detection and identification of emergent threats. The rapid spread of epidemics and pandemics in regions with underfunded and underdeveloped public health infrastructures highlights the urgent need for a global cooperative framework. Such a framework must prioritise the development of resilient health systems capable of withstanding the challenges posed by infectious diseases, thereby safeguarding the health and well-being of populations worldwide.

An investment in strengthening public health, primary care and other aspects of health systems is crucial for enhancing the capacity to prevent, detect, contain, and manage disease outbreaks, laying a solid foundation for core public health functions essential.

Particular attention should be paid to individuals in fragile, conflict-affected, and vulnerable settings; additionally other individual vulnerabilities factors should also be addressed including but not limited to disability, age, gender, indigeneity, ethnicity, etc..

 

RECOMMENDATIONS

The WMA calls on the following stakeholders to: 

WHO and United Nations

  1. Global Pandemic Infrastructure: Strengthen global infrastructure for preventing, monitoring, and responding to pandemics under the leadership of the World Health Organization (WHO). Ensure that this bolsters WHO’s pivotal role in leading international health efforts, while fostering a comprehensive commitment across all levels of government and society.
  1. Political Commitment: Ensure engagement at the highest level in each country for political commitment to pandemic prevention and preparedness between emergencies and to respond during emergencies.
  1. Global Health Equity: Promote global equity by addressing social determinants of health and tackling inequalities that may drive epidemics and pandemics. Put in place mechanisms to ensure timely and equitable access to countermeasures for all, while prioritizing resource allocation to public health needs. Strengthen health systems and continue broader societal efforts to enhance equity and the effectiveness of the global response. 
  1. Communication and Misinformation: Ensure consistent public messaging and monitor public discourse including on social media and combat misinformation and disinformation. 
  1. Legal Frameworks: Strengthen means of implementation and enforcement of international legal instruments for pandemic response, ensuring the effectiveness of the International Health Regulations and developing a comprehensive international pandemic legal instrument. 
  1. Data Collection, Sharing, and Universal Reviews: Strengthen data collection on infectious diseases and ensure its sharing across stakeholders, including health personnel, non-state actors (NSAs), and governments. Implement Universal Health and Preparedness Reviews with strengthened independent monitoring. Define benchmarks for equitable resource distribution, healthcare access, and outcomes across populations. Monitor disparities to guide equitable interventions.
  1. Stakeholder Collaboration: Broaden partnerships with governments and NSAs for an effective multi-sectoral response, focusing on pathogen and benefits sharing, and addressing intellectual property regulations for equitable resource distribution.
  1. Other Sources of Pandemic Risk: Enhance global health security by integrating climate change, environmental degradation, and conflict risk into pandemic preparedness giving particular attention to vulnerable populations through health system strengthening in climate and conflict-affected regions to improve resilience and response capabilities. 

National Governments 

  1. Preparedness, Response, and Governance: Develop a robust national preparedness architecture by learning from previous pandemics, including local and regional manufacturing of health products, local stockpiling, and enhance national governance with anti-corruption measures. Medical associations and physicians from all specialties must be involved in epidemic planning, preparedness, and response at all levels to enhance health system effectiveness during crises.
  1. Financing: Provide sufficient and sustainable funding for global PPPR including for the WHO, for research and development, and for national health systems strengthening.
  1. Equitable Resource Allocation: Use a common but differentiated approach in establishing obligations for financing. Ensure resources are directed to those most in need while maintaining critical health services in order to mitigate the severity and duration of pandemics. 
  1. Health Workforce Strengthening: Support the health workforce with appropriate education on PPPR and support for response, including mental health, safe working environments including access to protection measures, and sufficient human and material resources to deliver the services required. 
  1. Health System Strengthening: Ensure health system continuity so that regular healthcare services continue to be provided and that the viability of services is not compromised by public health measures.
  1. Mental Health Service: Expand mental health services to ensure comprehensive support for all affected populations during and after pandemics including integrating mental health care into primary health services, establishing dedicated mental health teams, and facilitating access to psychological support for patients, health personnel, and communities. 
  1. Digital Technology: Continue to develop digital health infrastructure to enhance PPPR capabilities while ensuring equitable and secure access to digital health services for all populations, with particular attention to remote and underserved communities.
  1. Social Protection: Implement socio-economic support measures during pandemics to protect populations from the adverse effects of health crises. 
  1. Manufacturing infrastructure: Develop infrastructure for pandemic-related research and production of critical equipment, diagnostics, therapeutics, vaccines and personal protective equipment (PPE). 
  1. Science-Guided Response: Guide response measures by scientific and expert recommendations, adapting to local contexts as necessary. Develop National Pandemic Preparedness Plans. 
  1. Communication Management: Invest in public health education to improve health literacy. Implement laws, regulations, and administrative rules targeting the spread of disinformation. Provide prompt, accurate and transparent crisis communication guided by science. 

Medical associations and scientific societies 

  1. Education and Training: Promote the integration of pandemic preparedness and response into higher education curricula and continuous professional development education for health personnel, including courses to integrate knowledge and skills related to emerging infectious diseases. 
  1. One Health: Collaborate with organizations in the animal environmental health fields to implement a One Health approach to epidemic risk management in order to establish new methods for surveillance and control of epidemics and pandemics.
  1. Research and Innovation Dissemination: Advocate for information sharing platforms that foster collaborative research and the exchange of data across the global scientific community.
  1. Partnerships in innovation: Promote partnerships between public institutions and private entities as appropriate to drive innovation, ensuring that the management of intellectual property rights promotes universal access to crucial medical technologies and treatments. Advocate for equitable and affordable access to innovations including medicines and patient-oriented technology. 
  1. Community Involvement: Promote strong relationships between the public and healthcare providers for inclusive pandemic management. 
  1. Resource Forecasting: Assist governments in resource forecasting and advocate for safe work environments and the access to quality assured PPE, and countermeasures with a specific focus on the protection in all clinical workplaces. 
  1. Misinformation Counteraction: Support the fight against misinformation and disinformation including by partnering with social media and online platforms to effectively identify incorrect information and disseminate accurate, evidence-based information. Treat the spread of disinformation by healthcare professionals as an unethical behavior with relevant sanctions.
  1. Health Literacy: Organize campaigns to increase health literacy and awareness about medical misinformation and disinformation.
  1. Research Acceleration: Encourage investment in research and fast-track ethical and peer review processes for pandemic-related research, while ensuring full respect for the principles in the WMA Declaration of Helsinki – Ethical Principles for Medical Research Involving Human Participants. 

Physicians

  1. People-Centred Communication Skills: Physicians should cultivate clear, empathetic communication skills to effectively convey accurate and evidence-based medical information, address misconceptions, and educate patients on identifying credible information in accordance with the WMA Declaration of Cordoba on Patient-Physician Relationship. 
  1. Advocacy: Report critical resource shortages, health system failures, misinformation and disinformation, and inequities in access to health and public health.
  1. Contribution to public health: Stay informed about epidemics and collaborate with public health authorities on PPPR while meeting obligations of declaring pathogens of concern and facilitating appropriate interventions in the communities served.

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

 

PREAMBLE

Human papillomavirus (HPV) vaccination presents a unique and valuable opportunity for physicians to substantially prevent morbidity and mortality from certain cancers in all populations, and to improve maternal health. This may result in economic benefits for countries who achieve widespread HPV vaccination in their population in the current move towards preventive and promotive healthcare. The HPV vaccine therefore merits consideration by the World Medical Association (WMA) separately from other vaccines.

HPV is, for the most part, sexually transmitted virus and is so common that most sexually active adults become infected at some point in their lives. Most infections are asymptomatic and resolve without medical intervention. However, HPV is the cause of nearly 100% of cervical cancer cases. Thirteen of the 40 types of HPV are oncogenic and, when they cause a persistent infection can produce cervical cancer as well as cancer of the vagina, vulva, anus, penis, the head and neck, oropharynx and anogenital area.

Few diseases reflect global inequities as much as cancer of the cervix. It is the fourth most common cancer in females globally, and most cervical cancer cases and deaths are in low and middle-income countries.

HPV vaccines protect against infections caused by targeted HPV types. All available vaccines afford protection against types 16 and 18, which are the most oncogenic types and can also offer protection against anogenital warts. HPV vaccination is recommended for females and males from 9-45 years of age and the immunocompromised people. HPV vaccines are safe, effective, and well tolerated.

WHO recommends a one or two-dose schedule HPV vaccination for females between 9-14 and 15-20 years old. Females older than 21 years require two doses with a 6-month interval.[1] Benefits of vaccinating young males include protection against genital warts and cancer in addition to preventing transmission of HPV to sexual partners.

In 2020 the World Health Assembly adopted the Global Strategy for cervical cancer elimination. To achieve accelerated elimination of cervical cancer, by 2030, 90% of girls will be fully vaccinated with the HPV vaccine by the age of 15, screening programs using a high-performance test will be running to screen 70% of women by the age of 35 and again by the age of 45 and 90% of women with invasive cancer will be managed.

School-based vaccination or systematic community programs are strategies that will increase vaccine accessibility to the appropriate age groups, particularly targeting youths prior to the commencement of sexual activity to ensure maximum benefit.

 

RECOMMENDATIONS

  1. Reaffirming its Statement on Access of Women and Children to Healthcare and its Statement on the Prioritisation of Immunisation, the WMA insists on the rights of all women, children, and indeed all people to adequate, safe medical care and urges governments to commit resources to immunisation programs.
  2. The WMA encourages expedited development and funding of programs to make safe, high quality HPV vaccines widely available to both females and males.
  3. The WMA strongly advocates for the provision of reliable, fast, and accessible cervical cancer screening programs for the detection and treatment of precancerous lesions in all countries, especially in those that have high mortality rates from cervical cancer.
  4. WMA clearly points out that HPV vaccination should not replace cervical cancer screening programs.
  5. WMA advises that cancer treatment and palliative care should be accessible to all individuals diagnosed with cervical cancer.
  6. A key recommendation is for school-based vaccination or systematic community programs to increase vaccine accessibility to the appropriate age groups, particularly targeting youths prior to the commencement of sexual activity to ensure maximum benefit.
  7. The WMA urges national health authorities, in collaboration with health professionals’ associations and other relevant health actors, to carry out intensive education and advocacy to:
  • In all individuals regardless of sex, improve awareness and understanding of HPV and associated diseases (such as, but not limited to, cervical cancer, head and neck cancer, anal cancer, and genital cancer), the availability and efficacy of HPV vaccinations, and the need for routine HPV related cancer screening in the general public;
  • Improve awareness that condoms do not provide sufficient protection against HPV infection because they do not cover the entire anogenital area and that HPV also causes cancers of the oropharynx, anus and penis;
  • Communicate the availability and efficacy of HPV vaccines to educate the population about the importance of getting the HPV vaccination;
  • Recommend HPV vaccination and routine cervical cancer screening and treatment for all eligible people regardless of the socioeconomic, cultural, or religious background, including those that are hard to reach (including for example those with disability, refugees and asylum seekers, and people of diverse sexual orientation and gender identity);
  • Support the availability of the HPV vaccine and routine cervical cancer screening for patient groups that benefit most from preventive measures, including but not limited to low-income and pre-sexually active populations;
  • Integrate HPV vaccination (either primary or catch-up immunisation) into all appropriate health care settings and visits involving eligible people; Routine cervical examination (whether vaccinated or not against HPV) should also be incorporated;
  • HPV vaccination and routine cervical cancer screening should also be offered to people who are incarcerated;
  • Integrate and understand the crucial need for routine cervical cancer screening in all appropriate health care settings and visits, and the enhanced sensitivity and effectiveness of HPV based screening compared with Pap smears, VIA (visual assessment with acetic acid), and VILI (visual assessment with lugols iodine);
  • Integrate HPV cancer prevention methods, early detection, early screening, diagnosis, treatment and palliative care into existing programs and pre-service training. Such training will leverage existing support for HPV programs and help to increase vaccination efforts;
  • Fund research aimed towards discovering screening methodology and early detection methods for other non-cervical HPV associated cancers;
  • Encourage and provide training for cervical cancer survivors to advocate for HPV vaccination and screening;
  • Sustain vaccination efforts to work towards and raise awareness of the WHO’s 90-70-90 Global Strategy to accelerate the elimination of cervical cancer as a public health problem;
  • Support and promote advocacy for HPV vaccination campaigns.
  1. The WMA urges physicians to educate themselves and their patients about HPV, associated diseases, HPV vaccination and routine cervical cancer screening.

 

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

 

PREAMBLE

Primary health care (PHC) is a key part of any health system, due to its wide coverage and distribution, its accessibility and its ability to solve the health problems of the population. For this reason, it is a fundamental element for social cohesion that corrects health inequalities between people and territories, guaranteeing equity in health care, and energizing close, accessible, and efficient health care that adapts to health changes.

PHC must enhance its positive aspects: high quality, safe, comprehensive, integrated, accessible, available, and affordable for everyone and everywhere, provided with compassion, respect, and dignity to solve the majority of the health problems of the population.

The PHC approach is foundational to achieving our shared global goals in Universal Health Coverage (UHC) and the health-related Sustainable Development Goals (SDGs).

PHC comprises a broad range of personal medical care, including preventive, diagnostic, palliative, therapeutic, curative, counseling and rehabilitative care, over time. It is not an exclusive disease-centered approach, but a person-centered approach. Furthermore, PHC is multi-sectoral health care and aims to empower individuals, families and communities to take an active role in improving their health. PHC should be provided in a manner that is accessible, comprehensive and led by a physician to ensure appropriate and high-quality care. It offers the full spectrum of essential health services across all ages.

PHC usually is the first contact of the people with the health care system. It can address the majority of health needs of the population through comprehensive and integrated services in a continuous and longitudinal way.

PHC offers a comprehensive care of essential health services across all ages.

Strong PHC is vital for efficient, cost-effective, equitable, appropriate and sustainable health care systems. A significant portion of health needs can be addressed at the primary care level, redistributing the workload and relieving strained emergency systems as well as secondary or tertiary health care. The provision of longitudinal care and a trustful patient-primary physician relationship will reduce parallel care demand and unnecessary referrals. Continuity of care has also been shown to reduce mortality, acute hospitalizations and out-of-hours care.

PHC contributes to the prevention, early detection, risk-factor identification and mitigation, and timely response to infectious, communicable diseases and noncommunicable diseases outbreaks, and optimal adherence to treatments and rehabilitation.

Robust PHC can enhance the responsiveness of health systems by adapting to the existing or future health needs of the population, contributing to a socially accountable care by actively engaging and mobilising communities, and allowing patients access to participatory and multidisciplinary care.

PHC is in a unique position to address the social determinants of health inequalities and to enhance individual physical and mental health and social well-being.

Specialist education in general practice/family medicine has developed differently in different regions. In some countries the specialty is as comprehensive and reputed as other specialties.

Where case management or coordination might limit access to appropriate medical care, patients should have the freedom to see a physician appropriate for the services they need, regardless of specialty. Above all, the best interests of the patient must be paramount.

PHC must consider the new challenges that health systems are facing, such as the high prevalence of chronic diseases, the risks of epidemics and pandemics, the environmental impact and climate change on health or the problem of antimicrobial resistance, as the main threats to health in the coming years, as indicated by the World Health Organization, prioritizing PHC actions and acting on these risks to respond to the main global health challenges.

 

RECOMMENDATIONS

The World Medical Association recommends that national governments/national health authorities:

  1. Strengthen PHC within health systems and plan and ensure adequate financial resources and equipment provision in PHC facilities, including a sufficient, well-trained supply of primary care physicians–family physicians, general internists, general pediatricians, and obstetricians/gynecologists – to meet the nation’s current and projected demand for health care services.
  2. Promote PHC with adequate human and material resources and means to make it more decisive, effective, efficient and sustainable.
  3. Ensure responsiveness to the health needs of the population through adaptation of health systems and enable community participation through adaptation of PHC systems to the population health needs.
  4. Establish functional referral systems and mechanisms that foster the coordination and integration of care across different levels (primary, secondary, tertiary) and the collaboration of PHC physicians with other medical specialists ensuring care continuity.
  5. Ensure workforce planning and adequate size of the PHC workforce by providing decent working conditions for the PHC workforce, including the improvement of working conditions and of remuneration, use of recruitment and retention strategies that take special consideration of hard-to-reach geographic areas and isolated socio-demographic groups and prioritize training of sufficient medical and paramedical personnel to ensure adequate future staffing in PHC.
  6. Develop other administrative support mechanisms to assist primary care physicians in the logistics of their practices, along with enhanced efforts to reduce administrative activities unrelated to patient care, to help ensure professional satisfaction and practice sustainability.
  7. Promote PHC as close health care connected to people as a basis for positive knowledge.

The World Medical Association recommends that its constituent members as well as medical professionals:

  1. Advocate for a sustainable PHC system that delivers integrated and comprehensive services inclusive of promotive, preventive, curative, rehabilitative and palliative care.
  2. Increase the resolution capacity and reduce the bureaucratic burden of the PHC.
  3. Reaffirm the need for high quality PHC services through the development and use of clinical guidelines, standardized training and accreditation of the PHC workforce.
  4. Develop professional autonomy and involvement in the management of PHC physicians.
  5. Work with national governments and academia to optimize the higher and postgraduate education of the PHC personnel. Such actions can include:
  • Develop and expand medical education programs to educate primary care physicians in increasing numbers.
  • Promote training opportunities for medical graduates to fulfill the estimated demand of the PHC workforce, as well as primary care experiences for all students that feature increasing levels of student responsibility and use of ambulatory and community-based settings.
  • Make available Continuous Medical Education that considers the particular needs of the PHC workforce.
  • Advocate for the establishment of a structured specialized education for general practitioners and family medicine doctors or other specialized education programmes for physicians working in PHC and give it prestige and make it attractive.
  1. Ensure that in a context of violence or in a military setting, PHC can also be delivered according to the needs of the population, ethically and with high quality.
  2. Provide students career counseling related to the choice of a primary care specialty and ensure that primary care physicians are well-represented as teachers, mentors, and role models to future physicians.
  3. Enhance the visibility of primary care faculty members and encourage positive attitudes toward primary care among all faculty members.
  4. Encourage efforts to align the representation of PHC physicians with specialized/ hospital-based physicians in political decision making and national medical organizations and to reduce inappropriate remuneration imbalances between physicians with comparable training in different levels of care.
  5. Advocate for PHC systems that involve patients and communities and can adapt and respond to specific settings and population health needs.
  6. Support the appropriate use of technologies, information systems, digital devices and big data tools that foster and improve PHC services.
  7. Support research on health service delivery in the primary care setting, promoting the research culture.
  8. Fulfill the international commitment of States to strengthen PHC as an essential step towards achieving universal health coverage, building sustainable PHC and towards achieving the highest attainable standard of health (Astana Declaration).
  9. To promote, through PHC a more accessible, close and humane medicine, centered in the person, and prioritizing the needs and interest of patients.

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


PREAMBLE

Understanding that early life experiences can impact health in later life and that the major drivers of health lie outside healthcare is essential to direct action to improve health where it is most needed. This is supported by Paragraph 11 of General Comment No. 14 of the Committee on Economic, Social and Cultural Rights, and by Article 24 of the Convention on the Rights of the Child, both of which recognise the importance of the role of the state in providing good living standards and healthy environments for their citizens. The WMA Declaration of Oslo on Social Determinants of Health and WMA Statement on Sustainable Development acknowledge that conditions, including environmental conditions, in which people are born, grow, are educated, live, work and age (sometimes termed “social” or “wider” determinants”) are major influences on healthy life expectancy, quality of life[i] and the magnitude of health inequalities.

Human health is a cardinal component of a society’s ability to prosper; declining human health adversely affects a nation’s productivity, and therefore a nation’s economy, which in turn limits many actions to prevent ill health and deliver healthcare to treat illness.

Therefore, in addition to health practitioners, many actors share in the responsibility to preserve and improve human health. For example, the ability to influence these wider determinants of health are spread across multiple government departments.

A cardinal challenge in striving for improved population health lies in the fact that decision makers tend to focus on short-term economic indicators, such as Gross Domestic Product (GDP)/Gross National Income (GNI), as the primary driver of government policy.

Investment in the health of the population has a long-term positive economic impact, but the focus on GDP/GNI often acts to the detriment of health. Many activities that increase GDP/GNI, such as smoking and the use of fossil fuels, damage health. Conversely, activities such as breastfeeding and parenting, which improve health, are not measured in GDP.

 

RECOMMENDATIONS

Recognizing this, the World Medical Association and its constituent members on behalf of their physician members, call on Governments to:

  1. Recognise that well-functioning health systems accessible to all are important, but the principal determinants of health and wellbeing lie outside healthcare;
  2. Prioritise population health and wellbeing in government policy decisions and incorporate metrics of population health and wellbeing into measures of national progress and performance;
  3. Acknowledge that securing and safeguarding population health and wellbeing are crucial to a sustainable future;
  4. Promote equity in health and address inequalities in whatever sphere they exist, by supporting actions that address the wider determinants of health.

 

[i] WMA Declaration of Oslo on Social Determinants of Health – WMA – The World Medical Association

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

 

PREAMBLE

Public health emergencies (PHEs) are regular occurrences that put the life and health of populations at risk. They have multiple origins and are frequently characterised by urgency, uncertainty and rapidly escalating demands to which health services may struggle to respond. Public health emergencies frequently transcend jurisdictional boundaries giving rise to co-ordination challenges for governments and other actors. They can also involve large scale displacement of people. Some of the PHEs are localised, some present threats of international concern. Climate change, conflict and extremes of global inequality are direct drivers of PHEs.

World Health Organization (WHO) defines a public health emergency as “an occurrence or imminent threat of an illness or health condition, caused by bioterrorism, epidemic or pandemic disease, or (a) novel and highly fatal infectious agent or biological toxin, that poses a substantial risk of a significant number of human fatalities or incidents or permanent or long-term disability”. Public health emergencies can result from a wide range of hazards and complex emergencies.

PHEs confront physicians, other health professionals, public authorities and at times the international community with severe challenges. Although fundamental ethical principles in medicine remain unchanged, the combination of urgency, uncertainty and extreme shortages of health resources can present health professionals with extreme difficulties in applying them. The familiar tension in medicine between obligations to individual patients and obligations to the public good can be distinctly pronounced during PHEs. This is particularly the case where the need for life-saving interventions overwhelms the available supply. PHEs can also require restrictions on individual and population rights and liberties that present their own ethical challenges.

This statement focuses on the medical ethical aspects of public health emergencies.

 

BASIC PRINCIPLES

  1. During a PHE, physicians and all other health responders should consider the following principles:
  • The obligation to help reduce overall suffering;
  • The obligation to show full and equal respect to all;
  • The requirement for justice and fairness in the allocation of scarce resources;
  • The requirement that any restrictions on individual choice or liberty must be proportionate, lawful and evidence-based;
  • The obligation to maximise overall health outcomes.
  1. Some physicians and health professionals will solely be focussing on population aspects of the response to PHEs. Their primary concern will be maximising benefits and minimising harms at a population level. The above principles will guide them as they seek to realise the greatest overall benefit for the largest number of people.

Issues of particular ethical concern during PHEs

  1. Although the basic ethical duties of physicians do not change during a PHE, their application in certain areas can be challenging. Issues of particular ethical concern during a PHE include but are not limited to:

Confidentiality

  1. Access to large amounts of accurate, real-time data is an essential part of the health response to many PHEs. Physicians and other health professionals retain ordinary duties of confidentiality to their patients. Information can be disclosed during a PHE where a patient or legal surrogate consents to its disclosure. In the absence of consent such information can be disclosed where there is a lawful justification or for overriding reasons of public interest. The disclosure of information should be limited only to the necessary information for the treatment of PHEs. Consideration must also be given to ensuring the ethical use of data including what happens to the data after the purposes for which it was collected are achieved.

Consent

  1. Patients retain the right to consent to or refuse treatment at all times during a PHE. Some compulsory interventions that do not amount to treatment may be acceptable where there is a lawful and ethical mandate supporting them. For example, where individuals present a serious risk of harm to others, and they refuse to accept necessary public health restrictions, confinement may be considered.

Restrictions of liberty

  1. PHEs, particularly where they involve emerging communicable pathogens, may require restrictions on individual and population freedoms. Social distancing and self-isolation are highly effective public health interventions and may be mandated by law during a PHE. Any interference with fundamental rights, including restrictions of liberty, must be justified in the public good, necessary, proportionate, based on lawfully-provided powers and authority, and only imposed for as long as necessary based on scientific evidence. The basic needs of any confined person must be met at all times.

Public engagement

  1. PHEs can have a profound effect on individuals, communities and societies. They are frequently characterised by fear, uncertainty, and involve severe socio- economic disruption. During PHEs, there is a risk of the widespread circulation of misinformation including conspiracy theories and direct attempts to undermine medical and scientific expertise. Clear communication of evidence-based medical and scientific information, including the justification for any decisions that impact social or economic functions, is essential. Active steps should be taken to tackle misinformation and disinformation, especially when it is coming from health professionals.
  1. PHEs frequently require challenging decisions involving trade-offs between fundamental goods. All people affected have a right to know that such decisions are being made and the criteria on which the decisions are based.

Resource allocation and triage

  1. Serious PHEs are often characterised by extreme shortages of health resources. This can present physicians and other health professionals with difficult decisions. In ordinary circumstances priority should be given to those with the greatest health need, provided they have capacity to benefit from the health intervention. Those with equal health needs have equal rights to health resources, whether or not the need arises directly from the PHE.
  1. In some circumstances, where health needs overwhelm available resources, it may be necessary to triage patients. Triage is a form of resource allocation that involves sorting or prioritizing individuals based on their health needs and their likelihood of responding to an intervention. In extreme conditions it can involve setting aside some people for non-treatment where others have a higher likelihood of benefiting from treatment, or where more people can be saved.
  1. Any form of triage must be based on open and defensible ethical principles and must be flexible enough to respond to rapidly changing circumstances. Triage must principally be based on factors determined by the medical community and directly relevant to an individual’s health status.
  1. Attention must also be paid to health trade-offs arising from decisions made to tackle public health emergencies. A focus on tackling communicable pathogens may, for example, require health resources to be diverted away from other health needs. Any such decision must be based on good moral reasons.

The rights and interests of health professionals

  1. There is a limit to the risks that health professionals can be expected to take during the exercise of their duties in a PHE. Physicians and other health professionals should be knowledgeable of ethical and legal issues and disaster response, including their rights and responsibilities to protect themselves from harm, issues surrounding their responsibilities and rights as volunteers, and associated liability issues. Where health professionals are exposed to risk, corresponding duties arise on employing bodies to mitigate those risks as far as possible.
  1. Health professionals responding to PHEs must be properly equipped to deal with the risks they will face, including access to appropriate personal protective equipment (PPE) at all times.
  1. Where health professionals face particular risks as a result of their role in responding to PHEs it may be appropriate for them to have priority access to interventions such as vaccines.

Research

  1. Research is an essential part of the health response to PHEs. Ethical principles guiding research in ordinary conditions are not changed during PHEs. Undertaking research in PHEs can nevertheless be challenging. Those participating in research can also be particularly vulnerable. It is essential that research in PHEs is undertaken with full respect for the principles set out in the WMA Declarations of Geneva, the WMA Declaration of Helsinki – Ethical Principles for Medical Research Involving Human Subjects, and the WMA Declaration of Taipei on Ethical Considerations Regarding Health Databases and Biobanks.

PHEs of international concern

  1. Some PHEs, such as those caused by communicable pathogens or highly-dispersed toxins, can rapidly cross national boundaries and present regional or global health risks. During these emergencies of international concern, the ethical principles outlined above remain unchanged. Given the persistence of serious global inequalities, particular attention must however be paid to transnational questions of justice and fairness in the allocation of health resources.

 

 

Adopted by the 73rd WMA General Assembly, Berlin, Germany, October 2022

 

PREAMBLE

The interaction between the physicians and their relatives seeking medical care can be complex. Moreover, this possibility is highly conditioned by cultural aspects. Interaction can start with asking for simple advice, consultation for minor ailments, and general questions about healthcare and health promotion. This can escalate to seeking medical care and even surgery. Physicians are often their relatives’ first point of call for medical and emotional support. Physicians may be able to offer immediate care in cases of emergency and contribute to well-informed, evidence-based self-care. Other than in emergencies, offering general health information or for minor health problems, physicians should avoid treating those close to them.

The ethical principles governing the work of physicians are equally important and valid when treating relatives. Respect for autonomy may be compromised by lack of privacy, unintentional breaches of confidentiality, and failure to seek informed consent. The relationship with the physician might compromise the patient’s ability to make independent decisions.

Treating relatives may pose challenges in the following circumstances:

  • When objectivity is compromised and decisively affected by emotional factors, there could be a risk of either under- or over-treating relatives or of encountering problems that are beyond the physician’s expertise or abilities, which could cause serious harms.
  • When there are potential barriers to considering sensitive medical history and/or conducting an appropriate physical examination, which may result in incorrect medical diagnosis and treatment.
  • When the physician fails to fulfil requirements concerning patient clinical records, which may result in difficulties if the related patient needs follow-up treatment or when liability issues arise.
  • When a negative medical outcome could compromise the relationship between the physician and the related patient.
  • When the treatment is not in the best interest or against the will of the related patient.
  • When the physician risks providing relatives, perhaps unintentionally and unconsciously, with undue advantages.

 

RECOMMENDATIONS

1.Physicians should avoid routinely acting as a relative’s primary care physician or serving as the attending physician when treating a potentially life-threatening condition. Physicians may provide care to a relative in emergencies, for minor health problems or when there is no other qualified physician available.

2. Related patients may ask for a second opinion about another physician’s care. If a second opinion is shared, it should be consistent with these recommendations and fulfil the duties of physicians to colleagues. Care should be taken to only discuss the treatment, which is most appropriate and recommended, rather than any judgements about the other treating physician’s care and advice.

3. If a physician treats a relative, the physician should be mindful of the following:

  • Strict respect for medical ethics, the patient’s autonomy and consent, with special consideration for minors.
  • The physician has the duty to respect a patient’s right to confidentiality and should not share information with anyone else without a lawful basis, including other family members, with the exception of necessary clinical documentation when referring to other health care personnel.
  • If a relative indicates an intention to seek a second opinion about another physician’s care, that intention must be respected.
  • Consent for treatment must be given by the patient, including competent minors, and for that consent to be valid, it must be fully informed.
  • Depending on the nature of the relationship, taking a sensitive history and performing a physical examination may be emotionally difficult or uncomfortable for the patient or the physician. In such situations the physician and the patient should consider consulting another physician.
  • Clear and concise patient records must be maintained at all times.

4. If the physician cannot accommodate the recommendations above, the physician should avoid treating relatives.

5. While physicians are encouraged not to treat relatives except in certain circumstances, it is acknowledged that physicians are often approached by their relatives for medical advice or treatment, and their help is frequently beneficial and appreciated.

6. In all circumstances, physicians shall maintain the highest professional and ethical standards, in accordance with the Declaration of Geneva, the WMA International Code of Medical Ethics, and the WMA Declaration of Lisbon on the Rights of the Patient.

 

 

Adopted by the 72nd WMA General Assembly (online), London, United Kingdom, October 2021

 

INTRODUCTION

Over the past decade, pressure on supply has led to shortages of certain medical products, including vaccines.  In many situations, these shortages result from putting economic objectives before public heath. These shortages are detrimental to patient care, to maintaining public health and to the organisation of healthcare systems.

The world is going through rapid change; technological progress, radical progress in matters of communication and access to information as well as the increasing power of multi-nationals are transforming the global landscape, including the pharmaceutical industry. Unfortunately, some of these developments have encouraged the production and sale of medical products which do not meet the required safety standards, whether due to the manufacturing process or inappropriate storage, or due to the criminal manufacture and fraudulent distribution of sub-standard or falsified medicines.

According to the WHO’s Global Surveillance and Monitoring System (GSMS) for sub-standard and falsified medical products, around one out of ten medicines is either of a sub-standard quality or falsified in countries with low or medium income. This observation is not limited to the most expensive medicines or the most well-known brands, but also concerns patented and generic products. The medicines most often flagged are the antimicrobials and antimalarials.

The WMA reiterates its position on biosimilar medicines, its resolution on prescribing medicines, its position on the substitution of medicines and resistance to antimicrobials.

The rational use of medicines implies ensuring that research, regulation, production, distribution, prescription, financing, delivery and proper administration of these medicines comply with coherent and rational scientific, professional, economic and social criteria.

From a healthcare point of view, a shortage of medicines is unacceptable, as it has a negative impact on confidence for patients, doctors, pharmacists and the healthcare system, it leads to insecurity and uncertainty and compromises treatment continuity; with all the risks that this implies.

With the objective of combatting the intolerable missed opportunities that such shortages represent for patients, undermining public trust in the healthcare system, the WMA is calling for the implementation of the following recommendations:

 

RECOMMENDATIONS

Availability of medicines

  1. As a public health issue and out of concerns for safety, the WMA urges national governments to improve the availability of medicines.
  2. National governments and regulatory authorities should:
    • Create a national entity responible for gathering and communicating information relative to demand and offer for medicines under their jurisdiction. Establish standards and mechanisms guaranteeing the continuity and the supply of medicines and thus avoid shortages.
    • Improve the monitoring of medical product supply chains, as the weakness of regulatory structures make the application of good medical product distribution particularly difficult.
    • Design contingency strategies to counter the dependence of States on foreign medicine production due to the delocalisation and centralisation of the majority of structures which produce the main pharmaceutical components used in the composition of major medicines.
    • Encourage national healthcare authorities to maintain stocks of essential medicines in order to minimise the risk of shortages. Indeed, the Covid-19 health crisis has demonstrated the limits of stocks held by States and has constrained them to reorganise and restrict access to certain medicines.
    • In the case of global epidemic, to pool scientific research and clinical trials with the objective of accelerating the development of vaccines and/or treatments to eradicate the pandemic.
    • Support legislative and regulatory initiatives which guarantee an appropriate national capacity to produce pharmaceutical products, in the interests of the well-being of the populace and national security.
    • Identify and create sustainable mechanisms which will guarantee sufficient stocks and sufficient access to necessary medicines.
    • Promote co-operation between governments in the prevention and the management of medicine and vaccine shortages.
    • Encourage governments to be more directive in their dealings with the pharmaceutical industry, notably in terms of adjusting quotas, of accelerating approvals and of importing substitute medicines when pharmaceutical companies are not able to ensure a continuous and adequate supply of medicines.
    • Consider demanding that medicine producers establish a continuity plan for the supply of vital and necessary medicines and vaccines in order to avoid production shortages wherever possible.
    • Ensure the transparancy, sharing and availability of quality information coming from reliable sources in order to establish a trustworthy flow of communications between all stake-holders and healthcare professionals and to the patients. In the case of shortages, governments should divulge and detail the causes to all stake-holders.
    • Enable WMA member states to acquire, via common supply contracts, healthcare and vaccine products in sufficient quantities during a pandemic and thus to have greater influence in negotiations with laboratories.
    • Avoid the ‘first come, first served’ approach, notably during a pandemic, leading to counter productive competition acting against the safeguarding of public health.
    • Allow an industrial level of security of supply in line with the deployment of Interpol’s programme combatting pharmaceutical criminality.

Safety of medicines

  1. The objective is to set up active supply processes to ensure the continuity of quality medical supplies while guaranteeing their safety.
  2. Elements of a high-quality, active supply process comprise:
    • Improvements in quantification, including forecasting.
    • Direct communication between supply agents and the manufacturers on the question of sustainable capacity.
    • Deliberate and well-considered approaches to a specific situation for each product (long term, short term, split contracts, etc.)
    • Responsible pricing with the emphasis on quality
    • Rational and necessary contracts.
    • Establish frameworks which limit the excessive accumulation of medicines and the useless scrapping of unused medicines with the objective of preserving the quality of their pharmaceutical properties.
    • Encourage governments to promote the sharing of public information on the real price of medicines. The authorities must regulate and limit the possibility of reaching agreements on price and discounting confidentiality in the medicine evaluation process. The system must be made more transparent in all areas, including the evaluation of new medicines.
  1. The WMA is clear on the fact that the quality of medicines is a public health priority and is recommending national medical associations and doctor members to:
    • Increase awareness among the public and medical practitioners of sub-standard and fake products.
    • Create a list of ‘essential’ medicines meeting a country’s healthcare needs.
    • Create an early alert system, based around vital medicines and those intended to treat a debilitating pathology, in particular those for which no alternative therapeutic options are available. The activation of such a system would trigger a sequence of measures for all the stake-holders (licensed manufacturers, wholesalers, hospital pharmacists) alongside reporting obligations and a close monitoring of corrective actions.
    • Create a scenario and emergency programmes, including a stress test for manufacture and inspection systems at regular intervals, with appropriate communication strategies adapted to the different stake-holders.
    • Persue efforts to harmonise regulatory standards between the countries and beyond regions.
    • Set up proactive and productive collaboration between all the essential stake-holders in order to prevent medicine shortages and mitigate the harmful effects these have on patient care.
    • Work with healthcare user associations to fight against the growing culture of ill-advised self-diagnosis, self-prescription and self-medication, which could make the supply chain vulnerable to the introduction of non-approved or counterfeit products.
    • Restrict the prevalence of low quality medicines by implementing and applying current good practices in manufactuting, storage and distribution which respect the environment (cGMP) and by preventing the deterioration of medicines.
    • Encourage the pharmaceutical sector to undertake to guarantee the continuity of supply of medicines, in order to avoid any interruptions in treatment.
  1. The WMA is insisting that national governments, in tandem with healthcare user associations and other stake-holders, do everything possible to ensure awareness of medicine safety for all patients.
    • At an international level and working together, Health Ministers and Medical Regulators should recommend that national medical associations actively oppose the illegal misappropriation of medicines, the illegal sales of medicines on the internet, the illegal importing of medicines and the counterfeiting of medicines.
    • Improve regulation and monitoring of the online pharmaceutical market through national regulation of e-commerce activities.
    • Regulations and mechanisms should be adopted to immediately close all websites illegally offering medical products not controlled by state authorities.
    • Improve the identification and the revelation of counterfeit medical products all over the world.
    • Launch international campaigns warning of the health risks linked to the use of counterfeit medical products, informing people about the dangers of buying medicines, or products offered as such, on the internet (counterfeit or fake medicines, etc.).
    • Improvement in detecting falsified and sub-standard medicines, including vaccines and other medical products, and their reporting worldwide. Falsified and sub-standard medicines, including vaccines and other other medical products, should be reported to the appropriate authorities whenever they are discovered. Pharmacies, hospital pharmacies and patients must be prevented by whatever means from being supplied with falsified or sub-standard medicines. All adverse side-effects of a falsified or sub-standard medicine must be immediately highlighted via an efficient and adapted reporting system.
    • Strengthen and align international rules against conterfeit medical products, allowing an efficient fight against the growing challenges of the systems of governance caused by the globalisation of manufacturing processes and supply chains.

Covid-19 health crisis

  1. The Covid-19 health crisis has highlighted the fundamental problems of availability, quality and safety of medicines.
  2. The already significant problems of availability, quality and safety of medicines have been starkly brought to light by the Covid-19 health crisis. The importance of these questions is even bigger, on a global scale, and the Covid-19 pandemic has created unprecedented challenges for the authorities of every State. A pandemic leads to a sharp increase in demand for certain medicines and major expectations of specific medicines and vaccines, creating the conditions for multiple tensions.
  3. The problem of medicine availability is particularly apparent for anesthetics and curares in life support, which are subject to closely monitored delivery in order to avoid any break in supply. The prescription and delivery of certain other medicines have been closely supervised in order to maintain supply for chronic illnesses.
  4. As a response to the unequal access to vaccinations, the implementation of the COVAX mechanism must be developed in the future so as to promote access to and distribution of vaccines, with the objective of protecting the people of all countries.
  5. The WHO warns and cautions consumers, healthcare professionals and health authorities about medicine safety: the growing offer of falsified medical products in the context of the Covid-19 pandemic is aided by the possibility of shortages.
  6. Concerning the quality of medicine, the health crisis has highlighted the risks of self-medication and the need for the States to set up information systems aimed at the general population. False hopes of possible cures for or prevention of Covid-19 by scientifically unproven methods have been known to have serious consequences for the health of the individual.
  7. Economic and/or political interests must not be in competition with the health of the public. Pooling of public health interests must be developed in order that economic and/or political interests are not the cause of failure to manage the situation, of stock shortages or of anti-competitive behaviour.
  1. The evolution of the current health crisis and notably the arrival of new variants show that States must be able to respond scientifically to this evolution without being hampered by overly-restrictive international regulations.

Adopted by the 49th WMA General Assembly, Hamburg, Germany, November 1997
and amended by the 59th WMA General Assembly, Seoul, Korea, October 2008,
by the 70th WMA General Assembly, Tbilisi, Georgia, October 2019 and
by the 72nd WMA General Assembly (online), London, United Kingdom, October 2021

 

PREAMBLE 

For centuries, women and girls worldwide have suffered from gender inequality and an uneven balance of power between men and women. Historically based gender bias has led to women and girls being restricted in their access to, inter alia, employment, education and health care.

Gender inequality creates dangers in medical treatment. When both genders are not offered equal quality treatment and care for the same medical complaints or when different manifestations of disease are not considered based on sex, patient outcomes will suffer.

In addition, in some countries, female healthcare providers have been prevented from, or face barriers to practicing their profession or being promoted to leadership positions due to religious and/or cultural convictions, or discrimination based on the intersecting grounds of sex and religion/ethnicity. A lack of gender representation and diversity within the medical profession may lead to female patients and their children not having equitable access to health care.

Discrimination against girls and women damages their health expectation. It serves as a barrier to accessing health services, affects the quality of health services provided, and reinforces exclusion from society for women and girls. For example, the education of girls positively affects their health and well-being as adults. Education also improves the chances of their children surviving infancy and contributes to the overall well-being of their families. Conversely, secondary discrimination due to social, religious and cultural practices – which diminishes women’s freedom to make decisions for themselves and to access employment and healthcare opportunities – has a negative impact on health expectation.

National laws, policies and practices can also foster and perpetuate discrimination in health care settings, prohibiting or discouraging women and girls from seeking the broad range of health care services they may need. Evidence demonstrates the harmful health and human rights impacts of such laws. For example, in some countries and due to national laws, legislations or social norms, women and girls lack decision-making power about their own medical treatment, surgery, childbearing or contraception.

Addressing discrimination in health care settings will contribute to the achievement of many of the United Nations Sustainable Development Goads (SDGs), ensuring that no woman or girl is left behind. It is fundamental to securing progress towards SDG 3, Good health and wellbeing, including achieving universal health coverage and ending the AIDS and tuberculosis epidemics; SDG 4, Quality education; SDG 5, Gender equality and women’s empowerment; SDG 8, Decent work and inclusive economic growth; SDG 10, Reduced inequalities; and SDG 16, Peace, justice and strong institutions.

Gender is a social determinant of health and health problems may manifest themselves differently in men and women. There is a need to address the differences in health and unequal health care between men and women, including both the biological and socio-cultural dimensions.

Access to healthcare, including both therapeutic and preventative strategies, is a fundamental human right. This imposes an obligation on government to ensure that these human rights are fully respected and protected.  Gender inequalities must be addressed and eradicated in all aspects of healthcare.

Machine learning, predictive algorithms and artificial intelligence (AI) in healthcare are expected to drastically change the way healthcare is practiced and managed. For example, AI could change the way in which diseases such as cancer are diagnosed and treated. However, even with the introduction of AI in healthcare, resource limitations may prevent most women globally from accessing such healthcare. In order not to amplify any gender inequalities, information being programmed into artificial intelligence algorithms being created to inform medical diagnoses and management must take into account the specific health considerations of women, for example women may present with different symptoms to men.

The WMA Declaration of Geneva establishes the physician’s respect for human dignity and that it should not allow considerations of gender to come between “my duties and my patients.”

 

RECOMMENDATIONS

Therefore, the World Medical Association urges its constituent members to:

  1. Promote the equal human right of health for women and children;
  2. Categorically condemn violations of the basic human rights of women and children, including violations stemming from social, political, religious, economic and cultural practices;
  3. Insist on the rights of all women and children to full and adequate medical care, especially where religious, social, and cultural restrictions or discrimination may hinder access to such medical care, and promote women’s and children’s health and access to health as human rights;
  4. Advocate for parity of health insurance premiums and coverage to ensure that women’s access to care is not impeded by prohibitively high expenses;
  5. Governments have an obligation to ensure that the information being programmed into artificial intelligence algorithms being created to inform medical diagnoses and management must include a representative sample of data from women to ensure the gender inequality gap is not amplified further.
  6. Ensure universal access to sexual and reproductive healthcare;
  7. Promote the provision of pre-conception, prenatal and maternal care, and post-natal care including immunization, nutrition for proper growth and healthcare development for children.
  8. Advocate for educational, employment and economic opportunities for women and for their access to information about healthcare and health services.
  9. Work towards the achievement of the human right to gender equality of opportunity and gender equality of treatment.

Adopted by the 72nd WMA General Assembly (online), London, United Kingdom, October 2021

 

PREAMBLE

Surgery and anesthesia care encompass all clinical fields and all health care providers dealing with surgical disease and pathologies. This includes, but is not limited to anesthesia, obstetrics and gynaecology and surgery including all of its subspecialties. They have historically been a neglected part of global health with very little investments made in developing surgical health systems, while an estimated quarter of the burden of disease worldwide can be attributed to surgical diseases. Moreover, the majority of the world’s population lacks access to safe, timely and affordable surgical care.

A workforce of 20 surgical, anesthesia and obstetric physician providers for every 100.000 members of the population is necessary to provide 80% of the world population essential and emergency surgical care within 2 hours. This includes emergency surgical and obstetric care such as caesarian sections and surgical care to prevent death and disability due to illnesses likely to benefit from surgical treatment such as injuries, cataracts and cancer.  The majority of low- and middle-income countries (LMICs) fall far below this target, with the need being especially great in the poorest regions of the world.

Surgeon shortages may be exacerbated by a lack of gender equity in the surgical workforce which remains a challenge. Despite the fact that in a number of countries, there are more female than male medical students, men still outnumber women by far in the surgical workforce.

Surgery and anesthesia care have been proven to be cost-effective, especially in LMICs. Surgical interventions are as cost-effective as common public health interventions like malaria bed nets, HIV drugs or childhood vaccinations.

Sixty percent of cancer patients and eighty percent of trauma patients will need some form of surgical intervention throughout their treatment. Considering both non-communicable diseases (NCDs) and injuries are on the rise globally, the demand for surgical care is expected to continue to increase.

In 2015 the World Health Assembly recognized surgery and anesthesia care as a vital component of Universal Health Coverage (UHC) through their Resolution 68.15 “Strengthening emergency and essential surgical care and anesthesia as a component of universal health coverage”.

 

RECOMMENDATIONS

WMA recommends that the relevant national authorities:

  1. Integrate quality surgical and anesthesia care in all levels of health care, including comprehensive primary health care in order to realize UHC and Sustainable Development Goals by 2030.
  1. Develop specific surgery and anesthesia guidelines and policies for their respective countries or jurisdictions adapted to local needs and capacities.
  1. Implement policies regulating the process of task shifting in surgery and anesthesia care in line with the “WMA Resolution on Task Shifting from the Medical Profession”.
  1. Invest in health system strengthening and advocate for increased financing and budgetary allocation for surgery and anesthesia care without depriving other areas of necessary funds.
  1. Provide the necessary infrastructure and procurement lines for hospitals to deliver safe, high-quality surgical care.
  1. Ensure policies, including narcotic and regulated drugs policies, do not hamper access to necessary surgical medications including analgesia and anesthetic agents.
  1. Create clinical protocols or guidelines at the national or regional level to assure antibiotics use in the peri-operative period are prescribed in a sustainable manner and in line with applicable antimicrobial resistance guidelines.
  1. Include surgical care and diseases in relevant courses to fight the dogma that surgical care is too expensive and complex to provide in low-resource settings.
  1. Offer equitable residency training opportunities to locally trained medical students of both genders in the field of surgery and anesthesia based on scientifically projected needs of the country or region in line with the “WMA Statement on Gender Equality” and contributing to the Global strategy on human resources for health: Workforce 2030.
  1. Allow adaptive training and work schedules to accommodate the potential need for maternity or paternity leave, and a healthy work-life balance, in order to make training programs more accessible irrespective of the trainee’s family responsibilities.
  1. Seek regional, national and international collaboration in clinical and academic domains where local capacity and resources may be lacking and where exposure could be beneficial to those from areas without high capacity or resources, such as through bilateral exchange programs.
  1. Support national initiatives on surgical data collection, capacity building, advocacy, policy planning and systems strengthening through collaboration with NGOs, universities, research initiatives, local communities, development banks, governmental organizations, and other stakeholders;

WMA commits to:

  1. Advocate at local, regional and national, and international fora in favor of person-centered care creating a more holistic health care system, offering medical, surgical, mental health and preventive health services in a national UHC approach, supporting WHA Resolution 68.15 “Strengthening emergency and essential surgical care and anesthesia as a component of universal health coverage”. 

 

 

Adopted by the 72nd WMA General Assembly (online), London, United Kingdom, October 2021

 

PREAMBLE

The sun is a great source of health benefits, but it is important to know its harmful consequences as well. The prevention of the harmful effects of the sun on our skin is advisable at all ages, especially in children and adolescents. Solar radiation generates a series of biological and physiological effects in the body that depend on the proportion and intensity of the radiation and that have beneficial effects, such as stimulating the synthesis of vitamin D, favoring the formation of hemoglobin and improving the mood, while other effects are harmful and aggressive to the skin, such as erythema, photoaging of the skin and precancerous or cancerous lesions. Dermatoses produced or aggravated by sun exposure are a health problem that healthcare professionals face most frequently.

Solar light is composed of a continuous spectrum of electromagnetic radiation divided into three major groups: ultraviolet (UV), visible and infrared. UV radiation is classified as UV-A, UV-B and UV-C.

The intensity of UV radiation can be measured by international standardized instruments such as the UV index which measures the strength of sunburn-producing solar UV radiation at a particular place and time.

Solar UV radiation, especially through UV-B, is an extremely important, yet neglected causative factor for skin cancers, both melanoma and non-melanoma, for ocular pathologies (e.g., cataracts, and age-related macular degeneration), and harmful effects on the immune system [3]. Recurrent and severe sunburns are a risk factor for non-melanoma skin cancer.

Solar radiation can also induce the onset and exacerbation of chronic actinic dermatitis (CAD) and melasma. Blue light plays an important role as well in the pathogenesis of melasma, therefore broad-spectrum photoprotection should be advocated and the intake of photosensitive foods and drugs should be reduced.

Risk of skin cancer differs according to skin type as well as the duration and intensity of solar light exposure. Chronic, long-term, cumulative UV exposure is associated with actinic keratosis and squamous cell carcinomas, while high-intensity, intermittent UV exposure, especially at a young age, is associated with basal cell carcinomas and melanomas. Therefore, photoprotection is important in young ages.

The World Health Organization (WHO), through the International Agency for Research on Cancer has raised the issue of solar UV radiation being a carcinogen since 1992 and since 2012 has classified solar UV radiation as a group 1 carcinogen (carcinogen to humans). Other well-known group 1 carcinogens are plutonium, asbestos and ionizing radiation.

Furthermore, current climate changes and the depletion of the ozone layer by approximately 4% per decade since the 1970s has led to a diminished filtration of UV-A and UV-B radiation and to increased UV radiation that reaches sea-level.

As a consequence, the incidence of melanoma and non-melanoma skin cancer is increasing worldwide.

WHO evidence indicates that four out of five cases of skin cancer can be prevented and simple preventive measures, such as limiting UV exposure in the midday sun, wearing UV protective clothing and hats or using mineral-based sunscreens, are recommended.

Photoprotection also includes make-up products, sunglasses, and windshields.

The WHO recognizes that while protection against UV exposure is recommended globally, there is concern that lack of UV exposure may reduce beneficial effects of vitamin D, including its potential to reduce the risk of some types of cancer.

 

RECOMMENDATIONS

1.     Photoprotection is a key preventative health strategy as most skin cancers are a result of UV solar exposure.

National Governments should:

2.     Inform health professionals and the public about the characteristics that sunscreen should meet (one that provides balanced, safe and easy-to-use protection) in order to avoid variability between the products supplied by laboratories, as well as improve safety and the labelling of the sunscreen.

3.     Recognize solar UV exposure as an important risk factor for developing skin cancer. UV exposure also is a prime cause of some ocular diseases and immune system dysfunctions.

4.     Work together to develop a Global Action Plan for the Prevention of Skin Cancer based on Photoprotective measures. This should include action against climate change to help reduce damage from ultra-violet radiation.

5.     Support skin cancer screening campaigns.

6.     Recognize prevention of skin cancer as a national health priority.

7.     Improve skin cancer’s screening, diagnosis and management.

8.     Include all forms of skin cancer in all Nationals Cancer Registries and improve the reporting of UV induced skin cancers and legislative frameworks to protect outdoor workers (recognition as occupational disease).

9.     Work with relevant stakeholders to liaise, engage and organize online and offline skin cancer prevention campaigns and educational programs on sun protection, with a primary focus on ages 0 – 18, in order to raise awareness of this health hazard and to encourage sun safety (use of protective clothing and hats, adequate sunscreen use, avoidance of excessive exposure) and healthy lifestyle choices among the young.

10.  Promote policies to fight climate change and air pollution.

11.  Consider the environmental impact of sunscreen.

WMA and its members should:

12.  Interact with healthcare providers and medical practitioners who have a significant role in empowering and educating their patients in the promotion of skin cancer awareness, sun-protective measures and encouraging patient access to screening, diagnosis and treatment.

13.  Educate primary care physicians and occupational physicians to recognise and refer patients with suspect lesions to dermatologists.

14.  Support the development of national guidelines on photoprotective measures and continued scientific research in this field to derive the risk-benefit balance of UV exposure.

15.  Support continued research and development of adequate protective clothing.

16.  Promote campaigns to encourage the measurement of UV exposure within each nation.

17.  Support media campaigns and educational programs that explain the harmful effects of UV exposure and optimal photoprotective measures targeting the most vulnerable, such as children and teenagers, fair skinned people, outdoor workers (e.g. agriculture, fishery, construction, forestry, athletes, swimming pool attendants).

18.  Promote health education and information on sunscreens and the most recommended and healthy habits for the skin, establishing correct sun protection habits that make it possible to enjoy the beneficial effects of the sun and avoid sun damage.

Individual physicians should:

19.  Counsel patients about the major health risks associated with excessive solar UV radiation exposure, inform patients about appropriate sun protective measures (e.g. skin coverage, sunscreen, and sunglasses) and encourage patients to undergo regular medical check-ups and to participate in skin cancer screening campaigns, where available.

20.  Counsel patients to self-examine their skin.

21.  Counsel those patients at risk (for example, patients on certain anti-cancer drugs) to understand the extra importance of protective measures.

22.  Counsel employers on UV light as a work-related health risk.

 

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

 

PREAMBLE

In 2017, almost 140,000 solid organ transplants were performed worldwide. Although impressive, this activity provided for only 10% of the global need for transplanted organs. The disparity between supply and demand of organs has led to the emergence of transplant-related crimes, including trafficking in persons for the purpose of the removal of organs and trafficking in human organs.

These crimes violate fundamental human rights and pose serious risks to both individual and public health. The true extent of transplant-related crimes remains unknown, but it is estimated that 5% to 10% of transplants globally take place in the context of the international organ trade, often involving transplant tourism to destinations where laws against the sale and purchase of human organs are nonexistent or poorly enforced. Trafficking in persons for the purpose of the removal of organs and trafficking in human organs can also take place within the boundaries of a given jurisdiction, not involving travel for transplantation. In all cases, the most vulnerable parts of the population often become victims of exploitation and coercion.

Concerned by the increasing demand for organs and by emerging unethical practices in the field, the World Health Organization has called on governments and health professionals to pursue self-sufficiency in transplantation, through strategies targeted at decreasing the burden of diseases treatable with transplantation and increasing the availability of organs, maximising donation from the deceased and ensuring the overall protection of the living donor. Progress towards self-sufficiency in transplantation is consistent with the establishment of official cooperation agreements between countries to share organs or to facilitate patients’ access to transplant programs that have not been developed in their countries of origin. Agreements between countries should be based on the principles of justice, solidarity and reciprocity.

Progress towards self-sufficiency in transplantation is the best long-term strategy to prevent transplant-related crimes.

The distinctive feature of transplant-related crimes is the necessary involvement of health professionals. It is precisely this feature that provides a unique opportunity to prevent and combat these crimes. Health professionals are key in evaluating prospective living donor and recipient pairs. They also care for desperate patients who are vulnerable and at risk of engaging in illicit transplant activities. In addition, since patients who receive a transplant require long-term specialised care, physicians must deal with the many challenges of providing care to patients who have received an organ through illicit means, while unveiling trafficking rings.

International organisations, including the Council of Europe, the European Union and the United Nations, as well as international professional platforms, have developed treaties, resolutions and recommendations for a concerted fight against transplant-related crimes.

The WMA emphasises the responsibility of physicians in preventing and combatting trafficking in persons for the purpose of the removal of organs and trafficking in human organs, as well as the important role of physicians and other health-care professionals in assisting international organisations, medical associations and policy makers in the fight against these criminal activities.

In the fight against transplant-related crimes it is of utmost importance that the principles of transparency of practice, traceability of organs and continuity of care are guaranteed for every transplant procedure performed nationally or abroad.

The WMA reaffirms its Statement on organ and tissue donation and its Declaration of Sydney on the determination of death and the recovery of organs. Condemning all forms of trafficking in persons for the purpose of the removal of organs and trafficking in human organs, the WMA calls for the implementation of the following recommendations.

 

RECOMMENDATIONS

Policy makers and health actors:

  1. Governments should develop, implement and vigorously enforce legislative frameworks that prohibit and criminalise trafficking in persons for the purpose of the removal of organs and trafficking in human organs, these should include provisions to prevent these crimes and protect their victims.
  2. Governments should consider ratifying or acceding to the United Nations Convention against Transnational Organised Crime and the Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children, supplementing the United Nations Convention against Transnational Organised Crime, as well as the Council of Europe Convention against Trafficking in Human Organs. They should also consider cooperating with existing international organisations for a more effective fight against transplant-related crimes. The WMA should play a leading role in influencing ethical practices in donation and transplantation.
  3. Health authorities should develop and maintain registries to record information regarding each organ recovery and transplantation procedure, as well as information on the outcomes of living donors and organ recipients, to ensure the traceability of organs, with due regard to professional confidentiality and personal data protection. Registries should be designed to record information on procedures that take place within a country and on transplant and living donation procedures on residents of that country carried out in other destinations.
  4. Countries are encouraged to periodically contribute this information to the Global Observatory on Donation and Transplantation developed in collaboration with the World Health Organization.
  5. Health authorities and medical associations should ensure that all health professionals are trained in the nature, extent and consequences of transplant-related crimes, as well as in their responsibilities and duties in preventing and fighting these criminal activities and in the means to do so.
  6. As self-sufficiency is the best long-term strategy to prevent transplant-related crimes, health authorities and policy makers should develop preventive strategies to decrease the burden of diseases treatable with transplantation and increase the availability of organs.
  7. Increasing organ availability should be based on the development and optimisation of ethically sound deceased donation programs following the determination of death by neurological and by circulatory criteria. Of note is that donation after the determination of death by circulatory criteria is accepted in a limited number of countries. Governments should explore whether donation after the circulatory determination of death is a practice acceptable within their community and, should this be the case, consider introducing it within their jurisdiction.
  8. In addition, governments should develop and optimise living donation programs based on recognised ethical and professional standards and ensure due protection and follow-up of living donors.
  9. Health authorities and/or insurance providers should not reimburse the costs of transplant procedures that have occurred in the context of transplant-related crimes. However, the costs of medications and post-transplant care should be covered, as for any other transplant patient.
  10. Authorities should also ensure that medical and psychosocial care is provided to victims of trafficking in persons for the purpose of organ removal and of trafficking in human organs. Consideration should be given to effective compensation of these persons for the damage suffered.
  11. National Medical Associations should advocate for and cooperate with authorities in developing frameworks for health professionals to report any confirmed or suspected case of trafficking of persons for the purpose of the removal of organs and of trafficking in human organs to the relevant authorities. National Medical Associations should advocate for the ability of health professionals to report suspected trafficking of individual persons, on an anonymous basis if necessary, to protect the safety of the reporter. Where applicable, the reporting of trafficking cases should be a permitted exception to the physician’s obligation to maintain patient confidentiality

Physicians and other health professionals:

  1. Physicians should never perform a transplant using an organ that has been illicitly obtained. If there are reasonable concerns about the origin of an organ, the organ must not be used. If a physician or a surgeon is asked to perform a transplant with an organ that has been obtained through a financial transaction, without the valid consent of the donor or without the authorisation required in a given jurisdiction, they must refrain from performing the transplant and should explain the reasons to the potential recipient.
  2. Physicians who participate in the preoperative evaluation of potential living donors should not only assess the medical suitability of the individual, but also attempt to ensure that the person has not been subject to coercion of any kind or is participating in the procedure for financial gain or any other comparable advantage. The legitimacy of the donor-recipient relationship and the altruistic motivations for donation should be scrutinised. Physicians should be particularly vigilant of “red flags” suggestive of a transplant-related crime. Non-resident living donors may be particularly vulnerable and should be given special consideration. For linguistic, cultural and other reasons, assessing the validity of their consent to donation can be especially challenging, as can ensuring that appropriate follow-up is offered to them. A referring physician should be identified in the country of origin of the living donor – and in that of their intended recipient, where appropriate.
  3. Physicians should never promote or facilitate the engagement of patients in transplant-related crimes. Moreover, they should inform patients of the risks these activities pose for their own health, that of their loved ones and, more generally, for public health. Patients should also understand that these activities entail an exploitation of vulnerable individuals who may themselves suffer from severe medical and psychosocial complications. By counselling patients, professionals may dissuade them from engaging in illicit transplant activities.
  4. Physicians have a duty to care for transplant patients, even if their organ was illicitly Should a physician have ethical or moral objections about caring for a patient who has received an illicit organ, they should make the necessary arrangements to transfer the care of the patient to another physician.
  5. Physicians should contribute to guaranteeing transparency of practices and traceability of organs. When patients who have undergone a donation or a transplantation procedure abroad seek follow-up care in their country of residence, all relevant information should be recorded in national transplant-registries and reported to health authorities, as should happen for all donation and transplantation procedures performed within the national transplant system.
  6. . Physicians have a responsibility to increase the deceased donor pool in order to satisfy the transplantation needs of patients. Physicians also have a duty towards possible organ donors in considering and facilitating organ donation if this is consistent with patients’ values and principles. Donation should be routinely offered as an option at the end of life, always in a respectful manner, taking into account the culture and religion of the potential donor and their surrogates. Conversations about donation opportunities should be led by experienced and trained professionals.
  7. Physicians should promote research in the field of donation and transplantation, in particular research targeted at increasing the availability of organs for transplantation, improving the outcomes of transplanted organs, and identifying alternative organ replacement strategies, as in the case of bioartificial organs.