ICoME draft June 2022 for Bangkok 220530

ICoME – Confidential revised draft 01.06.2022
1
THE WORLD MEDICAL ASSOCIATION, INC.
REVISED DRAFT OF INTERNATIONAL CODE OF MEDICAL ETHICS
Revised ICoME draft as approved by the WMA Medical Ethics Committee (April 2022)
and editorially revised by the ICoME workgroup (approved by WMA ExCo in June 2022)
Current revised text (as approved by the WMA Medical Ethics Committee in April 2022) with editorial amendments
from ICoME workgroup (approved by the WMA Executive Committee in June 2022).
WMA INTERNATIONAL CODE OF MEDICAL ETHICS
Preamble
1 The World Medical Association (WMA) has developed the International Code of Medical Ethics as a canon of ethical principles
for the members of the medical profession worldwide. In concordance with the WMA Declaration of Geneva: The Physician’s
Pledge and the WMA’s entire body of policies, it defines and elucidates the professional duties of physicians toward their
patients, other physicians and health professionals, themselves, and society as a whole.
The physician must be aware of applicable national ethical, legal, and regulatory norms and standards, as well as relevant
international norms and standards. Such norms and standards must not reduce the physician’s commitment to the ethical
principles set forth in this Code.
The International Code of Medical Ethics should be read as a whole and each of its constituent paragraphs should be applied
with consideration of all other relevant paragraphs. Consistent with the mandate of the WMA, the Code is addressed to
physicians. The WMA encourages others who are involved in healthcare to adopt these ethical principles.
General principles
2 The primary duty of the physician is to promote the health and well-being of individual patients by providing competent, timely,
and compassionate care in accordance with good medical practice and professionalism.
The physician also has a responsibility to contribute to the health and well-being of the populations they serve and society as a
whole, including future generations.
The physician must provide care with the utmost respect for human dignity and life.
May 2022 MEC 220/ICoME REV2/Apr2022 + editorial amendments
2
3 The physician must practise with conscience, honesty, integrity, and accountability, while always exercising independent
professional judgment and maintaining the highest standards of professional conduct.
4 Physicians must not allow their individual professional judgement to be influenced by the possibility of benefit to themselves or
their institution. The physician must recognise and avoid real or potential conflicts of interest. Where such conflicts are
unavoidable, they must be declared in advance and properly managed.
5 The physician must practise medicine fairly and justly and provide care without engaging in discriminatory conduct or bias on
the basis of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, culture, sexual
orientation, social standing or any other factor.
Care should be provided based on the patient’s health needs.
6 The physician must strive to use health care resources in a way that optimally benefits the patient, in keeping with fair, just, and
prudent stewardship of the shared resources with which the physician is entrusted.
7 When providing professional certification, the physician must only certify what the physician has personally verified.
8 Physicians must take responsibility for their individual medical decisions and must not alter their sound professional medical
judgments on the basis of instructions contrary to medical considerations.
9 When medically necessary, the physician must collaborate with other physicians and health professionals who are involved in the
care of the patient or who are qualified to assess or recommend care options. This communication must respect patient
confidentiality and be confined to necessary information.
10 The physician must offer help in medical emergencies, while considering the physician’s own safety and competence, and the
availability of other viable options for care.
11 The physician must never participate in or facilitate acts of torture or other cruel, inhuman or degrading treatment or punishment.
May 2022 MEC 220/ICoME REV2/Apr2022 + editorial amendments
3
12 The physician must engage in continuous learning throughout professional life in order to maintain and develop professional
knowledge and skills.
13 The physician should strive to practise medicine in ways that are environmentally sustainable with a view to minimising
environmental health risks to current and future generations.
Duties to the patient
14 In providing medical care, the physician must respect the dignity, autonomy, and rights of the patient. The physician must
respect the patient’s right to freely accept or refuse care in keeping with the patient’s values and preferences.
15 The physician must commit to the primacy of patient health and well-being and must offer care in the patient’s best interest. In
doing so, the physician must strive to prevent or minimise harm for the patient and seek a positive balance between the intended
benefit to the patient and any potential harm.
16 The physician must respect the patient’s right to be informed in every phase of the care process. The physician must obtain the
patient’s voluntary informed consent prior to any medical care provided, ensuring that the patient receives and understands the
information needed to make an independent, well-informed decision about the proposed care. The physician must respect the
patient’s decision to withhold or withdraw consent at any time and for any reason.
17 When a patient has substantially limited, undeveloped, impaired, or fluctuating decision-making capacity, the physician must
work with the patient’s trusted representative, if available, to make decisions in keeping with the patient’s preferences, when
those are known or can reasonably be inferred. When the patient’s preferences cannot be determined, the physician must make
decisions in the patient’s best interests. All decisions must be made in keeping with the principles set forth in this Code.
18 In emergencies, where the patient is not able to participate in decision making and no representative is readily available, the
physician may initiate an intervention without prior informed consent in the best interests of the patient and with respect for the
patient’s preferences, where known.
19 If the patient regains decision-making capacity, the physician must obtain informed consent for further intervention.
May 2022 MEC 220/ICoME REV2/Apr2022 + editorial amendments
4
20 The physician should be considerate of and communicate with others, where available, who are close to the patient, in keeping
with the patient’s preferences and best interest and with due regard for patient confidentiality.
21 If any aspect of caring for the patient is beyond the capacity of a physician, the physician must consult with or refer the patient to
another physician or health professional who has the necessary capacity.
22 The physician must maintain accurate, secure, and up-to-date medical records.
23 The physician must respect the patient’s privacy and confidentiality, even after the patient has died. A physician may disclose
confidential information if the patient provides voluntary informed consent or, in exceptional cases, when disclosure is necessary
to safeguard a significant and overriding ethical obligation to which all other possible solutions have been exhausted, even when
the patient does not or cannot consent to it.
This disclosure must be limited to the minimal necessary information, recipients, and duration.
24 If a physician is acting on behalf of or reporting to any third parties with respect to the care of a patient, the physician must
inform the patient accordingly at the outset and, where appropriate, during the course of any interactions.
At the outset and, where appropriate, during the course of any interactions, the physician must disclose to the patient the nature
and extent of those commitments and must obtain consent for the interaction.
25 The physician must refrain from intrusive or otherwise inappropriate advertising and marketing and ensure that all information
used by the physician in advertising and marketing is factual and not misleading.
26 The physician must not allow commercial, financial, or other conflicting interests to affect the physician’s professional
judgement.
27 When providing medical care remotely, the physician must ensure that this form of communication is medically justifiable and
that the necessary medical care is provided. The physician must also inform the patient about the benefits and limitations of
receiving medical care remotely, obtain the patient’s consent, and ensure patient confidentiality is upheld. Wherever medically
appropriate, the physician must aim to provide care to the patient through direct, personal contact.
May 2022 MEC 220/ICoME REV2/Apr2022 + editorial amendments
5
28 Current draft as approved by the MEC for use as a basis for discussion at the dedicated conference in 2022.
The physician has an ethical obligation to minimise disruption to patient care. Conscientious objection must only be exercised if
the individual patient is not discriminated against or disadvantaged and the patient’s health is not endangered.
If a physician intends to exercise a conscientious objection to a specific treatment or procedure, the physician must inform the
patient of this objection. If it is not practicable for the patient to see another physician who will perform the treatment or
procedure, the physician must initiate, without delay, arrangements for the patient to consult with a suitably qualified physician
or authorised health care professional who does not object to the treatment or procedure.
The physician must minimise distress for the patient and must not disrespect the patient on the grounds of the patient’s
conviction. The physician must respect other physicians’ and health professionals’ conscientious objections provided they are in
line with this Code.
Please note: The paragraph on conscientious objection is being considered separately at this time, as there will be a dedicated
conference to discuss this paragraph on 4-5 July 2022 in Jakarta, Indonesia.
29 The physician must maintain appropriate professional boundaries. The physician must never engage in abusive, exploitative or
other inappropriate relationships or behaviour with a patient and must not engage in a sexual relationship with a current patient.
30 In order to provide care of the highest standards, physicians must attend to their own health, well-being and abilities. This
includes seeking appropriate care to ensure that they are able to practise safely.
Duties to other physicians and health professionals
31 The physician must engage with other physicians and health professionals in a respectful and collaborative manner without
engaging in harassment, discriminatory conduct or bias. The physician must also ensure that ethical principles are upheld when
working in teams.
32 The physician should respect colleagues’ patient-physician relationships and not intervene unless needed to protect the patient
from harm. This should not prevent the physician from recommending alternative courses of action considered to be in the
patient’s best interests.
May 2022 MEC 220/ICoME REV2/Apr2022 + editorial amendments
6
33 The physician should report to the appropriate authorities conditions or circumstances which impede the physician or another
physician from providing care of the highest standards or from upholding the principles of this Code. This includes any form of
abuse or violence against physicians and other health personnel, inappropriate working conditions, and any other unsustainable
stress factors.
34 Due respect should be accorded to teachers and students of medicine and other health professionals.
Duties to society
35 The physician must support fair and equitable provision of health care. This includes addressing inequities in health and care, the
determinants of those inequities, as well as violations of the rights of both patients and health professionals.
36 Physicians play an important role in matters relating to health, health education and health literacy. In fulfilling this
responsibility, physicians should be prudent in discussing new discoveries, technologies, or treatments in non-professional,
public venues and should ensure that their statements are scientifically accurate and understandable.
Physicians must indicate if their own personal opinions are contrary to evidence-based scientific information.
37 Physicians should avoid acting in such a way as to weaken public trust in the medical profession. To maintain that trust,
physicians must hold themselves and fellow physicians to the highest standards of professional conduct and be prepared to report
behaviour that conflicts with the principles of this Code.
38 Physicians should share their medical knowledge and expertise for the benefit of patients and the advancement of health care,
and public and global health.
39 Physicians must support sound medical scientific research in keeping with the WMA Declaration of Helsinki and the WMA
Declaration of Taipei.
Physician’s duties as a member of professional medical organisations
40 As a member of professional medical organisations, the physician should follow, protect, and promote the ethical principles of
this Code. The physician should help prevent national or international ethical, legal, or regulatory requirements that undermine
any of the duties set forth in this Code.
May 2022 MEC 220/ICoME REV2/Apr2022 + editorial amendments
7
41 As a member of professional medical organisations, the physician should support fellow physicians in upholding the
responsibilities set out in this Code and take measures to protect them from undue influence, abuse, exploitation, violence, or
oppression.