D-1998-01-1998_OVE

‘.
L’ASSOCIATION MEDICALE MONDIALE. INC ASOCIACION MEDICA MUNDIAL, INC
THE WORLD MEDICAL ASSOCIATION. INC.
B. P. 63 • 01212 FERNEY-VOLTAIRE Cedex. France
28, avenue des Alpes· 01210 FERNEY·VOLTAIRE, Fram:e
Telephone; 0450407575
Fax : 04 50 40 59 37
October 1998
.Cable Address:
WOMEDAS, Ferney.Voltaire
E-maIladdnlss:wmaOlprolink.fr
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Original: English
WORLD MEDICAL ASSOCIATION DECLARATION OF OTIAWA
ON
THE RIGHT OF THE CmLD TO HEALTH CARE
Adopted by the 50th
WMA General Assembly
Ottawa, Canada, October 1998
PREAMBLE
l”.l<.EAMHLE
1. The health care of a child, whether at home or in hospital, includes medical, emotional,
social and financial aspects which interact in the healing process and which require
special attention to the rights ofthe child as a patient.
2. Article 24 ofthe J 989 United Nations Convention on the Rights.of.the Child recognises
the right of the child to the enjoyment of the highest attainable standard of health and to
facilities for the treatment of illness and rehabilitation of health, and states that nations
shall strive to ensure that no child is deprived ofhis or her right ofaccess to such health
care services.
3. In the context of this Declaration a child signifies a human being between the time of
birth and the end of herlhis seventeenth year, unless under the law applicable in the
country concerned children are legally recognized as adults at some other age.
GENERAL PRINCIPLES
4. Every child has an inherent right to life, as well as the right of access to the appropriate
facilities for health promotion, the prevention and treatment of illness and the
rehabilitation of health. Physicians and other health care providers have a responsibility
to acknowledge and promote these rights, and to urge that the material and human
resources be provided to uphold and fulfil them. In particular every effort should be
made:
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i) to protect to the maximum extent possible the survival and development of the .
child, and to recognise that parents (or legally entitled representatives) have primary
responsibility for the development of the child and that both parents have common
responsibilities in this respect;
ii) to ensure that the best interests of the child shall be the primary consideration in
health care;
iii) to resist any discrimination in the provision of medical assistance and health care
from considerations of age, gender, disease or disability, creed, ethnic origin,
nationality, political affiliation, race, sexual orientation, or the social standing of the
child or herlhis parents or legally entitled representatives;
iv) to attain suitable pre-natal and post-natal health care for the mother and child;
v) to secure for every child the provision of adequate medical assistance and health
care, with emphasis on primary health care, pertinent psychiatric care for those
children with such needs, pain management and care relevant to the special needs of
disabled children;
vi) to protect every child from unnecessary diagnostic procedures, treatment and e
research;
vii) to combat disease and malnutrition;
viii)to develop preventive health care;
ix) to eradicate child abuse inits various forms; and
x) to eradicate traditional practices prejudicial to the health ofthe child.
SPECIFIC PRINCIPLES
Quality of care
Quality of care
.5. Continuity and quality ofcare should be ensured by the team providing health care for a
child.
. 6. Physicians and others providing health care to childrenshould have the special training
. and skills necessary to enable them to respond appropriately to the medical, physical,
emotional and developmental needs ofchildren and their families. e
7. In circumstances where a choice must be made between child patients for a particular
treatment which is in limited supply, the individual patients should be guaranteed a fair
selection procedure for that treatment made on medical criteria alone and without
discrimination.
Freedom of choice
8. The parents or legally entitled representatives, or the child herself/himself if shelhe is of
sufficient maturity, should be able: to choose freely and to change the child's physician;
to be satisfied that the physician of choice is free to make clinical and ethical
judgements without any outside interference; and to ask for a second opinion of another
physician at any stage.
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Consent and self-deterniination
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9. A child patient and her/his parents or legally entitled representatives have a right to
active informed participation in all decisions involving the child's health care: The
wishes ofthe child should be taken into account in such decision making, and should be
given increasing weight dependant on her/his capacity of understanding. The mature
child, in the judgement ofthe physician, is entitled to make herlhis own decisions about
health care.
10. Except in an emergency (see par 12 below), informed consent is necessary before
beginning any diagnostic process or therapy on a child, especially where it is an invasive
procedure. In the majority of cases the consent shall be obtained from the parents or
legally entitled representatives, although any wishes expressed by the child should be
taken into account before consent is given. However, if the child is of sufficient
maturity and understanding, the informed consent shall be obtained from the child
hersel£'himself.
11. In general, a competent child patient and her/his parents or legally entitled
representatives are entitled to withhold consent to any procedure or therapy. While itis
presumed that parents or legally entitled representatives will act in the best interests of
the child, occasionally this may not be so. Where a parent. or legally entitled
representative refuses consent to a procedure and/or treatment, without which the child's
.health would be put in grave and irreversible danger and to which there is no alternative
within the spectrum of generally accepted medical care, the physician should obtain the
relevant judicial or other legal authorisation to perform such a procedure or treatment.
.& – – –
relevant judicial or other legal authorisation to perform such a procedure or treatment.
12. If the child is unconscious, or otherwise incapable of giving consent, and a parent or
legally entitled representative is not available, but a medical intervention is needed
urgently, then specific consent to the intervention may be presumed, unless it is obvious
and beyond any reasonable doubt on the basis of a previous firm expression or
convictionthatconsenito 'fue-mterveiitlon would be refused in the particU1ar~-sitWluon- – .
(subject to the proviso detailed in paragraph 7 above).
13. A child patient and her/his parents or legally entitled representatives are entitled to
refuse to participate in research or in the teaching of medicine. Such refusal must never
interfere with the patient-physician relationship or jeopardise the child's medical care or
other benefits to which she/he is entitled.
Access to information
14. The child patient and (except in the circumstances outlined in paragraph 18 below)
her/his parents or legally entitled representatives are entitled to be fully informed about .
her/his health status and medical condition, provided this would not be contrary to the
interests of the child. However, confidential information in the child's medical record
about a third party should not be provided to the child, the parents or the legally entitled
representatives without the consent ofthat third party.
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15. Any information should be provided in a manner appropriate to the culture and to the
level of understanding of the recipient. This is particularly important in the case of
information provided to the child, who should have the right of access to general health
information.
16. Exceptionally, certain information may be withheld from the child, or her/his parents or
legally entitled representatives, when there is good reason to believe that this
information would create a serious hazard to the life or health of the child or to the
physical or mental health of a person other than the child.
Confidentiality
17. In general the obligation of physicians and other health care workers to maintain the
confidentiality of identifiable personal and medical information of patients (including
information about health status, medical condition, diagnosis, prognosis, and treatment)
applies as much in the case ofchild patients as it does for those who are adult.
18. The child patient mature enough to be unaccompanied at a consultation by her/his _
parents or legally entitled representatives is entitled to privacy and may request
confidential services. Such a request should be respected, and information obtained
during such a consultation or counselling session should not be disclosed to the parents
or legally entitled representatives except with . the consent of the child, or in
circumstances where adult confidentiality can be breached. In addition, where the
attending physician has strong reason to conclude that, despite unaccompanied
attendance, the child is not competent to make an informed decision about treatment, or
that without parental guidance or involvement the child's health would be put in grave
~~ 4!~"y'~r~}~~~!!~e~,_th~_~ ~~~R!!~AALSk~Wl.!s~~s.1 !h,<uJuqy~iS~ lJtay,9i~}~l{.t~
and irreversible danger, then in exceptional circumstances, the physician may disclose to
the parents or legally entitled representatives confidential information gained during an
unaccompanied attendance. However, the physician should first discuss with the child
her/his reasons for doing so and attempt to persuade the child to agree to this action.
Admission to Hospital
19. A child should be admitted to hospital only if the care he/she requires cannot be . e
provided at home or on an outpatient basis.
20. A child admitted to hospital should be accommodated in an environment designed,
furnished and equipped to suit her/his age and health status, and a child should not be
admitted to adult accommodation except in special circumstances dictated only by
her/his medical condition, e.g. where the child is admitted for childbirth or termination
ofpregnancy.
21. Every effort should be made to allow a child admitted to hospital to be accompanied by
her/his parents or parent substitutes, who should be provided, where relevant, with
appropriate accommodation in or near the hospital at no or minimal cost and with the
opportunity to be absent from their place of work without prejudice to their continued
employment.
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22. Every child in hospital should be allowed as much outside contact and visiting as
possible consistent with good care, without restriction as to the age ofthe visitor, except
in circumstances where the attending physician has strong reason to believe that visiting
would not be in the best interests ofthe child herself/himself.
23. Where a child ofrelevant age has been admitted to hospital her/his mother should not be .
denied the opportunity to breast-feed, unless there is a positive medical contra-
indication to such.
24. A child in hospital should be afforded every opportunity and facility appropriate to
her/his age for play, recreation and the continuation of education. To facilitate the latter
the provision of specialised teachers should be encouraged or the child afforded access
to appropriate distance learning programmes.
Child Abuse
25. All appropriate measures must be taken to protect children from all forms of neglect or
negligent treatment, physical and mental violence, coercion, maltreatment, injury or
abuse, including sexualabuse. In this context attention is drawn to the provisions ofthe
.WMA's Statement on ChildAbuse andNeglect (WMA Document 17.W).
Health Education
26. Parents, and children appropriate to their age and/or development, should have access
to, and full support in the application of, basic knowledge of child health and nutrition,
igfh!~_~~!l!.e_:;ty_~_~~~~ ()!…breast-feed,ing, and of hygjene, enviro~ental sanitation,
including the advantages of breast-feeding, and of hygiene, environmental sanitation,
the prevention ofaccidents, and sexual and reproductive health education.
Dignity of the patient
27. A childpatient _~hould be treated at all times with tact and understanding and with
respect for her/his dignity and privacy. .. .
28. Every effort should be made to prevent, or if that is not possible to minimise, pain
and/or suffering, and to mitigate physical or emotional stress in the child patient.
29. The terminally ill child should be provided with appropriate palliative care and all the
assistance necessary to make dying as comfortable and dignified as possible.
Religious assistance
30. Every effort should be made to ensure that a child patient has access to appropriate
spiritual and moral comfort, including access to a minister of the religion. of her/his
own choice.
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