201804_CS_English

12/03/2018 WMA 209th Council Session, Riga 2018 – Provisional Schedule | Online Registration by Cvent
http://www.cvent.com/events/wma-209th-council-session-riga-2018/agenda-879abdce4c6f40d2ad07b3b4b810676d.aspx 1/2
AGENDA
Tuesday, April 24, 2018
 
9:00 AM  ­  6:00 PM Potential workgroup meetings     
Wednesday, April 25, 2018
 
9:00 AM  ­  6:00 PM Potential workgroup meetings     
11:30 AM  ­  12:30 PM Finance Group     
12:30 PM  ­  2:30 PM Executive Committee     
7:00 PM  ­  10:00 PM Meet the Associate Members of the World Medical Association
Informal Dinner sponsored by the Latvian Medical Association
  
Thursday, April 26, 2018
 
7:30 AM  ­  4:00 PM Registration ­ Radisson Blu Latvija Conference & SPA Hotel
9:00 AM  ­  10:30 AM Opening Plenary Session of the Council
10:30 AM  ­  10:45 AM Coffee Break
10:45 AM  ­  12:30 PM Finance and Planning Committee
12:30 PM  ­  2:00 PM Lunch break     
2:00 PM  ­  3:30 PM Finance and Planning Committee (continuation)
3:30 PM  ­  3:45 PM Coffee Break
3:45 PM  ­  5:00 PM Finance and Planning Committee (if needed) / Socio­Medical Affairs Committee
6:30 PM  ­  7:30 PM Welcome Reception
Offered by the Latvian Medical Association
  
Friday, April 27, 2018
 
9:00 AM  ­  10:30 AM Socio­Medical Affairs Committee (continuation)
10:30 AM  ­  10:50 AM Coffee Break
10:45 AM  ­  12:30 PM Socio­Medical Committee (continuation)
12:30 PM  ­  2:00 PM Lunch break     
2:00 PM  ­  3:30 PM Medical Ethics Committee
3:30 PM  ­  3:45 PM Coffee Break
3:45 PM  ­  5:00 PM Medical Ethics Committee (continuation)
7:00 PM  ­  9:30 PM Council Gala Dinner
Offered by the World Medical Association
  
Saturday, April 28, 2018
 
8:00 AM  ­  9:30 AM Council Plenary Session
9:30 AM  ­  9:45 AM Coffee Break
9:45 AM  ­  12:30 PM Council Plenary Session (continuation)
12:30 PM  ­  2:00 PM Lunch break     
WMA 209TH COUNCIL SESSION, RIGA 2018
12/03/2018 WMA 209th Council Session, Riga 2018 – Provisional Schedule | Online Registration by Cvent
http://www.cvent.com/events/wma-209th-council-session-riga-2018/agenda-879abdce4c6f40d2ad07b3b4b810676d.aspx 2/2
2:00 PM  ­  2:30 PM Conclusion of Council Session
3:00 PM  ­  9:00 PM Sightseeing tour and informal dinner
Offered by the Latvian Medical Association
  
1
THE WORLD MEDICAL ASSOCIATION, INC.
Document
no:
Council 209/Agenda/Apr2018 Original:
English
Title: Agenda of the 209th
Council Session
Destination: 209th
Council Session
Radisson Blu Latvija Hotel
Riga, Latvia
26-28 April 2018
Action(s)
required:
For
consideration
Note: The Council will convene on Thursday, 26 April 2018,
before the meetings of the Standing Committees. It will then
re-convene on Saturday, 28 April 2018, to consider the
reports of the Standing Committees.
Thursday, 26 April 2018, 9:00 am – 10:30 am
Saturday, 28 April 2018, 8:00 am – 2:30 pm
Membership of the Council
Dr David O. Barbe Dr Kenji Matsubara
Dr MooJin Choo Dr Mari Michinaga
Dr Andrew Dearden (Treasurer) Dr Frank-Ulrich Montgomery (Vice Chair)
Dr Louis Francescutti Dr Ramin Parsa-Parsi
Dr Michael B. Gannon Dr Mark Porter
Dr Mzukisi Grootboom Dr Serafín Romero
Dr Andrew W. Gurman Dr Andreas Rudkoebing
Dr René Héman Dr Heidi Stensmyren
Dr Ardis Dee Hoven (Chair) Dr Thomas Szekeres
Dr Miguel Roberto Jorge Dr Julio Trostchansky
Dr Toru Kakuta Dr Walter Vorhauer
Dr Ajay Kumar Dr Shuyang Zhang
Ex-officio (without voting rights)
Dr Yoshitake Yokokura, President
Dr Leonid Eidelman, President-Elect
Dr Ketan Desai, Immediate Past President
Dr Otmar Kloiber, Secretary General
Ms Marie Collegrave-Juge, Legal Advisor
Mr Adolf Hällmayr, Financial Advisor
Ms Joelle Balfe, Facilitator
* All statutory meetings of the WMA will be recorded for preparing minutes and reports.
March 2018 Council 209/Agenda/Apr2018
2
1. GENERAL BUSINESS
1.1 Call to order by the Chair of Council
1.2 Receive apologies for absence
1.3 Welcome new Council Member(s)
1.4 Chair’s opening remarks
1.5 Secretary General’s announcements
2. MINUTES OF THE PREVIOUS MEETINGS
Approve: Summary Minutes of the 207th
and 208th
Council Sessions
held in Chicago, United States, 10-14 October 2017
(Council 207/Minutes/Oct2017 and Council 208/Minutes/Oct2017)
3. INTERIM REPORT OF THE PRESIDENT
Receive: Report by the WMA President on presidential activities
from October 2017 to March 2018 (Council 209/President Report/Apr2018)
4. REPORT OF THE SECRETARY GENERAL
Receive: Report of the Secretary General to the Council
(Council 209/SecGen Report/Apr2018)
5. REPORT OF THE CHAIR OF COUNCIL
Receive: Report by the WMA Chair of Council
(Council 209/Chair of Council Report/Apr2018)
6. CONSIDERATION OF ITEMS TO BE CONSIDERED AS A MATTER OF
URGENCY BY THIS COUNCIL
7. COMMITTEE REPORTS
7.1 Medical Ethics Committee
Consider: Report of the Medical Ethics Committee (*MEC 209/Report/Apr2018)
March 2018 Council 209/Agenda/Apr2018
3
7.2 Finance and Planning Committee
Consider: Report of the Finance and Planning Committee (*FPL 209/Report/Apr2018)
7.3 Socio-Medical Affairs Committee
Consider: Report of the Socio-Medical Affairs Committee (*SMAC
209/Report/Apr2018)
8. ADVOCACY
Consider: Oral Report of WMA Advocacy and Communications Advisory Panel
9. WORK OF THE WORLD HEALTH ORGANIZATION (WHO)
9.1 71st
World Health Assembly
Receive: Oral Report on the Agenda of the upcoming 71st
WHA
Receive: Oral Report of WMA Activities at the WHO 71st
WHA
10. ANY OTHER BUSINESS
11. ANNUAL CEO REVIEW SESSION (CLOSED SESSION FOR COUNCIL MEMBERS
ONLY)
12. ADJOURNMENT
§§§
* Indicates document to be distributed in Riga.
12.03.2018

1
THE WORLD MEDICAL ASSOCIATION, INC.
Document
no:
Council 207/Minutes/Oct2017 Original:
English
Title: Minutes of the 207th
Council Session
Destination: 209th
Council Session
Radisson Blu Hotel Latvija
Riga, Latvia
26-28 April 2018
Action(s)
required:
For
consideration
Wednesday, 11 October 2017, 8:00 am – 8:15 am
Friday, 13 October 2017, 8:00 am – 10:30 am
Membership of the Council
Dr David O. Barbe Dr Kenji Matsubara
Dr MooJin Choo Dr Mari Michinaga
Dr Andrew Dearden (Treasurer) Prof. Dr med. Frank-Ulrich Montgomery (Vice Chair)
Dr Leonid Eidelman Dr Ramin Parsa-Parsi
Dr Louis Francescutti Dr Mark Porter
Dr Michael B. Gannon Dr Serafín Romero
Dr Mzukisi Grootboom Dr Andreas Rudkoebing
Dr Andrew W. Gurman Dr Heidi Stensmyren
Dr René Héman Dr Thomas Szekeres
Dr Ardis Dee Hoven (Chair) Dr Julio Trostchansky
Dr Miguel Roberto Jorge Dr Walter Vorhauer
Dr Toru Kakuta Dr Shuyang Zhang
Dr Ajay Kumar
Ex-officio (without voting rights)
Dr Ketan Desai, President
Sir Michael Marmot, Immediate Past President
Dr Yoshitake Yokokura, President-Elect
Dr Otmar Kloiber, Secretary General
Ms Marie Colegrave-Juge, Legal Advisor
Mr Adolf Hällmayr, Financial Advisor
Prof. Vivienne Nathanson, Facilitator
1. GENERAL BUSINESS
1.1 The meeting was called to order by the Chair of Council at 8:10 am on October 11,
2017.
October 2017 Council 207/Minutes/Oct2017
2
1.2 The Secretary General welcomed new members, from Dr David O. Barbe (United
States), Dr MooJin Choo (Korea), and Dr Serafín Romero (Spain). Apologies for
absence were received from Dr Thomas Szekeres (Austria; replaced by Dr Herwig
Lindner), Dr Julio Trostchansky (Uruguay; replaced by Dr Alarico Rodriguez), and
former WMA Presidents; Sir Michael Marmot, Dr Yank Coble, Dr Dana Hanson and
Dr Wonchat Subhachaturas.
1.3 Chair’s opening remarks. The Chair reminded participants that live tweeting (Twitter)
during the meeting regarding WMA finances, draft policies, and internal matters was
not allowed. Debates on policies that had not been adopted by the General Assembly
should be kept confidential. She also explained that participants who are not Council
members are welcome to participate in the meeting.
2. MINUTES OF THE PREVIOUS MEETINGS
The Council approved the Summary Minutes of the 206th
Council Sessions held in
Livingstone, Zambia, 20-22 April 2016 (Council 206/Minutes/Apr2017).
3. APPOINTMENT OF A CREDENTIALS COMMITTEE
The Council accepted the recommendation from the Secretary General that the Credentials
Committee be composed of one delegate each from the following NMAs: Kenya, Belgium,
Panama.
4. INTERIM REPORT OF THE PRESIDENT
The Council received the report of WMA President, Dr Ketan Desai, on presidential activities
from May to September 2017. Dr Desai delivered his report as written in document Council
207/Presidential Report/Oct2017.
5. REPORT OF THE SECRETARY GENERAL
The Council received the oral Report of the Secretary General to the Council which
complements the Council Report (GA 2017-Council Report-Oct2017). Dr Kloiber explained
the structure of the Report of the Council to the General Assembly. He thanked all members
who participated in the work of the WMA between meetings, noting in particular the One
Health Conference attended by more than 600 and hosted by the Japan Medical Association
and meetings on End of Life issues, held in Latin America, hosted by the Brazilian Medical
Association and also in Japan, hosted by the Japan Medical Association in collaboration with
the Confederation of Medical Associations of Asia and Oceania (CMAAO). The Secretary
General stressed that this type of cooperation and support for the regional work of NMAs is
essential.
Dr Kloiber reminded the Council that he had reported to last Council session the automatic
termination of membership of Russian Medical Society (RMS) for non-payment of Dues. He
informed the Council that the RMS had sent a letter challenging that decision and threatening
to litigate if WMA accepted another constituent member from Russia. The WMA was not
responding to the letter sent from the RMS.
October 2017 Council 207/Minutes/Oct2017
3
6. REPORT OF THE CHAIR OF COUNCIL
The Council received the Report by the WMA Chair of Council from May to September 2017
(Council 207/Chair of Council Report/Oct2017). Dr Hoven stressed the importance of
everyone participating and feeling welcome and able to provide their viewpoints on the issues
discussed by the Council. She encouraged participants to ask for clarifications if they had
questions about the process. She reiterated that everyone’s participation was valued and
desired.
The Council Adjourned at 8:45 for the meetings of the Standing Committees.
The Council reconvened to consider the reports of the Standing Committees at 8:06 on Friday 13
October 2017.
7. NEW ITEM TO BE CONSIDERED AS A MATTER OF URGENCY
The Chair informed the Council of a new proposed WMA Resolution submitted after the
Council had adjourned for the Standing Committee meetings and that the Council would have
to decide whether to accept it as a matter of urgency. The proposal was entitled “Council
Resolution on Poland (Council 207/Poland/Oct2017). She read the text of the proposed
resolution aloud to enable interpretation in French, Spanish and Japanese.
Dr Kloiber informed the Council that representatives from the Polish Chamber of Physicians
and Dentists had asked the WMA for help on this matter and Dr Kloiber proposed that this
help consists of the proposed Resolution as well as an immediate press release. He reviewed
the issues covered by the Resolution. Dr Mazur, representative of the Chamber, stated that
there was not enough public expenditure for health—not enough for patients and not enough
for adequate salaries of physicians, especially young physicians. Following ten days of
hunger strikes by some junior doctors, the Chamber had declared a Day of Solidarity with the
protesters and hoped that the WMA would show its support by approving the resolution. The
addition of an explicit statement of solidarity was accepted as a friendly amendment to the
Resolution.
The Council accepted the Resolution of Poland (Council 207/Poland REV/Oct2017), as
amended, as matter of urgency and approved it.
8. COMMITTEE REPORTS
The Council used a consent calendar to consider the Committee reports.
8.1 Medical Ethics Committee
The Council considered the report of the Medical Ethics Committee (MEC
207/Report/Oct2017). No extractions were requested and the Council approved the
report.
8.2 Finance and Planning Committee
The Council considered the Report of the Finance and Planning Committee (FPL
207/Report/Oct2017). No extractions were requested and the Council approved the
report.
October 2017 Council 207/Minutes/Oct2017
4
8.3 Socio-Medical Affairs Committee
The Council considered the Report of the Socio-Medical Affairs Committee SMAC
206/Report/Apr2017). No extractions were requested and the Council approved the
report.
9. REPORT OF THE ENVIRONMENTAL CAUCUS
Dr Vivienne Nathanson reported that the Caucus had met the previous evening and discussed
the next phase of the climate negotiations (COP23) to take place in Bonn, Germany. The
WMA delegation to the conference had discussed their inputs to the meeting, including the
expected revised Declaration of Delhi on Health and Climate Change, which would be voted
on by the General Assembly at its plenary session. The Caucus had discussed efforts by
NMAs in areas related to climate change and the possibility of bringing all WMA policies
related to the environment together into a single document in the future. Dr Nathanson noted
that she had finished her term as Chair of this caucus.
10. OUTREACH
The Chair informed the Council that the following reports had been referred to the Council by
the Finance and Planning Committee, which had not had time to receive them.
10.1 Report of the Chair of Associate Members
The Chair of Associate Members, Dr Joseph Heyman, referred to the written report
(FPL 207/Chair of AM Report/Oct2017). He reminded Council members that after their
terms had ended they could stay involved with WMA as associate members.
10.2 Report of the Past Presidents and Chairs of Council Network (PPCN)
Dr Jón Snædal referred to the written report, noting that the activities of this group had
been increasing.
10.3 Report of the Junior Doctors Network (JDN)
Dr Caline Mattar, Chair of the Junior Doctors Network presented the report (FPL
207/JDN Report/Oct2017). She noted in particular that the JDN had recently decided to
tackle the topics of working conditions and mental health of junior doctors. She thanked
the AMA for hosting the two-day meeting of the JDN prior to the General Assembly.
10.4 Report from the World Medical Journal
Dr Peteris Apinis reported that the WMJ continues to publish after 65 years. He
thanked Dr Elmar Dopplefeld, assistants Maira Sudraba and Velta Poz, and WMA
Public Relations Advisor, Mr Nigel Duncan, for their support.
10.5 Public Relations Report
WMA Public Relations Advisor, Mr Nigel Duncan, explained that it was his job to
assess what WMA matters would be of interest to the profession and to the public to
generate publicity for the WMA. At this meeting, he anticipated that the revised WMA
October 2017 Council 207/Minutes/Oct2017
5
Declaration of Geneva would be likely to generate the most publicity and he intended to
issue a press release immediately upon its adoption by the General Assembly. All
NMAs would receive the press release and should adapt it by including a welcome of
the policy by the NMA President or Chair, which would increase its interest to the
national press in each country. NMAs have a role to play in increasing the profile of the
WMA. He offered his assistance to any NMA that wanted help drafting press releases.
11. ANY OTHER BUSINESS
There were no other items of business for the Council.
12. ADJOURNMENT
The meeting was adjourned at 8:53 am.
§§§
27.11.2017

1
THE WORLD MEDICAL ASSOCIATION, INC.
Document
no:
Council 208/Minutes/Oct2017 Original:
English
Title: Minutes of the 208th
Council Session
Destination: 209th
Council Session
Radisson Blu Hotel Latvija
Riga, Latvia
26-28 April 2018
Action(s)
required:
For
consideration
Saturday, 14 October 2017, 4:40 pm – 4:45 pm
Membership of the Council
Dr David O. Barbe Dr Kenji Matsubara
Dr MooJin Choo Dr Mari Michinaga
Dr Andrew Dearden (Treasurer) Prof. Dr med. Frank-Ulrich Montgomery (Vice Chair)
Dr Leonid Eidelman Dr Ramin Parsa-Parsi
Dr Louis Francescutti Dr Mark Porter
Dr Michael B. Gannon Dr Serafín Romero
Dr Mzukisi Grootboom Dr Andreas Rudkoebing
Dr Andrew W. Gurman Dr Heidi Stensmyren
Dr René Héman Dr Thomas Szekeres
Dr Ardis Dee Hoven (Chair) Dr Julio Trostchansky
Dr Miguel Roberto Jorge Dr Walter Vorhauer
Dr Toru Kakuta Dr Shuyang Zhang
Dr Ajay Kumar
Ex-officio (without voting rights)
Dr Yoshitake Yokokura , President
Dr Ketan Desai, Immediate Past President
Dr Leonid Eidelman, President-Elect
Dr Otmar Kloiber, Secretary General
Ms Marie Colegrave-Juge, Legal Advisor
Mr Adolf Hällmayr, Financial Advisor
Prof. Vivienne Nathanson, Facilitator
1. GENERAL BUSINESS
1.1 The meeting was called to order by the Chair of Council at 4:40 pm on 14 October 2017.
1.2 Apologies for absence: Dr Thomas Szekeres (Austria; replaced by Dr Herwig Lindner),
Dr Julio Trostchansky (Uruguay; replaced by Dr Alarico Rodriguez)
October 2017 Council 208/Minutes/Oct2017
2
2. BUSINESS ARISING FROM THE GENERAL ASSEMBLY
2.1 Reproductive Technologies
The Council received the proposed revision of the WMA Statement on Reproductive
Technologies (MEC 206/Reproductive Technologies REV2/Apr2017; Final annex ítem
2.4) which was sent back to Council.
The document is to be read again by the MEC.
3. ANY OTHER BUSINESS
There were no other items of business for the Council
4. ADJOURNMENT
The meeting was adjourned at 4:45 pm.
§§§
27.11.2017
1
THE WORLD MEDICAL ASSOCIATION, INC.
Document
no:
Council 209/President Report/Apr2018 Original:
English
Title: Report of the Chair of Council (October
2017 – April 2018)
Destination: 209th
Council Session
Radisson Blu Latvija Hotel
Riga, Latvia
26-28 April 2018
Action(s)
required:
To be
received
My major mission as WMA President is, as I stated in my inaugural speech in Chicago in October
2017, to make all-out effort to advance the initiative and assist the past related activities to realize
the Universal Health Coverage (UHC) as well as strengthening of the health system of each
countries of the world. As the UHC is a very important concept to bring health to all the people in
the world, I will continue activities focusing on the developing of this concept.
In the past half-year activities as WMA President, I have worked concentrating my efforts on this
important theme in various meetings inside and outside of Japan as mentioned below.
1. The meetings and other events related to promotion of the UHC.
The 2017 Global Health Forum in November 2017:
I was invited by the Taiwan authority to the 2017 Global Health Forum hosted by the Taiwan
Health Ministry and Foreign Affairs. It was attended by 35 countries with 1000 people. The
discussion was mainly focused on SDGs and I told the forum about the importance of
attaining the UHC and strengthening of the health system.
The UHC Forum 2017 in December 2017:
The UHC Forum 2017 was held in Tokyo last December organized by the Japanese
government, World Bank, UNICEF, UHC2030 and JICA. I was invited to the forum and
joined the high level opening session. It was attended by some global leadership such as
Prime Minster Shinzo Abe, UN Secretary General Mr. António Guterres, Chair of World
Bank Mr. Jim Yong Kim, and WHO Director General Dr. Tedros Adhanom. I told the
meeting that a unity of the cross-over physicians is increasingly needed for infectious diseases
and disaster preparedness in progressing borderlessness with globalization. In this forum, one
of the highlights is that the WMA and WHO agreed to make an official MOU on
collaboration for establishing the UHC on global level and strengthening disaster
preparedness. As you know, I and Dr. Tedros signed the MOU on April 5 in Geneva.
JMA Harvard Taro Takemi Memorial International Symposium in February 2018:
The JMA held at its headquarters in Tokyo “JMA Harvard Taro Takemi Memorial
International Symposium” The subtheme is “Community Health Systems and Innovations:
Building the Foundation for Universal Health Coverage”. The symposium was attended by
about 350 people with a lecture by Sir Michael Marmot from the WMA. The JMA has an
April 2018 Council 209/President Report/Apr2018
2
international health program at the Harvard School of Public Health in Boston working for
many years to nurture the middle-career researchers from the world. This symposium was set
up to celebrate its 35th anniversary.
Signature of the MOU with the WHO in April 2018:
On April 5, as I mentioned above, I attended the signature ceremony to sign the MOU on
UHC and disaster preparedness between the WMA and WHO in Geneva. I believe that this
signature of the MOU will surely contribute to further enhance the presence of the WMA in
the global community. After the signature, I had a meeting with the leaders of some major
international organizations such as The Global Fund to Fight AIDS, Tuberculosis and Malaria,
GAVI The Vaccine Alliance, International Committee of the Red Cross, Medicins Sans
Frontieres and UN Office for Disaster Risk Reduction.
Global Ministerial Summit on Patient Safety in April 2018:
In this month as well, the Global Ministerial Summit on Patient Safety was held in Tokyo
attended by 46 countries. I joined the summit as WMA President and chaired the key-note
speech by Dr. Günther Jonitz, President of the Berlin Medical Association. I also delivered a
short comment on the activities of the WMA about patient safety during the round table
session as well as the UHC which may be closely linked to patient safety activities.
2. Other major activities
United Nations Office for Disaster Risk Reduction
In November 2017, I attended the WMA European Regional Meeting on End-of-Life
Questions in Vatican. The regional meeting in the Asian and Oceanian region was already
finished in Tokyo in September of 2017 and I reported the results of the meeting. I felt some
differences in ideas between the European, Asian and Oceanian regions. I hope that we will
have a deep discussion about this theme in Riga.
Also in December 2017, I was invited by the Medical Association of Thailand and
Tammathat University to attend the One Health International Conference 2017 Scientific
Program attended by about 400 people. The conference aimed to contribute to the
improvement of humans, animals and global health through discussion of specialists for
further collaboration between medicine and veterinary medicine.
2018 CMA Annual Scientific Meeting & The 2nd Pak-China Medical Congress & Belt
and Road Forum of Medical Associations was held in Beijing, China. The conference I
attended was entitled « Lifestyle diseases: Current situation and countermeasures in Japan and
China ». I emphasized that this theme is one of the extremely serious problems confronted by
countries around the world. I also told that all the physicians of the world must make
continuing efforts to address this problem.
In February of this year, I was appointed a member of the WHO Civil Society Working
Group on the Third High Level Meeting of the UN General Assembly on NCDs.
In the same month, the JMA accepted the specialist group of the Taiwan Medical Association
to investigate the present status of the long-term care insurance system in Japan. The JMA
helped the group to visit some of the related institutions under the long-term care for the
elderly.
April 2018 Council 209/President Report/Apr2018
3
In early this month, the JMA invited Professor Ronit Katz, member and former Chair AMA
Governing Council to the CBRNE conference focusing the preparedness for the Tokyo
Olympic Paralympic Games in 2020. It was an active discussion about terrorism disaster
countermeasures by specialists.
Respectfully submitted by Yoshitake Yokokura, MD, President of the WMA
§§§
17.04.18

1
THE WORLD MEDICAL ASSOCIATION, INC.
Document: Council 209/SecGen Report/Apr2018 Original:
English
Title: Secretary General’s Report to the
209th
WMA Council Session
(October 2017 – March 2018)
Destination: 209th
Council Session
Radisson Blu Latvija Hotel
Riga, Latvia
26-28 April 2018
Action(s)
required:
To be
received
Chapter I Ethics, Advocacy & Representations
1. Ethics
1.1 Declaration of Taipei
1.2 Declaration of Geneva
1.3 Regional discussions on End-of-Life issues
2. Human Rights
2.1 Right to health
2.2 Protecting patients and doctors
2.3 Prevention of torture and ill-treatment
2.4 Pain treatment
2.5 Health through peace
3. Public Health
3.1 Non-communicable diseases
3.2 Communicable diseases
3.3 Health and populations exposed to discrimination
3.4 Social determinants of health
3.5 Counterfeit medical products
3.6 Food security and nutrition
3.7 Health and the environment
4. Health Systems
4.1 Comparing healthcare systems using PROMS & PREMS
4.2 Patient safety
4.3 One Health
4.4 Antimicrobial resistance
4.5 Health workforce
April 2018 Council 209/SecGen Report/Apr2018
2
4.6 Violence in the health sector
4.7 Caring Physicians of the World Initiative Leadership Course
5. Health Policy & Education
5.1 Medical and health policy development and education
5.2 Support for national constituent members
Chapter II Partnership & Collaboration
1. World Health Organization (WHO)
2. UNESCO Conference on Bioethics, Medical Ethics and Health Law
3. Other UN agencies
4. World Health Professions Alliance (WHPA)
5. WMA Cooperating Centers
6. Other partnerships or collaborations
Chapter III Communication & Outreach
1. WMA newsletter
2. WMA social media (Twitter and Facebook)
3. The World Medical Journal
4. WMA African Initiative
5. Meeting with Arab Medical Union leaders
6. Secondments / internships
Chapter IV Operational Excellence
1. Advocacy
2. Paperless meetings
3. Governance
Chapter V Acknowledgement
April 2018 Council 209/SecGen Report/Apr2018
3
CHAPTER I ETHICS, ADVOCACY & REPRESENTATIONS
1. Ethics
1.1 Declaration of Taipei
The Declaration of Taipei on Ethical Considerations Regarding Health Databases and
Biobanks provides guidance for the protection of persons who allow their health data
and/or specimens to be used for future research or other uses. In some aspects, this is a
logical continuation of the safeguards provided by the Declaration of Helsinki; extending
them into virtual environments and scenarios such as administrative or commercial uses.
An important focus of the Declaration of Taipei is maintaining the protection provided by
informed consent. Since information about potential future uses of data or specimens is
naturally incomplete, the Declaration offers a multi-step mechanism to replace part of
informed consent. This is achieved through a predetermined governance structure and an
assessment by an ethics committee.
As regulations on health and medical databases are currently under discussion, the
dissemination of the Declaration is being actively pursued with urgency. We are grateful
to our members and partner organisations which already use the Declaration or advocate
for it.
1.2 Declaration of Geneva
Both before and since its adoption at the General Assembly in Chicago, the Declaration
of Geneva has encountered a remarkable and overwhelmingly positive reception. The
WMA will use upcoming ethics conferences and other events to promote this revised
physicians’ pledge. We offer to explain the revision process and provide an in depth
analysis of the wording that has been used. Again, we are grateful to the early adopters of
the Declaration of Geneva and thank our members and partners for using and
disseminating it.
1.3 Regional Discussions on End of Life issues
At the 200th
Council Session in Oslo in April 2015 the WMA policies on
physician-assisted suicide (PAS) and euthanasia were reaffirmed. However, a
controversial discussion about the wording and effect of the current policies led to the
submission of a policy document by the Royal Dutch and the Canadian medical
associations to the 201st
Council Session in Moscow in October 2015. The authors of the
document ultimately requested its withdrawal at the 203rd
Council Session in Buenos
Aires in April 2016. Instead, the Council mandated the Executive Committee to come
back with a plan for discussing end-of-life issues, including palliative care, living wills,
physician-assisted suicide (PAS) and euthanasia. At the 204th
Council Session in Taipei
in October the Executive Committee invited its members, especially those from Latin
America, Africa and Asia to hold regional meetings to discuss these issues. This took into
account the observation that the previous discussion was dominated mainly by voices
from Europe and North America.
April 2018 Council 209/SecGen Report/Apr2018
4
Since then four regional discussions have been held in Latin America, (Rio de Janeiro,
March 2017 in cooperation with CONFEMEL), Asia and the Pacific (Tokyo, September
2017, in cooperation with CMAAO), Europe (Vatican City, November 2017 in
cooperation with the Pontifical Academy for Life) and in Africa (Abuja,
January-February 2018).
Reports from those meetings are attached to this document. The discussions will be
continued on the global level at the joint WMA-Iceland Medical Association Ethics
Conference in Reykjavik next October.
2. Human Rights
2.1 Right to health
The WMA Secretariat follows the activities of the UN Special Rapporteur on the right of
everyone to the enjoyment of the highest attainable standard of physical and mental
health, Dr Dainius Puras, as well as health related matters addressed by the UN Human
Rights Council. Further to a meeting between Dr Puras, Dr O. Kloiber and C. Delorme in
September 2017 (see item 2.3.3), it was agreed to maintain contact with a regular
exchange of views on current topics of mutual interest.
2.2 Protecting patients and doctors
2.2.1 Actions of support
Country Case
TURKEY
January- February
2017
Sources:
TMA,
Human Rights
Foundation of
Turkey,
Amnesty
International
Following a public statement by the Turkish Medical Association (TMA)
in mid-January stressing that war is a public health problem and calling
for peace its leaders have been confronted with a campaign of
intimidation and threats. The Turkish Ministry of Internal Affairs filed a
criminal complaint against the TMA and the Ankara head prosecutor
opened an investigation. In addition, the Minister of Health filed another
lawsuit demanding all TMA’s Central Council members to be dismissed
from their position on the grounds that they are acting beyond the scope
of the mission of the TMA. The 11 members of the Central Council of
TMA were arrested and the TMA office was searched.
The WMA issued an immediate press release and a joint letter with other
health and human rights organisations (PHR, CPME, IRCT, EFMA) was
sent to the Turkish authorities (Link to the letter:
https://www.wma.net/wp-content/uploads/2018/01/Joint-letter-of-support-
TMA-January-2018-final.pdf). A second press release was issued
(https://www.wma.net/news-post/global-medical-bodies-in-joint-call-to-p
resident-erdogan/).
The UN Special Rapporteur on the Right to Health was alerted.
The Secretariat sent a call for support to all WMA members and partners.
Many national medical associations reacted immediately with letters,
tweets and other social media support. The TMA Council members were
finally released on the 2nd
and the rest on 5th
February, but an official
investigation is continuing on the basis of the charges of « Making
propaganda in favour of a terrorist organization” and « Provoking people
to be rancorous and hostile”.
April 2018 Council 209/SecGen Report/Apr2018
5
In the latest developments, the Turkish authorities have announced their
intention to amend legislation pertaining to professional organisations
(including the TMA, and organisations of lawyers, architects, etc.), which
used to enjoy relative autonomy from government. The amendments
envisaged include scrapping compulsory membership; making it possible
to have more than one organisation representing a specific profession,
flexible and changed election procedures. This amounts to abolishing
these organisations’ authority and function to supervise compliance with
professional ethics and makes these organisations weaker.
In addition, Prof. Onur Hamzaoglu – an internationally renowned
researcher and practitioner, recently re-elected to the Executive Board of
the International Association of Health Policy in Europe at its 18th
International Conference held at the end of September 2017 – was
arrested on 9th
February by the Turkish police. Prof. Hamzaoglu is also the
editor of Society and Physicians journal, a scientific journal on health
policies published by the TMA. He is being prosecuted for complicity in
terrorism.
The WMA Secretariat remains mobilized and ready to take further action.
ETHIOPIA
September 2017 –
February 2018
Source:
Swedish Medical
Association
Amnesty
International
The Secretariat received a call to sign a petition in support of the
Ethiopian-born Swedish cardiologist, Dr Fikru Maru, who has been in
detention for 4 years in Ethiopia. In May 2017, he was cleared of all prior
charges, but instead of releasing him, new charges were brought against
him and 37 other prisoners for being involved in a prison fire and revolt
(Dr Fikru was in hospital with a life-threatening condition when the fire
occurred). The Secretariat contacted the Swedish Medical Association,
which confirmed the case and was positive about the WMA taking action.
Dr Ketan Desai signed the petition on behalf of the WMA. The
information was shared on Facebook and Twitter.
The situation having not changed since the Summer, the Secretariat
discussed taking further actions with the Swedish Medical Association
(SwMA) and Amnesty’s Ethiopian desk officer. The WMA wrote to the
Ethiopian Prime minister and President (with copies and an
accompanying letter sent to the new Ethiopian WHO Director General Dr
Tedros Adhanom Ghebreyesus). On its part, the SwMA wrote to the
Swedish embassy in Ethiopia.
IRAN
February 2018
Source:
Amnesty
International
Physicians for
Human Rights
Dr Ahmadreza Djalali, an Iranian-born Swedish resident and academic,
has been sentenced to death for “corruption on earth” after a grossly
unfair trial. His conviction was based on torture-tainted “confessions” that
he was forced to make while in solitary confinement without access to his
lawyer or family. Amnesty International and Physicians for Human
Rights consider him a prisoner of conscience. The Secretariat wrote an
initial letter last November and issued a press release
(https://www.wma.net/news-post/wma-urges-immediate-release-of-jailed-
physician/).
Dr Djalali’s last appeal was rejected by the Supreme Court in February. A
second press release was issued on 13th
February calling for his immediate
release
(https://www.wma.net/news-post/wma-appeals-for-immediate-release-of-j
ailed-physician/).
April 2018 Council 209/SecGen Report/Apr2018
6
2.2.2 Protection of health professionals in areas of armed conflict and other situations of
violence
ICRC “Health Care in Danger” (HCiD) initiative
The WMA Secretariat has a close working relationship with the International
Committee of the Red Cross (ICRC) headquarters within the context of the HCiD
initiative, which has been prolonged by the ICRC for a second phase.
In early November 2016, a Memorandum of Understanding (MoU) between the
WMA and the ICRC was formally signed by Yves Daccord, Director-General of
the ICRC, and Dr Otmar Kloiber, WMA Secretary General. This MoU develops
and consolidates the long-standing cooperation between the WMA and the ICRC
and fosters understanding on topics of common interest, including on the
protection of health professionals and patients in situations of violence, on the role
of physicians in addressing sexual violence, as well as torture and ill-treatment in
detention, and more generally in addressing Social Determinants of Health in the
context of insecurity.
On 22 November 2017, the ICRC and the University of Geneva organised an
event on the MOOC (massive Open Online Courses) on Violence Against
Health Care (https://www.coursera.org/learn/violence-against-healthcare) to
discuss the best ways to promote and disseminate this tool within our networks.
M. Mihaila and C. Delorme from the WMA Secretariat attended the meeting.
The ICRC and the WMA are again planning a side-event during this year’s World
Health Assembly in May, possibly with the Permanent Missions of Switzerland,
Canada and Nigeria, the World Health Organization (WHO), Médecins Sans
Frontières (MSF) and other partners such as the International Committee of
Military Medicine (ICMM) and the International Hospital Federation (IHF). The
event will focus on Health Care in Danger best practices with a vareity of country
examples.
During the reporting period, C. Delorme established contact with the Disaster
Risk Management Focal Point at WHO to discuss ways to promote and support
the role of the health workforce in reducing risks to health from emergencies,
strengthening emergency preparedness and building the resilience of
communities.
During the 142nd
WHO Executive Board meeting, the WMA presented a public
statement
(https://www.wma.net/wp-content/uploads/2017/05/3.3-Public-health-preparednes
s-and-response-WHPA.pdf) on behalf of the World Health Professions Alliance
(WHPA) on WHO’s work in Health Emergencies.
2.3 Prevention of torture and ill-treatment
The WMA Secretariat follows relevant international activities in this area, in particular
those of the Human Rights Council.
2.3.1 Cooperation with the International Rehabilitation Council for Torture Victims
(IRCT)
April 2018 Council 209/SecGen Report/Apr2018
7
The Secretariat exchanged information on a regular basis with the IRCT during
the reporting period, in particular regarding the recently adopted WMA proposed
Statement on forced anal examinations to substantiate same-sex sexual activity
and on the role of physicians in preventing torture
2.3.2 Role of physicians in preventing torture and ill-treatment
Last May, the WMA Secretariat was contacted by the Health Care in Detention
Unit of the International Committee of the Red Cross (ICRC) to discuss an
opportunity to update the online course for physicians working in prisons.
Discussions are ongoing, including with the Norwegian Medical Association,
which played a key role in developing and hosting the original courses.
In February, the WMA was invited to participate in a one-year project on the
development of a supplement to the Manual on Effective Investigation and
Documentation of Torture and Other Cruel, Inhuman or Degrading
Treatment or Punishment, commonly called the Istanbul Protocol (IP). The
initiative is headed jointly by Physicians for Human Rights (PHR), the IRCT, the
Human Rights Foundation of Turkey, REDRESS, the UN Committee against
Torture, the UN Subcommittee for the Prevention of Torture, the UN Special
Rapporteur on Torture and the UN Voluntary Fund for Victims of Torture. The
purpose of the Project is to strengthen the IP with updates and clarifications based
on practical experience from users. C: Delorme participate in the working group
on ethical codes as one of the drafters.
2.3.3 Psychiatric treatment – Mental Health
Last June, the WMA Secretariat prepared written comments on the recent report
on mental health by the United Nations Special Rapporteur on Health, Dr Dainius
Purras (Report A/HRC/35/21). These comments were prepared with a key
contribution by Dr Miguel Jorge (Brazilian Medical Association), psychiatrist and
Chair of the WMA Socio-Medical Affairs Committee, with the aim of providing
the physicians’ perspective in the global discussion on the challenges and
opportunities related to the promotion of mental health as a global priority and a
fundamental human right. The written comments were then shared with the World
Psychiatric Association. Dr Puras replied by welcoming our report and a meeting
took place in September to discuss the matter further. The WMA Secretariat was
represented at this meeting by Dr O. Kloiber and C. Delorme.
2.4 Pain treatment
The WMA continues to be active in the field of palliative care in cooperation with the
WHO and civil society organisations working in this area. Within the context of the
current global discussion and the Special Session of the UN General Assembly on the
world drug problem, the WMA made a public statement at the session of the WHO
Executive Board (January 2017) on the public health dimension of the issue, underlining
the need for a committed public health approach encompassing the availability and access
to medicines for effective treatment and related healthcare services.
On 1st
March, the advisory group on palliative care of the Pontifical Academy for Life
issued a White Paper on Global Palliative Care Advocacy including a set of “Selected
recommendations” calling on various stakeholders in the health care sector to step up
April 2018 Council 209/SecGen Report/Apr2018
8
advocacy for health. As a representative of professional associations, they called upon the
WMA to especially foster the human rights aspect of access to palliative care.
2.5 Health through peace
On 7July 2017, country representatives meeting at a United Nations conference in New
York adopted the Treaty on the Prohibition of Nuclear Weapons, the first multilateral
legally-binding instrument for nuclear disarmament to have been negotiated in 20 years.
In September, the WMA Secretariat met with a representative of the International
Physicians for the Prevention of Nuclear War (IPPN) to explore possible ways of
collaboration on the global health imperative to eliminate nuclear weapons in line with
the WMA Statement on Nuclear Weapons by using the momentum of the Treaty
adoption. The WMA and IPPN are exchanging views on a regular basis within this
framework. IPPN offered its assistance on the revision of WMA Statement on Nuclear
Weapons in order to include reference to the recently adopted Treaty.
On the occasion of the opening for signature of the Treaty on the Prohibition of Nuclear
Weapons in New York on 20th
September, the IPPN together with the WMA, the
International Council of Nurses and the World Federation of Public Health Associations,
adopted a joint Statement urging Member States to sign the Treaty and to ratify it as soon
as possible thereafter so that it can enter into force.
3. Public Health
3.1 Non-communicable diseases (NCDs)
3.1.1 General
Member States and the WHO have made progress in fulfilling their commitments
according to the 2011 UN Political Declaration on Prevention and Control of
NCDs and adopted a Global Monitoring Framework with a set of global NCD
targets, a Global NCD Action Plan 2013-2020, and a formalized UN Interagency
Task Force on NCDs, which will coordinate a UN system-wide response to
NCDs.
In response to the first UN Political Declaration on Prevention and Control of
Non-communicable Diseases from 2011, the WHO also established the Global
Monitoring Framework as a Global Coordination Mechanism (GCM) on the
Prevention and Control of Non-communicable Diseases. The scope and purpose
of the coordination mechanism is to facilitate and enhance the coordination of
activities, multi-stakeholder engagement and action across sectors at the local,
national, regional and global levels. The WMA is an official member of this
coordination mechanism, which was launched in March 2015, and has attended
several WHO GCM/NCD meetings. Dr Bente Mikkelsen, head of the GCM
secretariat, is planning to present their work and achievements at the WMA
General Assembly in Reykjavík. The purpose of this presentation is also to
discuss possible cooperation with the WMA and how physicians can support
activities against NCDs.
April 2018 Council 209/SecGen Report/Apr2018
9
During the WHO Executive Board meeting the WMA made an intervention for
the preparation of the next high-level meeting on NCDs during the 2018 UN
General Assembly in New York and empgasised the strong commitment of the
WMA in the fight against NCDs. Following the long engagement of WMA with
the WHO GCM secretariat, WHO appointed Dr Yokokura, WMA president, to be
a member of the WHO Civil Society Workgroup to advise the Director General
on the planning and advocacy of the high level meeting on NCDs and on the
mobilization of civil society.
Dr Julia Tainijoki was invited by WHO to present WMA’s perspective and
experience on health literature and education at the third meeting of the WHO
GCM/NCD Working Group on Health Education and Health Literacy for
NCDs in February in Geneva. The Working Group was established to recommend
ways and means of encouraging Member States and non-State actors to promote
health education and health literacy for NCDs, with a particular focus on
populations with low health awareness and/or literacy.
At the same time, the WMA supported the launch of the publication of a new
speaking book for children with cancer. Previously, and together with other
partners, the WMA has supported the publication of speaking books on high
blood pressure, tobacco use cessation, kids in hospital and clinical trials.
On the occasion of the 20th
European Health Forum in Gastein, Austria in October
2017 WHO invited WMA to speak at the WHO workshop « investing in healthy
cities: « insuring” prevention ». The workshop focused on investing in healthy
cities as a means to improve population health and well-being.
At the Global Dialogue on Partnerships for Sustainable Financing of NCD
Prevention and Control in Copenhagen Denmark from 9-11 April 2018 the
WMA organised a session on ‘A vital investment: Scaling up health workforce for
NCDs’. The aim of this session was to highlight the importance of the health
workforce in the fight against NCDs and the investment needs and roles of
various stakeholders in strengthening countries’ capacities to develop HRH
policies and plans in line with national health strategies to achieve UHC and
SDG3.4.
3.1.2 Tobacco
The WMA is involved in the implementation process of the WHO Framework
Convention on Tobacco Control (FCTC). The FCTC is an international treaty
that condemns tobacco as an addictive substance, imposes bans on advertising and
promotion of tobacco, and reaffirms the right of all people to the highest standard
of health. The WMA attends every Conference of the Parties meeting. The next
Conference of the Parties to the FCTC meeting will take place from 1-6 October
2018 in Geneva.
3.1.3 Alcohol
The Secretariat maintains regular contact with the WHO staff in charge of this
topic, as well as with the Global Alcohol Policy Alliance (GAPA). During the 70th
session of the World Health Assembly last May, the WMA took part in a Civil
April 2018 Council 209/SecGen Report/Apr2018
10
Society consultation meeting organised by GAPA and the NCD Alliance in order
to discuss strategies to put alcohol back on the agenda of the WHO governing
bodies. The WMA was also invited by GAPA to an informal meeting on the same
topic with interested Member States.
In June, Clarisse Delorme represented the WMA at the WHO Forum on Alcohol,
Drugs and Addictive Behaviours, which took place at WHO headquarters in
Geneva. A statement was made recommending the development of all-inclusive
policies addressing the root causes of alcohol patterns as well as strengthening
health systems to improve countries’ capacity to develop policy and lead actions
that target alcohol problems.
Last February, the Secretariat received a request from IOGT International and
GAPA to support a joint letter sent on 1st
February to the Global Fund denouncing
their partnership with Heineken and emphasizing the dangers inherent in
collaborating with the producers and marketers of hazardous products such as
alcohol.
(http://iogt.org/open-letters/joint-open-letter-concern-regarding-global-fund-partn
ering-heineken/). The letter was endorsed by a number of regional and national
organisations and networks. The WMA joined the mobilisation and decided to
support the initiative as well. The news was shared on Twitter and Facebook.
3.1.4 Physical Activity
The WHO is in the process of developing a draft global action plan to promote
physical activity. The WMA was invited to be member of the strategic advisory
network to support and guide the WHO Secretariat in the development of this
Global Action Plan on Physical Activity, and attended the first technical advisory
meeting in June 2017. Recognising the importance of physical activity to
wellbeing and the attainment of the sustainable development goals, the action plan
offers the global community a unique opportunity to elevate the profile and set a
new ambitious agenda for united action in creating physical activity opportunities
for all. The WHO Secretariat hosted an open web-based consultation on a first
draft of the report from August to mid-September.
3.2 Communicable diseases
3.2.1 Multidrug-Resistant Tuberculosis Project
The WMA participated in the development of the WHO guidance document
entitled ‘Guidance on Ethics of Tuberculosis Prevention, Care and Control’ in
2010. Building on this document, the WHO is now in the processes of revising the
existing document with the aim of speaking more directly to the challenges faced
by healthcare workers (HCW) and decision-makers across the globe in helping
fulfil the third principle of the End TB Strategy, namely the protection of human
rights, ethics and equity. A first workgroup meeting has taken place with the
WMA delivering a presentation on health workers’ rights and obligations.
3.2.2 Influenza
The WMA was invited by Ms Françoise Grossetête, Member of the European
April 2018 Council 209/SecGen Report/Apr2018
11
Parliament, and Prof. Thomas Szucs to be a members of the steering group to
develop an EU Manifesto on Influenza Vaccination, which aims to help shift the
agenda at European and national level in support of influenza vaccination. The
Manifesto confirms the need for stronger policy-driven actions to reduce the
burden of influenza and emphasises the importance of the health workforce in this
topic. The digital launch was on 6th
March 2018 with the physical launch planned
for 24th
March 2018.
3.3 Health and populations exposed to discrimination
3.3.1 Women and health
The WMA continues to follow global activities on women and health and aims to
monitor the implementation phase of the “Global plan of action on strengthening
the role of the health system in addressing interpersonal violence, in particular
against women and girls, and against children”, which was adopted by the World
Health Assembly in May 2016.
Last August, in conformity with WMA’s related policy, the WMA Executive
Committee decided to support the United to End FGM knowledge platform. This
Platform is a new, free, online training tool to train professionals dealing with
those affected by female genital mutilation. It is currently available in nine
European languages, with two modules specifically for health professionals. The
Secretariat shared this information through social media.
3.3.2 Ageing
The WMA participated in the WHO consultation on the Global Strategy and
Action Plan on Ageing and Health, which was adopted by Members States at the
last World Health Assembly in May 2016, and is monitoring the implementation
phase of the Global Strategy.
For more activities in the area of ageing, please see Chapter III, section 4.
3.3.3 Zero HIV-related stigma & discrimination in health care settings
In March 2017, the Secretariat shared with WMA members the UNAIDS
reference document on eliminating discrimination in health care. This report aims
to serve as a reference for policy-makers and other key stakeholders engaged in
shaping policies and programmes to regulate healthcare and eliminate
discrimination and other structural barriers to achieving healthy lives for all. The
WMA has been involved in this initiative since it started in November 2015.
3.3.4 Refugees, migrants & access to health
In response to the WHO initiative on migrants’ health, the WMA made a public
statement on behalf of the World Health Professions Alliance (WHPA) at the 70th
World Health Assembly (May 2017) welcoming WHO’s efforts in promoting
migrant health and highlighting that late or denied treatment is discriminatory and
contravenes a fundamental human right.
April 2018 Council 209/SecGen Report/Apr2018
12
Clarisse Delorme was invited to present the WMA’s views on migrants’ health at
the Youth Pre-World Health Assembly Workshop organised by the International
Federation of Medical Students Association (IFMSA) on 19 May in Geneva.
In July, the WMA Secretariat, represented by Dr O. Kloiber, C. Delorme and M.
Mihaila, met with representatives of the Migration Health Division of the
International Organisation for Migration (IOM) to explore potential cooperation
and exchange information.
Further to this meeting, the WMA has been invited to join a working group led by
the IOM and WHO to ensure that the health needs of refugees and migrants are
adequately addressed in the “Global Compact for Migration” (GCM), the global
UN process currently taking place, which will culminate in a final outcome
agreement by the UN General Assembly further to intergovernmental negotiations
in 2018. The working group – composed of representatives from WHO and IOM
in close cooperation with ILO, OHCHR, UNFPA, UNAIDS1
, the World Bank and
other stakeholders including the International Federation of the Red Cross (IFRC),
the Platform for International Cooperation on Undocumented Migrants (PICUM)
and WMA – met in September and agreed on a Proposed Health Component,
which should feed the discussion around the zero draft GCM. The Proposed
Health Component for the GCM is available on the GCM website for Member
States and partners.
3.4 Social determinants of health (SDH) and Universal Health Coverage (UHC)
The WMA is actively engaged with the WHO Department of Health Workforce and is
participating in a Steering Committee to develop an eBook on the Social Determinants
of Health Approach to health workforce education and training. The project is part of the
WHO’s work to implement the guidelines on “Transforming and scaling up health
professionals’ education and training”, launched in Recife in 2013. The project also
supports World Health Assembly Resolution WHA66.23 “Transforming health
workforce education in support of universal health coverage”. The collaboration involves
participation in meetings organized by WHO and providing technical assistance and
guidance for the eBook.
During the Universal Health Coverage Forum in December 2017 in Tokyo, Japan Dr.
Yokokura, WMA president, spoke at the opening session. The goal of the Forum was to
mobilize broad political support for accelerating progress towards UHC and the SDGs,
including health security and pandemic preparedness. This forum brought together over
300 participants, including heads of government, ministers of finance and health, and
senior representatives from bi- and multi-lateral institutions, civil society organizations,
think tanks, and academia. At the forum WHO Director General Dr Tedros Adhanom
Ghebreyesus and WMA President Dr Yoshitake Yokokura agreed to strengthen the
collaboration of both organizations on Universal Health Coverage and Emergency
preparedness. A Memorandum of Understanding is planned to be signed on 5th
April
2018 in Geneva.
3.5 Counterfeit medical products
1
ILO: International Labour Organisation – OHCHR: Office of the High Commissioner for Human Rights –
UNFPA: United Nations Population Funds – UNAIDS: United Nations Programme on HIV/AIDS
April 2018 Council 209/SecGen Report/Apr2018
13
Counterfeit medicines are manufactured below established standards of safety, quality
and efficacy. They are deliberately and fraudulently mislabelled with respect to identity
and/or source. Counterfeiting can apply to both brand name and generic products, and
counterfeit medicines may include products with the correct ingredients but fake
packaging, products with the wrong ingredients, products without active ingredients, or
products with insufficient active ingredients. Counterfeit medical products threaten
patient safety, endanger public health, e.g. by increasing the risk of antimicrobial
resistance, and undermine patients’ trust in health professionals and health systems. The
involvement of health professionals is crucial to combating counterfeit medical products.
The WMA has joined the Fight the Fakes campaign that aims to raise awareness about
the dangers of fake medicines. Coordination among all actors involved in the
manufacturing and distribution of medicines is vital to tackle this public health threat.
The website also serves as a resource for organisations and individuals who are looking
to support this effort by outlining opportunities for action and sharing what others are
doing to fight fake medicines.
3.6 Food security and nutrition
The Food and Agriculture Organization of the United Nations (FAO) and the World
Health Organization (WHO) have received a mandate to develop a Declaration on
Nutrition and an accompanying Framework for Action (FFA) to guide its
implementation. They will organise several preparatory meetings and conferences during
the development process. The WMA is observing this process. One main criticism is the
short timeline and the low involvement of civil society in the process. NGOs also
complain that problems concerning the use of antibiotics in foodstuffs are not well
addressed in the current discussion.
The focus so far is on: Social protection to protect and promote nutrition,
nutrition-enhancing agriculture and food systems and the contribution of the private sector
and civil society to improving nutrition.
3.7 Health and the environment
3.7.1 Climate change
The WMA continues to be involved in the UN climate change negotiations,
particularly the implementation of the Paris agreement adopted at COP21 in
December 2015. For this purpose, a WMA delegation followed the two weeks of
negotiations during the COP 23, which took place from 6-17 November 2017 in
Bonn, Germany. The Secretariat liaised with WHO and the Global Climate and
Health Alliance (GCHA) to ensure coordinated actions during these negotiations.
The WMA made a public statement
(https://www.wma.net/wp-content/uploads/2017/05/3.5-Health-environment-and-
climate-change-WMA.pdf) at the 142nd
session of the WHO Executive Board on
the global strategy on health, environment and climate change.
During the reporting period, discussions were started with WHO and the GCHA
on setting up a regular mechanism of cooperation in the area of climate change.
April 2018 Council 209/SecGen Report/Apr2018
14
The WHO’s First Global Conference on Air Pollution and Health is scheduled
from 30th
October to 1st
November in Geneva. It will bring together global, national
and local partners to share knowledge and mobilize action for cleaner air and
better health. The WMA is in contact with WHO to discuss its involvement in the
event.
3.7.2 Chemicals safety
In December 2009, the WMA joined the Strategic Approach to International
Chemicals Management (SAICM) of the Chemicals Branch of the United Nations
Environment Programme (UNEP), which aims to develop a strategy for
strengthening the engagement of the health sector in the implementation of
the Strategic Approach.
Further to the 2016 World Health Assembly Resolution on the Role of the Health
Sector in the Strategic Approach to International Chemicals Management
towards the 2020 goal and beyond, the 70th
World Health Assembly last May
approved the Chemicals Roadmap (http://www.who.int/ipcs/saicm/roadmap/en/)
which identifies actions where the health sector has either a lead or important
supporting role to play, recognizing the need for multi-sectoral and
multi-stakeholder cooperation. The roadmap was developed in consultation with
Member States, United Nations agencies, and other relevant stakeholders. The
WMA participated in the consultation phase through electronic consultation and
meetings.
3.7.3 WMA Green Page
The WMA is partnered with the Florida Medical Association (FMA) on a joint
project “My Green Doctor”. This project is a medical office environmental
management service offered free of charge to members of the World Medical
Association (WMA) and the Florida Medical Association (FMA). The initial
version of My Green Doctor was launched by the FMA on World Earth Day
2010. In June 2014, the WMA and FMA agreed to work together on this project.
My Green Doctor provides a free practice management tool designed by doctors
to make medical offices more environmentally friendly. It provides everything
needed to assist practice or clinic managers in establishing their own
environmental sustainability programme: office policies, PowerPoints, a
step-by-step guide for your Green Teams, and even free advice by telephone. The
My Green Doctor website is now available in the “What we do – Education”
section of the WMA website.
4. Health Systems
4.1 Patient safety
To address the global problems of unsafe medication practices, the WHO has launched
a Global Patient Safety Challenge on Medication Safety with the overall goal to “reduce
the avoidable harm due to unsafe medication practices by 50% worldwide by 2020”. In
order to develop this initiative, the WHO invited the WMA and other relevant
stakeholders to several consultations this year.
April 2018 Council 209/SecGen Report/Apr2018
15
Under this overarching topic the WMA was invited by the WHO to participate in a
Global Consultation for Setting Priorities for Global Patient Safety in collaboration
with the Centre for Clinical Risk Management and Patient Safety, Department of Health.
This high-level global event brought together key international experts and senior policy
makers from ministries of health from both developed and developing countries. The
objective of this consultation was to identify the main challenges and barriers to
improving patient safety for patients, health-care providers and the environment of care,
and define priorities for future action by the WHO and countries.
Some years ago, the WMA, together with the WHO and the other health professions,
wrote the ‘Patient Safety Curriculum Guide- Multi Professional Edition’, and also
participated in its update a few years later. Now the WHO would like to carry out a
second revision of this curriculum guide in several steps. As the first step, the chapter
‘Improving Medication Safety’ should be updated in such a way that it can also stand
alone as a single document. At a first meeting in December 2017 we discussed the topics,
order and priorities of this chapter. Based on this discussion the WHO will develop a first
revised version to be commented on by the WMA and other health professionals.
4.2 One Health
In May 2015, the World Veterinary Association (WVA) and the World Medical
Association (WMA) in collaboration with the Spanish medical (SMA) and veterinary
(SVA) associations organized the Global Conference on ‘One Health’ Concept with the
theme: “Drivers towards One Health – Strengthening collaboration between Physicians
and Veterinarians”. The Global Conference brought together 330 delegates from 40
countries around the world. Veterinarians, physicians, students, public health officials
and NGO representatives listened to presentations by high-level speakers and had the
opportunity to learn, discuss and address critical aspects of the One Health concept. The
main objectives of the conference were to strengthen links and communications between
the professions and to achieve closer collaboration between physicians, veterinarians and
all relevant stakeholders to improve different aspects of the health and welfare of
humans, animals and the environment. A summary of the conference is available on the
WMA website.
The second conference was hosted by the Japan Medical Association and the Japan
Veterinary Association together with the World Veterinary and the World Medical
Association in Kitakyushu City, Fukuoka Prefecture, Japan on 10-11 November 2016.
The conference was attended by more than 600 participants from 44 countries around the
world with approximately 30 lectures covering different One Health issues. A summary
of the conference is available on the WMA website.
4.3 Antimicrobial resistance
Antimicrobial Resistance (AMR) is a growing concern and an important challenge to
public health. It has various aspects and different actors contribute to the problem.
The WHO developed the Global Action Plan on Antimicrobial Resistance, which
articulated five main objectives, with the healthcare workforce being a key player in their
attainment. Most notably, Objective 1 strives to “improve awareness and understanding
of antimicrobial resistance through effective communication, education and training.’’
The WHO established an AMR secretariat whose purpose is to link the various
April 2018 Council 209/SecGen Report/Apr2018
16
stakeholders, get them involved and coordinate the activities of the Action Plan. One
emphasis will be on the education of medical students and physicians.
The WMA participated in a WHO expert consultation meeting on health workforce
education and AMR. The outcome of this meeting was the development of the first draft
of the Global Interprofessional AMR Competency Framework for Health Workers’
Education. This tool will assist health policy planners and decision makers in countries
to work towards achieving the first objective of the WHO Global Action plan on AMR,
which aims to improve awareness and understanding of AMR through effective
communication, education and training. It is also intended to serve as the basis for the
development of a global prototype AMR curriculum for health workers’ education and
scheduled training. The WMA commented on the first draft version together with the
World Federation for Medical Education. Our comments included the knowledge and
training aspects required to carry out a proper diagnosis and the importance of
differentiating between different origins and severity of infections, i.e. it is of utmost
importance to have a deep knowledge of diagnosis before prescribing an antibiotic in
order to reduce the burden of AMR. Together with the School for Public Policy at the
George Mason University, the WMA has been providing a free online learning tool on
Antimicrobial Resistance for nearly a decade now.
The WMA participated in the ninth Meeting of the Strategic and Technical Advisory
Group on Antimicrobial Resistance (STAG – AMR) and the Meeting of the Technical
Coordination Group (TCG) in February 2018 in Geneva.
4.4 Health workforce
In May 2016, the World Health Assembly adopted the Global Strategy on Human
Resources for Health. One new and important statement in the WHO strategy is the
emphasis that investment in HRH has a growth-inducing effect and health care itself is a
large pillar of the economy. The argument that the health sector has a growth inducing
effect on the economy is now being adopted by more and more UN agencies. As a result,
the UN Secretary General appointed a High Level Commission on Health Employment
and Economic Growth, which launched its report ‘Working for Health and Growth –
Investing in the health workforce’ in September 2016. The report gives 10
recommendations on areas such as job creation, gender and women’s rights, education
technology and crisis and humanitarian settings. The Commission’s goal is to stimulate
and guide the creation of at least 40 million new jobs in the health and social sectors and
to reduce the projected shortfall of 18 million health workers, primarily in low and lower
middle income countries, by 2030.
Following the conclusion of its 10 year mandate, the Global Health Workforce Alliance
has transitioned into the Global Health Workforce Network (GHWN). The Global Health
Workforce Network aims to facilitate evidence generation and exchange, foster
intersectoral and multilateral policy dialogue, including providing a forum for
multi-sector and multi-stakeholder agenda setting, sharing of best practices, and
harmonization and alignment of international support for human resources for health. The
overall goal is to enable the implementation of Universal Health Coverage and the
Sustainable Development Goals. The WHO, together with the GHWN and Ireland,
organised the Fourth Global Forum on Human Resources for Health in November
2017 and adopted the outcome document Dublin Declaration on Human Resources for
Health.
April 2018 Council 209/SecGen Report/Apr2018
17
During this forum the WMA and the International Federation of Pharmacists (FIP)
organised a side session on: How can regulation ensure quality health care,
professional autonomy and protect the public’s interest?
Commercialised health care models may affect professional autonomy and the delivered
quality of care. The purpose of health care regulation is to protect the public’s interest
and ensure patient-centred quality care based on ethical principles, as opposed to
profit-oriented models of care. Professional autonomy through self-regulation defines
standards and ensures quality for health care models. Therefore, regulation has an
important role in the implementation of strategies such as the WHO Global Strategy on
Human Resources for Health to accelerate UHC and ensure a sustainable health
workforce.
Dr Julia Tainijoki, WMA Medical Advisor, spoke at another side event during this forum
entitled: “Addressing discrimination in health care settings through a focus on the
rights, roles and responsibilities of health workers” and presented the physician’s
perspective and WMA policies on this issue.
4.5 Violence in the health sector
Building on the success of the previous conference in Dublin, preparatory work has
started for the sixth International Conference on violence in the health sector, which will
take place in Toronto, Canada on 24 – 26 October 2018. The WMA is a member of the
organisation and scientific committees in charge of the preparations for the event. Two
meetings of the organisation committee took place during the reporting period. C.
Delorme, as member of the Committee, liaised with the ICRC so that a representative of
the Health Care in Danger initiative will be invited to the conference as a keynote
speaker.
4.6 Caring Physicians of the World Initiative Leadership Course
The CPW Project began with the Caring Physicians of the World book, published in
English in October 2005 and in Spanish in March 2007. Some hard copies (English and
Spanish) are still available from the WMA Secretariat upon request.
Regional conferences were held in Latin America, the Asia-Pacific region, Europe and
Africa between 2005 and 2007. The CPW Project was extended to include a leadership
course organised by the INSEAD Business School in Fontainebleau, France in December
2007, in which 32 medical leaders from a wide range of countries participated. The
curriculum included training in decision-making, policy work, negotiating and coalition
building, intercultural relations and media relations. Please visit the WMA website for
more readings and videos which reflect some experiences of previous course alumni.
The eighth course was held at the Mayo Clinic in Jacksonville, Florida, USA from 3 – 8
December 2017. The courses were made possible by educational grants provided by
Bayer HealthCare and Pfizer, Inc. This work, including the preparation and evaluation of
the course, is supported by the WMA Cooperating Center, the Center for Global Health
and Medical Diplomacy at the University of North Florida.
5. Health Policy & Education
5.1 Medical and health policy development and education
April 2018 Council 209/SecGen Report/Apr2018
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In recent years, the Center for the Study of International Medical Policies and Practices at
George Mason University, which is one of the WMA’s Cooperating Centers, has studied
the need for educational support in the field of policy creation. Surveys performed in
cooperation with the WMA found a demand for education and exchange. The Center
invited the WMA to participate in the creation of a scientific platform for international
exchange on medical and health policy development. In autumn 2009, the first issue of a
scientific journal, World Medical & Health Policy, was published by Berkeley Electronic
Press as an online journal. It has now been moved to the Wiley Press. The World Medical
& Health Policy Journal can be accessed at:
http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1948-4682
5.2 Support for national constituent members
See item 2.2.1
April 2018 Council 209/SecGen Report/Apr2018
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CHAPTER II PARTNERSHIP & COLLABORATION
During the reporting period, the WMA Secretariat held bilateral meetings with the WHO and staff
of other UN agencies on the following areas: Prevention of alcohol abuse, mental health, violence
against women, the environment, the migration of health professionals and the prevention of torture.
In addition, the Secretariat voiced the WMA’s concerns in various public settings as follows2
:
1. World Health Organization (WHO)
WHO Governance
WHO Executive Board, January 2018:
The 142nd
session of the WHO Executive Board took place in January 2018 in Geneva, Switzerland.
The WMA made public statements on a series of issues. For more information (agenda, working
documents and resolutions), see http://apps.who.int/gb/e/e_eb142.html
WHO Public Health Events
Fourth Global Forum on Human Resources for Health in November 2017 organised by WHO,
GHWN and Ireland in November 2017
WHO Meeting of the Strategic and Technical Advisory Group on Antimicrobial Resistance (STAG
– AMR) and Meeting of the Technical Coordination Group (TCG) in February 2018 in Geneva
WHO Global Consultation for Setting Priorities for Global Patient Safety in collaboration with the
Centre for Clinical Risk Management and Patient Safety, Department of Health
WHO workshop « investing in healthy cities: « insuring prevention » at the 20th
European Health
Forum Gastein, Austria in October 2017
WHO GCM/NCD Working Group on Health Education and Health Literacy for NCDs, in February
in Geneva
2. UNESCO Conference on Bioethics, Medical Ethics and Health Law
In recent years, the WMA has supported the “UNESCO Chair in Bioethics World Conference
on Bioethics, Medical Ethics and Health Law” organised by the UNESCO Bioethics Chair,
Prof. Dr Amnon Carmi. In October 2015, the conference convened in Naples, Italy. The WMA
participated again by structuring sessions on end-of-life issues and the (at that time) draft of a
new policy on Ethical Guidelines for Health Databases and Biobanks. WMA Past-Presidents,
Dr Yoram Blachar and Dr Jon Snædal, WMA Ethics Advisor Prof. Vivienne Nathanson, WMA
Legal Counsel, Ms Annabel Seebohm and the Secretary General served in preparing these
sessions. Immediate Past President, Dr Xavier Deau, held a keynote speech at the opening of
the conference.
The WMA was again invited to arrange two scientific sessions at the 12th
UNESCO Chair of
Bioethics Conference held in Limassol, Cyprus from 21-23 March 2017. The first discussed the
2
More information on the activities mentioned is set out under the relevant section of the report.
April 2018 Council 209/SecGen Report/Apr2018
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ongoing revision process of the « Declaration of Geneva, the physicians’ oath ». This session
was moderated by Dr Ramin Parsa-Parsi, Chair of the WMA work group, and Prof. Urban
Wiesing, Director at our cooperating institute, the University of Tübingen. The second session
was moderated by WMA Past President Dr Jon Snædal and Dr Otmar Kloiber, with
contributions by Dr Emmanuell Rial-Sibag from our cooperating Center at the University of
Neuchatel and Ms Annabel Seebohm, Secretary General of the Standing Committee of
European Doctors (CPME).
The WMA is invited to the 13th
World Conference on Bioethics, Medical Ethics and Health
Law, which will take place from 27-29 November 2018 in Jerusalem, Israel. Please visit the
conference page for more details.
3. Other UN agencies
AGENCY ACTIVITIES
Human Rights Council of the United
Nations, in particular:
UN Special Rapporteur (SR) on the right of
everyone to the enjoyment of the highest
attainable standard of physical and mental
health (Dr D. Puras)
Monitoring the SRs’ activities
Ongoing exchange of information
Meeting with the SR in September 2017
further to WMA written contribution to SR’s
report on mental health
Special Rapporteur on torture and other cruel,
inhuman or degrading treatment or
punishment (Dr Nils Melzer)
Monitoring the SR’s activities
Contact to be made with new SR
Special Rapporteur on the Rights of Persons
with Disabilities (Ms Catalina Devandas
Aguilar)
Monitoring the SR’s activities
Contact made late 2016
High Commissioner for Human Rights (Mr
Zeid Ra’ad Al Hussein)
The WMA is part of the consultation process
within the framework of the UN Resolution on
mental health and human rights adopted in
September 2016
UNAIDS Campaign on Zero HIV-related stigma &
discrimination in health care settings day
See item 3.3.3
OECD Meeting with Mrs Francesca Colombo, Head
of the Health Section, and her team.
Discussion about the new work strategy on
health system reporting and the use of Patient
Reported Outcome Measurements (PROMS).
November 2016 (see also item 6.1 and 10)
International Organisation for Migration
(IOM)
The WMA is part of the IOMWHO working
Group on Migrants’ Health. (see point 3.3)
WHO and World Bank Dr Yokokura gave one of the keynote speeches
at the Universal Health Coverage Forum
December 2017 in Tokyo, Japan
April 2018 Council 209/SecGen Report/Apr2018
21
4. World Health Professions Alliance (WHPA)
After over ten years, the World Federation of Dentists FDI took over the secretariat of the
World Health Professions Alliance Leadership from the WMA at the beginning of 2018.
World Health Professions Regulation Conference
Save the date: 19-20 May 2018 in Geneva, prior to the World Health Assembly
Health professional regulation faces many challenges in a world characterised by political,
social, economic and technological change. Widespread reform of health professional
regulation reflects policy initiatives by many governments to ensure sustainable, efficient and
effective health service delivery. But what are the implications of these challenges, and how do
we ensure the public’s best interests are met?
Scheduled to run over one-and-a-half days immediately before the World Health Assembly in
May 2018, the 6th
World Health Professions Regulation Conference (WHPRC) will provide
participants with insights, perspectives and discussion on current challenges in health
professional regulation.
There are three main themes that will be addressed during the conference:
1. A call to set the right standards in regulation
Topics will include: setting the right standards, who is regulating the regulators, ethics and
professional autonomy, barriers to implementation, and reimbursement.
2. Safety, quality and compliance: Benefiting patients, communities and populations
Topics will include: best practice guidelines, the role of regulation in sustainable prevention,
facilitation of migration, the cost of maintaining licenses, use of big data and case studies of
outcome-oriented models.
3. Supporting the quality of lifelong learning
Topics will include: continuing professional development (CPD) and a discussion on the need
for global standards, fostering innovation, improving patient treatment, the shift in CPD of
assessment vs independence, and regulation of specialization.
5. WMA Cooperating Centers
The WMA is now proud to enjoy the support of five academic cooperating centres. The WMA
Cooperating Centers bring specific scientific expertise to our projects and/or policy work,
improving our professional profile and outreach.
WMA Cooperating Center Areas of cooperation
Center for the Study of International
Medical Policies and Practices,
George-Mason-University, Fairfax,
Virginia, USA
Policy development, microbial resistance,
public health issues (tobacco), publishing the
World Medical and Health Policy Journal.
Center for Global Health and Medical
Diplomacy, University of North Florida,
USA
Leadership development, medical diplomacy
Institute of Ethics and History of Medicine,
University of Tübingen, Germany
Revising the Declaration of Geneva, medical
ethics
Institut de droit de la santé, Université de International health law, developing and
April 2018 Council 209/SecGen Report/Apr2018
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Neuchâtel, Switzerland promoting the Declaration of Taipei, medical
ethics, deontology, sports medicine
Steve Biko Center for Bioethics, University
of Witwatersrand, Johannesburg, South
Africa
Revising the Declaration of Helsinki, medical
ethics, bioethics
Institute for Environmental Research,
Yonsei University College of Medicine,
South Korea
Environmental health, climate change and
health issues
6. World Continuing Education Alliance (WCEA)
The World Medical Association signed an agreement with the WCEA to provide an online
education portal that will not only enable the WMA to host its online education, but also offers
an opportunity for member associations to develop their own portals and online content. This
offer is directed specifically at medical associations and societies that wish to engage in
providing online education. Interested groups, medical schools or academies are invited to
contact the WMA Secretary General (secretariat@wma.net) for more information. This
educational platform will be launched in May 2018.
7. Other partnerships or collaborations with Health and Human Rights Organizations
Organisation Activity
Amnesty International Ongoing contacts (exchange of information and support)
during the reporting period, in particular on the situations in
Turkey, Ethiopia and Iran.
Human Rights Watch Regular contact on issues of common interest.
Global Alliance on Alcohol
Policy (GAPA) and its
members
Regular exchange of information.
International Committee of
the Red Cross (ICRC)
Partners on the Health Care in Danger (HCiD) project since
September 2011.
Permanent cooperation with the Health in Detention and
HCiD Departments.
Memorandum of understanding between the ICRC and the
WMA signed in November 2016.
International Council of
Military Medicine (ICMM)
A Memorandum of Understanding between the ICMM and the
WMA was signed at the WMA General Assembly in October
2017 (Chicago).
Council for International
Organizations of Medical
Sciences (CIOMS)
Development of guidance for the scientific community in
medicine and health care in general. The WMA is a member
and currently represented on the Executive Board.
International Federation of
Health and Human Rights
Organisations (IFHHRO)
Regular exchange of information on human rights and health
matters.
International Federation of
Medical Students
Associations (IFMSA)
Internship program since 2013 (3 students in 2013 and 2
students in 2014).
Regular collaboration, mostly in relation to WHO statutory
meetings.
Participation of WMA officers and officials in the pre-World
Health Assembly conference of IFMSA in Geneva.
April 2018 Council 209/SecGen Report/Apr2018
23
International Federation of
Associations of
Pharmaceutical Physicians
(IFAPP)
Cooperation on issues of human experimentation and
pharmaceutical development, the role of physicians in that
process. A memorandum of understanding has been signed at
the WMA General Assembly, October 2017 (Chicago).
University of Pennsylvania
International Internship
Program
Annual Internship program on health policy, public health,
human rights, project management. Usually 2-3 students come
as interns to our office for the summer. The programme has
been running since 2014.
International Rehabilitation
Council for Torture Victims
(IRCT)
Regular exchange of information and joint actions on specific
cases or situations.
Global Climate & Health
Alliance (GCHA)
Regular exchange of information and ad hoc collaboration
within the context of the UN climate change negotiations.
New Jersey Medical School
Global TB Institute
The WMA is working with the New Jersey Medical School
Global TB Institute and the University Research Company
(URC) to update its online TB refresher course for physicians
with the support of the US Agency for International
Development (USAID).
Safeguarding Health in
Conflict Coalition
Observer status in the coalition.
Regular exchange of information.
World Coalition Against
The Death Penalty
Regular exchange of information, in particular regarding
individual cases requiring international support.
World Veterinary
Association
Co-organisation of the Global Conference on One Health,
21-22 May 2015 in Madrid, Spain in collaboration with the
Spanish medical and veterinary associations. 2nd
Global
Conference on One Health, Kitakyushu City, Fukuoka
Prefecture, Japan, 10-11 November 2016.
US Defense Health Board –
Ethics Subcommittee
WMA Past President, Dr Cecil Wilson, represented the WMA
at two sessions of the Defense Health Board – Ethics
Subcommittee in 2014 and 2015 advocating for always
allowing physicians in military service to respect medical
ethics, even in conflict. The report of the Board is available on
our website.
Association for the
Prevention of Torture
Exchange of information on the implementation of the
Convention against Torture with regard to the role of
physicians in preventing torture and ill treatment.
Physicians for Human
Rights
Regular exchange of information and joint actions on specific
cases or situations.
International Physicians for
the Prevention of Nuclear
War (IPPN)
Exchange of information and joint actions, in particular in the
context of the UN Treaty on the Prohibition of Nuclear
Weapons.
April 2018 Council 209/SecGen Report/Apr2018
24
CHAPTER III COMMUNICATION & OUTREACH
In July 2017 a new member of staff joined the WMA Secretariat. Ms Magda Mihaila is a journalist
and communications specialist who is now helping our team improve the way we get out messages
to our members and into our social media stream.
1. WMA Newsletter
In April 2012, the WMA Secretariat started a bi-monthly e-newsletter for its members. The
Secretariat appreciates any comments and suggestions for developing this service and making it
as useful for members as possible.
2. WMA social media (Twitter and Facebook)
In 2013, the WMA launched its official Facebook and Twitter accounts (@medwma). The
Secretariat encourages members to spread the word within their associations that they can
follow the WMA’s activities on Twitter and via Facebook.
3. The World Medical Journal
The World Medical Journal (WMJ) is issued every 3 months and includes articles on WMA
activities and feature articles by members and partners. The 60th
anniversary edition was
published as a final printed copy in 2014. It transferred to an electronic format in 2015, which
is available on the WMA website.
4. WMA African Initiative
WMA President 2013-2014, Dr Margaret Mungherera, started an initiative to bring African
medical associations closer to the WMA. The idea was that stronger inclusion of organised
medicine in international cooperation should not only help to get the African voice better heard,
but would also leverage national visibility and standing.
Dr Mungherera brought together medical associations from various parts of Africa in small
regional meetings to discuss issues around their current work, what obstacles they face and
where they have had success. Invitations are open to all African medical associations,
regardless of whether they are already members of the WMA.
Dr Mungherera set up regional consultative meetings with African NMAs in Kenya, South
Africa, Tunisia and Nigeria. This initiative has been supported by the medical associations of
South Africa and Tunisia, WMA President 2014-2015, Dr Xavier Deau, Past Chair of Council,
Dr Mukesh Haikerwal, as well as the Chairman of the Past-Presidents and Chairs of Council
Network, Dr Dana Hanson.
Immediate Past-President Dr Mungherera delivered presentations at the 4th
International
Conference on Violence in the Health Sector in Miami from 22-24 October 2014, the African
Health Conference in London from 27-28 February 2015, and at the 6th
World Congress on
Women’s Mental Health in Tokyo from 22-25 March 2015, among others.
Sadly, Dr Mungherera passed away on 4 February 2017 after a brave battle with cancer over
recent years. As a psychiatrist by education, a public health activist by nature, and a determined
April 2018 Council 209/SecGen Report/Apr2018
25
advocate for the people of Africa by conviction she was a marvellous physician leader on the
global stage. For many of us she was more than a colleague, she became a friend, teacher and
companion.
Margaret was with us for every meeting she could arrange for. The WMA remains grateful for
her service to our community.
5. Meeting with Arab Medical Union leaders
Upon the invitation of the President of the Kuwait Medical Association, who at the time also
chaired the Arab Medical Union, the WMA Chair of Council, Dr Ardis Hoven, and the
Secretary General had an opportunity to attend the Scientific Conference of the Kuwait
Medical Association and the coinciding meeting of Arab Medical Union leaders. The Chair
delivered a presentation on the WMA to the leaders of the Arab Medical Union, most of which
are not members of the WMA, and invited them to join. Later the Chair was given the
opportunity to participate in a panel discussion about End-of-Life issues, which mainly dealt
with the provision of palliative care, the withdrawal or withholding of futile treatment and the
respect for patient will (denial of treatment).
In another section, the Secretary General presented the WMA Declarations of Taipei and
Geneva.
6. Secondments / internships
The Danish Medical Association seconded Ms Eva Rahbek to the WMA Secretariat at the
Council Session in Riga. We have been running an internship programme with the IFMSA
since 2013 (3 Interns in 2017 from Poland, Spain and Rwanda), with the University of
Pennsylvania since 2014 (2 Interns in 2017) and last year we started an internship programme
with the Palack University Olomouc in the Czech Republic (1 intern in 2017).
A call was sent out to IFMSA members in February for two interns for the 2018 spring/summer
period and 2 UPENN interns have been accepted for the period from May to August 2018.
CHAPTER IV OPERATIONAL EXCELLENCE
1. Advocacy
In April 2017, the Council decided to discontinue the Advocacy Workgroup and to replace it
with a new Advocacy and Communications Advisory Panel with the mission to provide input
and guidance to:
Ÿ Enhance the promotion of WMA policies and positions among the NMAs and to
relevant external organisations, associations, and institutions; and
Ÿ Recommend advocacy and communications strategies to increase the visibility and
positive impact of WMA policies and activities.
The Panel is chaired by Dr Ashok Zachariah Philip, Malaysian Medical Association and
composed of the following members: Israel Medical Association (IsMA), South African
Medical Association (SAMA), Spanish Medical Association (CGCoM), American Medical
Association (AMA), Japanese Medical Association (JMA), French Medical Association
(CNOM), Junior Doctors Network (JDN).
April 2018 Council 209/SecGen Report/Apr2018
26
2. Paperless meetings
At its 188th
meeting, the WMA Council expressed its desire to reduce its environmental impact
by going paperless. Since the 189th
Council meeting, documents posted on the website before
the meeting have no longer been provided at the venue in print. Council members and officials
are responsible for downloading documents from the members’ area of the WMA website and
bringing them to the meeting via electronic media or on paper, if desired. Documents
developed on site during the meeting are available online via a WiFi connection or in print. The
Secretariat introduced box.com at the 197th
Council meeting as a parallel sharing and
synchronizing tool for official WMA documents. In October 2016, the WMA General
Assembly in Taipei decided to introduce entirely paperless meetings provided a suitable WiFi
connection is available.
3. Governance
A Workgroup on Governance Review was set up at the Council Session in Moscow in 2015
under the chair of Dr Rutger Jan van der Gaag. The Workgroup delivered its final report to the
207th
Council in Chicago after extended discussions with Constituent Members. Based on this
report, the Secretary General drafted a discussion document for a new Strategic Plan to be
considered at the Council Session in Riga.
CHAPTER V ACKNOWLEDGEMENT
The Secretariat wishes to record its appreciation of member associations and individual members
for their interest in, and cooperation with, the World Medical Association and its Council during the
past year. We thank all those who have represented the WMA at various meetings and gratefully
acknowledge the collaboration and guidance received from the officers, as well as the association’s
editors, its legal, public relations and financial advisors, staff of constituent members, council
advisors, associate members, friends of the association, cooperating centres, partner organizations
and officials.
We wish to mention the excellent working relationships we have with colleagues and experts in
international, regional and national organizations, be they (inter-)governmental or private. We
highly appreciate their willingness and efforts to enable our cooperation.
§§§
09.04.2018
1
THE WORLD MEDICAL ASSOCIATION, INC.
Document
no:
Council 209/Chair of Council
Report/Apr2018
Original:
English
Title: Report of the Chair of Council (October
2017 – March 2018)
Destination: 209th
Council Session
Radisson Blu Latvija Hotel
Riga, Latvia
26-28 April 2018
Action(s)
required:
To be
received
As we approach the Council meeting in Riga this month, I pause to reflect on the considerable
amount of work that has been accomplished by our members and by the WMA. Most recently at the
WHO headquarters in Geneva, a Memorandum of Understanding between the WHO and the WMA
was signed confirming co-operation on topics of mutual interest including action of the social
determinants of health, universal health coverage and the improvement of emergency preparedness.
My special thanks to our President, Dr. Yokokura and our Secretary General Dr. Otmar Kloiber on
bringing this to fruition.
A very important accomplishment regarding regional meetings on End of Life Care has been
achieved, and let me express my personal thanks to those countries who hosted and organized these
events. We will be discussing the outcomes of these meetings in Riga and I look forward to this. On
a more personal note, I was privileged to be able to attend the meeting at the Vatican and being the
beneficiary of the hospitality and kindness afforded to those in attendance by Archbishop Vincenzo
Paglia, President of the Pontifical Academy for Life. The diversity of knowledge as presented by
medical professionals, legal authorities, experts in palliative care and theologians provided for all of
us an extra ordinary experience. A special thank you to the German Medical Association for
providing leadership and support for this very important activity.
During the latter part of November, I was the recipient of an invitation to attend the Second Kuwait
Medical Association (KMA) Scientific conference. Both Dr. Kloiber and I had the opportunity of
meeting with the leadership of the KMA and discussing the value of the WMA thanks to the
invitation of Dr. Mohammad Al-Mutairi, President of the Kuwait Medical Association. This was an
excellent opportunity to represent the WMA in a part of the world where our representation has
been limited.
Of a more local nature, I was invited to speak at a regional Global Health meeting in Ohio,
discussing the work of the WMA as related to global health issues. The audience included
academics, public health organizations, and medical and dental students many of whom had been
engaged in work in a variety of places related to public health and prevention. I had an opportunity
to address antimicrobial resistance, the role of the entire medical and veterinarian community in
preparedness, the need for educational and training programs in One Health that are
multidisciplinary, and a focus on environmental health is necessary. The role that WMA plays in
such global work is indeed a challenge but absolutely necessary.
April 2018 Council 209/Chair of Council Report/Apr2018
2
On a final note, in recently writing a publication Foreword on Women’s Health in Global
Perspective, I was reminded of the barriers to health care and clinical needs that constitute threats to
adequate health care for women. With increasing migrant streams caused by war, climate change
and economic disruption, women have become targets of abuse, violence and deprivation. Gender
based health disparities intensify the need for our role in the Social Determinants of Health globally.
As leaders in Medicine, we have the opportunity and responsibility to lay aside politics and
concentrate on the needs of patients and our health care colleagues. As we enjoy the hospitality of
Riga, I encourage dialogue around even what we might consider difficult topics. Respect for and
encouraging the minority opinion is very desirable. We are diverse in many ways and that we must
celebrate.
Respectfully submitted by Ardis Dee Hoven, MD, Chair of Council
§§§
06.04.18
1
THE WORLD MEDICAL ASSOCIATION, INC.
Document
no:
MEC 209/Agenda/Apr2018/Rev Original:
English
Title: Agenda of the Medical Ethics Committee
Destination: Medical Ethics Committee
209th
Council Session
Radisson Blu Latvija Hotel
Riga, Latvia
26-28 April 2018
Action(s)
required:
For
consideration
Note: This agenda is revised on item 3.4 only.
Thursday, 26 April 2018
Membership of the Committee
Dr Andrew W. GURMAN
Dr David O. BARBE
Dr Michael Bryant GANNON
Dr Thomas SZEKERS
Dr Andrew DEARDEN
Dr Mark PORTER
Dr Shuyang ZHANG
Dr Serafin ROMERO
Dr Heidi STENSMYREN (Chair)
Dr Andreas RUDKJOEBING
Dr Frank-Ulrich MONTGOMERY
Dr Ramin PARSA-PARSI
Dr Ajay KUMAR
Dr Kenji MATSUBARA
Dr Mari MICHINAGA
Dr René HÉMAN
Dr Mzukisi GROOTBOOM
Ex-officio (with voting rights)
Dr Ardis Dee Hoven, Chair of Council
Dr Frank Ulrich Montgomery, Vice-Chair of Council
Dr Andrew Dearden, Treasurer
Ex-officio (without voting rights)
Dr Yoshitake Yokokura, President
Dr Leonid Eidelman, President-Elect
Dr Ketan Desai, Immediate Past President
Dr Otmar Kloiber, Secretary General
Ms Marie Colegrave-Juge, Legal Advisor
Mr Adolf Hällmayr, Financial Advisor
Ms Joelle Balfe, Facilitator
Dr Julia Tainijoki, Medical Advisor
March 2018 MEC 209/Agenda/Apr2018/Rev
2
1. GENERAL BUSINESS
1.1 Call to order by the Chair of Council
1.2 Report of the previous meeting held in Chicago, USA, 11-14 October 2017
Approve: Report of the Medical Ethics Committee (MEC 207/Report/Oct2017)
1.3 Chair’s Opening Remark
2. MONITORING REPORT (ORAL)
3. BUSINESS IN PROGRESS
3.1 Declaration of Therapeutic Abortion
Consider: Oral report from the working group.
Proposed revision of WMA Declaration of Therapeutic Abortion
(MEC 209/Therapeutic Abortion COM REV3/Apr2018)
3.2 Ethics of Telemedicine
Consider: Proposed revision of the WMA Statement on the Ethics of Telemedicine
(MEC 209/Ethics of Telemedicine COM REV/Apr2018)
3.3 Licensing of Physicians Fleeing Prosecution for Serious Criminal Offences
Consider: Proposed revision of the WMA Statement Licensing of Physicians Fleeing
Prosecution for Serious Criminal Offences
(MEC 209/Licensing Physicians Fleeing Prosecution COM REV/Apr2018)
3.4 Regional Meeting on End-of-Life Question (EoL workshops):
Receive: Oral report from the Secretary General
Report of the Symposium on End-of-Life Questions in Japan, September
2017 (MEC 209/End of Life Japan/Apr2018)
Report of the WMA African region meeting on End-of-Life Questions in
Nigeria, September 2017 (MEC 209/End of Life Nigeria/Apr2018)
Report of the WMA South American region meeting on End-of-Life
Questions in Brazil 2017 (MEC 209/End of Life Brazil/Apr2018)
Report on the WMA European Region Conference on End-of-Life
Questions 2017 (MEC 209/End of Life Europe/Apr2018)
March 2018 MEC 209/Agenda/Apr2018/Rev
3
4. NEW BUSINESS
4.1 Genetics and Medicine
Consider: Proposal for a major revision of the WMA Statement on Genetics and
Medicine
(MEC 209/Genetic and Medicine/Apr2018)
4.2 Biosimilar Medicinal Products
Consider: Proposed WMA Statement on Biosimilar Medicinal Products
(MEC 209/Biosimilar Medicinal Products/Apr2018)
5. CLASSIFICATION OF 2008 POLICIES
Consider: Recommendations received on MEC Document
(MEC 209/Policy Review 2008/Apr2018)
6. WMA HUMAN RIGHTS
Receive: Oral Report from the WMA Secretariat
7. ANY OTHER BUSINESS
8. ADJOURNMENT
§§§
05.04.2018

1
THE WORLD MEDICAL ASSOCIATION, INC.
Document
no:
MEC 207/Report/Oct2017 Original:
English
Title: Report of the Medical Ethics Committee
Destination: Medical Ethics Committee
209th
Council Session
Radisson Blu Latvija Hotel
Riga, Latvia
26-28 April 2018
Action(s)
required:
For
Consideration
Wednesday, 11 October 2017
Membership of the Committee
Dr. Andrew W. GURMAN
Dr. David O. BARBE
Dr. Michael Bryant GANNON
Dr. Thomas SZEKERS
Dr. Andrew DEARDEN
Dr. Mark PORTER
Dr. Shuyang ZHANG
Dr. Serafin ROMERO
Dr. Heidi STENSMYREN (Chair)
Dr. Andreas RUDKJOEBING
Dr. Frank-Ulrich MONTGOMERY
Dr. Ramin PARSA-PARSI
Dr. Ajay KUMAR
Prof. Leonid EIDELMAN
Dr. Kenji MATSUBARA
Dr. Mari MICHINAGA
Dr. René HÉMAN
Dr. Mzukisi GROOTBOOM
Ex-officio (with voting rights)
Dr. Ardis Dee Hoven, Chair of Council
Prof. Dr. Frank Ulrich Montgomery, Vice-Chair of Council
Dr. Andrew Dearden, Treasurer
Ex-officio (without voting rights)
Dr Ketan Desai, President
Dr. Yoshitake Yokokura, President-Elect
Sir Michael Marmot, Immediate Past President
Dr Otmar Kloiber, Secretary General
Ms. Marie Colegrave-Juge , Legal Advisor
Mr. Adolf Hällmayr, Financial Advisor
Prof. Vivienne Nathanson, Facilitator
1. GENERAL BUSINESS
October 2017 MEC 207/Report/Oct2017
2
1.1 The Chair of the Council called the meeting to order at 08:45 on Wednesday October
11, 2017.
1.2 The Committee approved the report of the previous meeting held in Livingstone,
Zambia, 20-22 April 2017 (MEC 206/Report/Apr2017).
1.3 Dr Thomas SZEKERES was replaced by Dr Herwig LINDNER.
2. MONITORING REPORT (ORAL)
The General Secretary highlighted the importance of including all members in discussions of
ethical issues at WMA, especially those who do not regularly attend WMA Council or
General Assembly meetings. The recently held regional meetings are a good way to involve
these members.
Dr Kloiber noted that there are a number of important issues emerging that impact the medical
profession and encouraged members to submit proposed policies on the following topics:
clinical independence, commercialisation of health care, artificial intelligence, and new
technologies to modify the genome of humans and nano-technology.
3. BUSINESS IN PROGRESS
3.1 Declaration of Geneva
The Committee received an oral report from the Chair of the Workgroup on the
Declaration of Geneva, Dr Ramin PARSA-PARSI. He reported on the open
consultation in May/June this year and the workgroup meeting in Sweden in September.
WMA ethics advisor, Prof Urban WIESING, gave an overview of the history of the
declaration and explained the changes proposed by the workgroup.
RECOMMENDATION
3.2.1 That the proposed WMA Declaration of Geneva (MEC 207/ Declaration of
Geneva/Oct2017) be approved by Council and forwarded to the General
Assembly for adoption.
On the recommendation of the Committee, the Chair of Council agreed to read the
Declaration of Geneva at the beginning of each ceremonial session of future General
Assemblies. For this year, it will be read at the conclusion of the General Assembly,
following adoption of the revision during the plenary session. Further it was decided to
present the new version in the conference UNESCO Chair in Bioethics World
Conference Bioethics, Medical Ethics & Health Law and 14th
World Congress of
Bioethics.
3.2 Declaration of Therapeutic Abortion
The Committee received the oral report of Dr Selealo MAMETJA, the chair of the
workgroup, and considered the Proposed WMA Declaration of Therapeutic Abortion
(MEC 207/Therapeutic Abortion REV2/Oct2017). The workgroup had a meeting
shortly before the committee meeting and proposed some additional adjustments to the
October 2017 MEC 207/Report/Oct2017
3
document and also that the name of the document be changed from “therapeutic
abortion” to “medically indicated abortion”.
RECOMMENDATION
3.2.1 That the proposed WMA Declaration of Therapeutic Abortion (MEC
207/Therapeutic Abortion REV2/Oct2017), be circulated to constituent
members for comments
3.3 Person Centered Medicine
The Committee considered the proposed WMA Statement on Person Centered Medicine
and comments (MEC 207/Person Centered Medicine COM REV/Oct2017)
RECOMMENDATION
3.3.1 That the Council recognize the work on the topic of person centered medicine
but that the policy not be pursued at this time.
3.4 Child Abuse
The Committee considered the proposed WMA Statement on Child Abuse and
comments (MEC 207/Child Abuse COM REV/Oct2017)
RECOMMENDATION
3.4.1 That the revision of the proposed WMA Statement on Child Abuse and
comments (MEC 207/Child Abuse COM REV/Oct2017) be approved by
Council and forwarded to the General Assembly for adoption.
3.5 Organ and Tissue Donation
The Committee considered the proposed revision of the WMA Statement on Organ and
Tissue and comments (MEC 207/Organ and Tissue Donation COM REV/Oct2017). The
Committee will present the statement to the Council for consideration, with an
additional proposed amendment to paragraph 17 to clarify language regarding donor
consent.
RECOMMENDATION
3.5.1 That the proposed WMA Statement on Organ and Tissue and comments (MEC
207/Organ and Tissue Donation REV2/Oct2017) be approved by Council and
forwarded to the General Assembly for adoption, pending agreement of the
Council on language in paragraph 17 regarding donor consent.
3.6 Declaration of Hamburg
The Committee considered the proposed minor revision of the WMA Declaration of
Hamburg (MEC 207/Declaration of Hamburg/Oct2017)
October 2017 MEC 207/Report/Oct2017
4
RECOMMENDATION
3.6.1 That the proposed WMA Declaration of Hamburg (MEC 207/Declaration of
Hamburg/Oct2017), be approved by Council and forwarded to the General
Assembly for information.
3.7 United Nations Rapporteur on the Independence and Integrity of Health
Professionals
The Committee considered the proposed WMA Proposal for a United Nations
Rapporteur on the Independence and Integrity of Health Professionals
(MEC 207/UN Rapporteur/Oct2017) and the oral report of Ms Clarisse DELORME,
WMA Advocacy Advisor, who had met with the ICRC to discuss the relevance of the
existing statement.
RECOMMENDATION
3.7.1 That the revision of the proposed WMA Proposal for a United Nations
Rapporteur on the Independence and Integrity of Health Professionals
(MEC 207/UN Rapporteur/Oct2017) be rescinded and achieved.
3.8 Ethics of Telemedicine
The Committee considered the proposed WMA Statement on the Ethics of
Telemedicine (MEC 207/Ethics of Telemedicine/Oct2017)
RECOMMENDATION
3.8.1 That the revision of the proposed WMA Statement on the Ethics of
Telemedicine (MEC 207/Ethics of Telemedicine/Oct2017) be circulated to
constituent members for comments.
3.9 Licensing of Physicians Fleeing Prosecution for Serious Criminal Offences
The Committee considered the proposed WMA Statement Licensing of Physicians
Fleeing Prosecution for Serious Criminal Offences (MEC 207/Licensing Physicians
Fleeing Prosecution/Oct2017)
RECOMMENDATION
3.9.1 That the revision of the proposed WMA Statement Licensing of Physicians
Fleeing Prosecution for Serious Criminal Offences (MEC 207/Licensing
Physicians Fleeing Prosecution/Oct2017) be circulated to constituent members
for comments.
3.10 Regional meetings on End-of-Life Question (EoL workshop)
October 2017 MEC 207/Report/Oct2017
5
The Committee received an oral report from the Secretary General on the regional
meeting in Japan held in September 2017 in conjunction with the CMAAO meeting and
with the support of the JMA. He reported that the appetite for discussing euthanasia and
physician assisted suicide in the Asia region is very low among most countries, with the
exception of Australia and New Zealand. He noted that no medical association
attending the meeting has policy that supports euthanasia or physician assisted suicide.
He also noted that discussion of unwanted or futile treatment is a topic that is often
discussed regionally.
Prof. Ulrich MONTGOMERY informed the Committee about the upcoming End of
Life conference in the Vatican in November this year. He stressed that the conference is
nearly full and that members interested in attending should contact the German Medical
Association immediately.
4. WMA HUMAN RIGHTS
The WMA Advocacy Advisor referred to the Council report (Council 207/SecGen
Report/Oct2017) and highlighted the meeting with the UN Special Rapporteur on Health, Dr
Dainius PURAS, regarding his latest report on mental health, human rights, and attacks on
health professionals. The Executive Committee recommends to invite him to either the next
Council meeting or General Assembly in 2018.
In July 2017, the Treaty on the Prohibition of Nuclear Weapons, the first multilateral legally-
binding instrument for nuclear disarmament, was adopted. On the occasion of the opening for
signature of the Treaty, the IPPN together with the WMA, the International Council of Nurses
and the World Federation of Public Health Associations, adopted a joint Statement urging
Member States to sign the Treaty and to ratify it as soon as possible so that it can enter into
force.
5. ANY OTHER BUISNESS
5.1 The Secretary General reminded the committee that WMA has three policies related to
capital punishment:
• WMA Resolution on Physician Participation in Capital Punishment
• WMA Resolution to Reaffirm the WMA’s Prohibition of Physician Participation in
Capital Punishment
• WMA Statement on the United Nations Resolution for a Moratorium on the Use of
the Death Penalty
6. ADJOURNMENT
The meeting was adjourned at 11:40 on Wednesday 11th
October to report back to the
Council.
§§§
12.10.2017

1
THE WORLD MEDICAL ASSOCIATION, INC.
Document
no:
MEC 209/Therapeutic Abortion COM REV3/Apr2018 Original:
English
Title: Proposed revision of WMA Declaration on Therapeutic Abortion
Destination: Medical Ethics Committee
209th
Council Session
Radisson Blu Latvija Hotel
Riga, Latvia
26-28 April 2018
Action(s)
required:
For
Consideration
Note: As part of the annual policy review process, the Council in Buenos Aires (April 2016) decided that
the WMA Declaration on Therapeutic Abortion should be reaffirmed with minor revision. The
WMA secretariat submitted a revision to the 204th
Council session in Taipei (October 2016). The
Council decided to circulate this version to WMA members for comments. Given the controversies
of opinions reflected in the comments from members, the Council appointed a workgroup with
South Africa as the chair. This version is the compilation from the working group.
The 207th Council session in Chicago (October 2017) considered the version proposed by the
workgroup and decided to circulate it within WMA membership for comments.
Abbreviation key:
AM Associate Members
AMA American Medical Association
AMV Associazione Medica del Vaticano
BMA British Medical Association
April 2018 MEC 209/Therapeutic Abortion COM REV3/Apr2018
2
CGCM Consejo General de Colegios Médicos de Espana
CMA Canadian Medical Association
CNOM Conseil National de l’Ordre des Médecins, France
DMA Danish Medical Association
FMA Finnish Medical Association
GMA Bundesärztekammer (German Medical Association)
IsMA Israeli Medical Association
NMA Norwegian Medical Association
PCPD Polish Chamber of Physicians and Dentists (Naczelna Izba Lekarska)
RDMA Royal Dutch Medical Association
SwMA Swedish Medical Association
TuMA Turkish Medical Association
GENERAL COMMENTS
AM The Associate Members had a lively and respectful discussion about this difficult topic. We believe limiting it to medically-indicated abortion may
make it easier to come to a satisfactory conclusion. The Associate Members are divided about a single issue in this document. It is the issue about
referral. All of us believe physicians who are not comfortable or capable performing abortions should not have to do so. Some physicians feel that it is
against their personal moral convictions to have to refer someone for a procedure the referring physician feels is immoral. Alternative language
acceptable to these physicians is proposed as an alternative paragraph 8 (1). We are also including an additional alternative (2) that further defines
medically-induced abortions using the terms “direct” and “indirect”.
Other AMs feel just as strongly that these physicians, with a moral objection to medically-indicated abortion, should still have to help the patient get the
necessary medical treatment. Those physicians feel the alternative language allows physicians to behave unethically to their patients because of their
personal moral beliefs, not necessarily shared by the patient. They feel that the disagreeing physician has to help the patient find needed care. We do
not endorse either version of paragraph 8, but leave it to the rest of the process to make the final decision on how to word paragraph 8.
Other minor suggestions are included for consistency and clarity.
AMV As we have previously stressed, the medical establishment should work towards protecting and promoting every human life (born and unborn).
Considering the importance of the mother’s interests, we cannot accept the interruption of pregnancy before viability outside the case of a risk for the
woman’s life or a grave health problem. This declaration also undermines the physician’s right to conscientious objection by forcing referrals to other
physicians.
BMA We welcome this revision of the declaration which addresses our previous comments on MEC 204. We have reservations regarding the changed title of
the declaration to ‘medically-indicated abortion’ which is potentially ambiguous and value laden in terms of grounds for an abortion. For example,
some might argue that abortion is rarely and only in extremis ‘medically-indicated’ when the health risks of pregnancy and childbirth are over and
above that which would normally be expected; not taking into account the inherent risks of pregnancy and childbirth for women, and/or the particular
circumstances of a woman and her family (for example, the pregnancy is a consequence of rape). The BMA currently refers to ‘induced abortion’, and
would suggest this becomes the title.
April 2018 MEC 209/Therapeutic Abortion COM REV3/Apr2018
3
Keywords: Abortion, Pregnancy, Mother, Respect, Autonomy, Fundamental Right [Within the context of abortion, the term ‘mother’ can be seen as
emotive. A pregnant woman is not a mother until she gives birth.]
CNOM The CNOM (French Medical Council) thanks the working group for this new version but cannot support it as it is.
DMA The Danish Medical Association supports the revised version of this declaration. We have two minor suggestions: In section 2, we would suggest
deleting “between the patient and the physician” so that the sentence ends after “matter”. And, in light of the change in title, in section 9 we would
suggest changing “therapeutic abortion” to “medically indicated abortion”. [Note: those comments have been added in the table below]
FMA FMA can accept the revised document. We have one minor comment to the text: Para 9: to change wording to medically-indicated instead of
therapeutic. [Note: this comment has been added in the table below]
GMA The GMA has incorporated a small number of suggested editorial revisions below. [Note: those comments have been added in the table below]
NMA NMA supports this document, but suggest one new item under Recommendations
PCPD The Polish Chamber of Physicians and Dentists is of the opinion that physicians have a right to conscientious objection to providing certain medical
services and those medical doctors who do not provide certain services may not be disciplined or discriminated against which should be safeguarded by
national laws by the so called “conscience clause”.
Abortion is one of the medical procedures that is most often associated with the issue of conscientious objection. The Polish Chamber, therefore
welcomes clear reference to the physicians’ right to conscientious objection to providing abortion.
As the Polish Constitutional Court stated in its judgment of 7 October 2015 in the proceedings initiated by the Polish Chamber it is not only the
physician’s right but it is the physician’s duty to act according to his / her conscience. Acting against physician’s conscience may be required only in
cases where a delay in providing medical assistance would result in posing danger to life or serious harm.
At the same time the Constitutional Court said that it is against the Polish constitution to require that a doctor who objects to provide abortion has to
refer the woman to another easily accessible physician or health facility willing to perform abortion. As the Court indicated this would unproportionally
infringe the physician’s conscience. Also it is not a duty of a physician to gather and provide information about other physicians who do not object to
perform abortion – in fact gathering such information by a physician could constitute a breach of other laws. This kind of information should be
provided to patients by those who are in charge of running the healthcare system (public authorities, healthcare facility management, National Health
Fund) and not by individual doctors whose conscience does not allow them to participate in abortion.
The reasoning of this verdict should be fully supported, therefore the Polish Chamber proposes to amend points 8 and 9 by deleting second sentence in
point 8, rephrasing the third sentence in point 8 and deleting point 9 which puts an obligation on all doctors despite their ethical convictions.
In those cases where medically-indicated abortion is legally allowed it should be performed by a competent physician in approved healthcare facilities –
these procedures should not be delegated to other health care professions. Therefore the Polish Chamber proposes to amend point 5 of the draft by
deleting the part “or other health care worker”. [Note: this specific comment about paragraphs 5, 8 and 9 have been added in the table below]
RDMA Preliminary question:
How does this declaration relate to the declaration on the WMA-website,
WMA Declaration of Oslo on Therapeutic Abortion
Adopted by the 24th World Medical Assembly, Oslo, Norway, August 1970
and amended by the 35th World Medical Assembly, Venice, Italy, October 1983
and the 57th WMA General Assembly, Pilanesberg, South Africa, October 2006
1. The WMA requires the physician to maintain respect for human life.
April 2018 MEC 209/Therapeutic Abortion COM REV3/Apr2018
4
2. Circumstances bringing the interests of a mother into conflict with the interests of her unborn child create a dilemma and raise the question
as to whether or not the pregnancy should be deliberately terminated.
3. Diversity of responses to such situations is due in part to the diversity of attitudes towards the life of the unborn child. This is a matter of
individual conviction and conscience that must be respected.
4. It is not the role of the medical profession to determine the attitudes and rules of any particular state or community in this matter, but it is our
duty to attempt both to ensure the protection of our patients and to safeguard the rights of the physician within society.
5. Therefore, where the law allows therapeutic abortion to be performed, the procedure should be performed by a physician competent to do so
in premises approved by the appropriate authority.
6. If the physician’s convictions do not allow him or her to advise or perform an abortion, he or she may withdraw while ensuring the
continuity of medical care by a qualified colleague.
Is there a more recent version? Otherwise we don’t understand the changes made to this declaration being ‘reaffirmed with minor revision’.
SwMA This is a proposed revision of the existing WMA Declaration on therapeutic abortion. The existing policy is not entirely clear as to whether its scope is
only abortions performed due to medical reasons or if it also covers other situations where a pregnancy is terminated following a request by the
pregnant woman.
The SMA would like to stress that it is of utmost importance that the change of terminology – from “therapeutic abortion” to “medically-indicated
abortion” – in the revised version must not in any way be interpreted as if the WMA opposes other abortions than strictly medically-indicated ones.
*Numbering will be deleted (or adjusted) when the revised text is adopted.
No Proposed Text:
MEC 207/Therapeutic Abortion
REV2/Oct2017
Specific Comments
Additions: bold/underlined
Deletions: lined-out
Comments only: [italic]
Proposed Revised Text by:
Rapporteur
MEC 209/ Therapeutic Abortion
REV3/Apr2018
Title WMA Declaration on Medically-
Indicated Abortion
WMA Declaration on therapeutic Medically-Indicated
Termination [CNOM]
Medically-Indicated Termination of
Pregnancy: (most of peer-review
literature around medical indications
uses the term)
PREAMBLE
[New paragraph]: The doctor should always bear in
mind that the first moral principle imposed upon him is
to respect human life (born and unborn) [AMV]
1. Medically-indicated abortion refers to
interruption of pregnancy due to health
reasons, in accordance with evidence-
Medically-indicated abortion refers to interruption of
pregnancy due to serious health reasons, in accordance
with evidence-based medicine principles and good current
Medically-indicated termination of
pregnancy refers to interruption of
pregnancy due to health reasons, in
April 2018 MEC 209/Therapeutic Abortion COM REV3/Apr2018
5
based medicine principles and good
clinical practice.
clinical practice. [AMV]
For the purpose of this declaration medically-indicated
abortion refers to interruption of pregnancy due to health
reasons, in accordance with evidence-based medicine
principles and good clinical practice. [SwMA]
Medically-indicated abortion refers to interruption of
pregnancy due to health reasons [It is necessary to explain
the term ‘medically indicated abortion’ (the same holds for
therapeutic abortion, since that term is unclear also).
Does ‘medically indicated’ include: abortion induced
because of the mother’s physical or mental health, of social
reasons and to prevent the birth of an affected child?] …
[RDMA]
Medically-indicated abortion refers to interruption of
pregnancy due to health reasons, in accordance with
evidence-based medicine medical principles and good
clinical practice. [CMA]
Medically-indicated abortion refers to interruption of
pregnancy due to health reasons, in accordance with
principles of evidence-based medicine principles and good
clinical practice. [GMA]
Medically-indicated abortion refers to interruption of
pregnancy due to health reasons for the mother, in
accordance with evidence-based medicine principles and
good clinical practice. [CGCM]
Medically-indicated abortion refers to interruption of
pregnancy due to health reasons … [IsMA: are you
referring to the health of the fetus, mother or both ?]
accordance with principles of
evidence-based medicine and good
clinical practice
April 2018 MEC 209/Therapeutic Abortion COM REV3/Apr2018
6
2. Abortion is a medical matter between
the patient and the physician. Attitudes
toward abortion are a matter of
individual conviction and conscience
that must be respected.
[Delete paragraph] [SwMA]
[Delete paragraph; abortion is not only about “individual
conviction and conscience”. Medicine has a lot to say
concerning fetal life] [AMV]
Medically-indicated Aabortion is a medical matter
between the patient and the physician …[AM]
Abortion is a medical matter between the patient and the
physician … [DMA]
… Attitudes toward abortion are a matter of individual
conviction and conscience that mustshould be respected.
[BMA]
[The BMA supports the right of doctors to have a
conscientious objection to abortion and believes that such
doctors should not be marginalised because of their beliefs.
This is, however, a qualified right with some specific
limitations. As noted in the new paragraph 8 – to save a
woman’s life – and, therefore, the term ‘should’ rather
than ‘must’ would be preferable.] [BMA]
AbortionMedically-indicated abortion is a medical matter
between the patient and the physician. Attitudes toward
abortion are a matter of individual conviction and
consciencevalues that must be respected. [CGCM]
Abortion is a medical matter between the patient and the
physician. Attitudes toward abortion are a matter of
individual conviction and conscience that must be
respected. [CNOM]
Termination of pregnancy is a medical
matter between the patient and the
physician. Attitudes toward
termination of pregnancy are a matter
of individual conviction and
conscience that should be respected.
April 2018 MEC 209/Therapeutic Abortion COM REV3/Apr2018
7
3. Circumstances where the interest of a
woman is in conflict with the interests
of her unborn fetus may create a
dilemma as to whether or not the
pregnancy should be deliberately
terminated. The diversity of responses
to such situations is due in part to the
diversity of attitudes towards the life of
the fetus, for various reasons including
cultural, religious and traditional.
Circumstances where the interest of a woman is in conflict
with the interests of her unborn fetus may create a dilemma
raise the question as to whether or not the pregnancy
should be deliberately terminated. The diversity of
responses attitudes to such situations is due in part to the
diversity of attitudes differing views towards the woman´s
autonomy and the life of the fetus, for various reasons
including cultural, religious and traditional. [SwMA]
Circumstances where the interest life of a woman is in
conflict with the interestslife of her unborn fetus may
create a dilemma as to whether or not the pregnancy should
be deliberately terminated. The diversity of responses to
such situations is due in part to the diversity of attitudes
towards the life of the fetus, for various reasons including
cultural, religious and traditional. [AMV]
Circumstances – where the interest in pursuing a
pregnancy which puts the woman’s life at risk of a
woman is in conflict with the interests of her unborn fetus
– may create a dilemma as to whether or not the pregnancy
should be deliberately terminated. The diversity of
responses to such situations is due in part to the diversity of
attitudes towards the life of the fetus, for various reasons
including medical, cultural, religious and traditional.
[CNOM]
A circumstance where the patient may
be harmed by carrying the pregnancy
to term presents a conflict between the
life of the foetus and the health of the
pregnant woman. Diverse responses
to resolve this dilemma situation
reflect the diverse cultural, legal,
traditional, and regional standards of
medical care throughout the world
RECOMMENDATIONS RECOMMENDATIONS
April 2018 MEC 209/Therapeutic Abortion COM REV3/Apr2018
8
4. Doctors should be aware of local
abortion laws, regulations and reporting
requirements. National laws, norms,
standards, and clinical practice related
to abortion should promote and protect
women’s health and their human rights,
voluntary informed consent, and
autonomy in decision-making,
confidentiality and privacy. National
medical associations should advocate
that national health policy upholds these
principles.
Doctors should need to be aware of local abortion laws,
regulations and reporting requirements. National laws,
norms, standards, and clinical practice related to abortion
should must promote and protect women’s health and their
human rights, voluntary informed consent, and autonomy
in decision-making, confidentiality and privacy. National
Mmedical Aassociations should advocate that national
health policy upholds these principles. [SwMA]
Doctors should be aware of local abortion laws, regulations
and reporting requirements. National laws, norms,
standards, and clinical practice should promote and
protect every person’s health related to abortion should
promote and protect women’s health and their human
rights, voluntary informed consent, and autonomy in
decision-making, confidentiality and privacy. National
medical associations should advocate that national health
policy upholds these principles. [AMV]
Doctors Physicians should be aware of local abortion laws,
regulations and reporting requirements. National laws,
norms, standards, and clinical practice related to abortion
should promote and protect women’s health, dignity, and
their human rights, voluntary informed consent, and
autonomy in decision-making, confidentiality and
privacy… [AM]
Doctors should be aware of local abortion laws and ethical
norms, regulations and reporting requirements thereof.
National laws, norms, standards, and clinical practice
related to abortion should promote and protect women’s
health and their human rights, as well as respect voluntary
informed consent, and autonomy in decision-making,
Physicians should be aware of local
termination of pregnancy laws,
regulations and reporting
requirements. National laws, norms,
standards, and clinical practice related
to termination of pregnancy should
promote and protect women’s health,
dignity and their human rights,
voluntary informed consent, and
autonomy in decision-making,
confidentiality and privacy. National
medical associations should advocate
that national health policy upholds
these principles.
April 2018 MEC 209/Therapeutic Abortion COM REV3/Apr2018
9
maintaining medical confidentiality and privacy. National
medical associations should advocate that national health
policy upholds, promotes and complies with these
principles. [CGCM]
Doctors should be aware of local abortion laws, regulations
and reporting requirements relating to medically-
indicated termination. National laws, norms, standards,
and clinical practice related to medically-indicated
termination should promote and protect women’s health
and their human rights, voluntary informed consent, and
autonomy in decision-making, confidentiality and privacy.
… [CNOM]
[Added paragraph:] Women who decide to terminate
pregnancy should not be punished. National Medical
Associations and physicians should speak out against
legislation and practices that are in opposition to this
fundamental right. [It is important that women are not
punished if they decide to terminate pregnancy] [NMA]
5. Where the law allows medically-
indicated abortion to be performed, the
procedure should be performed by a
competent physician or other health
care worker in accordance with
evidence-based medicine principles and
good medical practice in an approved
facility that meets necessary medical
standards
Where the law allows medically-indicated abortion to be
performed, the procedure should be performed by a
competent physician or other health care worker in
accordance with evidence-based medicine principles and
good medical practice in an approved facility that meets
necessary medical standards. [SwMA]
Where the law allows medically-indicated abortion to be
performed, the procedure should be performed by a
competent physician or other health care worker in
accordance with evidence-based medicine principles and
good current medical practice in an approved facility that
Where the law allows medically-
indicated termination of pregnancy to
be performed, the procedure should be
performed by a competent physician
or other health care worker in
accordance with evidence-based
medicine principles and good medical
practice in an approved facility that
meets required medical standards
April 2018 MEC 209/Therapeutic Abortion COM REV3/Apr2018
10
meets necessary medical standards. [AMV]
Where the law allows medically-indicated abortion to be
performed, the procedure should be performed by a
competent physician or other health care worker in
accordance with … [PCPD]
Where the law allows medically-indicated abortion to be
performed, the procedure should be performed by a
competent physician or other health care worker in
accordance with principles of evidence-based medicine
principles and good medical practice in an approved
facility that meets necessary medical standards. [GMA]
Where the law allows medically-indicated abortion to be
performed, the procedure should be performed by a
competent physician or other health care worker in
accordance with evidence-based medicine principles and
good medical practice in an approved facilityappropriate
health centre that meets necessary medical standards.
[CGCM]
Where the law allows medically indicated abortion to be
performed, the procedure should be performed by a
competent physician or other health care worker in
accordance with evidence-based medicine principles and
good medical clinical practice in an approved facility that
meets necessary required medical standards. [AMA]
6. The convictions of both the doctors and
the patient must be respected.
[Delete paragraph] [SwMA]
The convictions of both the doctors and the patient and
physician must be respected. [AM]
The convictions of both the physician
and the patient should be respected
April 2018 MEC 209/Therapeutic Abortion COM REV3/Apr2018
11
The convictions of both the doctors and the patient
mustshould be respected. [BMA]
[See note on para 2.] [BMA]
The convictions and values of both the doctors and the
patient must be respected. [CGCM]
[Delete paragraph; combined with 7] [AMA]
7. Patients with moral convictions must be
supported appropriately and provided
with necessary medical and
psychological treatment.
[Delete paragraph] [SwMA]
Patients with moral convictions must be supported
appropriately and provided with necessary medical and
psychological treatment along with appropriate
counselling and spiritual support if desired. [AM]
Patients with moral convictions must be supported
appropriately and offered provided with necessary medical
and psychological treatment. [BMA]
Patients with moral convictions [Is meant: moral
convictions against abortion?] must be supported
appropriately and provided with necessary medical and
psychological treatment. [RDMA]
Patients with moral convictions conflicts must be
supported appropriately and provided with necessary
medical and psychological treatment. [GMA]
Patients with moral convictions objections against
abortion that need to undergo this treatment must be
supported appropriately and provided with necessarythe
Patients with moral convictions
against medically-indicated abortion
must be supported appropriately and
provided with necessary medical and
psychological treatment along with
appropriate spiritual support if desired
April 2018 MEC 209/Therapeutic Abortion COM REV3/Apr2018
12
appropriate medical and psychological treatment.
[CGCM]
Patients and physicians with moral convictions must be
respected, supported appropriately and provided with
necessary medical and psychological treatments, including
psychological support. [AMA]
Patients with moral convictions must be supported
appropriately and provided with the necessary medical and
psychological treatment. [CNOM]
The doctor must provide pregnant women with
adequate, reliable and complete information on the
evolution of pregnancy and fetal development. It is not
in accordance with medical ethics to deny, hide or
manipulate information to influence the mother’s
decision about the continuity of her pregnancy. [CGCM]
Covered under no.4 voluntary consent
8. Individual doctors have a right to
conscientious objection to providing
abortion, but that right does not entitle
them to impede or deny access to lawful
abortion services because it delays care
for women, putting their health and life
at risk. In such cases, the physician
must refer the woman to a willing and
trained health professional in the same,
or another easily accessible health-care
facility, in accordance with national
law. Where referral is not possible, the
physician who objects, must provide
safe abortion or perform whatever
Individual doctors have a right to conscientious objection
to providing abortion, but that right does not entitle them to
impede or deny Physicians who, for reasons of
conscience, will not perform abortions must never in
any way let their personal convictions interfere with or
delay a woman´s access to lawful abortion services
because it delays care for women, putting their health and
life at risk. In such cases, the physician must without delay
refer the woman to a willing and trained health professional
in the same, or another easily accessible health-care
facility, in accordance with national law. Where referral is
not possible, the physician who objects, must provide safe
abortion or perform whatever procedure is necessary to
save the woman’s life and to prevent serious injury to her
Physicians have a right to
conscientious objection to advising or
performing an abortion; therefore, they
may withdraw while ensuring the
continuity of medical care by a
qualified colleague. In all cases,
doctors physician must perform those
procedures necessary to save the
woman’s life and to prevent serious
injury to her health
April 2018 MEC 209/Therapeutic Abortion COM REV3/Apr2018
13
procedure is necessary to save the
woman’s life and to prevent serious
injury to her health1
.
the woman´s health1
. [SwMA]
Individual doctorsphysicians have a right to conscientious
objection to providing medically-indicated abortion, but
that right does not entitle them to impede or deny access to
lawful medically-indicated abortion services because it
delays care for women, putting their health and life at
risk…Where referral is not possible, the physician who
objects, if capable, must provide safe abortion or perfom
whatever procedure is necessary to save the woman’s life
and to prevent serious injury to her health. [AM]
[Alternative language (1) also proposed for this paragraph,
see the general comments at the top of the document:]
Individual physicians have a right to conscientious
objection to providing medically-indicated abortion, but
that right does not entitle those physicians to impede or
deny access to lawful medically-indicated abortion
services. In such cases, the physician must make the
objection known to their patient and leave her free to
consult another physician or other health professional.
The physician may withdraw while ensuring the
continuity of medical care by a qualified colleague. The
objecting physician may also announce publically the
refusal to participate in abortion, warning women not
to seek abortion services where they are not provided.
[AM]
[Alternative language (2)]: Individual physicians have a
right to conscientious objection to providing
elective abortions while supporting medically indicated
1
Safe abortion: technical and policy guidance for health systems. Second Ed. World Health Organization; 2012
April 2018 MEC 209/Therapeutic Abortion COM REV3/Apr2018
14
indirect abortions to save the life of mother. However,
that right does not entitle those physicians to impede or
deny access to lawful elective abortion services. In such
cases, the physician must make the objection known to
their patient and leave her free to consult another
physician or other health professional. The physician
may withdraw while ensuring the continuity of medical
care by a qualified colleague. The objecting physician
may also announce publically the refusal to participate
in elective abortions, warning women not to seek
abortion services where they are not provided. [AM]
Individual doctors have a right to conscientious objection
to advising or performing an abortion; therefore, they
may withdraw while ensuring the continuity of medical
care by a qualified colleague. In all cases, doctors must
perform those procedures necessary to save the
woman’s life and to prevent serious injury to her health
to providing abortion, but that right does not entitle them to
impede or deny access to lawful abortion services because
it delays care for women, putting their health and life at
risk. In such cases, the physician must refer the woman to a
willing and trained health professional in the same, or
another easily accessible health-care facility, in accordance
with national law. Where referral is not possible, the
physician who objects, must provide safe abortion or
perfom whatever procedure is necessary to save the
woman’s life and to prevent serious injury to her health2
.
[AMV]
… Where [Does this mean that if abortion is necessary to
2
Safe abortion: technical and policy guidance for health systems. Second Ed. World Health Organization; 2012
April 2018 MEC 209/Therapeutic Abortion COM REV3/Apr2018
15
save the woman’s life or health, that in that case the
physician has to perform the abortion nonetheless? If so, it
may be better in that situation not to speak of ‘abortion’,
since the aim is not to terminate the pregnancy, but to save
the woman’s life or to prevent serious injury to her. The
abortion is than a consequence of that procedure. A
proposal to redefine this therefore is: If, in order to save
the woman’s life or to prevent serious injury to her health
(maternal indication), it is necessary to perform a
procedure that results in terminating the pregnancy, the
physician who objects to providing abortion has to perform
this procedure if referral to another physician is not
possible.] … [RDMA]
… In such cases, the physician must refer the woman to a
willing and trained health professional in the same, or
another easily accessible health-care facility, in accordance
with national law. Where referral is not possible, tThe
physician who objects, must may not refuse to provide
medical care, including to provide safe abortion or
perform whatever procedure is necessary, only when a
delay would result in posing danger to life or serious
harm to save the woman’s life and to prevent serious
injury to her health3
. [PCPD]
[Alternatively, the second sentence of point 8 may be
amended as follows:] … In such cases, the physician
should inform in due time the patient as well as the
physician’s employer of the objection to perform
abortion,must refer the woman to a willing and trained
health professional in the same, or another easily accessible
3
Safe abortion: technical and policy guidance for health systems. Second Ed. World Health Organization; 2012
April 2018 MEC 209/Therapeutic Abortion COM REV3/Apr2018
16
health-care facility, in accordance with national law…
[PCPD]
Individual doctors have a right to conscientious objection
to providing abortion, [If the abortion is a medical
necessity, then physician should provide that service, so
there should be no right to refuse in this case] … [TuMA]
Individual doctors have a right to conscientious objection
to providing abortion, but that right does not entitle them
tothey may not under any circumstances impede or deny
access to lawful abortion services because it delays care for
women, putting their health and life at risk. [Second and
third sentences of this paragraph deleted and replaced by:]
If the physician’s convictions do not allow him or her to
advise or perform an abortion, he or she may withdraw
while ensuring the continuity of medical care by a
qualified colleague. [CMA: The CMA does not support
mandatory referral, as recommended in this draft. We are
unaware of any empirical evidence that such an approach
is required in order to ensure equitable access to care.
However, many physicians will see the obligation to refer
to a willing provider as being morally equivalent to the act
of performing the procedure itself.]
Individual doctors have a right to conscientious objection
to providing regarding abortion, but that right does not
entitle them to impede or deny access to lawful abortion
serviceshealthcare services and professionals equipped
to carry out the legal abortion because it delays care for
women, putting their health and life at risk. … Where
referral is not possible, the objecting physician who
objects, must provide safe abortion or perfom whatever
April 2018 MEC 209/Therapeutic Abortion COM REV3/Apr2018
17
procedure is necessary to save the woman’s life and to
prevent serious injury to her health4
. [CGCM]
[Delete paragraph and replace by:] Neither physician or
hospital personnel shall be required to perform any act
that violates personally held moral principles. In
general, physicians should refer a patient to another
physician or institution to provide treatment the
physician declines to offer. [AMA]
… In such cases, the physician must should refer the
woman … [IsMA]
Individual doctors have a right to conscientious objection
to providing abortion, but that right does not entitle them to
impede or deny access to medically-indicated
termination lawful abortion services because it delays care
for women, putting their health and life at risk. In such
cases, the physician must refer the woman to a willing and
trained health professional in the same, or another easily
accessible health-care facility, in accordance with national
law. Where referral is not possible, the physician who
objects, must provide safe abortion or perfom whatever
procedure is necessary to save the woman’s life and to
prevent serious injury to her health5
. [Comment about this
last sentence: This is not the case in France: French
Medical Ethics Code: Article 18 (article R.4127-18 of the
CSP): A doctor may only perform a voluntary termination
of pregnancy in accordance with the law. He is always free
to refuse to do so and, if so, must inform the person
4
Safe abortion: technical and policy guidance for health systems. Second Ed. World Health Organization; 2012
5
Safe abortion: technical and policy guidance for health systems. Second Ed. World Health Organization; 2012
April 2018 MEC 209/Therapeutic Abortion COM REV3/Apr2018
18
concerned of his decision in accordance with the law and
within the timeframe required by law.] [CNOM]
9. Physicians must work with society to
seek to ensure that no woman loses her
life because therapeutic abortion
services are unavailable, even in
extreme circumstances.
Physicians must work with society to seek to ensure that
no woman loses her life suffers harm because therapeutic
abortion services are unavailable, even in extreme
circumstances. [SwMA]
Physicians must work with society to seek to ensure that no
woman loses her life because therapeutic medically-
indicated abortion and pregnancy services are
unavailable, even in extreme circumstances. [AM]
Physicians must work with society to seek to ensure that no
woman loses her life because therapeutic abortion services
no person loses his/her life because healthcare centers
are unavailable, even in extreme circumstances. [AMV]
Physicians must work with society to seek to ensure that no
woman loses her life because therapeutic medically-
indicated abortion services are unavailable, even in
extreme circumstances. [RDMA, FMA, CGCM, DMA]
[Delete paragraph] [PCPD]
Physicians must work with the relevant institutions and
authoritiessociety to seek to ensure that no woman loses
her life because therapeutic medically-indicated abortion
services are unavailable, even in extreme circumstances.
[GMA]
Physicians must work with society to seek to ensure that no
woman loses her life because therapeutic medically
Physicians must work with relevant
institutions and authorities to ensure
that no woman is harmed because
medically-indicated termination of
pregnancy services are unavailable.
April 2018 MEC 209/Therapeutic Abortion COM REV3/Apr2018
19
indicated abortion services are unavailable, even in
extreme circumstances. [AMA]
[Added paragraph:] Public health systems must develop
medical care systems that enable medically-indicated
abortion in order to avoid putting the pregnant
woman’s health at risk in cases where this treatment is
indicated. [CGCM]
Covered above
[Added paragraph:] In all his/her actions the doctor is
obliged to safeguard the dignity and integrity of the
women under his/her care. [CGCM]
Covered in number 4
§§§
08.03.2018

1
THE WORLD MEDICAL ASSOCIATION, INC.
Document
no:
MEC 209/Ethics of Telemedicine COM REV/Apr2018 Original:
English
Title: Proposed revision of WMA Statement on the Ethics of Telemedicine
Destination
:
Medical Ethics Committee
209th
Council Session
Radisson Blu Latvija Hotel
Riga, Latvia
26-28 April 2018
Action(s)
required:
For
Consideration
Note: As part of the annual policy review process, the Council in Livingstone (April 2017) decided that the
WMA Statement on the Ethics of Telemedicine should undergo a major revision. The South African
Medical Association (SAMA) volunteered to undertake that work. The 207th Council session in
Chicago (October 2017) considered the proposal and decided to circulate it within WMA
membership for comments.
Related
WMA
statements
• WMA Statement on Guiding Principles for the Use of Telehealth for the Provision of Health Care. Adopted by
the 60th
WMA General Assembly, New Delhi, India, October 2009
• WMA Statement on Mobile Health Adopted by the 66th
WMA General Assembly, Moscow, Russia, October 2015
Abbreviation key:
AM Associate Members
AMA American Medical Association
March 2018 MEC 209/Ethics of Telemedicine COM REV/Apr2018
2
AMV Associazione Medica del Vaticano
BMA British Medical Association
CGCM Consejo General de Colegios Médicos de Espana
CMA Canadian Medical Association
CNOM Conseil National de l’Ordre des Médecins, France
DMA Danish Medical Association
FMA Finnish Medical Association
IsMA Israel Medical Association
KMA Korean Medical Association
NMA Norwegian Medical Association
NZMA New Zealand Medical Association
RDMA Royal Dutch Medical Association
SAMA South African Medical Association
SwMA Swedish Medical Association
GENERAL COMMENTS
BMA It could be helpful if the document specified more clearly what kind of doctor-patient interaction it covers, for example does it include the
range of phone apps for video consultations? If so, the document arguably limits the potential scope of circumstances in which teleservices
services could be beneficial to patients and the wider health system. [Comments on specific paragraphs below]
CNOM The CNOM (French Medical Council) supports this proposal and thanks the SAMA for its excellent work
DMA The DMA supports this very relevant statement. We have two specific suggestions: Firstly, in section 4.1 – at the very end of that section –
we would suggest adding the phrase “and increase social inequality on medicine”. So that it read: “Telemedicine technologies could be
unaffordable to patients and hence impede access and increase social inequality on medicine. Secondly, in section 7 – we would like to add
“patient competencies”. So that it reads: Telemedicine should be tailor-made to patient competencies and local contexts, including
regulatory frameworks. [Note: those comments have been added in the table below]
FMA FMA thanks SAMA for the draft revision of this statement. We understand that countries are in different stages in utilizing telemedicine.
However, we see that the use of telemedicine will increase in the future and it will provide viable and cost-effective options in patient care.
Therefore, we propose some minor amendments to the text that would recognize this gradual change in health care practices.
KMA Regarding the liability of physicians, it is not realistic to impose the duty of confirming the use of telecommunication system and necessary
instruments for telemedicine application by a patient, a medical expert, or family members caring for the patient on physicians since it is
not their field of expertise. Therefore, it is necessary to amend the contents.
NMA The Norwegian Medical Association supports this document with one amendment in item 4.1.
NZMA We are generally supportive of the content in this revised statement and have no specific amendments. However, we note that the statement
does not address consultations across jurisdictions. We believe it would be useful for the next iteration to attempt to address the
March 2018 MEC 209/Ethics of Telemedicine COM REV/Apr2018
3
complexities and potential pitfalls of the long-distance provision of health care and advice when patient and doctor are in different
countries.
RDMA Preliminary question:
The RDMA does not see ANY changes in this Statement compared to the one that is adopted in 2007 and available on the WMA-website.
It seems to be exactly the same. Is this the right version?
General comment:
This statement does not differentiate between 1) the situation that telemedicine is the one and only possible practice of medicine in a
certain case, and 2) the situation that telemedicine is a choice/preference of the physician, whereas a face-to-face is still possible /
available. This makes the Statement unclear with regard to wat CAN be done and what SHOULD be done.
SwMA We would like to suggest adding a reference to related WMA policies in the preamble (WMA Statement on mobile health, WMA
Statement on guiding principles for the use of telehealth for the provision of health care).
Regarding terminology, we are a bit unsure if telemedicine is the best and most up-to-date term. If not, perhaps it could be substituted for
“digital medicine”, “tele- and digital techniques in health care” or something similar?
Numbering will be deleted (or adjusted) when the revised text is adopted.
No Proposed Text:
MEC 207/Ethics of
Telemedicine/Oct2017
Specific Comments
Additions: bold/underlined
Deletions: lined-out
Comments only: [italic]
Proposed Revised Text by:
Rapporteur
MEC 209/Ethics of Telemedicine REV/Apr2018
Title WMA Statement on the Ethics of
Telemedicine
WMA Statement on the Ethics of Telemedicine
DEFINITION DEFINITION
1. Telemedicine is the practice of medicine
over a distance, in which interventions,
diagnostic and treatment decisions and
recommendations are based on data,
documents and other information
transmitted through telecommunication
systems.
Telemedicine is the practice of medicine over a distance
and a new patient – physician relation instrument, in
which interventions, diagnostic and treatment
interventionsdecisions and medical recommendations are
based on data, documents and other information
transmitted through telecommunication systems such as
the internet, information networks, mobile telephones,
social media or other media not requiring a personal
presence of a similar nature as telemedicine refers to
both the transfer of data between the physician and
Telemedicine is the practice of medicine over a
distance, in which interventions, diagnoses,
therapeutic decisions, and subsequent treatment
recommendations are based on patient data,
documents and other information transmitted
through telecommunication systems.
Telemedicine can take place between a physician
and a patient or between two or more physicians
including other healthcare professionals.
March 2018 MEC 209/Ethics of Telemedicine COM REV/Apr2018
4
the patient and the transfer of data between
physicians. [CGCM]
Telemedicine is the practice of medicine over a distance,
in which interventions, diagnoses,tic and treatment
therapeutic decisions, and subsequent treatment
recommendations are based on patient data, documents
and other information transmitted through
telecommunication systems. [AMA]
PREAMBLE PREAMBLE
2. The development and implementation of
information and communication
technology are creating new modalities
for providing care for patients. These
enabling tools offer different ways of
practising medicine. The adoption of
telemedicine is justified because of its
speed, and its capacity to reach patients
with limited access to medical
assistance, in addition to its power to
improve health care.
[WE SUGGEST ANOTHER PARAGRAPH HERE:] The
face to face clinical encounter is the paradigm for good
Medicine. Doctors will try to protect this important
aspect of the patient-doctor relationship. [AMV]
[Added text:]… It is used for patients who cannot see an
appropriate physician because of inaccessibility due to
distance, physical disability, employment, family
commitments (including caring for others), cost, and
physician schedules. [AM]
The development and implementation of information and
communication technology are creating new modalities
for providing care for patients. These new methods of
communication with enabling tools that provide new
offer different ways of practising medicine. The adoption
of telemedicine and other telematic media is justified
because of its speed, and its capacity to reachcontact
patients with limited access to medical assistance, in
addition to its power to improvethe possibility of
improving health care. [CGCM]
The development and implementation of information and
communication technology are creating new ways
The development and implementation of
information and communication technology are
creating new and different ways for of practicing
medicine. Telemedicine is used for patients who
cannot see an appropriate physician timeously
because of inaccessibility due to distance, physical
disability, employment, family commitments
(including caring for others), patients’ cost and
physician schedules. It has capacity to reach
patients with limited access to medical assistance
and have potential to improve health care.
March 2018 MEC 209/Ethics of Telemedicine COM REV/Apr2018
5
modalities for providing patient care. care for patients.
These enabling tools This continuum of technologies
offers new and different ways of practising medicine.
The adoption of telemedicine is justified should be
encouraged because of its speed, and its capacity to
reach patients with limited access to medical assistance,
Telemedicine has the potential to in addition to its
power to improve health care. [AMA]
New Face-to -face consultation between physician and
patient remains the gold standard of clinical care.
Telemedicine may hinder the ability of a physician
to physically examine and may result in
unintended harm.
NEW The delivery of telemedicine services must be
consistent with in-person services and supported
by evidence.
New [Added paragraph:] Telemedicine is not only a patient –
physician communication tool but also a patient –
physician relationship tool, therefore distance
medicine is a medical action with the same ethical
considerations and demands as a medical action in
person. [CGCM]
The principles of medical ethics that are
mandatory for the profession must also be
respected in the practice of telemedicine
[Added paragraph:]. [CGCM] (Combined the two new added paragraphs)
3. Physicians must respect the following
ethical guidelines when practising
telemedicine.
Physicians must respect the following ethical guidelines
when practisingpracticing telemedicine. [RDMA]
.
PRINCIPLES PRINCIPLES
4. Patient-physician Relationship and
Confidentiality
Physicians must respect the following ethical
guidelines when practising telemedicine.
4.1 The patient-physician relationship must
be based on a personal encounter and
The patient-physician relationship must should ideally be
based on a personal encounter and sufficient knowledge of
The patient-physician relationship must be based
on a prior personal examination and sufficient
March 2018 MEC 209/Ethics of Telemedicine COM REV/Apr2018
6
sufficient knowledge of the patient’s
personal history. Telemedicine should be
employed primarily in situations in which
a physician cannot be physically present
within a safe and acceptable time period.
Physicians must be aware that certain
telemedicine technologies could be
unaffordable to patients and hence
impede access.
the patient’s personal history. [SwMA]
… Physicians must be aware that not all patients are
data literate and that certain telemedicine technologies
could be unaffordable to patients and hence impede
access. [NMA]
[Not all patients have the competence to handle the
technology needed for performing telemedicine] [NMA]
4.1 The patient-physician relationship must be based on a
personal encounter and sufficient knowledge of the
patient’s personal history. Telemedicine must assure
that the elements of this personal encounter include
the ability to interview, examine, and test, in an
appropriately comprehensive manner. It should also
provide for the diagnosis and treatment of the
identified medical condition. [AM]
4.2 Telemedicine should be employed primarily in
situations in which an appropriate physician cannot be
physically presentavailable within a safe and acceptable
time period. Physicians must be aware that certain
telemedicine technologies could be unaffordable to
patients and hence impede access. [AM]
… Physicians must be aware that certain telemedicine
technologies could be unaffordable to patients and hence
impede access and increase social inequality on
medicine. [DMA]
The patient-physician relationship must be based on a
personal encounter and sufficient knowledge of the
patient’s personal history. [Why is that necessary? What
in case this personal encounter has not yet taken place? I
would say: is preferably based on a former personal
knowledge of the patient’s medical history.
Telemedicine should be employed primarily in
situations in which a physician cannot be
physically present within a safe and acceptable
time period. It could also be used in management
of chronic conditions or follow-up after initial
treatment where it has been proven to be safe and
effective.
March 2018 MEC 209/Ethics of Telemedicine COM REV/Apr2018
7
encounter] … [RDMA]
… Telemedicine should be employed primarily in
situations in which a physician cannot be physically
present within a safe and acceptable time period… [This
statement does not take account of the other
circumstances in which telemedicine could be beneficial.
For example, the long-term management of specific
conditions where a face to face consultation would not be
necessary or where attending for an appointment in
person may be difficult for a patient because of reduced
mobility.] [BMA]
… Telemedicine should be employed primarilycan be
employed in increasing number of situations, although
in many settings it is primarily used in situations in
which a physician cannot be physically present within a
safe and acceptable time period … [FMA]
The patient-physician relationship must be based on a
personal encounter a previous examination and sufficient
knowledge of the patient’s medical records personal
history. Telemedicine should be employed primarily
above all in situations in which a physician cannot be
physically present within a safe and acceptable time
period. Physicians and medical institutions must be
aware that certain telemedicine technologies could be
unaffordable to patients and hence impede access
inaccessible and therefore ineffective for certain
patients. [CGCM]
The patient-physician relationship must be based on an
personal encounter established through a prior in-
personal relationship that provides and sufficient
knowledge of the patient’s personal history …[AMA]
(Evidence-based)
March 2018 MEC 209/Ethics of Telemedicine COM REV/Apr2018
8
…. Physicians must be aware that certain telemedicine
technologies can generate too important costs for could
be unaffordable to patients and hence impede access.
[CNOM]
4.2 The patient-physician relationship must
be based on mutual trust and respect. It
is therefore essential that the physician
and patient be able to identify each other
reliably when telemedicine is employed.
The patient-physician relationship must be based on
mutual trust and respect. It is therefore essential that the
physician and patient be able to identify each other
reliably when telemedicine is employed. [Added text]
This should be governed by the same ethical principles
that regulate the practise of face-to-face medicine, with
the defense of patient rights as well as due respect for
healthcare professionals being guaranteed and in the
event that the practice of telemedicine refers to a
medical team, there must be a physician identified as
responsible for the distance medical care. [CGCM]
The patient-physician relationship must be based
on mutual trust and respect. It is therefore essential
that the physician and patient be able to identify
each other reliably when telemedicine is
employed. In case of consultation between two or
more professionals within or between different
jurisdictions, the primary physician remains
responsible for the care and coordination of the
patient with the distant medical team.
[Added paragraph:] The use of telemedicine should
always be preceded by the express consent of the
patient, or, in the case of relatives or close friends with
the prior identification of all the persons involved.
[CGCM]
(Consent has been addressed elsewhere)
New [Added paragraph:] In the practice of telemedicine, it is
essential to preserve patient confidentiality and
privacy. For this, the physician providing telemedicine
services must adopt the appropriate technical and
management measures to preserve the security of their
services and patient rights. These measures must
guarantee an appropriate level of the existing risk, in
addition to the strictest protection of patient data and
compliance with legal regulations on this matter. In
any case, the use of telemedicine should guarantee the
patient the same levels of protection as face-to-face
medicine. [CGCM]
(Covered in 4.4)
March 2018 MEC 209/Ethics of Telemedicine COM REV/Apr2018
9
[Added paragraph:] The physician will exercise caution
to maintain his attitude and image in the use of new
social media, especially on the internet and social
networks, with language that is appropriate in form
and content.
[CGCM]
(This topic could be appropriately tended to
under social media)
[Added paragraph:] When telemedicine is implemented
by the patient or by their relatives or close friends,
they will always be attended and supervised by the
physician responsible for their care.
[CGCM]
4.3 Ideally, telemedicine should be
employed only in cases in which a prior
in-person relationship exists between the
patient and the physician involved in
arranging or providing the telemedicine
service.
IdeallyOriginally, telemedicine should beideally was
employed only in cases in which a prior in-person
relationship existsexisted between the patient and the
physician involved in arranging or providing the
telemedicine service. With changes in technology, this
requirement is less necessary. [AM]
[This will depend on the needs of a patient, there are some
interactions for which there is no specific need for a prior
in-person relationship to exist or where a patient may
prefer greater anonymity, without this engaging ethical
issues.] [BMA]
Ideally,In many cases the use of telemedicine should be
employed only in cases in whichbenefits from a prior in-
person relationship exists between the patient and the
physician involved in arranging or providing the
telemedicine service. [FMA]
… [Added text:] In emergencies, the use of telemedicine
is ethically acceptable. [CGCM]
[Delete paragraph; this is now in the first paragraph of
(Remove, this issue has been discussed earlier
in the statement)
March 2018 MEC 209/Ethics of Telemedicine COM REV/Apr2018
10
this section] [AMA]
Ideally, but not necessarily, telemedicine should be
employed only in cases in which … [CNOM]
4.4 The physician must aim to ensure that
patient confidentiality and data integrity
are not compromised. Data obtained
during a telemedical consultation must
be secured through encryption and other
security precautions must be taken to
prevent access by unauthorized persons.
The physician must aim to ensure that patient
confidentiality and data integrity are not compromised.
Data obtained during a telemedical consultation must be
secured through encryption and other security precautions
must be taken to prevent access by unauthorized persons
unauthorized access and breaches of identifiable
patient data. [AM]
[Delete paragraph and replace by:] The physician and
the health institutions where the medicine is practised
must take extreme measures to ensure patient
confidentiality, secrecy and safety, with special
attention to the privacy configuration of the telematic
media and encryption of files, personal access codes
and security measures of a similar nature. [CGCM]
… Data obtained during a telemedical consultation must
be secured through encryption and other appropriate
security protocolssecurity precautions must be taken to
prevent access by unauthorized persons. [AMA]
The physician must aim to ensure that patient
confidentiality of the information exchanged during
the consultation and data integrity are not compromised.
[CNOM]
The physician must aim to ensure that patient
confidentiality, privacy and data integrity are not
compromised. Data obtained during a
telemedicine consultation must be secured to
prevent unauthorized access and breaches of
identifiable patient information through
appropriate and up to date security measures in
accordance with local legislation. Electronic
transmission of information must also be
safeguarded against unauthorized access.
4.5 [Added paragraph:] The physician who practices
telemedicine must always consider the principle of
patient autonomy and have their informed consent.
[CGCM]
Proper informed consent requires that all
necessary information regarding the distinctive
features of telemedicine visit be explained fully to
patients including, but not limited to:
March 2018 MEC 209/Ethics of Telemedicine COM REV/Apr2018
11
• explaining how telemedicine works,
• how to schedule appointments,
• privacy concerns,
• the possibility of technological failure
including confidentiality breaches,
• protocols for contact during virtual visits,
• prescribing policies, and
• coordinating care with other health
professionals in a clear and understandable
manner, without influencing the patient’s
choices.
[Added paragraph:] When patient information is
transmitted by telecommunication systems between
physicians, the principles of confidentiality and
medical secrecy in face-to-face patient-physician
relationships must be maintained. [CGCM]
Addressed elsewhere
Physicians must be aware that certain telemedicine
technologies could be unaffordable to patients and
hence impede access. Inequitable access to
telemedicine can further widen the health
outcomes gap between the poor and the rich.
New 5 5. Autonomy of the Physician
5.1 A physician is not obligated to provide
treatment or counseling via telemedicine.
5.2 Telemedicine can potentially infringe on the
physician’s autonomy owing to 24/7 virtual
availability. The physician’s autonomy must take
into consideration the limitations of the
physician’s ability to advise; provide care
remotely; availability and the extent of his or her
5. Autonomy and privacy of the Physician
5.1 A physician should not to participate in
telemedicine if it violates the legal or ethical
framework of the country.
5.2 Telemedicine can potentially infringe on the
physician privacy due to 24/7 virtual availability.
The physician need to inform patients about
availability and recommend services such as
emergency when inaccessible.
5.3 The physician should exercise their
March 2018 MEC 209/Ethics of Telemedicine COM REV/Apr2018
12
referrals.
5.3 The physician will exercise discretion
regarding whether cases brought for consultation
are appropriate for telemedicine. In this context,
the physician should consider the degree of prior
acquaintance with the patient and his or her
medical history. In certain cases, the physician
may choose to refer the patient to in-person
medical treatment.
5.4 A physician may discontinue treatment via
telemedicine, at his or her discretion, if he/she
believes that the treatment or remote consultation
harms the quality of care provided to the patient.
[IsMA]
professional autonomy in deciding whether a
telemedicine versus face-to-face consultation is
appropriate.
5.4 A physicians should exercise autonomy and
discretion in selecting the telemedicine platform
to be used
(new 6) Responsibilities of the Physician 6. Responsibilities of the Physician
5.1
(start
6.1)
A physician whose advice is sought
through the use of telemedicine should
keep a detailed record of the advice
he/she delivers as well as the
information he/she received and on
which the advice was based.
A physician whose advice is sought through the use of
telemedicine shouldmust keep a detailed record of the
advice he/she delivers as well as the information he/she
received and on which the advice was based. [SwMA]
A physician whose advice is sought through the use of
telemedicine systems should keep a detailed record of the
advice he/she delivers as well as the information he/she
received and on which the advice was based. [CGCM]
A physician whose advice is sought through the use of
telemedicine should keep a detailed record of the advice
he/she delivers as well as the information he/she received
and on which the advice was based in order to ensure
traceability. [CNOM]
A physician whose advice is sought through the
use of telemedicine should keep a detailed record
of the advice he/she delivers as well as the
information he/she received and on which the
advice was based in order to ensure traceability.
March 2018 MEC 209/Ethics of Telemedicine COM REV/Apr2018
13
5.2 It is the obligation of the physician to
ensure that the patient and the health
professionals or family members caring
for the patient are able to use the
necessary telecommunication system
and necessary instruments. The
physician must seek to ensure that the
patient has understood the advice and
treatment suggestions given and that the
continuity of care is guaranteed.
It is the obligation ofThe physician need to ensure that
the patient and the health professionals or family
members caring for the patient are able to use the
necessary telecommunication system and necessary
instruments… [SwMA]
… The physician, as in any other patient-physician
encounter, must seek to ensure that the patient has
understood the advice and treatment suggestions given
and that the continuity of care is guaranteed. [AM]
It is the obligation of the physician to ensure [Only in case
that this patient is his/her responsibility and that the
physician exclusively is reachable trough
telecommunication.
Part from that: what does this obligation actually mean?
It seems unreasonable and impossible that the physician
has to buy / provide for the telecommunication system and
necessary instruments for the patient.] … [RDMA]
… The physician must seek to ensure that the patient has
understood the advice and treatment suggestions given
and that the continuity of healthcare is guaranteed.
[CGCM]
… The physician must seek to ensure that the patient has
understood the advice and treatment suggestions given
and take steps to promote continuity of care. that the
continuity of care is guaranteed. [AMA]
If a decision is made to use telemedicine it is
necessary to ensure that the users (patients and
healthcare professionals) are able to use the
necessary telecommunication system.
The physician must seek to ensure that the patient
has understood the advice and treatment
suggestions given and take steps in so far as
possible to promote continuity of care.
[Added paragraph:] The physician must always inform
the patient of the risks of telemedicine services
regarding the security of their data, their privacy and
the measures adopted to protect them. He/She will
also inform the patient about the data stored in his/her
March 2018 MEC 209/Ethics of Telemedicine COM REV/Apr2018
14
medical records and the security measures for
protection and custody thereof. Likewise, the
circumstances and deadlines for deleting this data
must be foreseen. [CGCM]
5.3 The physician asking for another
physician’s advice or second opinion
remains responsible for treatment and
other decisions and recommendations
given to the patient.
[Delete paragraph] [SwMA]
… [Added text:] If the second opinion is requested of
another physician through a telecommunications
system, the privacy and confidentiality of the patient’s
clinical and personal details should also be
safeguarded in this system. [CGCM]
The physician asking for another physician’s
advice or second opinion remains responsible
for treatment and other decisions and
recommendations given to the patient.
[Added paragraph:] The physician must adopt
measures to prevent unauthorised access to
communications in telemedicine in order to protect
confidentiality and contents. [CGCM]
(Covered elsewhere)
5.4 A physician should be aware of and
respect the special difficulties and
uncertainties that may arise when he/she
is in contact with the patient through
means of tele-communication. A
physician must be prepared to
recommend direct patient-doctor contact
when he/she feels that the situation calls
for it.
A The physician should be aware of and respect the
special difficulties and uncertainties that may arise when
he/she is in contact with the patient through means of
tele-communication. A The physician must be prepared
to recommend direct patient-doctor contact when he/she
feels that the situation calls for it. [SwMA]
… A physician must be prepared to recommend direct
patient-doctor contact when he/she feels that the situation
calls for itappropriate and necessary. [AM]
A physician should be aware of and respect the special
difficulties and uncertainties that may arise when using
telemedicine technologies. he/she is in contact with the
patient through means of tele-communication. A
physician must be prepared to recommend direct patient-
doctor contact when he/she believes it is in the patient’s
The physician should be aware of and respect the
special difficulties and uncertainties that may arise
when he/she is in contact with the patient through
means of tele-communication. A physician must
be prepared to recommend direct patient-doctor
contact when he/she believes it is in the patient’s
best interests
March 2018 MEC 209/Ethics of Telemedicine COM REV/Apr2018
15
best interests. feels that the situation calls for it. [AMA]
[Added paragraph]: The physician must make sure
that they are aware of, and meet, any relevant
licensing requirements that may exist under the
circumstances. This might include those in the
jurisdiction where the physician is located, as well as
the jurisdiction where the patient is located. [CMA]
Physicians should only practise telemedicine
in countries/jurisdictions where they are
licenced to practise. Cross-jurisdiction
consultations should only be allowed between
two physicians.
Physicians should ensure that their medical
indemnity cover include cover for
telemedicine.
6. (new
7)
Quality of Care 6. Quality of Care
6.1
(start
7.1)
Quality assessment measures must be
used regularly to ensure the best
possible diagnostic and treatment
practices in telemedicine.
QualityHealthcare quality assessment measures must be
used regularly to ensure patient security and the best
possible diagnostic and treatment practices induring
telemedicine procedures. Quality must be the
cornerstone of communications in telemedicine.
Information regarding professional practice should
always be clear and understandable and should be
disseminated respecting the deontological principles
that should prevail in all areas.
[CGCM]
… [Added text]: The delivery of telemedicine services
must follow evidence-based practice guidelines to the
degree they are available, to ensure patient safety,
quality of care and positive health outcomes. [AMA]
Healthcare quality assessment measures must be
used regularly to ensure patient security and the
best possible diagnostic and treatment practices
during telemedicine procedures. The delivery of
telemedicine services must follow evidence-based
practice guidelines to the degree they are
available, to ensure patient safety, quality of care
and positive health outcomes. Like all health care
interventions, telemedicine must be tested for its
effectiveness, efficiency, safety, feasibility and
cost-effectiveness.
6.2 The possibilities and weaknesses of
telemedicine in emergencies must be
acknowledged. If it is necessary to use
telemedicine in an emergency situation,
the advice and treatment suggestions are
… If it is necessary to use telemedicine in an emergency
situation, the advice and treatment suggestions are
influenced by the level of threat toseverity of the patient´s
medical condition and the know-how and capacity of the
persons who are with the patient. [SwMA]
The possibilities and weaknesses of telemedicine
in emergencies must be duly identified. If it is
necessary to use telemedicine in an emergency
situation, the advice and treatment suggestions are
influenced by the severity of the patient´s medical
March 2018 MEC 209/Ethics of Telemedicine COM REV/Apr2018
16
influenced by the level of threat to the
patient and the know-how and capacity
of the persons who are with the patient
… are influenced by the level of threat to the patient and
the know-how and capacity of the persons who are with
the patient. [What does this mean for the physician’s
responsibility?] [RDMA]
The possibilities and weaknesses of telemedicine in
emergencies must be duly identifiedacknowledged. If it is
necessary to use telemedicine in an emergency situation,
the advice and treatment suggestions must be
proportional. are influenced by the level of threat to the
patient and the know-how and capacity of the persons
who are with the patient They will be adapted both to
the patient’s level of vital risk and to the knowledge
and healthcare capabilities of the people with the
patient. [CGCM]
… If it is necessary to use telemedicine in an emergency
situation, the advice and treatment suggestions are
influenced by the level of threat to the patient and the
competencies know-how and capacity of the persons who
are with the patient. [Added text]: Entities that deliver
telemedicine services must establish protocols for
referrals for emergency services. [AMA]
condition and the competency of the persons who
are with the patient. Entities that deliver
telemedicine services must establish protocols for
referrals for emergency services.
RECOMMENDATION RECOMMENDATIONS [AMA] RECOMMENDATIONS
7. Telemedicine should be tailor-made to
local contexts including regulatory
frameworks.
Telemedicine should be tailor-made appropriately
adapted to local contexts including regulatory
frameworks. [SwMA]
[Added paragraph:] Physicians and other health care
professionals should be involved in the development of
telemedicine tools, to ensure usability and that the
tools meet health care needs. Physicians and other
health care professionals should also receive sufficient
education to ensure appropriate and efficient use of
Telemedicine should be appropriately adapted to
local regulatory frameworks, which may include
licencing of telemedicine platforms in the best
interest of patients.
March 2018 MEC 209/Ethics of Telemedicine COM REV/Apr2018
17
telemedicine tools. [SwMA]
[Delete paragraph and replace by:] Telemedicine should
accommodate local cultures and traditions with
international, national and regional regulatory
controls to assure standards of quality medical care.
[AM]
Telemedicine should be tailor-made to patient
competencies and local contexts, including regulatory
frameworks. [DMA]
Telemedicine should be tailor-made to local contexts
includingand should include regulatory frameworks.
[CGCM]
[This paragraph with the following changes should be the
third item (currently numbered 9.) of the section
“RECOMMENDATIONS”; see below about the next
items:] Telemedicine should adhere be tailor-made to
local medical practice laws and contexts including
regulatory frameworks. [AMA]
[Added paragraph]: NMAs will guarantee disciplinary
procedures against physicians who violate the ethical
and deontological norms of the place where they
exercise remote, electronic communications regardless
of the place and country in which the patient with
whom they are related is located. [CGCM]
8. The WMA and National Medical
Associations should encourage the
development of national legislation and
international agreements on subjects
related to the practice of telemedicine.
The WMA and National Medical Associations should
encourage the development of national legislation and
international agreements on subjects related to the practice
of telemedicine., while protecting the patient-physician
relationship, confidentiality, and quality of medical
care. [AM]
Where appropriate the WMA and National
Medical Associations should encourage the
development of ethical norms, practice guidelines,
national legislation and international agreements
on subjects related to the practice of telemedicine,
while protecting the patient-physician relationship,
March 2018 MEC 209/Ethics of Telemedicine COM REV/Apr2018
18
Where appropriate, Tthe WMA and National Medical
Associations should encourage the development of
national legislation and international agreements on
subjects related to the practice of telemedicine. [FMA]
[FMA notes that separate legislation for the practice of
telemedicine is not always necessary since it is covered by
general legislation on practice of medicine.]
[This paragraph with the following changes should be the
fourth item (currently numbered 10.) of the section
“RECOMMENDATIONS”; see below about the next
items:] The WMA and National Medical Associations
should encourage the development of national legislation,
practice guidelines, and international agreements on
subjects related to the practice of telemedicine. [AMA]
confidentiality, and quality of medical care.
[Added paragraph:] National Medical Associations
should urge prevention of outside agencies limiting
patient and physician choice of the specific technology
utilized, as long as it complies with national and
regional regulation and law. [AM]
9. Similar to all other medical practices,
telemedicine must be backed up by
evidence.
[Delete paragraph] [SwMA]
[This paragraph with the following changes should be the
fifth item (currently numbered 11.) of the section
“RECOMMENDATIONS”; see below about the next
items:] The delivery of telemedicine services must be
consistent with in-person services and Similar to all
other medical practices, telemedicine must be backed up
supported by evidence. [AMA]
(Move it into pre-amble and
recommendations)
10. Telemedicine must not be viewed as a
cost-effective substitute for face-to-face
healthcare.
Telemedicine mustshould not be viewed as a cost-
effective substitute forequal to face-to-face healthcare
and should not be introduced solely to cut costs.
Telemedicine should not be viewed as equal to
face-to-face healthcare and should not be
introduced solely to cut costs or as a perverse
March 2018 MEC 209/Ethics of Telemedicine COM REV/Apr2018
19
[SwMA]
1. [Delete paragraph and replace by:] While
physicians and supporting institutions need adequate
compensation, telemedicine should not be used as an
intentional way to increase earnings and thereby
increase cost to the medical system. [AM]
[This statement presumably seeks to protect against
inappropriate substitutions of telemedicine for face-to-
face healthcare on cost grounds alone. As currently
drafted however, it could also be interpreted as ruling out
switching the method of delivery where it might be cost-
effective and either have no substantive impact on the
quality of care offered or be beneficial to the patient.]
[BMA]
Telemedicine must not be viewed ascan be a cost-
effective substituteoption but it must not hinder
patient’s access tofor face-to-face healthcare where
needed. [FMA]
Telemedicine must not be viewed solely as a cost-
effective substitute for face-to-face healthcare. [CGCM,
AMA]
[This paragraph with the above change should be the
sixth item (currently numbered 12.) of the section
“RECOMMENDATIONS”; see below about the next
items]
[Added text:] In addition to enabling immediate access
to certain patients, it makes it possible to cut waiting
times for healthcare. [CGCM]
incentive to over-service and increase earnings for
doctors.
[Added paragraph:] Physician relationships and
collegiality depend upon educational changes
Use of telemedicine requires the profession to
explicitly identify and manage adverse
March 2018 MEC 209/Ethics of Telemedicine COM REV/Apr2018
20
addressing the appropriate use of telemedicine and the
courtesies surrounding referrals. [AM]
consequences on collegial relationships and
referral patterns.
[Added paragraph:] New technologies and styles of
practice integration may require new guidelines and
standards. [AM]
New technologies and styles of practice
integration may require new guidelines and
standards.
11. Physicians should lobby for ethical
telemedicine strategies in the best
interest of patients.
Physicians should lobby for also maintain the principles
of medical ethics when practicing ethical telemedicine
strategies in the best interest of patients. [CGCM]
[Move this paragraph with the following changes to the
first item (currently numbered 7.) of the section
“RECOMMENDATIONS”:] Physicians should lobby for
ethical telemedicine strategies practices that are in the
best interests of patients. [AMA]
Physicians should lobby for ethical telemedicine
practices that are in the best interests of patients.
12. Proper informed consent requires that all
necessary information regarding the
telemedicine visit be explained fully to
patients including explaining how
telemedicine works, how to schedule
appointments, privacy concerns, the
possibility of technological failure
including confidentiality breaches,
protocols for contact during virtual
visits, prescribing policies, and
coordinating care with other health
professionals in a clear and
understandable manner, without
influencing the patient’s choices.
The patient must consent to the use of telemedicine.
Proper informed consent requires that all necessary
information regarding the telemedicine visit be explained
fully and in a clear and understandable manner, to
patients including explaining how telemedicine works,
how to schedule appointments, privacy concerns, the
possibility of technological failure including
confidentiality breaches, protocols for contact during
virtual visits, prescribing policies, and coordinating care
with other health professionals in a clear and
understandable manner, without influencing the patient’s
choices. [SwMA]
… confidentiality breaches [Why? What does this mean
for the physician if this is beyond his control (as it in fact
often is…)?] … [RDMA]
… without influencing the patient’s choices [And if the
patient does not agree, does the physician have the
obligation to offer a face-to-face consult?] … [RDMA]
(Move between 4 and 5)
March 2018 MEC 209/Ethics of Telemedicine COM REV/Apr2018
21
[Added text:] … This information may be provided by
physicians, technology providers, hospitals, academic
centers, medical practice administrators and others
involved in providing care to the patient. [AM]
[Delete paragraph and replace by:] The use of
telemedicine should always be conditional based on the
existence of adequate information and patient consent.
The functioning of telecommunication systems, the
means to request medical attention, the possible risks
of their use, the contact protocols during virtual visits,
the means of prescription and the coordination of care
with other health professionals should always be
transmitted in a clear and understandable way without
influencing patient decisions. [CGCM]
[Move this paragraph with the following changes to the
second item (currently numbered 8.) of the section
“RECOMMENDATIONS”:] Proper informed consent
requires that all necessary information regarding the
distinctive features of telemedicine visit be explained
fully to patients including, but not limited to:
• explaining how telemedicine works,
• how to schedule appointments,
• privacy concerns,
• the possibility of technological failure including
confidentiality breaches,
• protocols for contact during virtual visits,
• prescribing policies, and
• coordinating care with other health professionals in a
clear and understandable manner, without influencing
the patient’s choices.
[AMA]
March 2018 MEC 209/Ethics of Telemedicine COM REV/Apr2018
22
§§§
08.03.2018
1
THE WORLD MEDICAL ASSOCIATION, INC.
Document no: MEC 209/Licensing of Physicians Fleeing Prosecution COM
REV/Apr2018
Original:
English
Title: Proposed revision of WMA Statement on Licensing of Physicians
Fleeing Prosecution for Serious Criminal Offences
Destination: Medical Ethics Committee
209th
Council Session
Radisson Blu Latvija Hotel
Riga, Latvia
26-28 April 2018
Action(s)
required:
For
Consideration
Note: As part of the annual policy review process, the Council in Livingstone (April 2017)
decided that the WMA Statement on Licensing of Physicians Fleeing prosecution for
Serious Criminal Offence should undergo a major revision. The French Medical
Association (CNOM) volunteered to undertake that work. The 207th Council session in
Chicago (October 2017) considered the proposal and decided to circulate it within WMA
membership for comments.
Legend:
Abbreviation key:
AM Associate Members
AMA American Medical Association
AMV Associazione Medica del Vaticano
BMA British Medical Association
April 2018 MEC 209/Licensing of Physicians Fleeing Prosecution COM REV/Apr2018
2
CGCM Consejo General de Colegios Médicos de Espana
CMA Canadian Medical Association
DMA Danish Medical Association
FMA Finnish Medical Association
GMA Bundesärztekammer (German Medical Association)
NMA Norwegian Medical Association
RDMA Royal Dutch Medical Association
SAMA The South African Medical Association
SwMA Swedish Medical Association
GENERAL COMMENTS
AM There appears to be an inconsistency between paragraph 3 and paragraph 5. Paragraph 3 discusses those physicians who have been found
guilty as opposed to paragraph 5, which deals with those who have been alleged to have committed offenses. This inconsistency either
must be made consistent, or be further explained. The new country should have the ability to independently evaluate the charges against
the physician to be sure they were not politically invented, and that they are valid. We support this document after the inconsistency
between paragraphs 3 and 5 is clarified.
AMA The statement as written contains too many undefined concepts and terms. The statement uses terms “allegations” and “convictions”
interchangeably even though they refer to different concepts.
To focus the statement, we have eliminated the concepts related to war crimes and to allegations of crimes. If desired, a separate statement
on licensure of physicians convicted of war crimes or crimes against humanity could be undertaken, but it should not co-exist with a
statement on convictions for other crimes.
We also propose changing the title of the statement:
WMA Statement on Licensure of Physicians with Criminal Convictions
AMV This document is accepted as it is.
BMA Overall we would support the main thrust of this document. From a UK perspective though, the responsibilities for licensing, and, for
ensuring that a doctor from overseas is fit to practice in the UK, falls on the regulatory body, the GMC, not the national medical
association.
This statement should be strengthened: it should be an obligation on any licensing authority to make reasonable and appropriate enquiries
with regards to the former countries in which the doctor has been registered to practice medicine.
DMA The DMA has no comments to this document
FMA FMA supports the revision of this document. We have a few comments to the text. [Note: those comments have been added in the table
April 2018 MEC 209/Licensing of Physicians Fleeing Prosecution COM REV/Apr2018
3
below]
GMA The GMA has incorporated a small number of suggested editorial revisions below. [Note: those comments have been added in the table
below]
Keywords: Crime, Licencse, Medical Associations, Medical Licensure, Prosecution, Regulation
NMA NMA supports this document as it is.
RDMA 1) This Declaration is not consistent with regard to the question what kind of offences it addresses: sometimes the Declaration mentions
“serious criminal offences”, other times it mentions ‘war crimes or crimes against humanity’. It is preferable to be consistent.
2) There is a difference between being accused of something (not sure if a person is guilty yet) and being convicted for something. Is it
justifiable to deny physicians to practice if it is still unclear if they are really guilty of what they have been accused of?
SAMA SAMA supports the statement in current format.
Numbering will be deleted (or adjusted) when the revised text is adopted.
No Proposed Text:
MEC 208/Licensing of Physicians
Fleeing Prosecution/Oct2017
Specific Comments
Additions: bold/underlined
Deletions: lined-out
Comments only: [italic]
Proposed Revised Text by:
Rapporteur
MEC 209/Licensing of Physicians Fleeing Prosecution
REV/Apr2018
Title WMA Statement on Licensing of
Physicians Fleeing Prosecution for
Serious Criminal Offences
WMA Statement on Licensingure of
Physicians Fleeing Prosecution for
Serious with Criminal
OffencesConvictions [AMA]
WMA Statement on Licensure of Physicians with Serious
Criminal Convictions.
PREAMBULE PREAMBULE [SwMA, AMA] PREAMBLE
1. Physicians are bound by medical ethics
to dedicate themselves to the good of
their patients. Physicians who are
prosecuted for serious criminal offences
or who have participated in war crimes
or crimes against humanity are engaged
in a practice that violates medical ethics,
Physicians are bound by medical ethics to
dedicate themselves to the good of their
patients. Physicians who are prosecuted for
involved in serious criminal offences or
who have participated in war crimes or
crimes against humanity are engaged in a
practice that violates medical ethics, human
Physicians are bound by medical ethics to dedicate themselves
to the good of their patients. Physicians who have been
convicted of serious criminal offences in particular genocide,
war crimes or crimes against humanity* have violated medical
ethics, human rights and international law and are therefore
unworthy of practising medicine.
April 2018 MEC 209/Licensing of Physicians Fleeing Prosecution COM REV/Apr2018
4
human rights and international law.
Physicians in such situations are
unworthy of practicing medicine.
rights and international law. Physicians in
such situations are unworthy of practicing
medicine. [AM]
Physicians are bound by medical ethics to
dedicate themselves to the good of their
patients. Physicians who are prosecuted for
have committed serious criminal offences,
including or who have participated in war
crimes or and crimes against humanity,
have are engaged in a practices that violates
medical ethics, human rights and
international law. Physicians in such
situations are unworthy of practicing and
are unfit to practice medicine. [SwMA]
Physicians are bound by medical ethics to
dedicate themselves to the good of their
patients. Physicians who are prosecuted
forengaged in [That they are prosecuted
does not mean that they are guilty of doing
so. Therefore, we prefer the other
formulation] serious criminal offences
[What are ‘serious criminal offences’?] or
who have participated in war crimes or
crimes against humanity are engaged in a
practice that violates medical ethics, human
rights and international law… [RDMA]
… Physicians in such situations are
unworthyineligible of practicing medicine.
[FMA]
In accordance with the principle of the presumption of
innocence, only physicians who have been convicted should be
declared unworthy of practising medicine.
Foot note:
*as defined by the Rome Statute of the International
Criminal Court
April 2018 MEC 209/Licensing of Physicians Fleeing Prosecution COM REV/Apr2018
5
… Physicians in such situations are
unworthy of practiscing medicine. [GMA]
[Paragraph not numbered:]… Physicians
who are convicted of prosecuted for serious
criminal offences or who have participated
in war crimes or crimes against humanity
or are engaged in a practice that violates
medical ethics, or human rights should not
be allowed to practice medicine and
international law. Physicians in such
situations are unworthy of practicing
medicine. [AMA]
REFLECTION REFLECTION [GMA]
REFLECTION DISCUSSION [AMA]
DISCUSSION
2. Physicians seeking to work in any
country are subject to the licensing
arrangements of that country. Physicians
applying for a license to practice must
demonstrate their professional
competence, both technical and moral,
to the approved licensing bodies.
Physicians seeking to work in any country
are subject to the licensing arrangements of
that country. The duty to demonstrate
suitability to practice medicine rests with
the person seeking registration.
Physicians applying for a license to practice
must demonstrate their professional
competence, both technical and moral, to
the approved licensing bodies. [SwMA]
… Physicians applying for a license to
practice must demonstrate their
professional competence, both technical
and moral [To prove that you did NOT do
something is very difficult. How does the
working group think this should be
Physicians seeking to work in any country are subject to the
licensing arrangements of that country. The duty to
demonstrate suitability to practice medicine rests with the
person seeking registration.
April 2018 MEC 209/Licensing of Physicians Fleeing Prosecution COM REV/Apr2018
6
done?]… [RDMA]
Physicians seeking to work in any country
are subject to the licensing
arrangementsrequirements of that
country… [CMA]
… Physicians applying for a licencse to
practisce must demonstrate their
professional competence, both technical
and moral, to the approved licensing
bodies. [GMA]
Physicians seeking to practice medicine
work in any country are subject to the
licensing arrangements of their local
jurisdiction. that country. Physicians
applying for a license to practice must
demonstrate their professional competence
and compliance with relevant ethical
standards as required by both technical
and moral, to the approved licensing bodies
of the physician’s country or jurisdiction
of origin. [AMA]
3. Physicians whose licences are revoked
by their licensing body after being found
guilty of serious professional
misconduct, or following a criminal
conviction, cannot be allowed to
practise in a second country. The
relevant licensing authorities must
require not only proof of qualification
Physicians whose licences are have been
revoked because of by their licensing body
after being found guilty of serious
professional misconduct, or following a
criminal conviction, cannot should not be
allowed to practise in a second country. The
relevant licensing authorities must in all
countries should require not only proof of
Physicians who have been convicted of serious criminal
offences must not be allowed to practise in another
country. The relevant licensing authorities must ensure
both that physicians have the required qualifications and
that they have not been convicted of a serious criminal
offence.
April 2018 MEC 209/Licensing of Physicians Fleeing Prosecution COM REV/Apr2018
7
but also proof that the applicant
continues to be in good professional
standing in his or her country of origin.
qualification but also proof that the
applicant continues to be is in good
professional standing in his or her country
of origin. [SwMA]
Physicians whose licences are revoked by
their licensing body after being found guilty
of serious professional misconduct, or
following a criminal conviction related to
their profession [Not any crime does make
a physician unsuitable for his/her job, does
it?], cannot be allowed to practise in a
second country …[RDMA]
Physicians whose licences are revoked by
their licensing body after being found guilty
of serious professional misconduct, or
following a criminal conviction, cannot be
allowed to practise in a secondany other
country… [CMA]
[Move this paragraph with the following
changes to next item (currently numbered
4.):] Physicians whose original licenses
licences are revoked by their licensing
body in their country or jurisdiction of
origin after being found guilty of serious
professional misconduct, or following a
criminal conviction, cannot should not be
allowed to practise in another country or
jurisdiction. in a second country. The
relevant Relevant licensing bodies in the
new country or jurisdiction authorities
must require not only proof verification of
April 2018 MEC 209/Licensing of Physicians Fleeing Prosecution COM REV/Apr2018
8
initial qualifications for licensure, but also
proof verification that the applicant
continues to be in good professional
standing in his or her country or
jurisdiction of origin. [AMA]
4. Yet physicians who have been
prosecuted for serious criminal offences
or accused by international agencies of
war crimes or crimes against humanity
have sometimes been able to leave their
country and to obtain a licence to
practice medicine in a host country from
the relevant licensing authority. This
practice is contrary to the public interest
and is detrimental to patient safety.
Yet However, physicians who have been
prosecuted for serious criminal offences or
accused by international agencies of war
crimes or crimes against humanity have
sometimes been able to leave their country
in which these suspected crimes were
committed and to obtain a licence to
practice medicine in a host country from the
relevant licensing authority in another
country. This practice is contrary to the
public interest, and is detrimental to patient
safety and damaging the reputation of
and trust in physicians. [SwMA]
Yet physicians who have been prosecuted
for serious criminal offences … [BMA]
Yet physicians who have been prosecuted
for serious criminal offences [Sometimes
physicians are in their countries prosecuted
for criminal offences (e.g. the member of
the Council of the Turkish Medical
Association right now), while the WMA
thinks this is not right. How to handle these
cases?] … [RDMA]
Yet pPhysicians who have been prosecuted
Physicians who have been convicted of serious criminal
offences, in particular of genocide, war crimes or crimes
against humanity, have sometimes been able to leave the
country in which these crimes were committed and obtain a
licence to practise medicine from the relevant licensing
authority in another country.
This practice is contrary to the public interest, damaging to the
reputation of medical profession, and may be detrimental to
patient safety
April 2018 MEC 209/Licensing of Physicians Fleeing Prosecution COM REV/Apr2018
9
for serious criminal offences …[CMA]
… This practice is contrary to the public
interest, damaging to the reputation of
medical profession, and ismay be
detrimental to patient safety. [FMA]
… and to obtain a licence to practisce
medicine in a host country from the
relevant licensing authority… [GMA]
[Move this paragraph with the following
changes to previous item (currently
numbered 3.):] Yet physicians Physicians
who have been prosecuted for serious
criminal offences or accused by
international agencies of war crimes or
crimes against humanity convicted of a
crime have are sometimes been able to
leave their country and to relocate and
obtain a new licence license to practice
medicine in another country or
jurisdiction. in a host country from the
relevant licensing authority. This practice is
contrary to the public interest and puts
patients at risk. is detrimental to patient
safety. [AMA]
[Added paragraph:]… Sometimes
allegations against physicians are
politically motivated and do not reflect
actual misconduct. [AM]
RECOMMENDATION RECOMMENDATIONS [AMA] RECOMMENDATIONS
April 2018 MEC 209/Licensing of Physicians Fleeing Prosecution COM REV/Apr2018
10
NEW [Added paragraph:] The WMA
recommends that physicians who have
been involved in serious criminal
offences or who have participated in war
crimes or crimes against humanity be
denied membership in national medical
organizations. [AM]
The WMA recommends that physicians who have been
convicted of serious criminal offences, in particular of
genocide, war crimes or crimes against humanity, be denied
membership to national medical associations.
[Added paragraph]: Where possible,
national medical organizations should be
granted powers to revoke the licenses of
physicians who have been involved in
serious criminal offences or who have
participated in war crimes or crimes
against humanity. [AM]
5. The WMA recommends that national
medical associations use their own
powers to ensure that physicians against
whom serious allegations of participation
in war crimes or crimes against humanity
have been made, are not able to obtain
licences to practise until they have
satisfactorily responded to these
allegations. The WMA reminds the
national medical associations of their
duty to ensure efficient communications
amongst themselves and to inform the
relevant national authorities of serious
offences in order for the latter to be able
to take appropriate action.
The WMA recommends that national
medical associations use their own powers
to ensure that physicians against whom
serious allegations of participation in war
crimes or crimes against humanity have
been made, are not able to obtain licences
to practise until they have satisfactorily
responded to these allegations. The WMA
reminds the national medical associations
of their duty to ensure efficient
communications amongst themselves and to
inform the relevant national licensing
authorities of serious offences in order for
the latter to be able to take appropriate
action. [AM]
The WMA recommends that national
The WMA recommends that national medical
associations use their own authority to be informed, in so
far as is possible, if serious allegations of participation in
war crimes or crimes against humanity have been made
against physicians, while at the same time respecting the
presumption of innocence.
April 2018 MEC 209/Licensing of Physicians Fleeing Prosecution COM REV/Apr2018
11
medical associations use their own powers
work to ensure that physicians against
whom serious and credible allegations of
participation in war crimes or crimes
against humanity have been made, are not
able to obtain licences to practise until they
have satisfactorily responded to these
allegations. Where evidence of
involvement in such abuses is compelling,
the evidence should be drawn to the
attention of appropriate authorities. The
WMA reminds the national medical
associations of their duty to ensure efficient
communications amongst themselves and to
inform the relevant national authorities of
serious offences in order for the latter to be
able to take appropriate action. [SwMA]
The WMA recommends that national
medical associations, or relevant
regulatory bodies, use … [BMA]
[Added text:] It should be an obligation
on any licensing authority to make
reasonable and appropriate enquiries
with regards to the former countries in
which the doctor has been registered to
practice medicine. [BMA]
The WMA recommends that national
medical associations use their own powers
to ensure that physicians against whom
serious allegations of participation in war
crimes or crimes against humanity have
April 2018 MEC 209/Licensing of Physicians Fleeing Prosecution COM REV/Apr2018
12
been made, are not able to obtain licences
to practise until they have satisfactorily
responded to these allegations [What about
‘criminal offences’? What is the difference
between ‘allegations’ and ‘serious
allegations’? Is there a difference between
allegations and prosecution? If not, please
be consistent in formulating. Who has to
decide that an allegation has been
satisfactorily responded to? Is an allegation
enough? Shouldn’t it be a conviction?] …
[RDMA]
The WMA recommends that nNational
mMedical aAssociations use their own
powers to ensure that physicians against
whom serious allegations of participation in
war crimes or crimes against humanity have
been made, are not able to obtain licences
to practise until they have satisfactorily
responded to these allegations. The WMA
reminds the nNational mMedical
aAssociations of their duty to ensure
efficient communications amongst
themselves and to inform the relevant
national regulatory and legal authorities of
serious offences in order for the latter to be
able to take appropriate action. [CMA]
The WMA recommends that national
medical associations use their own powers
to ensure that physicians who are
prosecuted for serious criminal offences
or against whom serious allegations of
April 2018 MEC 209/Licensing of Physicians Fleeing Prosecution COM REV/Apr2018
13
participation in war crimes or crimes
against humanity have been made, …
[FMA]
The WMA recommends that national
medical associations use their own
influence and, where applicable,
authoritypowers to ensure that physicians
against whom serious allegations of
participation in war crimes or crimes
against humanity have been made, are not
able to obtain licences to practise until they
have satisfactorily responded to these
allegations. … [GMA]
The WMA recommends that national
medical associations use their own powers
to ensure that physicians against whom
serious allegations of participation in war
crimes or crimes against humanity have
been made, are not able to obtain licences
to practise until they have satisfactorily
responded to these allegations or have a
final exculpatory sentence. … [CGCM]
The WMA recommends that all national
medical associations and relevant
licensing bodies use their own powers to
ensure that all physicians against whom
serious allegations of participation in war
crimes or crimes against humanity have
been made, who have been convicted of a
criminal offense, either locally or from
another jurisdiction, be unable are not
April 2018 MEC 209/Licensing of Physicians Fleeing Prosecution COM REV/Apr2018
14
able to obtain licences to practise
medicine. until they have satisfactorily
responded to these allegations. [Modify and
move the next sentence of the original text
to a new paragraph as shown below:]
[AMA]
The WMA reminds recommends that the
national medical associations of their duty
to ensure efficient communications
amongst themselves and to that they
inform the relevant national licensing
authorities of physicians’ criminal
convictions. serious offences in order for
the latter to be able to take appropriate
action. [AMA]
The WMA recommends that national medical associations
ensure that there is efficient communication amongst
themselves and that they inform relevant national licensing
authorities of physicians’ criminal convictions.
*****
April 2018
1
THE WORLD MEDICAL ASSOCIATION, INC.
Document
no:
MEC 209/End of Life Japan/Apr2018 Original:
English
Title: Report of the Symposium on End-of-Life
Questions in Japan 2017
Destination: Medical Ethics Committee
209th
Council Session
Radisson Blu Latvija Hotel
Riga, Latvia
26-28 April 2018
Action(s)
required:
For
consideration
Note The Symposium on End-of-Life Questions was held in Japan
on September 14 and 15, 2017, with participation of the
Confederation of Medical Associations in Asia and Oceania
(CMAAO) members and the two World Medical Association
(WMA) Asian regional members, namely, the Chinese
Medical Association and the Israel Medical Association. This
report was prepared by Professor Tatsuo Kuroyanagi, lawyer
and the legal adviser of the Japan Medical Association
(JMA).
Symposium on End-of-Life Questions Result Report
The Symposium on End-of-Life Questions was held on September 14 and 15, 2017, with
participation of the Confederation of Medical Associations in Asia and Oceania (CMAAO)
members and the two World Medical Association (WMA) Asian regional members, namely, the
Chinese Medical Association and the Israel Medical Association. The symposium generated certain
achievements, and the following is the report of its results.
1. Introduction
The main purpose of this symposium was to investigate different opinions that exist among the
WMA Asia-Pacific members and their home countries/jurisdictions with regard to the three WMA
policies, namely WMA Declaration on Euthanasia, WMA Statement on Physician-Assisted Suicide,
and WMA Resolution on Euthanasia.
The Japan Medical Association (JMA) planned this symposium because the WMA
Executive Committee referred the investigation to the JMA. The JMA also carried out a
questionnaire survey on five items of “End-of-Life Questions” in July 2017 to ensure fruitful
discussion at the symposium and asked the member National Medical associations (NMAs) to
present their views based on their answers to the questionnaire survey.
April 2018 MEC 209/End of Life Japan/Apr2018
2
The JMA sent the questionnaire to 21 NMAs, and 19 submitted their answers. At the
symposium, 17 NMAs presented their reports by further elaborating or partially modifying their
answers.
This report of the questionnaire survey results was prepared based on the answers that the
JMA received and the presentations made by each NMA during the symposium.
2. Target NMAs for the questionnaire survey
21 WMA members in the Asia-Pacific region were the target of the questionnaire survey, namely,
19 CMAAO members, the Chinese Medical Association and the Israel Medical Association. The
JMA sent out the questionnaire to these 21 NMAs via e-mail, and asked them to submit their
answers.1
The 19 NMAs that submitted their answers in writing were; Australia, Bangladesh,
Cambodia (absent), Hong Kong, India, Indonesia, Japan, Korea, Malaysia, Myanmar, Nepal, New
Zealand (absent), Pakistan, Philippines, Singapore, Taiwan, and Thailand, which are CMAAO
members, and China and Israel, which are non-CMAAO members. Two CMAAO members, Macau
and Sri Lanka, did not submit their answers. New Zealand and Cambodia were unfortunately unable
to attend the symposium but had submitted detailed answers via e-mail.
3. Background
The WMA has made it clear that it is against euthanasia and physician-assisted-suicide (PAS).
However, legislations allowing these procedures have been enacted in Switzerland in the past and in
the Netherlands, Belgium, Luxemburg, and some states in the United States in recent years. In
Switzerland legislation has allowed PAS, but not euthanasia. In addition, on February 6, 2015, the
Supreme Court of Canada ruled that the crime of aiding suicide as stipulated in the Penal Code is
unconstitutional in view of respecting the patients’ right of self-determination, and this ruling has
led to a legislation that approves PAS.
During the Meeting in Oslo in 2015, the WMA Council re-confirmed the opinions on the issue of
active euthanasia and PAS. The overwhelming majority of the members wished to maintain the
current position of opposing such practice. The Council Meeting in Taipei in 2016 decided to hold
regional discussions on this issue especially in the Asian, African and Latin American regions.
4. Questions addressed in the symposium (questionnaire items)
As mentioned in the Introduction, the core purpose of the investigation and deliberation of this
symposium was to study the reality concerning “Euthanasia and Physician-assisted-suicide” among
the WMA Asia-Pacific members and their home countries/jurisdictions. Upon consulting with the
WMA Secretariat in advance, the following four categories of questions were prepared.
Q-1 Questions regarding Euthanasia and Physician-assisted Suicide
Q-2 Questions regarding Advance directive (Living Will)
Q-3 Questions regarding Withholding or Withdrawing of Life-sustaining Treatment
Q-4 Questions regarding Palliative Care including End-of-life Care
In order to prevent confusion due to different understandings of the terminology, the titles of
WMA policy documents related to each question were listed in marginal notes when preparing the
1
It should be noted that the JMA also sent out the questionnaire to three other NMAs that are also the
WMA members in the Asia-Pacific region, namely, Fiji, Samoa, and Vietnam, and requested to submit
their answers. However, the JMA received no confirmation of reception nor any answers from them, so
they were excluded from the survey.
April 2018 MEC 209/End of Life Japan/Apr2018
3
text of the questions; respondents were asked to follow the definitions provided in these policy
documents, if any. In referring to the policy documents, the Powerpoint file created and provided by
WMA General Secretary Otmar Kloiber, which he used at the Latin American symposium in March
2017, was used as a reference, and some relevant texts of the policy documents that were mentioned
in this Powerpoint file were extracted and noted in the questionnaire text as needed.
After these four questions were sent out, Question 5 that concerns the adult guardianship
program with the right of medical consent and other legal measures was added later, in light of poor
legal interventions available in Japan in case of providing highly invasive treatment in daily
medical practice for extremely aged patients with dementia who lost the ability of self-
determination or providing critical procedure involved in the end-of-life care.
5. Grouping at the symposium
The original plan was to divide the participating NMAs alphabetically and have them orally discuss
the written opinions of each in groups. However, after examining the pre-submitted answers and
receiving considerably delayed answers from two NMAs, the JMA decided to divide the NMAs
into four groups based on the similarities in legal systems and religions. CMAAO Council Chair
Dr. Yeh Woei Chon (Singapore), Vice Chair Dr. Kar Chai Koh (Malaysia), and advisor Dr. Dong-
Chun Shin (Korea) were asked to serve as the symposium chairs (facilitators), and they reviewed all
the answers of NMAs the night before the symposium.
The names and titles of the rapporteurs of the four groups are shown in the table in
Attachment 2.
Stakeholders of the participating NMAs and other experts also joined the groups, including
WMA Secretary General Otmar Kloiber, German Medical Association President Prof. Dr. Frank
Ulrich Montgomery, International Manager Dr. Ramin Parsa-Parsi, and the immediate past
American Medical Association President Dr. Andrew Gurman. They had lively discussion during
this 2-day symposium.
On the second day of the symposium, a summary table of all answers by question, which the
JMA had prepared based on the submitted responses, was distributed to everyone involved so that
each could verify and/or modify the answers by question item. The sorting (or classification)
contained in the summary shown in Attachment 1 was produced through such a process.
6. Answers
The answers to the above five questions are summarized below. Please refer to the report in
Attachment 1 for details.
6-1. Answer to Question 1
Question 1 asked if there is any law or court ruling that tolerates a physician’s involvement in
euthanasia and/or assisted suicide.
All member associations answered “No” to this question.
However, we learned from the Australian Medical Association that the State of Victoria will be
voting on a euthanasia bill in coming months. There is an appetite for euthanasia and PAS in
numerous Australian states and New Zealand where several parliamentary bills have been
defeated.
6-2. Answer to Question 2
Question 2 asked whether legislation on Advanced Directive exists or not.
We also asked about “Orders Not to Attempt Resuscitation (DNAR)” and the practice of
appointing a legal representative in relation to this question.
As for the existence of legislation, the result showed half of the member countries and
participating countries have such legislation. It is worth noting that the practice of “advanced
care planning” with physicians at its core is becoming popular.
6-3. Answer to Question 3
April 2018 MEC 209/End of Life Japan/Apr2018
4
Question 3 asked about withholding or withdrawing of a life support system. This question also
concerns the WMA Declaration of Lisbon on Patient’s Rights, in which death with dignity is
endorsed as a form of practicing the right of self-determination by a patient. We observed a
subtle difference in opinion on the ideas of “withholding” and “withdrawing,” so we should
carefully examine each answer over time.
6-4. Answer to Question 4
Question 4 asked about “palliative care.” Enriched palliative care is expected to improve the
pain management in the end-of-life care, which may resolve the issue raised in Question 1.
However, the uses of narcotic drugs such as morphine and opioids, which are commonly used
in palliative care, are strictly regulated by the authorities in many countries, and it appeared that
this area of medical care is still being developed.
The involvement of religion was also asked in relation to this question, and the response in
general implied that religion plays a role in most countries and jurisdictions.
6-5. Answer to Question 5
The responses from several member associations, namely Australia, Korea, New Zealand and
Taiwan, suggest that this problem is being addressed.
7. Summary
At the CMAAO General Assembly Tokyo in 2017, all of the NMAs have opposed euthanasia and
PAS. With the exception of Australia and New Zealand, there is no significant desire in the civil
society of the Asia/Oceania region to discuss the concept of euthanasia and PAS. All the NMAs
support the creation of Advanced Directive and advanced care planning with physicians for the
terminally-ill patients.
Additional Note 1. Observations as the symposium organizer
The main purpose of this symposium was not about consolidating opinions but finding facts. The
core of the questions concerns the life or death at the end of life. Naturally, the natural environment,
culture, religion, and social structure of different countries/jurisdiction are deeply involved in the
NMAs’ answers in the survey. In terms of religion alone, there are Judaism, Christianity
(Catholicism and Protestantism), Islam, Hinduism, Buddhism (Hinayana and Mahayana), Taoism,
Confucianism, etc.—some accept reincarnation, some believe in the absolute being, and their
beliefs in life and death are very variable. When asked about the role of religion in the questions
relating to palliative care, the NMAs’ answers and explanations suggested strong influence of
religion. The Bangladesh’s answer was “Most of the people believe one God and it helps.”
Indonesia answered “Belief in One and Only God,” “Life is given by God and cannot be taken
away except by Him or His permission,” and “Important to save the soul, to be prepared for life
after death.” Pakistan, which adapts the Talqueen practice for every terminal Moslem patients
(Pukovisa 2017), answered “Pakistan, an orthodox religious country–this issue not only can be
discussed but presently there is no room to make any kind of legislation in this regards.”
Cambodia’s answer was “Buddhism is major religion and any act to prolong survival is a good
thing.” Nepal answered “Dominated by Hindu and Buddhist religion, people believe in afterlife in
hell or heaven.” Thailand answered “Buddhism plays an important role. Buddhists in Thailand
claim suicide as sin.” Again, these answers indicate that the answers to Question 1 are also strongly
influenced by religion.
In addition, the oral reports and the Powerpoint slides used during presentation suggested
that the family and community bonds are extremely firm in the island regions in Oceania such as
Indonesia, Philippines, Malaysia and the countries/jurisdictions in the Southeast Asian region such
April 2018 MEC 209/End of Life Japan/Apr2018
5
as Pakistan, India, Bangladesh, Myanmar, Thailand, and Cambodia. It was also indicated that the
idea of self-determination that developed in the Western countries has not necessarily fully
infiltrated in these areas.
In relation to Question 1, which was the main theme of this survey, a voice of question was
raised about the use of the word “(active) euthanasia” and the fact that the Supreme Court of India
used the word “passive euthanasia,” which the Indian Medical Association quoted in their answers.
The definitions and implications of the words “euthanasia = die Euthanasie” and “physician-
assisted-suicide” are often interpreted differently depending on the users, which suggests that they
need to be set straight within the WMA to avoid confusion in future discussions. The WMA
Resolution on Euthanasia that was adapted by the 2002 Washington General Assembly states “The
World Medical Association has noted that the practice of active euthanasia with physician
assistance, has been adopted into law in some countries” in its third sentence. On this point, the
well-established law dictionary in America, the Black’s Law Dictionary, lists “active euthanasia”
and “passive euthanasia” as the antonym in its 7th edition (1999) and the latest edition (10th
edition; 2014) (Attachment 3). It should also be noted that although the word “physician-assisted-
suicide” was used in the questionnaire this time, a criminal type of‘murder at the victim’s request’
separately from ‘physician-assisted-suicide’ exists in many jurisdictions including Japan. In the
present wording of the policy documents, however, this criminal type is supposed to be excluded. If
this type is to be included, perhaps the word “physician-assisted-dying” could be introduced and
listed together with “physician-assisted-suicide” to indicate ascertainment. To note, putting its
propriety aside, the aforementioned dictionary by Black is using the word “passive euthanasia” to
mean “the act of allowing a terminally ill person to die by either withholding or withdrawing life
sustaining support such as a respirator or feeding tube,” as the Supreme Court of India did.
Lastly, we are deeply grateful to Dr. Otmar Kloiber for his support throughout the planning
and holding of the symposium. We also thank Dr. Yeh Woei Chon, Chair of CMAAO, Dr. Kar
Chai Koh, Vice-Chair and Dr. Dong Chun Shin, Advisor for overseeing the proceedings of the
symposium and consolidating opinions.
This report was prepared by JMA Legal Advisor Professor Tatsuo Kuroyanagi in
cooperation with the International Affairs Division staff of JMA, Mr. Yuji Noto, Mr. Hisashi
Tsuruoka, Ms. Mieko Hamamoto, Ms. Rei Kobayashi and Ms. Michiyo Takano. It should be noted
that Kuroyanagi solely bears the responsibility for wording and content of this report.
Additional Note 2. Conflict of Interest Statement
The author of this report is Professor Tatsuo Kuroyanagi, Legal Adviser of the Japan Medical
Association. There is no financial or commercial interest connected to this work.
§§§
09.03.2018

1
THE WORLD MEDICAL ASSOCIATION, INC.
Document
no:
MEC 209/End of Life Nigeria/Apr2018 Original:
English
Title: Report of the WMA African region
meeting on End-of-Life Questions in
Nigeria 2017
Destination: Medical Ethics Committee
209th
Council Session
Radisson Blu Latvija Hotel
Riga, Latvia
26-28 April 2018
Action(s)
required:
For
consideration
Note The Symposium on End-of-Life Questions was hosted by the
Nigerian Medical Association in Abuja, Nigeria on 1st
and 2nd
February 2018. This report was prepared by Nigerian Medical
Association.
REPORT OF THE WMA AFRICAN REGION MEETING ON END OF LIFE ISSUES
PREAMBLE
As part of the efforts of the World Medical Association (WMA) to generate open regional
discussions on the dilemmas related to End of Life issues, particularly with respect to Palliative
care, Euthanasia and Physician assisted suicide, the WMA Council meeting held in Livingstone,
Zambia in the month of April 2017, encouraged the African region of the WMA to organize an
African Region meeting on End of Life issues.
Arising from the foregoing, the Coalition of African Medical Associations gave the nod to the
Nigerian Medical Association to host the WMA African Region Meeting on End of Life issues.
Accordingly, the WMA African Region meeting on End of Life issues (Palliative care, Euthanasia
and Physician assisted suicide) was hosted by the Nigerian Medical Association in Abuja, Nigeria
on the 1st and 2nd of February 2018.
The End of Life meeting which held at the Transcorp Hilton Hotel and Towers, Abuja, had as its
theme ‘An Excursion into the End of Life Spectrum: Defining the boundaries between Palliative
care, Euthanasia and Physician assisted suicide’. It was graced by some invited dignitaries as well
as the Secretary General of WMA (Dr. Otmar Kloiber) who made a presentation on WMA policy
on End of Life issues. It also had in attendance Presidents and delegates of National Medical
Associations from Nigeria, Zambia, Kenya, South Africa, Cote D’Ivoire and Botswana.
Activities conducted during the meeting included Welcome cocktail, formal opening ceremony,
Scientific sessions with presentations by various Guest speakers on End of Life issues, Breakout
technical sessions, sight-seeing/visitations and a closing dinner.
April 2018 MEC 209/End of Life Nigeria/Apr2018
2
The formal opening ceremony was chaired by the Senate President, Senator Dr. Bukola Saraki (who
was represented by Senator Dr. Lanre Tejuosho), while the Minister of Health, Prof. I.F. Adewole
(who was also in attendance) represented both Nigeria’s President (Muhammadu Buhari GCFR)
and Nigeria’s Vice President (Prof. Yemi Osinbajo).
OBSERVATIONS
The meeting made the following observations:
1) There is no specific policy or legislation on Euthanasia and Physician assisted suicide in Africa.
2) Aside from countries such as Nigeria, Zambia, Kenya, Uganda, South Africa and Botswana with
some initiatives, policies, guidelines and practices on palliative care, there is a dearth of policy
guidelines and legislation on palliative care in most African countries.
3) In African culture, tradition and religion, life is held sacred and families never abandon their
loved ones at the end of life.
4) Palliative care is generally accepted in African culture, tradition, and religion.
5) Involvement of Physicians in Euthanasia and Physician assisted suicide flies in the face of the
Physicians’ Pledge and ethics governing the medical profession.
6) There is a low level of awareness on End of Life issues among African populations and
medical/health professionals.
7) There is a dearth of standard health care systems and medical personnel equipped to deliver
palliative care.
8) There is a high poverty rate; poor access to affordable, equitable and quality health care; and
poor access to palliative care in most African countries.
RESOLUTIONS
1) National Medical Associations in Africa are unanimously opposed to Euthanasia and Physician
assisted suicide in any form.
2) National Medical Associations in Africa support policies and legislations permitting and
strengthening palliative care.
3) There is need for improved political will and commitment to palliative care by African
Governments.
4) African National Medical Associations (NMAs), Non-Governmental Organizations (NGOs), etc.
need to embark on enlightenment and advocacy campaigns to orientate various arms of government
and policy makers, as well as the general public on the importance and availability of palliative
care.
5) There is need for increased awareness amongst care givers, patients and other stakeholders, with
the capacity of Physicians and other relevant health professionals to deliver palliative care
continuously built.
April 2018 MEC 209/End of Life Nigeria/Apr2018
3
6) There is great need for strengthening of African healthcare systems, universal health coverage,
improved budgetary allocation to health, and integration of palliative care and other chronic
medical conditions into the health care financing/health insurance schemes of African countries.
§§§
09.03.2018

1
THE WORLD MEDICAL ASSOCIATION, INC.
Document
no:
MEC 209/End of Life Brazil/Apr2018 Original:
English
Title: Report of the WMA South American
region meeting on End-of-Life Questions
in Brazil 2017
Destination: Medical Ethics Committee
209th
Council Session
Radisson Blu Latvija Hotel
Riga, Latvia
26-28 April 2018
Action(s)
required:
For
consideration
Note The Symposium on End-of-Life Questions was hosted by the
Brazilian Medical Association in Rio de Janeiro in 2017. This
report was prepared by Brazilian Medical Association.
Latin American Meeting on End-of-Life Ethical Dilemmas
CONCLUSIONS
Medicine in recent decades has had and continues to enjoy dizzying advances. However, they are
not all successes. On the one hand, the life expectancy is greatly advanced, but on the other hand,
the times of suffering, the trials and useless treatments, the solitude of the patient, the lack of
answers, and in an endless way the suffering of the agony.
Human dignity is linked to the life of each individual and the radical equality of all human beings
from the beginning, regardless of their concrete conditions. Life is always dignified, unworthy are
the conditions in which many human beings live and are unworthy the decisions and behaviors that
provoke them, produce or cause them.
The medical science put at the service of suffering and sick who are no longer cured, is where
palliative care is developed when trying to give the technical and human attention that the patients
need in terminal situation, with the best possible quality and looking for the professional excellence.
After palliative medicine emerges with force, it does not seek to lengthen or shorten life, it only
seeks the patient’s greater well-being respecting the moment of death, but accompanying to the end.
Today its services must be a right or at least an attainable service for all patients.
It is well known that hope is energy to live, on the contrary, contempt, lack of affection, marginality
annul the interest in life, are the prelude to death that especially affects the most disadvantaged and
weakest on which often society, far from offering comfort and understanding, multiplies the
feelings of uselessness, incapacity, dependence and, consequently, it worsens its state and now
offers the way out to end up in an organized manner with life.
April 2018 MEC 209/End of Life Brazil/Apr2018
2
Death occurs at a certain moment in life, so it can neither be worthy nor unworthy, what can be
worthy or unworthy are the conditions of life that have preceded it.
Volunteering is not enough to guarantee the freedom and dignity of the person. The human being will
often find himself in situations of vulnerability where he can manifest his will, but he does not do it freely.
That is why his dignity must be defended against third parties and even against their own decisions.
Pity and compassion must be the engine for all lives to make sense, that no one dies in solitude, or
mobilize so that no one suffers avoidable pains. However, if the doctor is prepared not only to cure
but also to kill, the ethics of medical practice and the trust that the patient must have in his doctor
will be very battered.
With euthanasia, a social message is sent to the most severely disabled patients, who can be morally
coerced, even if it is silent and indirectly, to request a faster end, since they are considered a useless
burden for their families and for society. In such a way that patients weaker or in worse
circumstances would be the most pressured to request euthanasia.
The request for euthanasia by the patients is reduced by improving the training of professionals in the
treatment of pain and in palliative care. A permissive legislation with euthanasia would restrain the
involvement, both scientific and care, of some doctors and health professionals in the care of patients
with no possibility of cure that require a considerable dedication in time and human resources.
Societies should be aware of the risks of legislation allowing euthanasia where the social climate
can lead doctors and family members to slip into its application in cases of unconscious or
incapable patients who have not expressed their authorization, this is the phenomenon of the
« slippery slope » that has led in the Netherlands to its application in people who had not requested it
or did not meet the legal requirements.
At present it is not that there is a legal vacuum in relation to the regulation of this matter, but what
is regulated is the duty of the physician to preserve life, as correlative to the fundamental right of all
citizens. That duty of the physician must be exercised in accordance with the rules that indirectly
regulate the Lex Artis, which refers to the laws that order the health professions and the rigorous
fulfillment of the ethical obligations.
The medical profession faced to the social debate on euthanasia has agreed to recognize that cases of
petition for euthanasia are exceptional when providing quality medical care and that the debate on the
decriminalization of euthanasia revolves around the social consequences of legislating for these cases.
By vocation, training and mentalization, he or she who chooses medicine as a reason for being
knows that all his/her efforts, all the knowledge, are to save the lives of their patients and save as
much suffering as possible, cannot be dedicated simultaneously to end someone’s life for whose life
he/she has fought. Euthanasia in any case should be a medical activity.
The sick at the end of life need a helping hand not to precipitate their death, nor to prolong their
agony with the therapeutic obstinacy, but to be with them and relieve their suffering with palliative
care while their death arrives.
Rio de Janeiro, 18 March 2017
§§§
09.03.2018
1
THE WORLD MEDICAL ASSOCIATION, INC.
Document
no:
MEC 209/End of Life Europe/Apr2018 Original:
English
Title: Report on the WMA European Region
Conference on End-of-Life Questions
2017
Destination: Medical Ethics Committee
209th
Council Session
Radisson Blu Latvija Hotel
Riga, Latvia
26-28 April 2018
Action(s)
required:
For
consideration
Note The WMA together with the German Medical Association
and the Pontifical Academy for Life organized a two-day
WMA European Region Conference on End-of-Life
Questions, which took place in the Vatican’s Aula Vecchia
del Sinodo on 16 and 17 November 2017
Report on the WMA European Region Conference on End-of-Life
Questions
The two-day WMA European Region Conference on End-of-Life Questions took place in the Vatican’s Aula
Vecchia del Sinodo on 16 and 17 November 2017. Around 150 participants gathered from Europe and beyond,
including WMA leaders and members, experts in palliative care, ethicists, lawyers and religious leaders. The
presentations on euthanasia and physician assisted suicide (PAS) and the views expressed covered the full
spectrum of opinion. The purpose of the event, which was co-organised by the WMA, the German Medical
Association and the Pontifical Academy for Life, was to explore ethical dilemmas relating to end-of-life issues to
assist the WMA in deciding whether or not to amend its policy on these issues.

In an address prepared by Pope Francis and read by Cardinal Peter Turkson, the Pope said it was clear that not
adopting, or else suspending, disproportionate measures, meant avoiding overzealous treatment. From an
ethical standpoint, this was completely different from euthanasia, which was always wrong, in that the intent of
euthanasia was to end life and cause death.

In his introductory remarks, Professor Dr. Frank Ulrich Montgomery, President of the German Medical
Association, explained that the WMA had always had a very clear position on end-of-life issues – it condemned
euthanasia and PAS as unethical. He later added that he found none of the arguments in favour of PAS
compelling. Like euthanasia, PAS was unethical and must be condemned by the medical profession. Medical
ethics should not simply follow public opinion.

Archbishop Vincenzo Paglia, President of the Pontifical Academy for Life, reiterated that Pope Francis’s message
reaffirmed and added precision to previous papal texts about end-of-life care.

WMA President Dr. Yoshitake Yokokura referred to the symposium on end-of-life held by the Confederation of
Medical Associations in Asia and Oceania in Tokyo in September, where most national medical associations had
opposed euthanasia and PAS.

April 2018 MEC 209/End of Life Europe/Apr2018
2
But Dr. René Héman, Chairman of the Royal Dutch Medical Association, took a different view. He quoted the
recently revised Declaration of Geneva and the pledge that ‘I will respect the autonomy and dignity of my
patient’. He explained the situation in the Netherlands, where euthanasia was still a punishable offence and was
forbidden unless specific requirements were met. These include instances where there has been a voluntary and
well considered request, where there is unbearable suffering and no prospect of improvement and where one
other independent physician has been consulted. Also, there has to be a conviction that no other reasonable
solution for the patient’s situation is available and that the termination of life or assisted suicide are performed
with due care. Dr Héman said it would never be good to end a person’s life, but sometimes it would be worse not
to. He argued that euthanasia was based on the principles of respect for a patient’s autonomy and on
compassion.

Dr. Yvonne Gilli, from the Swiss Medical Association, outlined the situation in Switzerland, where there had been
an increase in the rate of assisted suicides in the last ten years. She referred to revised guidelines just issued by
the Swiss Academies of Arts and Sciences, which included more focus on guiding physicians through a
professional dialogue with a dying patient. They made more specific recommendations on palliative sedation and
on assisted suicide.

A discussion on theological approaches, featuring representatives of the Catholic, Jewish, Islamic and Orthodox
Christian faiths, all of whom expressed opposition to euthanasia and PAS, was followed by presentations on the
legal aspects of end-of-life issues.

Prof. John Keown, Professor of Christian Ethics at the Kennedy Institute of Ethics, Georgetown University,
explained the common and criminal law relating to euthanasia and PAS and relating to withholding and
withdrawing life-preserving treatment for competent and incompetent patients. Prof. Dr. Volker Lipp, Professor
of Civil Law, Procedural Law, Medical Law and Comparative Law, at Georg-August-Universität, Göttingen spoke
about the diversity in various legal systems. He examined the various definitions of the term “euthanasia” and
said care should be taken about using it as it was an ambiguous concept.

Dr. Laurence Lwoff, Head of the Bioethics Unit, Human Rights Directorate, Council of Europe, talked about the
Council of Europe Guide on the decision-making process regarding medical treatment in end-of-life situations.
This gave rise to complex situations relating to equity of access to health care, professional obligations, free and
informed consent and previously expressed wishes.

Presentations were followed by lively panel discussions and robust question and answer sessions. Dr. Jeff
Blackmer, from the Canadian Medical Association, defended the role of doctors in Canada, where medically
assisted dying became legal in 2016.

The first day concluded with speeches from Prof. Dr. Leonid Eidelman, President of the Israeli Medical
Association and President elect of the WMA, and Prof. Pablo Requena, Professor of Moral Theology at the
Pontifical University of the Holy Cross, and the delegate of the Vatican Medical Association at the WMA.

Dr. Eidelman referred to the experience of the Netherlands and said that one of the most important factors
separating physicians who did or did not accept PAS and euthanasia was whether they saw their actions as
similar to or different from other regular medical treatments they gave their patients. Was it a regular medical
intervention like treatment with antibiotics or was it something extraordinary demanding a different attitude? In
his view physicians should not be involved in PAS or euthanasia for several reasons. Many requests disappeared
with symptom control and psychological support.

Prof. Requena said that compassion was not a good reason for euthanasia and unbearable suffering was not a
medical reason. He said he doubted that society had the moral sense to protect physicians on this issue. That was
why it was important that physicians protected themselves and that medical societies and the WMA continued to
oppose euthanasia as a medical aid. Finally, he quoted the Hippocratic Oath, which stated ‘I will not give a lethal
drug to anyone if I am asked nor will I advise such a plan’.

The second day began with the question ‘Is there a right to determine one’s own death?’ The opening speaker
was Prof. Dr. Urban Wiesing, from the Institute for Ethics and History of Medicine at the University of Tuebingen
in Germany, who argued for the concept of plurality, saying that there was no consensus on end-of-life issues
from an ethical point of view. He said the answer to ethical plurality was a political one. He argued that there was
no slippery slope involved as a result of PAS. Nor was there any loss of trust in physicians.

April 2018 MEC 209/End of Life Europe/Apr2018
3
Prof. Dr. Christiane Druml, Chairperson of the Austrian Bioethics Commission and UNESCO Chair of Bioethics at
the Medical University of Vienna, said it was a clear and undisputed principle that treatments which were not or
no longer indicated or treatments which the patient refused must not be performed. But there were still cases
where disproportionate treatment was initiated. Medical interventions which provided no benefit for the patient
or which were more burdensome than potentially beneficial to the patient were ethically and medically
unjustified because they came at a disproportionate burden.

Dr. Anne de la Tour, President of the French Society of Palliative Care spoke about end stage decisions on
medication, feeding and terminal sedation, and the differences between sedation and euthanasia.

Dr. Gunnar Eckerdal, from the Department of Oncology at Sahlgrenska University Hospital in Sweden, talked in
more detail about the role of nutrition. He said that treatment without clinical indication should be stopped.
Treatment that was not going to give effect should not be started. He argued that PAS and euthanasia were not
secure and involved wrong diagnoses and wrong prognoses, as well as underdiagnosed and undertreated
depression.

Dr. Marco Greco, President of the European Patients’ Forum, said his organisation did not have an official
position on euthanasia and PAS. But empowerment was a multi-dimensional process that helped people gain
control over their own lives and increased their capacity to act on issues that they themselves defined as
important. He emphasised the importance of the partnership between patients and those caring for them. Shared
decision-making was absolutely fundamental.

Dr. Heikki Pälve, former CEO of the Finnish Medical Association, spoke about dealing with public opinion from
his recent experience in Finland. He said that public opinion had been strongly in favour of euthanasia as were
46 per cent of physicians. But the national medical association was opposed. This created difficulties. He believed
that euthanasia fundamentally changed and to some degree also damaged trust in the health care system and
said that the slippery slope argument was a fact, and a very undesirable one.

The conference concluded with a lively panel discussion on whether there was a need to change WMA policy,
featuring speakers on both sides of the argument and questions from the audience.

Summary

Throughout the meeting, proponents of right-to-die policies emphasised that their intention was to protect
physicians in their own countries who are acting within the law, not to change or influence policies in other
countries. They based their arguments on the concepts of patient self-determination, dignity and compassion.
Those who were opposed to euthanasia and PAS, representing the majority of attendees, rejected these
procedures as being diametrically opposed to the ethical principles of medicine and expressed concern that they
could lead to misuse or abuse, e.g. in the case of mentally or psychologically incapacitated people. They also
expressed concern that these procedures could cause damage to the complete trust which characterises the
patient-physician relationship or lead to social pressure for the elderly or those with chronic illness to end their
lives.

The majority of attendees ultimately advocated for the retention of the existing policies of the WMA on
euthanasia and PAS.

Despite disagreements during the many intentionally transparent and open debates held throughout the event,
participants were united in their support for high-quality, accessible palliative care and their belief that PAS and
euthanasia should never be seen as a cost-saving measure.

This report is based on an article by Nigel Duncan, which originally appeared in the December 2017 issue of the
World Medical Journal, and contains supplementary material.
§§§
04.04.2018

1
THE WORLD MEDICAL ASSOCIATION, INC.
Document
no:
MEC 209/Genetic and Medicine/Apr2018 Original:
English
Title: Proposal for a major revision of the
WMA statement on Genetics and
Medicine
Destination: Medical Ethics Committee
209th
Council Session
Radisson Blu Latvija Hotel
Riga, Latvia
26-28 April 2018
Action(s)
required:
For
consideration
The Danish Medical Association believes that it would be timely for the WMA to initiate a major
revision of the WMA Statement on Genetics and Medicine. The main reason for our proposal is that
the current version of the statement does not deal sufficiently with the ethical issues that arise
through the development and use of NGS in personalized medicine.
The goal of a major revision would be to develop the statement to:
– include a thorough treatment of the ethical implications of using NGS for personalized
medicine
– be up-to-date with regards to the ethical issues of genetics and medicine that are included in
the current statement
– be aligned with the principles of the WMA Declaration of Taipei on Ethical Considerations
regarding Health Databases and Biobanks
Ethically relevant features of personalized medicine
There is no universally recognized definition of personalized medicine1
but the salient feature is
that it aims to adapt treatment to individual patients. This is often done by identifying genetic
characteristics of either the patient or the illness and then adapting the treatment in accordance with
the significance of those characteristics. The goal is to improve our ability to diagnose and classify
illnesses in order to prevent or treat them more precisely, effectively and with fewer, less severe
side effects.2
Personalized medicine entails ethical issues both through its development and in its use. The key
reason for this is that both the development and application of personalized medicine often involves
extensive genome sequencing.
1
Sometimes also referred to as precision medicine or genomic medicine.
2
Personalizing medicine can also be sought by adapting the treatment to other relevant person-specific features than
genetic ones. In this context, we will however attention on the relevance of genetic features as is it is mainly increased
attention to those features that generates the ethically relevant issues.
March 2018 MEC 209/Genetic and Medicine/Apr2018
2
A key feature in relation to developing personalized medicine is that large groups of participants
have their whole genomes sequenced and that data from that process is analyzed exploratively in
combination with other types of health care data to identify correlations and patterns that might be
of clinical relevance.
The information generated by extensive genome sequencing, including whole genome sequencing,
often has the following characteristics:
– Very large volumes of health care data are generated about each participating person and the
development of personalized medicine requires the sequencing genomes from large number
of persons
– The full significance of the data is not known at the time of the sequencing, which means that,
at a later time, the data could be used to generate much more information about the individual
– There is a significant risk of secondary or incidental findings which might include
information about health care risks
– The data generated from the sequencing of one person’s genome contains information about
other genetically related persons
– Due to the nature of the data generated by genome sequencing, the data cannot be fully
anonymized
– The genetic information generated by the sequencing is permanent for each participating
person
Individually, each of these characteristics could also be found in other types of health care
information. For example, incidental findings regularly occur in relation to radiological
examinations.
However, the combination of the characteristics makes data from extensive genome sequencing
particularly sensitive and therefore detailed ethical guidelines are appropriate.
A working group to revise the current statement
In light of this – and that the development and use of personalized medicine is expected to
accelerate in the coming years – we believe that it would be relevant to initiate a major revision of
the WMA-Statement on Genetics and Medicine. Specifically, we propose that the WMA establishes
a working group to be responsible for the revision and the DMA would be happy to responsible for
such a working group.
We are aware that the current statement is up for review in 2019 but given the speed of the
development of personalized medicine and the use of NGS, we believe that a revision should be
initiated now.
§§§
19.03.2018
1
THE WORLD MEDICAL ASSOCIATION, INC.
Document
no:
MEC 209/Biosimilar Medicinal
product/Apr2018
Original:
English
Title: Proposed WMA Statement on Biosimilar
Medicinal Products
Destination: Medical Ethics Committee
209th
Council Session
Radisson Blu Latvija Hotel
Riga, Latvia
26-28 April 2018
Action(s)
required:
For
consideration
Note This WMA Statement is proposed to the Committee by the Israeli
Medical Association.
PREAMBLE
1. The expiry of patents for the first original biotherapeutics has led to the development and
authorization of copy versions, called ‘similar biological medicinal products’’ or biosimilars.
that are highly similar to an already approved biological medicine, known as the reference
medicine.
2. In light of the fact that biosimilars are made in living organisms, there may be some minor
differences from the reference medicine. The manufacture of biosimilars tends to be more
complex than for chemically derived molecules. Therefore, the active substance in the final
biosimilar can have an inherent degree of minor variability. Biosimilars are not always
interchangeable with the reference products even after regulatory approval.
3. Biosimilars are not the same as generics. A generic drug is an identical copy of a currently
licenced pharmaceutical product that has an expired patent protection and must contain the
‘same active ingredients as the original formulation’. A biosimilar is a different product with a
similar, but not identical, structure that elicits a similar clinical response. As a result,
biosimilars medicines have the potential to cause an unwanted immune response. Whereas
generics are interchangeable, biosimilars are not.
4. Biosimilars have been available in Europe for almost a decade following their approval by the
European Medicines Agency (EMA) in 2005. The first biosimilar was approved by the FDA
for use in the U.S. during 2015.
5. Biosimilar medicines have transformed the outlook for patients with chronic and debilitating
conditions, as similar efficacy as that of the innovator product can be obtained at a lower cost.
6. Biosimilars will also increase access for patients without access to the bio-originator. Greater
global access to effective biopharmaceuticals can reduce disability, morbidity, and mortality
associated with various chronic diseases.
March 2018 MEC 209/Biosimilar Medicinal Products/Apr2018
2
7. Nonetheless, the potentially lower cost of biosimilars raises the risk that insurers may favor
them over the original reference medicine, even when they may not be appropriate for an
individual patient.
RECOMMENDATIONS
8. National medical associations should work with their governments to cultivate national
guidance on safety of biosimilars.
9. National medical associations should advocate for delivering biosimilar therapies that are as
safe and effective as their reference products.
10. National medical associations should lobby against allowing insurers and health funds to
promote biosimilar and reference medicine’s interchangeability and automatic substitution, that
can be to the detriment of patients.
11. Physicians must ensure that patient medical records accurately reflect the biosimilar medicine
that is being taken.
12. Physicians shouldn’t prescribe a biosimilar to patients already showing success with the
reference medicine.
13. Physicians should raise awareness of the issues surrounding biosimilars and promote clearly
delineated labelling of biosimilars.
19.03.2018
THE WORLD MEDICAL ASSOCIATION, INC.
Document
no:
MEC 209/Policy Review 2008/Apr2018 Original:
English
Title: Annual Policy Review 2008:
Recommendations received on MEC
documents
Destination: Medical Ethics Committee
209th
Council Session
Radisson Blu Latvija Hotel
Riga, Latvia
26-28 April 2018
Action(s)
required:
For
Consideration
The ongoing policy review process adopted by the WMA requires a review of every policy for which
it had been ten years since adoption or last revision.
The first step in the review process is to survey Constituent Members for their advice on whether a
policy requires (a) reaffirmation, (b) minor or editorial changes before reaffirmation (c) a major
revision, or (d) rescinding and archiving. On 6 February 2018, a memo was sent to Constituent
Members asking them to recommend the classifications of the 2008 policies. The result of this
consultation is as follows:
1) List of Respondents (26):
Australian Medical Association (AuMA) Norway Medical Association (NMA)
Bangladesh Medical Association (BMA) Netherlands medical Association(RDMA)
Canadian Medical Association (CMA) Consejo General de Colegios Medicos de España
(CGCM)
Conseil National de l´Ordre des Médecins
France (CNOM)
Swedish Medical Association (SwMA)
Danish Medical Association (DMA) Taiwan Medical Association (TMA)
Israeli Medical Association (IsMA) Medical Association of Thailand (MAT)
Japan Medical Association (JMA) Turkish Medical Association (TuMA)
Korean Medical Association (KMA) British Medical Association (BMA)
Kuwait Medical Association (KuMA) Vatican Medical Association (AMV)
German Medical Association (GMA) Pakistan Medical Association (PkMA)
Austrian Medical Chamber (AMC) Finnish Medical Association (FMA)
Rwanda Medical Association (RMA) American Medical Association (AMA)
Colegio Medico de Mexico (CMM) South African Medical Association (SAMA)
March 2018 MEC 209/Policy Review 2008/Apr2018
2) Policies abbreviations:
Capital punishment: Resolution on Physician Participation in Capital Punishment
Torture : Resolution on the Responsibility of Physicians in the Denunciation of Acts of
Torture or Cruel, Inhuman or Degrading Treatment of Which They are
Aware
Code of ethics: International Code of Medical Ethics (MEC)
3) Specific comments from NMAs:
Capital punishment *
(JMA) JMA believes that « Resolutions » should not undergo a major revision because they are
supposed to have been adopted reflecting the times when they were adopted. This resolution should
be also reaffirmed without changes.
(KMA) Merging this resolution with the WMA Resolution to reaffirm the WMA’s Prohibition of
Physician Participation in Capital Punishment.
(SwMA) We agree with the Secretariat´s suggestion to merge this resolution with the « WMA
Resolution to reaffirm the WMAs prohibition of physician participation in capital punishment ».
(BMA) We agree that is makes little sense to have two documents saying much the same thing.
Torture
(JMA) Citing the other related documents will lead to an endless, unnecessary procedure.
(KMA) If a doctor recognizes that a patient has been under torture and other cruel, inhuman or
degrading treatment, it should be accurately recorded and kept with the ethical obligation to report
to an authorized institution. However, since there are concerns about patients and doctors being
under retaliation, or the infringement of personal information, it is necessary to take extra caution.
(SwMA) This resolution has a long introduction, in which a large number of declarations,
conventions and resolutions are mentioned. To put greater focus on the actual recommendations,
perhaps the introduction could be shortened and, if necessary, reference to the different documents
placed in an annex or footnotes?
(RDMA) We also think that it is important to qualify in this Resolution the relation with the other
ones. More in general should the WMA be careful to have several resolutions, statements and
Declarations on the same subject
(DMA) The DMA recommends a major revision for this resolution. While the document contains
many important messages, these messages are not well communicated. For example, the documents
should not open with 15 references to other documents without a clear statement on the relevance of
those messages.
(AMA) We recommend a major revision. The policy would benefit from re-formatting to the
customary WMA style and has too many extraneous references at the beginning of the document.
Code of Ethics
March 2018 MEC 209/Policy Review 2008/Apr2018
(JMA) agrees to the viewpoints of the WMA Secretariat. It is true that ICME is now complemented
by the other ethics policies, and requires a thorough review. WMA should start working on this
review process internally while paying due consideration to the DoG.
(RDMA) At first glance we don’t see a need for complete re-writing. We do however think it is very
useful to compare all the different documents of the WMA dealing with medical ethics and conduct
of physicians. Maybe it is possible to merge some of them? Also it is very important that they
contain consistent messages. Therefore, we suggest that a broader project, comparing the
WMA-documents may, may be useful. Apart from that and because of that we do agree with
postponing the revision process of this particular Code of Medical Ethics, with the implementation
of the DoG still going on.
(DMA) The WMA-secretariat recommends that decision on this document be postponed to avoid
confusion during the ongoing reception of the DoG. While the DMA certainly agrees that such
confusion must be avoided, we do believe that a decision to start a major revision is appropriate –
and that the revision process could be initiated after the meeting in Riga. The revision of this
important document must be very thorough indeed and will require a substantial internal WMA
process. By the time a public consultation may be appropriate, we believe that the risk of confusion
with the DoG will be minimal. The DMA would be proud to participate in the reviewing process as
we have just finalized a reviewing process of our own ethical principles.
(TuMA) It could be useful to review it thoroughly after updating DoGeneva.
(FMA) Agree with postponing by one year. Internal work could start even earlier.
4) Constituent Members’ classification
Name of Policy
Constituent Members
Capital
Punishment
Torture Code of ethics
AMA Merge C Postpone
AMC Merge B Postpone
AMV Merge B Postpone
AuMA C B Postpone
BaMA A A A
CMA A B Postpone
CGCM B Postpone
CMM B Postpone
CNOM C B Postpone
DMA B C C
FMA Merge B Postpone
GMA A B C
IsMA Merge B Postpone
JMA A A Postpone
KMA Merge B Postpone
KuMA Merge A C
NMA Merge B
PkMA A B Postpone
RDMA Merge B Postpone
RMA A B B
March 2018 MEC 209/Policy Review 2008/Apr2018
SAMA B A
SwMA Merge B Postpone
TMA A B
MAT A A A
TuMA Merge B C
BMA Merge B C
TOTAL 24 26 23
5) Summary of classification
Name of Policy
Classification
Capital Punishment Torture Code of Ethics
Reaffirm (a) 8 5 2
Reaffirm with minor
revision (b)
1 19 1
Major revision (c) 2 2 5
Rescind and archive (d)
12 (merge) 15 (postpone
decision)
Proposed
classification based on
members’
recommendations
Merge with WMA
Resolution to reaffirm the
WMA’s Prohibition of
Physician Participation in
Capital Punishment *
B Postpone decision
In the light of this response, the Committee is asked to recommend to Council a classification for
this policy in MEC.
The Secretariat can take care of a policy requiring minor revision, which will be circulated to the
member associations for comment and considered at the October 2018 Committee and Council
meetings. Constituent Members are invited to volunteer, either individually or in workgroups, to
undertake any major policy revision. Recommendations for rescinding and archiving will go to the
Assembly in October 2018 for final decision.
§§§
09.04.2018
1
THE WORLD MEDICAL ASSOCIATION, INC.
Document
no:
FPL 209/Agenda/Apr2018/Rev Original:
English
Title: Agenda of the Finance and Planning
Committee
Destination: Finance and Planning Committee
209th
Council Session
Radisson Blu Latvija Hotel
Riga, Latvia
26-28 April 2018
Action(s)
required:
For
consideration
Note: This agenda has been revised on the items 3.1, 3.3 and 5.2.
Thursday, 26 April 2018
Membership of the Committee
Dr Moojin Choo Dr Toru Kakuta
Dr Louis Francescutti Dr Mari Michinaga
Dr Andrew W. Gurman Dr Andreas Rudkjoebing
Dr René Héman (Chair) Dr Julio Trostchansky
Dr Miguel Roberto Jorge Dr Walter Vorhauer
Ex-officio (with voting rights)
Dr Ardis Dee Hoven, Chair of Council
Dr Frank Ulrich Montgomery, Vice-Chair of Council
Dr Andrew Dearden, Treasurer
Ex-officio (without voting rights)
Dr Yoshitake Yokokura, President
Dr Leonid Eidelman, President-Elect
Dr Ketan Desai, Immediate Past President
Dr Otmar Kloiber, Secretary General
Ms Marie Collegrave-Juge, Legal Advisor
Mr Adolf Hällmayr, Financial Advisor
Ms Joelle Balfe, Facilitator
Ms Sunny Park, Head of Operations
March 2018 FPL 209/Agenda/Apr2018
2
1. GENERAL BUSINESS
1.1 Call to order by the Chair of the Council
1.2 Report of the previous meeting held in Chicago, United States, 11-14 October 2017
Approve: Report of the Finance and Planning Committee
(FPL 207/Report/Oct2017)
1.3 Chair’s Opening Remarks
2. FINANCE
2.1 Membership Dues Payments
Consider: Report on Membership Dues Payments for 2018
(FPL 209/Dues Report/Apr2018)
Receive: Oral Report on Dues Arrears
2.2 Financial Statement
Consider: Pre-audited Financial Statement for 2017
(FPL 209/FinStat 2017/Apr2018)
3. PLANNING
3.1 WMA Strategic Plan
Consider: Oral report by the Secretary General on the Draft Strategic Plan 2020
3.2 WMA Statutory Meetings
Consider: Planning of Future WMA Meetings
(FPL 209/WMA Future Meetings/Apr2018)
3.3 WMA Special Meetings
Receive: Oral Report
1) WMA Meetings in Geneva during WHA, 21-26 May 2018
2) Icelandic Medical Association / WMA Medical Ethics Conference
October 1-4, 2018 in Reykjavik, Iceland
3) 13th UNESCO World Conference on Bioethics, Medical Ethics and
Health Law in Jerusalem, Israel, 27-29 November 2018
4) 14th
World Congress of Bioethics and 7th National Bioethics Conference,
Bangalore, India, December 3-7, 2018, Potential WMA participation
March 2018 FPL 209/Agenda/Apr2018
3
4. MEMBERSHIP
4.1 Constituent membership
Consider: Applications for Constituent members, if any
4.2 Associate Membership
Consider: Report of the WMA Associate Membership for 2017
(FPL 209/AM Membership/Apr2018)
Receive: Report of Chair of Associate Members
(FPL 209/Chair of AM Report/Apr2018)
Receive: Report of the Junior Doctors Network (JDN)
(FPL 209/JDN Report/Apr2018)
Receive: Report of the Past Presidents and Chairs of Council Network (PPCN)
(FPL 209/PPCN Report/Apr2018)
5. GOVERNANCE
5.1 Review Committee
Receive: Oral report of the Chair of Review Committee
5.2 Nominating process for senior posts
Consider: Proposal to introduce a self-declaration statement to the nominating process
for WMA Presidency (FPL 209/Nominating process/Apr2018)
6. OUTREACH
6.1 World Medical Journal
Receive: Report of WMJ Editor
(FPL 209/WMJ Report/Apr2018)
6.2 Public Relations
Receive: Public Relations Report for October 2017 – March 2018
(FPL 209/PR Report/Apr2018)
7. ANY OTHER BUSINESS
8. ADJOURNMENT
§§§
29.03.2018

1
THE WORLD MEDICAL ASSOCIATION, INC.
Document
no:
FPL 207/Report/Oct2017 Original:
English
Title: Report of the Finance and Planning
Committee
Destination: Finance and Planning Committee
209th
Council Session
Radisson Blu Latvija Hotel
Riga, Latvia
26-28 April 2018
Action(s)
required:
For
consideration
Wednesday, 11 October 2017
Membership of the Committee
Dr Moojin Choo Dr Toru Kakuta
Dr Louis Francescutti Dr Mari Michinaga
Dr Andrew W. Gurman Dr Andreas Rudkjoebing
Dr René Héman (Chair) Dr Julio Trostchansky
Dr Miguel Roberto Jorge Dr Walter Vorhauer
Ex-officio (with voting rights)
Dr Ardis Dee Hoven, Chair of Council
Prof. Dr med. Frank Ulrich Montgomery, Vice-Chair of Council
Dr Andrew Dearden, Treasurer
Ex-officio (without voting rights)
Dr Ketan Desai, President
Sir Michael Marmot, Immediate Past President
Dr Yoshitake Yokokura, President-Elect
Dr Otmar Kloiber, Secretary General
Ms Marie Colegrave-Juge, Legal Advisor
Mr Adolf Hällmayr, Financial Advisor
Prof Vivienne Nathanson, Facilitator
1. GENERAL BUSINESS
1.1 The Chair of the Council called the meeting to order at 11:40 am.
October 2017 FPL 207/Report/Oct2017
2
1.2 The Committee approved the report of the previous meeting held in Livingstone from
20-22 April 201 (FPL 206/Report/Apr2017).
1.3 The Chair thanked the American Medical Association for hosting the meeting. He
noted the very full agenda and the fact that the work of the Finance and Planning
Committee enables the health of the organization and its ability to pursue its mission.
2. FINANCE
2.1 Financial Statement
2.1.1 The Committee considered the Audited Financial Statement for 2016 (FPL
207/FinStat 2016/Oct2017). The WMA Treasurer, Dr Andrew DEARDEN,
highlighted several key points from the Statement.
The Treasurer also addressed concerns about accepting funding from the
pharmaceutical industry. He stressed that we must be transparent about where
all funding comes from, the amounts, and the projects or activities to which
they are applied. The Secretary General stated that it is WMA’s policy to
avoid any undue influence on the work of the WMA and that information about
sponsorship is available in the Secretary General Report to the Council.
According to US law, it is also published on the websites of the donors. The
Treasurer stressed that funding from outside sources is not used for the core
work of the WMA, including the cost of statutory meetings. This funding is
used exclusively for special projects, including educational efforts and other
meetings.
RECOMMENDATION
2.1.1.1 That the Audited Financial Statement for 2016 (FPL 207/FinStat
2016/Oct2017) be approved by the Council and be forwarded to the
General Assembly for approval and adoption.
2.1.2 The Committee received the oral report on 2016 Dues Arrears. The Treasurer
announced that 99.35 % of 2016 contributions had been received.
2.2 WMA Budget and Membership Dues Payments
2.2.1 The Committee considered the Proposed WMA Budget for 2018 vs. Actual
2016 Expenditures (FPL 207/Budget 2018/Oct2017).
The Treasurer reviewed the details of the report, including some of the new
proposed activities that would be possible due to the WMA’s strong financial
situation. The Canadian Medical Association asked the Treasurer to clarify
whether the proposed new projects would be accomplished within the existing
staff resources or would require hiring additional staff at the WMA Secretariat.
The Secretary General responded that some of the activities would be
accomplished by existing staff, but that there was a plan to add new staff to
support the expanded work. He introduced the newest WMA Staff member,
Communication and Information Manager Ms. Magda MIHAILA.
October 2017 FPL 207/Report/Oct2017
3
RECOMMENDATION
2.2.1.1 That the Proposed WMA Budget for 2018 (FPL 207/Budget
2018/Oct2017) be approved by the Council and be forwarded to the
General Assembly for adoption.
2.2.2 The Committee received the Report on Membership Dues Payments for 2017
(FPL 207/Dues Report/Oct2017) including the dues in arrears. This document
will be forwarded to the General Assembly for information.
2.2.3 The Committee received WMA Dues Categories 2018 (FPL 207/Dues
Categories 2018/Oct2017). This document will be forwarded to the General
Assembly for information.
2.2.4 The Committee received the oral report of Finance Workgroup. The Treasurer
reported that the workgroup would review the WMA sponsorship policy,
which should be done periodically to ensure that it is clear and current. He
noted the launch of the educational platform that would occur late in 2017 or
early 2018, which was possible due to the accumulated financial surplus.
The Secretary General reported on the situation in Venezuela and asked the
Committee to support the Finance Group’s request that the WMA waive the
dues for the Venezuelan Medical Association for 2017 and consider them in
good standing.
RECOMMENDATION
2.2.4.1 That the Council waive the membership dues of the Venezuela
Medical Association.
2.3 Auditor
The Committee considered an oral report and the recommendation of the Treasurer to
reappoint KPMG as the auditor for the 2017 WMA Financial Statement.
RECOMMENDATION
2.3.1 That the Council appoint KPMG as auditor of the 2017 WMA Financial
Statement.
3. PLANNING
3.1 WMA Strategic Plan
The Secretary General reported that he had been instructed by Council to delay
development of the next Strategic Plan, pending the outcomes from the Governance
workgroup, which has now concluded its mandate. The recommendations in the
workgroup’s final report will be integrated into the next Strategic Plan. The draft
Strategic plan will be presented at the Council Session in April 2018.
October 2017 FPL 207/Report/Oct2017
4
3.2 WMA Statutory Meetings
The Committee considered the planning and arrangements for future WMA meetings
(FPL 207/WMA Future Meetings/Oct2017).
3.2.1 The Secretary General informed the committee that the recent unrest and the
treatment of physicians, human rights defenders, and persons critical of the
government in Turkey has led to a recommendation by the ExCo that WMA
reverse last year’s decision to hold the 2019 General Assembly in Istanbul. The
Secretary General recognized that this is unfortunate, as it was WMA’s hope to
be able to support the TMA by holding the meeting there. Several members
echoed their regret at the situation. He proceeded to explain that the Georgian
Medical Association had agreed to host the General Assembly in 2019 instead
of 2020. Therefore, the ExCo is recommending that WMA postpone
indefinitely the invitation of the Turkish Medical Association and accept the
Georgian Medical Association’s offer to host the 2019 General Assembly.
The Secretary General clarified that this postponement will be reconsidered
when the situation in Turkey stabilizes. He added that the WMA would release
a press statement explaining the WMA’s decision not to go to Istanbul in 2019
and expressing our continued strong support for the TMA.
RECOMMENDATION
3.2.1.1 That the Council recommend to the Assembly that the WMA
postpone indefinitely the invitation of the Turkish Medical
Association to host a meeting in 2019 and accept the Georgian
Medical Association’s offer to host the 2019 General Assembly.
3.2.2 The Committee considered the invitation of the Portuguese Medical
Association to host the 215th
Council session in 2020.
RECOMMENDATION
3.2.2.1 That the invitation of the Portuguese Medical Association to host the
215th
Council Session in Porto in April 2020 be accepted.
3.2.3 The Committee considered the invitation of the German Medical Association
to host the 73rd General Assembly in 2022.
RECOMMENDATION
3.2.3.1 That the invitation of the German Medical Association to host the 73rd
General Assembly in Berlin in October 2022 be accepted.
3.2.4 Regarding the Council’s decision in April 2017 to recommend that the 2021
General Assembly be held in China, the Secretary General informed the
Committee that he had remaining concerns regarding free access by the press
during the meeting as well as issues related to electronic communications, the
method by which WMA organizes and shares documents. He noted that he
October 2017 FPL 207/Report/Oct2017
5
believed both concerns could be resolved but that they currently represented
issues that need to be addressed.
At the direction of the ExCo, the Secretary General informed the Committee
that the World Heart Federation had been denied permission at the last minute
to hold a meeting in China unless its member from Taiwan agreed to change its
name. If this happened to the WMA, both the WMA and participants would
risk losing money spent on the meeting, travel arrangements, and registration
fees, which could amount to more than 500,000 Euros. In discussion, it was
clear that the divergence of positions between the Chinese Medical Association
and the Taiwan Medical Association regarding the name of the Taiwan
Medical Association remained unresolved. The Secretary General reminded
the Committee that the WMA has previously made a decision not to interfere
in this internal political situation and stressed that the WMA has no mandate or
statute that gives us the right to make any demands regarding the name of a
member. Several members supported this decision in their comments during
discussion. The Secretary General informed the Committee of the ExCo’s
recommendation that the two medical associations, possibly with help from the
WMA providing a moderator, use the next year to reach an agreement on this
matter and that the Committee wait until 2018 to consider any changes to our
plan to hold the 2021 General Assembly in China.
The medical associations from China and Taiwan agreed to discuss the issue of
the name of the Taiwan Medical Association between themselves, possibly
with support from the WMA.
The April 2017 decision of the Council to recommend to the 2017 General
Assembly that WMA accept the invitation of the Chinese Medical Association
to host the meeting in 2021 remains on the agenda (GA Council Report-
Provisional Annex/Oct2017, Item 4.1) and will be presented to the Assembly
during the plenary session.
3.3 WMA Special Meetings
The Committee received the oral report from the Secretary General concerning two
meetings:
3.3.1 Dr Jon SNÆDAL informed the Committee that the Icelandic Medical
Association and the WMA will hold a Medical Ethics Conference October in
conjunction with the WMA General Assembly in Reykjavik, Iceland, 1-4
October, 2018 in Reykjavik, Iceland
3.3.2 13th UNESCO World Conference on Bioethics, Medical Ethics and Health
Law in Jerusalem, Israel, 27-29 November 2018.
3.3.3 Nominations are closed for the WMA CPW Leadership course, which will be
held from 3-8 December 2017. This meeting will be held in cooperation with
the Mayo Clinic and receives financial support from Bayer and Pfizer.
October 2017 FPL 207/Report/Oct2017
6
4. MEMBERSHIP
4.1 Constituent membership
4.1.1 The Committee considered the Application from the Czech Medical Chamber
(FPL 207/Apply-Czech/Oct2017). The Secretary General explained that the
Czech Medical Association, a longtime WMA member, recently terminated its
membership in WMA in recognition of the fact that the Czech Medical
Chamber is a more representative of physicians in the country and more
appropriate organization to be the WMA member from the Czech Republic.
RECOMMENDATION
4.1.1.1 That the Czech Medical Chamber be admitted to the WMA
Constituent Membership.
4.1.2 The Committee considered the Application from the Belarusian Association of
Physicians (FPL 207/Apply-Belarus/Oct2017). The Secretary General
explained that WMA has been in contact with this Association for many years
and now welcomes their application for membership in WMA. The
organization does have a legal advisor who is a member of their board and
therefore a member of their association, but this does not create an issue with
our bylaws and should not preclude their membership in WMA.
RECOMMENDATION
4.1.2.1 That the Belarusian Association of Physicians be admitted to the
WMA Constituent Membership.
4.1.3 The Committee considered the Application from the Pakistan Medical
Association (FPL 207/Apply-Pakistan/Oct2017). The Secretary General
informed the Committee that the Pakistan Medical Association was previously
a WMA member. Thanks to the work of WMA President, Dr. Ketan Desai,
they have been persuaded to re-join WMA. The Pakistan Medical Association
does have six non-physician “honorary members” for specific merits, but we
do not believe this creates any conflict with our ability to support their
application for WMA membership.
RECOMMENDATION
4.1.3.1 That the Pakistan Medical Association be admitted to the WMA
Constituent Membership.
4.1.4 The Committee considered the Application from the National Medical
Chamber of Russia (NMC) (FPL 207/Apply-Russia/Oct2017)
The Secretary General explained that the Russian Medical Chamber includes
organizations from 79 of the 82 regions in Russia, with the remaining three
scheduled to join the NMC later this year. He considered the NMC the most
representative of the national-level physician organizations in Russia, with a
strong focus on self-governance, aiming to steer and supervise physician
October 2017 FPL 207/Report/Oct2017
7
conduct and develop ethical standards. Following careful review of their
application by the WMA Legal Advisor, Mr. Marie COLEGRAVE, it was his
recommendation that WMA approve their application. In response to a request
from the Danish Medical Association, the Secretary General provided an
overview of the assessments WMA had done to learn about the NMC and the
reasons the NMC appears to be the most representative association in Russia.
In response to a question from the Canadian Medical Association, the
Secretary General explained that the amount of dues paid by the NMC would
be low at first. He had made it clear to the President of the NMC that he
expected the dues payments to increase incrementally as the financial strength
of the organization grows. Dr. Peteris Apinis, President of the Latvian Medical
Association, stated that he was familiar with the organization and its very well-
respected leader.
The Secretary General noted that there remains an issue of former WMA
member, the Russian Medical Society (RMS), which apparently believes it still
has standing in WMA, despite being automatically terminated early in 2017 for
non-payment of the subscription due. The RMS had sent a letter to WMA,
essentially threatening legal action if the WMA accepts another member from
Russia. The ExCo discussed this in depth and concluded that this should not
interfere with the decision to admit the NMC into membership.
RECOMMENDATION
4.1.4.1 That the National Medical Chamber of Russia be admitted to the
WMA Constituent Membership.
5. GOVERNANCE
5.1 Governance Review
The Committee received the Report of the Governance Review Workgroup (FPL
207/Governance Review/Oct2017) by Prof. Dr Rutger J. van der GAAG, the Chair of
Workgroup.
Prof. van der GAAG reported that the mandate and the work of the workgroup had
concluded. He reviewed some additional recommendations resulting from the
workgroup meeting the previous day that are not contained in the written report.
Several NMAs and the Chair of Council commended the workgroup Chair for his
exceptional leadership of the group, noting the progress made and trust built over time
as the workgroup considered numerous difficult issues.
The Chair recognized that there remains work to do in order to implement the changes
recommended by the workgroup. She informed the Committee that she would take the
Workgroup report to the ExCo to discuss and develop a plan for moving forward,
deciding what incremental, short term, and long-term activities WMA should undertake
to continue to make progress on the topics and issues identified. She stressed the
importance of tying this work to the Strategic Plan and to be creative, forward thinking,
and deliberative about enacting change. The Chair of Council thanked the Workgroup
Chair and its members for their hard work.
October 2017 FPL 207/Report/Oct2017
8
RECOMMENDATION
5.1.1 That the Council accept the report of the Workgroup and that it be presented to
the General Assembly for information and discussion.
5.2 Review Committee
The Chair of the Review Committee, Dr. Mark PORTER, reported that, following the
formation of the Committee in Livingstone, the Committee had reviewed the new
proposed policies for this meeting and was beginning cooperation with the Secretariat in
the 10-year policy review process.
5.3 Revision of WMA Articles and Bylaws / Rules
5.3.1 The Committee considered the Proposed Revision of the Rules Applicable to
WMA Associate Membership (FPL 207/AM Rules/Oct2017).
The Secretary General recommended that Medical Students and Junior Doctors
be granted free Associate Membership for a period of five years, with the
understanding that they would not receive any products other than online
access to the WMA members area and would not have voting rights in the
Associate Members meeting.
RECOMMENDATION
5.3.1.1 That the Proposed Revision of the Rules Applicable to WMA
Associate Membership (FPL 207/AM Rules/Oct2017) be approved by
the Council and be forwarded to the General Assembly for approval.
5.3.2 The Committee considered the Appendix of the JDN Terms of Reference
(FPL 207/JDN ToR Appendix/Oct2017), which addressed election procedures
necessitated by the increased membership of the group.
RECOMMENDATION
5.3.2.1 That the Appendix of the JDN Terms of Reference (FPL 207/JDN
ToR Appendix/Oct2017) be approved by the Council.
6. OUTREACH
6.1 Associate Members Report
The Committee deferred the Report of the Chair of Associate Members (FPL
207/Chair of AM Report/Oct2017) by Dr. Joseph HEYMAN, to the Council.
6.2 Past Presidents’ and Chairs’ Network
The Committee deferred the Report of the Past Presidents and Chairs of Council
Network (PPCN) (FPL 207/PPCN Report/Oct2017) to the Council.
October 2017 FPL 207/Report/Oct2017
9
6.3 JDN Report
The Committee deferred the Report of the Junior Doctors Network (JDN) (FPL
207/JDN Report/Oct2017) by Dr. Caline MATTAR, to the Council.
6.4 World Medical Journal
The Committee deferred the Report by the WMJ Editor (FPL 207/WMJ/Oct2017) by
Dr. Peteris APINIS, to the Council.
6.5 Public Relations
The Committee deferred the Public Relations Report for May – September 2017 (FPL
207/PR Report/Oct2017) by WMA Press Officer Mr. Nigel DUNCAN, to the Council.
7. ANY OTHER BUSINESS
No other business was raised.
8. ADJOURNMENT
The meeting was adjourned at 14:55.
§§§
12.10.2017

1
COMPARISON OF MEMBERSHIP DUES PAID IN 2018, 2017 AND 2016
CONSTITUENT MEMBERS – COUNTRY
Membership rate per member
Category A – 0,40 2018 2017 2018/2017 2016
Category B – 0,95 Euro Euro Euro Euro
Category C – 1,60 Rate Classes Rate Classes Rate Classes
Category D – 2,15 A-D/member A-D/member A-D/member
1. Current year
AFRICA
ANGOLA B – C – – C
CABO-VERDE B – B – – B
CAMEROON B – B – – B
CONGO A 6 000 A -6 000 – A
CÔTE D’IVOIRE B 95 B -95 95 B
EGYPT B – B – – B
ETHIOPIA A – A – – A
GHANA 1 055 B 1 055 B – 1 055 B
GUINEA A 120 A – A
KENYA B 713 B – B
LESOTHO B – B – B
MALAWI A – A – 40 A
MALI A – A – – A
MOZAMBIQUE A – A – – A
NAMIBIA C – C – – C
NIGERIA 14 250 B 14 250 B – 1 285 B
RWANDA 80 A A – A
SÉNÉGAL A 544 A -544 – B
SOMALIA *** A – A – – A
SOUTH AFRICA 14 040 C 14 040 C – 14 040 C
SUDAN B – B – – B
Destination: Finance and Planning Committee
209th Council Session
Radisson Blu Latvija Hotel
Action(s)
required:
This document is composed of two parts, comparison of
membership dues paid and number of declared members paid
(Annex 1) for 2016, 2017 and 2018 as of 5 April 2018.
THE WORLD MEDICAL ASSOCIATION, INC.
Title:
FPL 209/Dues Report/Apr2018
Report on Membership Dues Payment for
2018
Original:
Document no:
English
26-28 April 2018
Riga, Latvia
For
Information
Note:
2
Membership rate per member
Category A – 0,40 2018 2017 2018/2017 2016
Category B – 0,95 Euro Euro Euro Euro
Category C – 1,60 Rate Classes Rate Classes Rate Classes
Category D – 2,15 A-D/member A-D/member A-D/member
TANZANIA A – A – – A
TUNISIA 433 B 633 B -200 – C
UGANDA A 40 A -40 40 A
ZAMBIA 950 B 950 B 950 B
ZIMBABWE *** – A – A – – A
Sub-total 30 809 38 440 -6 879 17 505
ASIA
BANGLADESH 570 B 570 B – 412 B
CHINA *** 20 000 C 80 000 C -60 000 3 555 C
INDIA 71 250 B 71 250 B – 71 250 B
ISRAEL 53 750 D 52 500 D 1 250 52 500 D
KUWEIT 2 150 D 2 100 D 50 2 102 D
MYANMAR 380 B 285 B 95 285 B
NEPAL A 163 A -163 163 A
PAKISTAN 475 B ** 475 **
SRI LANKA B – B – – B
VIETNAM B 422 B -422 – B
Sub-total 148 575 207 290 -58 715 130 267
EUROPE
ALBANIA 3 200 C 3 200 C – 1 920 C
ANDORRA D – D – – D
ARMENIA B – B – – B
AUSTRIA 15 093 D 14 742 D 351 14 742 D
AZERBAIJAN C – C – – C
BELARUS C **
BELGIUM 4 934 D 4 820 D 115 4 820 D
BULGARIA C – C – – C
CROATIA 1 500 D – D 1 500 1 575 D
CYPRUS D – D – – D
CZECH REP. *** 12 900 D ** D 12 900 1 680 D
DENMARK 32 250 D 31 500 D 750 31 500 D
ESTONIA 1 075 D 1 050 D 25 1 050 D
FINLAND 27 950 D 27 300 D 650 27 300 D
FRANCE 107 715 D 105 210 D 2 505 105 210 D
GEORGIA 259 B 437 C -177 272 B
GERMANY *** 112 875 D 220 500 D -107 625 220 500 D
GREECE 10 750 D 10 500 D 250 10 500 D
HUNGARY 6 450 D 6 300 D 150 6 300 D
ICELAND 1 828 D 1 785 D 43 1 785 D
IRELAND 1 505 D 1 470 D 35 1 470 D
ITALY D 12 600 D -12 600 12 600 D
KAZAKHSTAN C 240 C -240 240 C
LATVIA 3 118 D 3 045 D 73 3 045 D
3
Membership rate per member
Category A – 0,40 2018 2017 2018/2017 2016
Category B – 0,95 Euro Euro Euro Euro
Category C – 1,60 Rate Classes Rate Classes Rate Classes
Category D – 2,15 A-D/member A-D/member A-D/member
LIECHTENSTEIN D – D – – D
LITHUANIA D – D – – D
LUXEMBOURG D 1 275 D -1 275 1 296 D
MACEDONIA C – C – – C
MALTA 1 075 D 1 050 D 25 1 050 D
MONTENEGRO C – C – – C
NETHERLANDS 128 153 D 124 121 D 4 032 33 128 D
NORWAY 32 250 D 31 500 D 750 31 500 D
POLAND 897 D 876 D 21 876 D
PORTUGAL D 5 250 D -5 250 5 250 D
ROMANIA 16 000 C 15 040 C 960 14 400 C
RUSSIA *** C 11 200 C -11 200 – D
SERBIA C 16 002 C -16 002 – C
SLOVAKIA D 479 D -479 479 D
SLOVENIA 6 927 D 6 829 D 98 – D
SPAIN *** D 105 000 D -105 000 105 000 D
SWEDEN 43 215 D 42 210 D 1 005 42 210 D
SWITZERLAND 38 732 D 36 863 D 1 869 36 863 D
TURKEY 1 600 C 1 600 C – 1 600 C
UKRAINE 95 B 95 B – B
UNITED KINGDOM 219 300 D 214 200 D 5 100 214 200 D
UZBEKISTAN B – B – 67 B
VATICAN 108 D 105 D 3 105 D
Sub-total 831 753 1 058 392 -226 639 934 531
LATIN AMERICA
ARGENTINA D 700 D -700 4 200 D
BAHAMAS D – D – – D
BELIZE 160 C **
BOLIVIA B 422 B -422 422 B
BRAZIL 80 800 C 80 800 C – 80 800 C
CHILE 4 504 D 4 400 D 105 4 400 D
COLOMBIA C – C – – C
COSTA RICA C 600 C -600 1 609 C
EL SALVADOR B – B – – B
HAITI A – A – 100 A
MEXICO C 533 C -533 533 C
PANAMA 566 C 803 C -237 – C
PERU C – C – – C
TRINIDAD AND TOBAGO D 420 D -420 420 D
URUGUAY D 4 110 D -4 110 5 273 D
VENEZUELA *** C – C – – D
Sub-total 86 030 92 788 -6 917 97 757
NORTH AMERICA
4
Membership rate per member
Category A – 0,40 2018 2017 2018/2017 2016
Category B – 0,95 Euro Euro Euro Euro
Category C – 1,60 Rate Classes Rate Classes Rate Classes
Category D – 2,15 A-D/member A-D/member A-D/member
CANADA 64 715 D 63 210 D 1 505 63 210 D
USA 260 150 D 254 100 D 6 050 254 100 D
Sub-total 324 865 317 310 7 555 317 310
PACIFIC
AUSTRALIA 44 406 D 45 555 D -1 149 39 297 D
FIJI C – C – – C
HONG KONG 2 043 D 1 995 D 48 1 995 D
INDONESIA B – B – – B
JAPAN *** D 317 100 D -317 100 317 100 D
KOREA 37 625 D 36 750 D 875 36 750 D
MALAYSIA 2 400 C 2 400 C – 2 400 C
NEW ZEALAND 400 D 2 100 D -1 700 2 100 D
PHILIPPINES B 713 B -713 661 B
SAMOA B – B – – B
SINGAPORE 516 D 504 D 12 504 D
TAIWAN D 23 125 D -23 125 23 125 D
THAILAND 1 066 C 1 066 C – 1 066 C
Sub-total 88 455 431 307 -342 852 424 998
TOTAL 1 510 487 2 145 527 -634 447 1 922 369
2. Previous years
Belgium (2006-2012) 2 002 D 2 002 D 2 002 D
Panama (2015-2016) 1 556 C
Russia (2015) 5 250 D
Rwanda (2015-2017) 44 A
Tunisia (2015-2016) 2 066 B
Ukraine (2015, 2016) 185 B
Uzbekistan (2013-2015) 189 D
Vietnam (2016) 422 B
Sub-total 2 046 6 231 7 441
TOTAL 1 512 533 2 151 758 -639 225 1 929 810
** Not member at that time
*** Note by the Secretary General:
The following statutory members have formal special arrangements with the WMA:
• Due to the current impossibility to transfer money out of Zimbabwe, the technical inability to collect our dues, the
extreme inflation rate in the country and after having consulted with the Zimbabwe Medical Association the
Secretary General considers the Zimbabwe Medical Association in Good Standing without having received dues so
far but considers that ZiMA pays its annual dues (20 EUR) till the financial situation changes.
5
Membership rate per member
Category A – 0,40 2018 2017 2018/2017 2016
Category B – 0,95 Euro Euro Euro Euro
Category C – 1,60 Rate Classes Rate Classes Rate Classes
Category D – 2,15 A-D/member A-D/member A-D/member
• German Medical Association pays its dues in two equal parts on January 1st and July 1st.
• Japan Medical Association pays its dues in with its new business year in April.
• Spanish Medical Association pays its dues in two equal parts on February 1st and August 1st.
• The Czech Medical Association resigned in April 2017 and the Czech Medical Chamber joined the membership in
October2017.
• The membership of the Russian Medical Society was terminated in April 2017 following procedure accroding to
WMA Bylaws, Chapter 1, Section 5B and the National Medical Chamber of Russia joined the membership in Octboer
2017.
• Due to the financial crises in Venezuela, the membership dues of Venezuela Medical Association was waived for
the years 2013 to 2017.
• Chinese Medical Association pays its dues by three installments. 1st installment was received on 4 April 2018.
• Due to the war in Somalia, the Secretary General considers the Somalia Medical Association is in good standing
and waived the membership dues since 2011.
ANNEX
6
COMPARISON OF DECLARED MEMBERS IN 2018, 2017 AND 2016
CONSTITUENT MEMBERS – COUNTRY
2018 2017 2018/2017 2016
1. Current year
AFRICA
ANGOLA – – – –
CABO-VERDE – – – –
CAMEROON – – – –
CONGO – 15 000 -15 000 –
CÔTE D’IVOIRE – 100 -100 100
EGYPT – – – –
ETHIOPIA – – – –
GHANA 1 111 1 111 – 1 111
GUINEA – 300 -300 –
KENYA – 750 -750 –
LESOTHO – – – –
MALAWI – – – 100
MALI – – – –
MOZAMBIQUE – – – –
NAMIBIA – – – –
NIGERIA 15 000 15 000 – 1 352
RWANDA 200 – 200 –
SÉNÉGAL – 1 360 -1 360 –
SOMALIA – – – –
SOUTH AFRICA 8 775 8 775 – 8 775
SUDAN – – – –
TANZANIA – – – –
TUNISIA 456 666 -210 –
UGANDA – 100 -100 100
ZAMBIA 1 000 1 000 – 1 000
ZIMBABWE 50 50 – 50
Sub-total 26 592 44 212 -17 620 12 588
ASIA
BANGLADESH 600 600 – 434
CHINA 12 500 50 000 -37 500 2 222
INDIA 75 000 75 000 – 75 000
ISRAEL 25 000 25 000 – 25 000
KUWEIT 1 000 1 000 – 1 000
MYANMAR 400 300 100 300
NEPAL – 407 -407 407
PAKISTAN 500 ** 500 **
SRI LANKA – – – –
VIETNAM – 444 -444 –
Sub-total 115 000 152 751 -37 751 104 363
EUROPE
ANNEX
7
2018 2017 2018/2017 2016
ALBANIA 2 000 2 000 – 1 200
ANDORRA – – – –
ARMENIA – – – –
AUSTRIA 7 020 7 020 – 7 020
AZERBAIJAN – – – –
BELARUS – ** **
BELGIUM 2 295 2 295 – 2 295
BULGARIA – – – –
CROATIA 697 – 697 750
CYPRUS – – – –
CZECH REP. 6 000 ** 6 000 800
DENMARK 15 000 15 000 – 15 000
ESTONIA 500 500 – 500
FINLAND 13 000 13 000 – 13 000
FRANCE 50 100 50 100 – 50 100
GEORGIA 273 273 – 286
GERMANY 52 500 105 000 -52 500 105 000
GREECE 5 000 5 000 5 000
HUNGARY 3 000 3 000 – 3 000
ICELAND 850 850 – 850
IRELAND 700 700 – 700
ITALY – 6 000 -6 000 6 000
KAZAKSTAN – 150 -150 150
LATVIA 1 450 1 450 – 1 450
LIECHTENSTEIN – – – –
LITHUANIA – – – –
LUXEMBOURG – 607 -607 617
MACEDONIA – – – –
MALTA 500 500 – 500
MONTENEGRO – – – –
NETHERLANDS 59 606 59 105 501 15 775
NORWAY 15 000 15 000 – 15 000
POLAND 417 417 – 417
PORTUGAL – 2 500 -2 500 2 500
ROMANIA 10 000 9 400 600 9 000
RUSSIA – 7 000 -7 000 –
SERBIA – 10 001 -10 001 –
SLOVAKIA – 228 -228 228
SLOVENIA 3 222 3 252 -30 –
SPAIN – 50 000 -50 000 50 000
SWEDEN 20 100 20 100 – 20 100
SWITZERLAND 18 015 17 554 461 17 554
TURKEY 1 000 1 000 – 1 000
UKRAINE 100 100 – –
UNITED KINGDOM 102 000 102 000 – 102 000
UZBEKISTAN – – – 70
VATICAN 50 50 – 50
Sub-total 390 395 511 152 -120 757 447 912
LATIN AMERICA
ANNEX
8
2018 2017 2018/2017 2016
ARGENTINA – 333 -333 2 000
BAHAMAS – – – –
BELIZE 100 ** 100 **
BOLIVIA – 444 -444 444
BRAZIL 50 500 50 500 – 50 500
CHILE 2 095 2 095 – 2 095
COLOMBIA – – – –
COSTA RICA – 375 -375 1 005
CUBA – – – –
EL SALVADOR – – – –
HAITI – – – 250
MEXICO – 333 -333 333
PANAMA 353 502 -149 –
PERU – – – –
TRINIDAD AND TOBAGO – 200 -200 200
URUGUAY – 1 957 -1 957 2 522
VENEZUELA – – – –
Sub-total 53 048 56 739 -3 691 59 349
NORTH AMERICA
CANADA 30 100 30 100 – 30 100
USA 121 000 121 000 – 121 000
Sub-total 151 100 151 100 – 151 100
PACIFIC
AUSTRALIA 20 653 21 692 -1 039 18 712
FIJI – – – –
HONG KONG 950 950 – 950
INDONESIA – – – –
JAPAN – 151 000 -151 000 151 000
KOREA 17 500 17 500 – 17 500
MALAYSIA 1 500 1 500 – 1 500
NEW ZEALAND 186 1 000 -814 1 000
PHILIPPINES – 750 -750 696
SAMOA – – – –
SINGAPORE 240 240 – 240
TAIWAN – 11 011 -11 011 11 011
THAILAND 666 666 – 666
Sub-total 41 695 206 309 -164 614 203 275
TOTAL 777 830 1 122 263 -344 433 978 587
1
THE WORLD MEDICAL ASSOCIATION, INC.
Document
no:
FPL 209/WMA Future Meetings/Apr2018 Original:
English
Title: Planning and Arrangements for future
WMA Meetings
Destination: Finance and Planning Committee
209th
Council Session
Radisson Blu Latvija Hotel
Riga, Latvia
26-28 April 2018
Action(s)
required:
For
consideration
1. ITEMS TO BE CONSIDERED
1.1 Meeting dates
Survey was sent out to the members in January 2018 and the following dates are most
preferable dates for upcoming meetings in 2021/2022:
1.1.1 218th
Council session (venue is not decided): 22-24 April 2021
1.1.2 72nd
General Assembly (venue is not decided): 13-16 October 2021
1.1.3 221st
Council session (venue is not decided): 7-9 April 2022
1.2 New invitations received from
1.2.1 Rwanda Medical Association (RMA) in Kigali1
• Preferably for the 71st
General Assembly in October 2020
• or nearby future vacant years for Council Session, i.e. April 2021 or 2022
1.2.2 British Medical Association (BMA) in London2
• for the 71st
General Assembly in October 2020
• or future years including 2021 and 2022
1.2.3 Ordre National des Medecins Conseil National de l’Ordre (CNOM France) in
Paris3
• for the 221st
Council Session in April 2022
1
Secretariat received a completed questionnaire and see the city Kigali is eligible as a venue for the WMA Council
Session or General Assembly.
2
Secretariat received a completed questionnaire and see the city London is eligible as a venue for the WMA General
Assembly. Only concern would be that there may be some difficulty for Russian representatives for visa issuing due to
the recent political situation.
3
Secretariat received a completed questionnaire and see the city Paris is eligible as a venue for the WMA Council
Session.
April 2018 FPL 209/WMA Future Meetings/Apr2018
2
The Secretariat will proceed an on-going survey on meeting dates and call for invitation
of future meetings during July 2018. For consideration by the 210th
Council Session in
Reykjavik in October 2018, invitations shall be submitted to the secretariat until 31
August 2018.
1.3 GA Beijing (or Shanghai) 2021
Following to the decision made by the General Assembly in October 2017, the
invitation of the Chinese Medical Association was postponed until the 2018 General
Assembly.
2. DATES/VENUES OF WMA ASSEMBLIES AND COUNCIL SESSIONS 2005-2021
The venues of WMA General Assembly meetings are determined by a global rotation system
ideally, whereby the WMA General Assembly is held in each of the six regions of the WMA
over a period of six years.
Year Dates Region Venue Note
2005 12-15 October Latin America Santiago, Chile
2006 12-15 October Africa Sun City, South Africa
2007 3-6 October Europe Copenhagen, Denmark 150th
Anniversary
2008 15-18 October Pacific Seoul, Korea 100th
Anniversary
2009 13-15 May Asia Tel Aviv, Israel
14-17 October Asia New Delhi, India
2010 20-22 May Europe Evian-les-Bains, France
13-16 October North America Vancouver, Canada
2011 7-9 April Pacific Sydney, Australia
12-15 October Latin America Montevideo, Uruguay
2012 26-28 April Europe Prague, Czech Republic
10-13 October Pacific Bangkok, Thailand
2013 4-6 April Pacific Bali, Indonesia
16-19 October Latin America Fortaleza, Brazil
2014 24-26 April Pacific Tokyo, Japan
8-11 October Africa Durban, South Africa
2015 16-18 April Europe Oslo, Norway
14-17 October Europe Moscow, Russia
2016 28-30 April Latin America Buenos Aires, Argentina
19-22 October Pacific Taipei, Taiwan
2017 20-22 April Africa Livingston, Zambia
11-14 October North America Chicago, United States
2018 26-28 April Europe Riga, Latvia
3-6 October Europe Reykjavik, Iceland 100th
Anniversary
2019 25-27 April Latin America Santiago, Chile
23-26 October Europe Tbilisi, Georgia 30th
Anniversary in
2019
2020 16-18 April Europe Porto, Portugal
21-24 October
April 2018 FPL 209/WMA Future Meetings/Apr2018
3
2021 22-24 April4
13-16 October5
Asia Beijing, China6
106th
Anniversary
in 2021
2022 7-9 April7
5-8 or 12-15
October8
Europe Berlin, Germany 75th
Anniversary in
2022
• All future meetings are listed in the WMA website.
3. ARRANGEMENTS OF STATUTORY MEETINGS
3.1 General Assembly, Reykjavik 2018
• Dates: Wednesday 3 to Saturday 6 October 2018
• Venue for meeting rooms: Harpa conference center
• Hotel for accommodation: Hilton Reykjavik Nordica
• Preliminary schedule
– The pre-meetings of Executive Committee, workgroups and JDN meeting will be
held on Monday 1 October and/or Tuesday 2 October, prior to the meeting.
– The three Standing Committees and the Credentials Committee will meet on
Wednesday 3 October.
– Scientific Session: Icelandic Medical Association/WMA Medical Ethics
Conference will take place in Harpa conference center from 1- 4 October. The
scientific session on 4 October will be replaced by joining the Medical Ethics
Conference.
– There will be a half-day Tour for accompanying persons on Thursday 4 October.
– The main meeting of the Council will take place on Friday 5 October.
– The Assembly Ceremonial Session will take place after the Council Session on
Friday 5 October.
– There will be a half-day Tour for all participants on Friday 5 October.
– The Assembly Plenary Session will be held on Saturday 6 October.
1 Oct 2 Oct 3 Oct 4 Oct 5 Oct 6 Oct
Mon Tue Wed Thu Fri Sat
IcMA
Conference on
Medical Ethics
1st
day of
conference
2nd
day of
conference
3rd
day of
conference (full
day)
WMA pre-
meetings (ExCo
and other
possible WGs)
WMA pre-
meetings (Open
WG meetings
are planned in
conjunction
WMA Council WMA
Scientific
session
WMA GA and
social
WMA GA
plenary
4
Pending Council’s approval
5
Pending Council’s and GA’s approval
6
Pending GA’s approval (see consideration item 1.3)
7
Pending Council’s approval
8
Pending Council’s and GA’s approval: The German Medical Association has requested to hold off the decision until
October 2018 for them to have some time to search the most preferable venue.
April 2018 FPL 209/WMA Future Meetings/Apr2018
4
with the Ethics
conference)
• Interpretation
Simultaneous Interpretations in English, Spanish, French and Japanese will be
provided.
• Social events
– The Welcome reception for all participants will be offered by the Icelandic
Medical Association on Wednesday 3 October.
– The Icelandic Medical Association will offer the dinner to all participants on
Friday 5 October.
– The WMA Assembly dinner for all participants will be offered by the World
Medical Association on Saturday 6 October.
Ÿ More details will be available on the WMA website and the registration will be open
in May 2018.
3.2 212th
Council Session, April 2019
Ÿ Dates: Thursday 25 to Saturday 27 April 2018
Ÿ Hotel: Hotel Santiago (Mandarin Oriental) in Santiago, Chile
Ÿ Preliminary schedule
– The pre-meetings of Executive Committee, workgroups and JDN meeting
will be held on Wednesday 24 April, one day prior to the meeting.
– The meeting will begin with the Opening Plenary Session of the Council on
Thursday 25 April.
– The three Standing Committees will meet on Thursday 25 April and Friday 26
April.
– The Council Plenary Session will take place on Saturday 27 April.
Ÿ Interpretation
Simultaneous interpretation in English, Spanish, French and Japanese will be provided.
Ÿ Social events
– The Welcome reception for all participants will be offered by the Colegio
Médico de Chile on Thursday 25 April.
– The Council dinner will be offered by the World Medical Association on Friday
26 April.
– The Half-day tour and dinner for all participants will be offered by the Colegio
Médico de Chile on Saturday 27 April.
Ÿ More details will be available on the WMA website and the registration will be open
in October 2018.
§§§
17.04.2018
1
THE WORLD MEDICAL ASSOCIATION, INC.
Document
no:
FPL 209/AM Membership/Apr2018 Original:
English
Title: Report on the Associate Membership
for 2017
Destination: Finance and Planning Committee
209th
Council Session
Radisson Blu Latvija Hotel
Riga, Latvia
26-28 April 2018
Action(s)
required:
To be received
1. This report covers the period up to 31 December 2017.
2. The total number of Associate Members who are in good standing is 1,115. The regional
breakdown of the 1,115 Associate Members (including 25 as life members) is:
Japan: 647 in good standing
All other countries: 468 members in good standing in the other regions, including 25 life
members and 137 IFMSA/JDN members in free membership
3. Applications for Associate Membership shall be obtained only from the WMA directly, or from
a National Medical Association that is a Constituent Member of the WMA. The application
should be returned, with the proper amount of membership dues to the WMA General
Secretariat.
4. Medical students and junior doctors (on graduation as physicians for a period of five years) will
be granted Associate Membership of the WMA. No membership fee will be charged, but no
products, services or publications (except electronic publications) will be provided to these
members. In addition, these members will not have the right to vote.
5. Online applications for the different member types have been implemented on the WMA
website.
§§§
16.04.2018

1
THE WORLD MEDICAL ASSOCIATION, INC.
Document
no:
FPL 209/Chair of AM Report/Apr2018 Original:
English
Title: Report of the Chair of the Associate
Members (October 2017 – March 2018)
Destination: Finance and Planning Committee
209th
Council Session
Radisson Blu Latvija Hotel
Riga, Latvia
26-28 April 2018
Action(s)
required:
To be
received
While in Chicago we had a very successful “Meet the Associate Members” informal dinner
sponsored by the American Medical Association. We will be enjoying another informal get-
together in Riga on the evening of April 25th
which was open to all attending the council meeting.
Registration was required in advance. Special thanks to the Latvian Medical Association for
making this possible.
At the end of our meeting in Chicago, there were 85 members of our active Google group. We have
more than doubled in size to 195 members of this wonderful discussion platform. We had a very
robust discussion of each of the circulated documents for this meeting. One document alone had
over fifty comments. The discussions are respectful and enlightening and are open to all associate
members. A summary of our comments appears on each document.
We held a conference call on March 26 for the leaders of the Junior Doctors Network, the Past
Presidents and Chairs Network and the Chair of the AMs along with the Secretary General. We
wanted to connect to look for ideas for coordination of the three parts of the AMs and to make the
AM experience more valuable to the WMA and to the AMS themselves. A summary of the meeting
follows:
Attendees:
Dana Hanson, Chair, Past Presidents and Chairs Network (PPCN)
Jon Snædal, PPCN Secretary
Caline Mattar, Chair, Junior Doctors Network (JDN)
Yassen Tcholakov, JDN Socio-Medical Affairs
Otmar Kloiber, Secretary General, World Medical Association (WMA)
Joe Heyman, Chair, WMA Associate Members
1) There was a discussion about how to get more recognition for WMA policies among the rank
and file membership of national medical associations (NMAs). It would be great if an NMA
introduced a resolution at the Council Meeting that suggested that NMAs review WMA policy
when considering new policy or reviewing existing policy.
2) We will try to come up with an agenda for a meeting in Iceland of all AMs with possible
broadcast.
April 2018 FPL 209/Chair of AM Report/Apr2018
2
3) We discussed a voluntary effort to include other associate members when a particular policy is
being developed among one of the groups in the AMs. We may have leadership communicate
with each other between meetings briefly to keep everybody in the loop.
4) We may wish to bring subjects that are not policy, or are not policy currently under review, to
the AMs at large for discussion in the Google Group.
5) We discussed the barriers to broadcast the Scientific Session to the AMs who cannot attend. At
least for the time being we cannot broadcast it for everyone since speakers speak in several
languages and because there are software and financial barriers.
6) We discussed the relationships between the WMA and the international specialty societies. It
is healthy.
7) We discussed recruiting associate members. We have three types of members right now, a)
those involved in international medicine, b) those involved in Public Health, and c) those who
are interested for other reasons. We should focus on recruiting people who are interested in
public health and/or medical ethics.
8) We discussed efforts to broadcast meetings with GoToMeeting, Zoom, and Adobe Connect in
the hope we can more easily involve those members who can not attend in person.
9) We considered adding an additional hour or another meeting time for AMs where a panel
discussion might be possible.
10) We would like to find a periodic formal way in which the AM Chair could meet with the
executive committee to bring them up to date on what has happened with the AMs and for the
AM chair to learn more about the WMA activities and concerns.
11) We discussed a role for medical students that would not compete with the International
Federation of Medical Student Associations (IFMSA).
12) We discussed how we might interest Council members to join the AMs.
13) We ruled out regional meetings of AMs for now.
Respectfully submitted by Joe Heyman, MD, Chair of the Associate Members
§§§
03.04.18
1
THE WORLD MEDICAL ASSOCIATION, INC.
Document
no:
FPL 209/JDN Report/Apr2018 Original:
English
Title: Report of the Junior Doctors Network
(JDN) (October 2017 – March 2018)
Destination: Finance and Planning Committee
209th
Council Session
Radisson Blu Latvija Hotel
Riga, Latvia
26-28 April 2018
Action(s)
required:
To be
received
During the reporting period, the JDN working groups (WG) have continued their activities, those
including Working conditions, and Medical care for the psychiatric patient.
Additionally, the WG Global Medical Exchanges on surveying the membership on interest and
mapping existing initiatives. The survey is currently at its pilot stage.
The working group on Antimicrobial Resistance (AMR) is gearing up towards another AMR social
media campaign in collaboration with the WMA secretariat to promote the WMA policy and AMR
course during Antibiotic Awareness Week in November, and is looking forward to the policy
revision coming up.
As part of a revision of the internal processes of the network, new terms of reference are now
proposed to regulate the JDN WGs. This will be presented for discussion at the Meeting in Riga.
JDN members participated in the 4th
Global Forum on Human Resources for Health which was held
in Dublin and contributed to the organization of the Youth forum portion of the event.
We continue to have monthly management team meetings in addition to the general membership
teleconference to ensure coordination of activities and appropriate follow up. We continue to have a
reporting system with half yearly reports submitted by the JDN officers in April, and end of year
reports submitted in September. JDN working groups as well will start reporting on their activities
twice yearly. The next report is due prior to the start of the Riga meeting.
We have planned our JDN meeting in Riga and we are implementing a new format which includes
capacity building. We will be having a climate change workshop as part of the meeting, as well as a
leadership in healthcare workshop in collaboration with the Alumni of the WMA Caring Physicians
of the World course.
JDN continues to support regional collaborations. There is an active group of Junior Doctors in
Latin America which continues to evolve and new members from the Eastern Mediterranean are
joining the network. JDN is also working on establishing close collaboration with the European
Junior Doctors EJD, on several topics of mutual interest.
April 2018 FPL 209/JDN Report/Apr2018
2
With regards to Medical Education, JDN continues its collaboration with the World Federation for
Medical Education, and the network will be represented at the WFME meeting by the JDN Chair,
Dr Caline Mattar and the JDN Education Officer Dr Audrey Fontaine.
The JDN continues to foster its partnership with the IFMSA through continued collaboration and
coordination.
Since the last meeting, we have seen an increasing number of Junior Doctor representatives of
National Associations join the network. We highly value close collaboration with NMAs in order to
continue to increase participation of young physicians from the national organizations.
This report was prepared by Dr Caline Mattar, Chair of the Junior Doctors Network.
§§§
03.04.18
1
THE WORLD MEDICAL ASSOCIATION, INC.
Document
no:
FPL 209/PPCN Report/Apr2018 Original:
English
Title: Report of the Past Presidents and Chairs
of Council Network (October 2017 –
March 2018)
Destination: Finance and Planning Committee
209th
Council Session
Radisson Blu Latvija Hotel
Riga, Latvia
26-28 April 2018
Action(s)
required:
To be
received
The PPCN has continued its work this year.
Dr Dana Hanson has participated in the WMA AM Leadership conference call on 26 March with
Dr Jón Snaedal, PPCN Secretary. (see FPL 209/Chair of AM Report/Apr2018)
Dr Yank Coble has continued supporting and organising the WMA Leadership Course with Mayo
Clinic Jacksonville campus for the course in December 2017.
Dr Yoram Blachar has continued to engage to the UNESCO World conference on Bioethics,
Medical Ethics and Health Law in Limassol and next meeting (13th
) will be held in Jerusalem, Israel,
27-29 November 2018.
Dr Jón Snaedal has been taking a lead to organise the Icelandic Medical Association/WMA Medical
Ethics Conference to be held in conjunction with the WMA General Assembly in Reikjavik in 2018.
He has served as President of the International College for Person Centered Medicine (ICPCM)
which has been cooperating with the WMA on organising its annual Geneva conference on person
centered medicine since 2006. The ICPCM conference was held on 8-11 April 2018.
Dr Mukesh Haikerwal AC is continuing to raise WMA’s profile in social media networks. He is
actively supporting our outreach to our African members and non-member Medical Associations.
Dr. Haikerwal AC represented the WMA at the World Self-Medication Industry Assembly in
Sydney October 2017.
Advise on current questions has been and is being provided by members of the PPCN upon request
of the secretariat.
We would thank Dr. Kloiber and staff for their support.
Submitted by Dr. Dana Hanson, Chair of PPCN
§§§
04.04.18

1
THE WORLD MEDICAL ASSOCIATION, INC.
Document
no:
FPL 209/Nominating process/Apr2018 Original:
English
Title: Proposal to introduce a self-declaration
statement to the nominating process for
WMA Presidency
Destination: Finance and Planning Committee
209th
Council Session
Radisson Blu Latvija Hotel
Riga, Latvia
26-28 April 2018
Action(s)
required:
For
consideration
Note: This is submitted by the British Medical Association.
Summary: This proposal is to introduce a self-declaration statement
to the nominating process for WMA Presidency.
It is necessary to conduct due diligence to establish
whether the candidate may bring the Association into
disrepute. Performing this exercise, ensures reputational
assurances for the Association and nominating
constituent member, by exercising principles of
transparency and openness.
The proposal must consider capacity, resources and
system capability to ensure it is not unduly burdensome
on the Association, nor the nominating body, and
therefore must be proportionate.
Related WMA policies: WMA Articles and Bylaws
WMA Nomination Form for the Election to the Office of
President
Current mechanism for appointment for President:
1. Extract from WMA articles & bylaws
B) Method of Nomination 
A Constituent Member of the World Medical Association may
nominate any qualified candidate for the office of President by submitting the said nomination
in writing to the WMA Secretariat, together with the candidate’s written acceptance of
nomination. Such nomination shall include a certification that the candidate is a member of
the Constituent Member making the nomination, and that the candidate’s character,
March 2018 FPL 209/Nominating process/Apr2018
2
integrity and competence are beyond reproach, thus qualifying the candidate to be
nominated for the office of President. Such assurance shall be made on forms provided by
the Secretary General over the signature of the responsible officer of the Constituent
Member and the seal of the National Medical Association. Such nomination must reach the
Secretariat at least 3 weeks prior to the opening of the General Assembly at which the
election is to be held. (see Annex 1; current declaration form for a constituent member of the
WMA to nominate candidate)
2. Mechanism for early termination/dismal; extract from WMA articles & bylaws
F) Termination
i) The Council shall be empowered to take action to preserve the integrity and reputation of
the World Medical Association, including, but not limited to, suspending the authority of the
President, President-Elect, or Immediate Past President to act as an officer of the WMA for
cause. A decision to suspend the authority of the individual to act as an officer of the WMA
shall require a 2/3 majority of the Council members present and voting. Before voting on a
proposal to suspend the authority of the individual to act as an officer, the Council must:
a) Provide an opportunity for the concerned individual to address the Council, in person
and/or in writing
b) Consult with the Constituent Member of which the individual is a member
ii) An affirmative vote to suspend the authority of the President, President-Elect, or
Immediate Past President from acting as an officer must be based on substantial evidence
and a reasonable degree of certainty that the individual no longer meets the criteria
established in section B) and D)(iv) to serve in the office or has neglected the duties of the
office.
iii) Between Council meetings, the Executive Committee shall be empowered to investigate
accusations made against the President, President-Elect, or Immediate Past President and
shall communicate with the Council, as appropriate, regarding the situation. The accused
individual shall be excluded from participating in this process but shall be afforded the
opportunity to respond to the accusation(s). The Chair of Council shall report the findings of
the Executive Committee to the Council at its next meeting. The Executive Committee shall
not have the authority to suspend the authority of the individual to act as an officer.
iv) In the event of the suspension of the authority of the President to act as an officer, the
Council, if it deems necessary, may make such appointment or provisions for the discharge of
duties of the office until the next meeting of the General Assembly.
v) Following the suspension by the Council of the authority of the President-elect or
President to act as an officer, at the next meeting of the General Assembly, the Council shall
provide a recommendation to the General Assembly regarding permanent termination from
office. The General Assembly may accept the Council’s recommendation or reject it and take
such other action as it deems appropriate. Permanent termination from office shall require a
2/3 majority of the delegates present and voting.
3. Proposed mechanism:
March 2018 FPL 209/Nominating process/Apr2018
3
The following proposal draws on discussions with HR professionals and employment lawyers
with extensive experience in conducting and advising on appointments processes.
To include following declaration to the nomination form for WMA constituents:
‘I declare that the information given in this form and in any accompanying documentation is
true to the best of my knowledge and belief and permission is granted for enquiries to be
made to confirm qualifications, experience, dates of employment/ membership, for the release
by other people or organisations of necessary information to verify the content. I understand
that the declaration of any conflict will not necessarily prevent the nominee being offered this
position, however the nominee may be dismissed following appointment if any of information
given is false, misleading or if I, the nominating body, have withheld any relevant details’.
The nominating body will also have to declare any personal interests within the written
acceptance declaration.
It is expected that the ‘vetting’ and ‘screening’ exercise will be conducted by the proposing
constituent member, who will then be expected to sign a declaration. This process will
establish the candidate’s suitability to the role, in terms of skills and experience.
4. Further considerations:
-Public announcement to all WMA constituent members, of the proposed future mechanism.
-Include a role profile; therefore, candidate needs to demonstrate effective leadership
through:
[Example; extract from BMA Council chair appointment form]
1. The ability to command confidence and respect and exercise influence
2. Excellent communication skills, written and verbal with all potential audiences
3. Strategic leadership, chairing skills and negotiation capability
4. Promotion of effective relationships and open communication
5. Teamwork, influencing people and resources, and diplomacy
6. Personal integrity and a commitment to maintaining the highest standards of integrity
and probity
The above list of principles will need to be adapted to suit the requirements of the WMA, for
example, principle 2 as it is currently written may discourage nominations from non-anglophone
countries. In addition, principle 3, is not applicable for the role of the WMA President.
Within the WMA articles and bylaws under ‘Procedure & Schedule’, you will find a list of
principles scattered throughout the section. This could simply be pulled into one place, in the form
of a role profile.
§§§
29.03.2018
Annex 1;
If the nominee is successfully appointed, are there any conflicts that can be transported to
the WMA Y/N
If you have answered yes, please provide details in the space below:
[allow space for free text]
March 2018 FPL 209/Nominating process/Apr2018
4
THE WORLD MEDICAL ASSOCIATION, INC.
NOMINATION FORM FOR THE ELECTION TO THE
OFFICE OF PRESIDENT FOR 2017-2018
We, the undersigned, on behalf of the ____________________________________________
(Name of the Constituent Member)
do hereby place in nomination for the office of President of the World Medical
Association for 2017-2018 the name of Dr./Prof. ___________________________. The
(Physician’s name)
nominee has been endorsed for this office of President by our Association, of which he/she
has been a member for _________ years.
(number)
Dr./Prof. ____________________________ has demonstrated total commitment to the
(Physician’s name)
highest standards of medical ethics throughout his/her professional life.
He/she is a ____________________who has served as _____________________________
(G.P./Specialty) (Office held)
of the ________________________________________________________. In all ways,
(Name of the Constituent Member)
Dr./Prof. _______________________________ has been exemplary in professional and
(Physician’s name)
personal conduct. Based on the personal knowledge of our colleagues, this Association
believes that Dr./Prof. ________________________________ is an individual of
(Physician’s name)
impeccable integrity who will serve the World Medical Association with honor and
distinction.
Signed and sealed on __________________
(Date)
_________________________ _________________________
President or Chairperson Secretary General
Candidate’s curriculum vitae and written acceptance are enclosed herewith.
1
THE WORLD MEDICAL ASSOCIATION, INC.
Document
no:
FPL 209/WMJ Report/Apr2018 Original:
English
Title: Report of WMJ Editor
Destination: Finance and Planning Committee
209th
Council Session
Radisson Blu Latvija Hotel
Riga, Latvia
26-28 April 2018
Action(s)
required:
To be
received
The World Medical Journal turns 64 this year. The majority of the leaders of the World Medical
Association and national medical associations are a little older or a little younger than the WMJ
itself. Over this period of time the world has changed; these years have seen several wars and
epidemics, the discovery of new medications, fantastic developments in medical technologies and,
ultimately, people are now able to live their lives on this earth 20 years longer thanks to the efforts
of medical and public health professionals. Both for a journal and a person, 64 years of age have
connotations of maturity, experience, stability, and also difficulties making changes. On the other
hand, 64 years is a perfect age to look back at past developments and make long-term forecasts for
the future.
I have had the pleasure of being Editor in Chief of the WMJ since 2008 and year by year I am
preparing to leave this position. The maximum term for the President of the Latvian Medical
Association is running out for me and I will simply no longer belong to the WMA community.
It was a great honour to take over the Journal from Mr Alan Rowe. This unique man was the leader
of our journal for many years and managed to unite doctors all over the globe, setting a great
example writing excellent articles and through his fantastic mastery of the English language. I think
it is unlikely that our journal will again experience such English language skills combined with a
deep sense of both medical and ethical issues anytime soon.
During all these years Professor Elmar Doppelfeld has been by my side to support me with ideas,
opinions and experience. I would like to thank my assistants, Maira Sudraba and Velta Pozņaka,
who worked on the journal with great devotion. It is they who do most of the work. And I am
grateful to Otmar Kloiber who can be counted on for an opinion and a critical view on every single
article. If it were not for him, we would have a much more cumbersome journal; it would be a much
lesser WMA journal. And, of course, I thank Nigel Duncan who prepares excellent materials about
WMA activities.
The World Medical Journal is essentially a newsletter meant for the leaders of medical associations
all over the world. The primary goal of the journal, as I see it, is to inform these leaders about key
events, documents, movements and the direction in which the WMA is going, as well as to deliver
information about the events of different national medical associations. After all, the earth is small
and we can be proud that our people are represented in every country.
April 2018 FPL 209/WMJ Report/Apr2018
2
Not only does every country in the world have its own medical association, it also has a national
medical journal. We are clearly very different. In large countries with hundreds of thousands of
working doctors these journals are thick, issued weekly and pharmaceutical companies gladly place
illustrative information on their products in them, thus maintaining the journals’ financial well-
being and allowing them to reach every doctor free of charge. In smaller countries and those with
tighter healthcare budgets the journals are published less frequently, they are thinner and not
available to every doctor.
The World Medical Journal is an excellent brand; it is the journal of the WMA. We can think of the
WMA as a country of the world’s doctors, the global medical community, and the WMJ as the
mouthpiece of this country, exactly as large and powerful as a country of this size deserves.
Admittedly, the printed media is leaving the global information space. Views on received
information differ around the globe, but most experts agree that more than 70% of this information
comes from electronic sources (TV, video, internet etc.) and only 10-15% comes from printed
media. A large part of the world’s population sends the contents of their advertisement-stuffed
mailboxes straight into the trashcan.
For a couple of years already the WMJ has also been prevailingly published in digital form. We
only mail printed journals to the world’s leading libraries. The articles are delivered to us in digital
form and we send the journal to national medical associations in digital form. The World Medical
Journal is issued four times per year. Each issue is supposed to contain forty pages, while issues no.
2 and no. 4 are thicker as we complement these with materials from the WMA Council Meeting and
General Assembly.
The WMJ has a neuroprotective function: writing to a medical journal is an operation which
increases the number of neuronal cells and the activity of synopsis in the central nervous system.
The journal is also a record of history, which is the present day from a viewpoint in the future. I am
not certain that in 4 years from now one will still be able to read about the World Medical
Association via the wmj.net portal, whereas I am absolutely sure that all issues of the journal,
starting from the 1950s, will be accessible in the University of Washington Library in Seattle. This
is why I encourage the leaders of all national medical associations to contribute their articles to the
WMJ. There may possibly remain no other historical evidence of the activities performed by your
national association under your leadership at the global level.
§§§
19.04.18
1
THE WORLD MEDICAL ASSOCIATION, INC.
Document
no:
FPL 209/PR Report/Apr2018 Original:
English
Title: Public Relations Report for October 2017
– April 2018
Destination: Finance and Planning Committee
209th
Council Session
Radisson Blu Latvija Hotel
Riga, Latvia
26-28 April 2018
Action(s)
required:
To be
received
Fifteen press releases have been issued since the General Assembly in Chicago.
2017
Oct 13: President‘s inaugural speech
Oct 13: WMA Expresses Solidarity with Polish Doctors
Oct 14: Revised Physicians‘ Pledge Published
Oct 14: WMA Opposes Recreational Cannabis
Oct 15: WMA to Postpone Assembly in Istanbul
Oct 17: Chicago Assembly decisions
Oct 18: Quality Assurance guidance
Oct 19: Climate change funding called for
Oct 26: WMA opposes euthanasia bill
Nov 10: WMA calls for release of Iranian doctor
2018
Jan 29: Indian Government criticised over dismantling medical council
Jan 30: WMA condemns arrests of Turkish Medical Association leaders
Feb 1: Joint letter to Erdogan calls for release of TMA leaders
Feb 26: International community criticised over Syrian hospital bombing
Apr 5: WHO and WMA sign memorandum of understanding
General Publicity
There was a good response to the publication of the revised Declaration of Geneva following the
Chicago Assembly. The Pledge was exclusively published by JAMA (the Journal of the American
Medical Association) and in the weeks following publication media reports appeared all over the
world. This prompted some constructive debate and was generally very well received. A number of
national medical associations posted the revised Declaration on their website and there were many
reports of the Pledge being adopted by various NMAs and being recited at the start of physician
meetings. In the days immediately following the Assembly, there were literally hundreds of tweets
posted from around the world.
April 2018 FPL 209/PR Report/Apr2018
2
Other policy statements from the Assembly that received good publicity included the statements on
medical cannabis, bullying and harassment and climate change. A selection of media coverage can
be found on the WMA website.
Several other topics have received considerable media publicity in the last six months. These
include the issue of physician assisted suicide and in particular the end of life conference held in
Rome, which was marked by a message from the Pope. This received extensive publicity around the
world.
The other event that provoked considerable media attention was the arrest of leaders of the Turkish
Medical Association. Following the arrests, the WMA led a mass campaign on twitter that drew
worldwide attention to the issue. This demonstrated yet again that social media has become a
powerful medium for instant, short term reaction to events.
Twitter
The number of followers on the WMA twitter account continues to grow and reached 9,000 in
March. The total is increasing by around 2,000 a year. The average number of WMA tweets being
posted over recent months has been more than 70 a month. Estimated statistics show that the largest
group of followers come from the US, the UK, Canada and Australia. Not surprisingly, almost half
of the followers are in the 25-34 age range, with very few above the age of 55.
The WMA has joined with other organisations to campaign on influenza and fake medicines. Some
posts have been boosted as part of the official campaign.
Ms Magda Mihaila, the WMA Communication and Information manager, has now taken on full
responsibility for twitter (https://twitter.com/#!/medwma) as well as Facebook.
Facebook
WMA Facebook postings are dealt with by the office in Ferney, led by Ms Mihaila. Items are now
being posted regularly on the site and the number of Facebook followers has risen to over 10,700.
Some posts reach as much as 8.5 k views. In the future, the office intends to increase the number of
followers among the members of WMA. In the future, WMA intends to create more original
content for social media.
§§§
09.04.18
1
THE WORLD MEDICAL ASSOCIATION, INC.
Document
no:
SMAC 209/Agenda/Apr2018/REV Original:
English
Title: Agenda of the Socio-Medical Affairs
Committee
Destination: Socio-Medical Affairs Committee
209th
Council Session
Radisson Blu Latvija Hotel
Riga, Latvia
26-28 April 2018
Action(s)
required:
For
consideration
Note This revised agenda includes new items 4.3,
6.1 and 6.2.
Thursday 26 April 2018
Membership of the Committee
Dr Miguel Roberto JORGE (Chair)
Dr David O. BARBE
Dr Michael Bryant GANNON
Dr Thomas SZEKERES
Dr Mark PORTER
Dr Louis FRANCESCUTTI
Dr Shuyang ZHANG
Dr Walter VORHAUER
Dr Serafín ROMERO
Dr Ramin PARSA-PARSI
Dr Ajay KUMAR
Dr Toru KAKUTA
Dr Kenji MATSUBARA
Dr MooJin CHOO
Dr René HÉMAN
Dr Mzukisi GROOTBOOM
Dr Heidi STENSMYREN
Dr Julio TROSTCHANSKY
Ex-officio (with voting rights)
Dr Ardis Dee Hoven, Chair of Council
Dr Frank Ulrich Montgomery, Vice-Chair of Council
Dr Andrew Dearden, Treasurer
Ex-officio (without voting rights)
Dr Yoshitake Yokokura, President
Dr Leonid Eidelman, President-Elect
Dr Ketan Desai, Immediate Past President
Dr Otmar Kloiber, Secretary General
Ms Marie Colegrave-Juge, Legal Advisor
Mr Adolf Hällmayr, Financial Advisor
Ms Joelle Balffe, Facilitor
Ms Clarisse Delorme, Advocacy Advisor
March 2018 SMAC 209/Agenda/Apr2018/REV
2
1. GENERAL BUSINESS
1.1 Call to order by the Chair of the SMAC
1.2 Report of the previous meeting held in Chicago, United-States, 11-14 October 2017
Approve: Report of the Socio-Medical Affairs Committee
(SMAC 207/Report/Oct2017)
1.3 Chair’s Opening Remark
1.4 Health and Migration, Dr. Poonam Dhavan, Migration Health Programme Coordinator,
International Organisation for Migration (IOM)
2. MONITORING REPORT (ORAL)
3. BUSINESS IN PROGRESS
3.1 Health and Environment
Receive: Oral Report of the Environment Caucus
3.2 Plastic Bags, Ecological Issues & Environmental Degradation
Consider: Proposed revision of the WMA Statement on Environmental Degradation
and Sound Management of Chemicals
(SMAC 209/Environmental Degradation/Apr2018)
3.3 Medical Tourism
Consider: Proposal for a WMA Statement on Medical Tourism
(SMAC 209/Medical Tourism REV5/Apr2018)
3.4 Women in Medicine
Consider: Proposed WMA statement on Women in Medicine & Comments
(SMAC 209/Women in Medicine COM REV2/Apr2018)
3.5 Professional Autonomy of Physicians
Consider: Proposed revision of the WMA Declaration of Seoul on Professional
Autonomy and Clinical Independence & comments
(SMAC 209/Declaration of Seoul COM REV/Apr2018)
Consider: Proposed revision of the WMA Declaration of Madrid on Professionally-led
Regulation & comments
(SMAC 209/Declaration of Madrid COM REV/Apr2018)
March 2018 SMAC 209/Agenda/Apr2018/REV
3
3.6 Sustainable Development
Consider: Proposed WMA Statement on Sustainable Development & Comments
(SMAC 209/Sustainable Development COM REV/Apr2018)
3.7 Avian & Pandemic Influenza
Consider: Proposed WMA Statement on Avian and Pandemic Influenza & Comments
(SMAC 209/Pandemic Influenza COM REV/Apr2018)
4. NEW ITEMS
4.1 Nuclear Weapons
Consider: Proposed revision of WMA Statement on Nuclear Weapons
(SMAC 209/Nuclear Weapons/Apr2018)
4.2 Development and Promotion of a Maternal and Child Health Handbook
Consider: Proposed WMA Statement on the Development and Promotion of a
Maternal and Child Health Handbook
(SMAC 209/Maternal and child Handbook/Apr2018)
4.3 Pseudoscience, pseudotherapies, intrusion and sects in the field of health
Consider: WMA Declaration on Pseudoscience, pseudotherapies, intrusion and sects in
the field of health (SMAC 209/ Pseudoscience /Apr2018)
5. CLASSIFICATION OF 2008 POLICIES
Consider: Recommendations received on SMAC Documents
(SMAC 209/Policy Review 2008/Apr2018)
6. ANY OTHER BUSINESS
6.1 Presentation and preliminary discussion on a proposal for a WMA Network on Disaster
Medicine (Japanese Medical Association)
6.2 Presentation and preliminary discussion on a white paper on Artificial Intelligence
(American Medical Association)
7. ADJOURNMENT
§§§
10.04.2018

1
THE WORLD MEDICAL ASSOCIATION, INC.
Document
no:
SMAC 207/Report/Oct2017 Original:
English
Title: Report of the Socio-Medical Affairs
Committee
Destination: Socio-Medical Affairs Committee
209th
Council Session
Radisson Blu Latvija Hotel
Riga, Latvia
26-28 April 2018
Action(s)
required:
For
consideration
Wednesday, 11 October 2017
Membership of the Committee
Dr. Miguel Roberto JORGE (Chair)
Dr. David O. BARBE
Dr. Michael Bryant GANNON
Dr Thomas SZEKERES
Dr. Mark PORTER
Dr. Louis FRANCESCUTTI
Dr. Shuyang ZHANG
Dr. Walter VORHAUER
Dr. Serafín ROMERO
Dr. Ramin PARSA-PARSI
Dr. Ajay KUMAR
Prof. Leonid EIDELMAN
Dr. Toru KAKUTA
Dr. Kenji MATSUBARA
Dr. MooJin CHOO
Dr. René HÉMAN
Dr. Mzukisi GROOTBOOM
Dr. Heidi STENSMYREN
Dr. Julio TROSTCHANSKY
Ex-officio (with voting rights)
Dr Ardis Dee Hoven, Chair of Council
Prof. Dr med. Frank Ulrich Montgomery, Vice-Chair of Council
Dr Andrew Dearden, Treasurer
Ex-officio (without voting rights)
Dr Ketan Desai, President
Sir Michael Marmot, Immediate Past President
Dr Yoshitake Yokokura, President-Elect
Dr Otmar Kloiber, Secretary General
Ms Marie Colegrave-Juge, Legal Advisor
Mr Adolf Hällmayr, Financial Advisor
Prof Vivienne Nathanson, Facilitator
October 2017 SMAC 207/Report/Oct2017
2
1. GENERAL BUSINESS
1.1 The meeting was called to order by the Chair of Council at 16:05 on 10 October 2017.
1.2 Apologies for absence: Dr. T. SZEKERES replaced by Dr H. LINDNER; Dr.J.
TROSTCHANSKY replaced by Dr A. RODRIGUEZ.
1.3 The Committee approved the report of the previous meeting held in Livingstone,
Zambia (SMAC 206/Report/Apr2017).
2. MONITORING REPORT (ORAL)
Dr. J. TAINIJOKI, WMA Medical Advisor, informed the Committee that a high-level
Meeting on Non-Communicable Diseases is scheduled prior to the next United Nations
General Assembly in September 2018. The Secretariat is involved in the preparation process,
advocating for a holistic approach on NCDs, which should include Social Determinants of
Health. She invited members interested to contact the secretariat.
3. BUSINESS IN PROGRESS
3.1 Health and Environment
The Chair of Council, Dr. A. HOVEN, reminded the Committee that Dr. D. SHIN, Co-Chair
of the Health and Environment Caucus [Prof. V. NATHANSON is the other co-Chair],
resigned from his position a few months ago. Dr. A. HOVEN announced that she would
appoint a new Chair to the Caucus and asked for constituent members to volunteer for this
position. Dr. A.HOVEN will appoint a new Chair from among the volunteers after the
Chicago meetings.
3.2 Role of Physicians in Adoption Practices
The Committee considered the proposal for a WMA Statement on the Role of Physicians
in Preventing Exploitation in Adoption Practices (SMAC 207/Trafficking with Minors COM
REV3/Oct2017).
RECOMMENDATION
3.2.1 That the proposal for a WMA Statement on the Role of Physicians
in Preventing Exploitation in Adoption Practices (SMAC 207/Trafficking with
Minors REV3/Apr2017) be approved by the Council and forwarded to the
General Assembly for adoption.
3.3 Medical Tourism
October 2017 SMAC 207/Report/Oct2017
3
The Committee considered the proposal for a WMA Statement on Medical Tourism and
comments (SMAC 207/Medical Tourism REV4/Oct2017) submitted by the Israel Medical
Association, rapporteur.
RECOMMENDATION
3.3.1 That the proposal for a WMA Statement on Medical Tourism (SMAC
207/Medical Tourism REV4/Oct2017) be sent back to the rapporteur for
further work.
3.4 Tuberculosis
The Committee considered the proposed revision of WMA Resolution on Tuberculosis and
comments (SMAC 207/Tuberculosis COM REV2/Oct2017).
RECOMMENDATION
3.4.1 That the proposed revision of WMA Resolution on Tuberculosis (SMAC
207/Tuberculosis REV2/Oct2017) be approved by the Council and forwarded
to the General Assembly for adoption.
3.5 Health and Climate Change
The Committee considered the proposed WMA Declaration on Health and Climate Change
and comments (SMAC 207/Climate Change COM REV3/Oct2017)
RECOMMENDATION
3.5.1 That the proposed WMA Declaration on Health and Climate Change (SMAC
207/Climate Change REV3/Oct2017) be approved by the Council and
forwarded to the General Assembly for adoption.
3.6 Women in Medicine
The Committee considered the proposed WMA statement on Women in Medicine &
Comments (SMAC 207/Women in Medicine COM REV/Oct2017).
RECOMMENDATION
3.6.1 That the proposed WMA statement on Women in Medicine (SMAC
207/Women in Medicine REV/Oct2017) be re-circulated to constituent
members for comments.
3.7 Fair Medical Trade
The Committee considered the proposed WMA Statement on Fair Medical Trade &
Comments (SMAC 207/Fair Medical Trade COM REV/Oct2017).
RECOMMENDATION
October 2017 SMAC 207/Report/Oct2017
4
3.7.1 That the proposed WMA Statement on Fair Medical Trade (SMAC 207/Fair
Medical Trade REV2/Oct2017), as amended, be approved by the Council and
forwarded to the General Assembly for adoption.
3.8 Plastic Bags & Ecological Issues
The Committee considered the proposed WMA Statement on Curbing Consumption of Plastic
Bags to Address Growing Ecological Issues & Comments (SMAC 207/Plastic Bags COM
REV/Oct2017).
RECOMMENDATION
3.8.1 To appoint a rapporteur to review the WMA Statement on environmental
degradation and sound management of chemicals in order to incorporate the
issue of plastic bags pollution. The Swedish Medical Association volunteered
to undertake that work.
3.9 Professional Autonomy of Physicians
The Committee considered the proposed revision of the WMA Declaration of Seoul on
Professional Autonomy and Clinical Independence (SMAC 207/Declaration of
Seoul/Oct2017) and the proposed revision of the WMA Declaration on Professionally-led
Regulation (SMAC 207/Declaration of Madrid/Oct2017).
RECOMMENDATION
3.9.1 That the proposed revision of the WMA Declaration of Seoul on Professional
Autonomy and Clinical Independence (SMAC 207/Declaration of
Seoul/Oct2017) be circulated to constituent members for comments.
3.9.2 That the proposed revision of the WMA Declaration of Madrid on
Professionally-led Regulation (SMAC 207/Declaration of Madrid/Oct2017) be
circulated to constituent members for comments.
3.10 Sustainable Development
The Committee received the oral report from the working group, chaired by Dr. M.
MICHIGANA (Japan Medical Association), and then considered the Proposed WMA
Statement on Sustainable Development (SMAC 207/Sustainable Development/Oct2017).
RECOMMENDATION
3.10.1 That the Proposed WMA Statement on Sustainable Development (SMAC
207/Sustainable Development/Oct2017) be circulated to constituent members
for comments.
3.11 Avian & Pandemic Influenza
The Committee received the oral report from the Secretary General and then considered the
proposed revision of WMA Statement on Avian and Pandemic Influenza (SMAC
207/Pandemic Influenza/Oct2017) prepared by Dr. Caline MATTAR, AMR specialist.
October 2017 SMAC 207/Report/Oct2017
5
RECOMMENDATION
3.11.1 That the proposed revision of WMA Statement on Avian and Pandemic
Influenza (SMAC 207/Pandemic Influenza/Oct2017) be circulated to
constituent members for comments.
3.12 Family Planning and the Right of a Woman to Contraception
The Committee considered the proposed revision of WMA Statement on Family Planning and
the Right of a Woman to Contraception (SMAC 207/Right to Contraception/Oct2017), which
underwent a minor revision as part of the annual policy review process.
RECOMMENDATION
3.12.1 That the proposed revision of WMA Statement on Family Planning and the
Right of a Woman to Contraception (SMAC 207/Right to
Contraception/Oct2017) be approved by the Council and forwarded to the
General Assembly for information.
3.13 Noise Pollution
The Committee considered the proposed revision of the Statement on noise pollution (SMAC
207/Noise Pollution/Oct2017), which underwent a minor revision as part of the annual policy
review process.
RECOMMENDATION
3.13.1 That the proposed revision of the Statement on noise pollution (SMAC
207/Noise Pollution/Oct2017) be approved by the Council and forwarded to
the General Assembly for information.
3.14 Support of the Medical Associations in Latin America and the Caribbean
The Committee considered the proposed revision of the Resolution on Support of the Medical
Associations in Latin America and the Caribbean (SMAC 207/Latin America and
Caribbean/Oct2017) which underwent a minor revision as part of the annual policy review
process.
RECOMMENDATION
3.14.1 That the proposed revision of the Resolution on Support of the Medical
Associations in Latin America and the Caribbean (SMAC 207/Latin America
and Caribbean/Oct2017) be approved by the Council and forwarded to the
General Assembly for information.
3.15 Economic Embargoes and Health
October 2017 SMAC 207/Report/Oct2017
6
The Committee considered the proposed revision of WMA Resolution on Economic
Embargoes and Health (SMAC 207/Economic Embargoes/Oct2017) which underwent a
minor revision as part of the annual policy review process.
RECOMMENDATION
3.15.1 That the proposed revision of WMA Resolution on Economic Embargoes and
Health (SMAC 207/Economic Embargoes/Oct2017) be approved by the
Council and forwarded to the General Assembly for information.
4. ADJOURNMENT
The meeting was adjourned at 17.10.
§§§
12.10.2017
1
THE WORLD MEDICAL ASSOCIATION, INC.
Document
no:
SMAC 209/Environmental
Degradation/Apr2018/REV
Original:
English
Title: Proposed revision of the WMA Statement
on Environmental Degradation and
Sound Management of Chemicals
Destination: Socio-Medical Affairs Committee
209th
Council Session
Radisson Blu Latvija Hotel
Riga, Latvia
26-28 April 2018
Action(s)
required:
For
consideration
Note At the meeting in Chicago in October 2017 the Socio-Medical
Affairs Committee considered a proposed WMA Resolution
on Curbing Consumption of Plastic Bags to Address Growing
Ecological Issues. Rather than adopting the proposed policy,
it was decided to review the WMA Statement on
Environmental Degradation and Sound Management of
Chemicals in order to incorporate the issue of plastic bags
pollution. The Swedish Medical Association was appointed
rapporteur and submits this proposed revision of the existing
WMA statement, with the support of Peter Orris. The
proposed revision includes wording regarding plastic
pollution. Amendments are highlighted in bold, underlined or
strikethrough.
This revised version includes an amendment under the
section “National and International Actions” which was
omitted in the original text.
PREAMBLE
This Statement focuses on one important aspect of environmental degradation, which is
environmental contamination by harmful domestic and industrial substances. It emphasizes the
harmful chemical contribution to environmental degradation and physicians’ role in promoting sound
management of chemicals as part of sustainable development, especially in the healthcare
environment.
Most chemicals to which humans are exposed come from industrial sources and include, food
additives, household consumer and cosmetic products, agrochemicals, and other substances (drugs;
dietary supplements) used for therapeutic purposes. Recently, attention has been concentrated on the
effects of human engineered (or synthetic) chemicals on the environment, including specific
January 2018 SMAC 209/Environmental Degradation /Apr2018/REV
2
industrial or agrochemicals and on new patterns of distribution of natural substances due to human
activity. As the number of such compounds has multiplied, governments and international
organizations have begun to develop a more comprehensive approach to their safe regulation. The
increasing amount of plastic waste in our environment is another serious concern, that needs to
be addressed.
While governments have the primary responsibility for establishing a framework to protect the
public’s health from chemical hazards, the World Medical Association, on behalf of its members,
emphasizes the need to highlight the human health risks and make recommendations for further
action.
BACKGROUND
Chemicals of Concern
During the last half-century, the use of chemical pesticides and fertilizers dominated agricultural
practice and manufacturing industries rapidly expanded their use of synthetic chemicals in the
production of consumer and industrial goods.
The greatest concern relates to chemicals, which persist in the environment, have low rates of
degradation, bio-accumulate in human and animal tissue (concentrating as they move up the food
chain), and which have significant harmful impacts on human health and the environment
(particularly at low concentrations). Some naturally occurring metals including lead, mercury, and
cadmium have industrial sources and are also of concern. Advances in environmental health research
including environmental and human sampling and measuring techniques, and better information
about the potential of low dose human health effects have helped to underscore emerging concerns.
Health effects from chemical emissions can be direct (occurring as an immediate effect of the
emission) or indirect. Indirect health effects are caused by the emissions’ effects on water, air and
food quality as well as the alterations in regional and global systems, such as red tide in many
oceans, and the ozone layer and the climate, to which the emissions may contribute.
National and International Actions
The model of regulation of chemicals varies widely both within and between countries, from
voluntary controls to statutory legislation. It is important that all countries move to a coherent,
standardized national legislated approach to regulatory control. Furthermore, international
regulations must be coherent such that developing countries will not be forced by economic
circumstances to accept elevated toxic exposure levels circumvent potentially weak national
regulations. An example of a legislative framework can be found at
http://ec.europa.eu/environment/chemicals/index.htm.
Synthetic chemicals include all substances that are produced by, or result from, human activities
including industrial and household chemicals, fertilizers, pesticides, chemicals contained in products
and in wastes, prescription and over-the-counter drug products and dietary supplements, and
unintentionally produced byproducts of industrial processes or incineration, like dioxins.
Furthermore, nanomaterials, in some circumstances, can be regulated by synthetic chemicals
regulations but in other cases, may need explicit regulation.
Notable International Agreements on Chemicals
January 2018 SMAC 209/Environmental Degradation /Apr2018/REV
3
Several notable agreements on chemicals exist. These were prompted by the first United Nations
Conference on the Human Environment declaration in 1972 (Stockholm) on the discharge of toxic
substances into the environment. These agreements include the 1989 Basel Convention to
control/prevent trans-boundary movements of hazardous wastes, the 1992 Rio Declaration on
Environment and Development, the 1998 Rotterdam Convention on informed consent and shipment
of hazardous substances, and the 2001 Stockholm Convention on Persistent Organic Pollutants. It
should be noted that little information is available on the efficacy of the controls.
Strategic approach to international chemicals management
Worldwide hazardous environmental contamination persists despite these agreements, making a
more comprehensive approach to chemicals essential. Reasons for ongoing contamination include
persistence of companies, absolute lack of controls in some countries, lack of awareness of the
potential hazards, inability to apply the precautionary principle, non-adherence to the various
conventions and treaties and lack of political will. The Strategic Approach to International
Chemicals Management (SAICM) was adopted in Dubai, on February 6, 2006 by delegates from
over 100 governments and representatives of civil society. This is a voluntary global plan of action
designed to assure the sound management of chemicals throughout their life cycle so that, by 2020,
chemicals are used and produced in ways that minimize significant adverse effects on human health
and the environment. The SAICM addresses both agricultural and industrial chemicals, covers all
stages of the chemical life cycle of manufacture, use and disposal, and includes chemicals in
products and in wastes.
Plastic waste
Plastic has been part of life for more than 100 years and is regularly used in some form by
nearly everyone. While some biodegradable varieties are being developed, most plastics break
down very slowly with the decomposition process taking hundreds of years. This means that
most plastics that have ever been manufactured are still on Earth, unless burnt polluting the
atmosphere with poisonous smoke.
Concerns about the use of plastic include accumulation of waste in landfills and in natural
habitats, physical problems for wildlife resulting from ingestion or entanglement in plastic,
the leaching of chemicals from plastic products and the potential for plastics to transfer
chemicals to wildlife and humans. Many plastics in use today are halogenated plastics or
contain other additives used in production, that have potentially harmful effects on health
(e.g. carcinogenic or promoting endocrine disruption).
Our current usage of plastic is not sustainable, accumulating waste and therefore
contributing to environmental degradation and potentially harmful effects on health. Specific
regulation is therefore needed to counter the harmful distribution of slowly degradable plastic
waste into the environment and the incineration of such waste which often creates toxic
byproducts.
WORLD MEDICAL ASSOCIATION (WMA) RECOMMENDATIONS
Despite these national and international initiatives, chemical contamination of the environment due
to inadequately controlled chemical production and usage continues to exert harmful effects on
global public health. Evidence linking some chemicals to some health issues is strong, but far from
all chemicals have been tested for their health or environmental impacts. This is especially true
for newer chemicals or nano materials, particularly at low doses over long periods of time. Plastic
January 2018 SMAC 209/Environmental Degradation /Apr2018/REV
4
contamination of our natural environment, including in the sea where plastic decomposes to
minute particles, is an additional area of serious concern. Physicians and the healthcare sector are
frequently required to make decisions concerning individual patients and the public as a whole based
on existing data. Physicians therefore caution that they, too, have a significant role to play in closing
the gap between policy formation and chemicals management and in reducing risks to human health.
The World Medical Association recommends that:
ADVOCACY
• National Medical Associations (NMAs) advocate for legislation that reduces chemical
pollution, reduces human exposure to chemicals, detects and monitors harmful chemicals in
both humans and the environment, and mitigates the health effects of toxic exposures with
special attention to vulnerability during pregnancy and early childhood.
• NMAs urge their governments to support international efforts to restrict chemical pollution
through safe management, or phase out and safer substitution when unmanageable (e.g.
asbestos), with particular attention to developed countries aiding developing countries to
achieve a safe environment and good health for all.
• NMAs facilitate better communication between government ministries/departments
responsible for the environment and public health.
• Physicians and their medical associations advocate for environmental protection, disclosure
of product constituents, sustainable development, and green chemistry within their
communities, countries and regions.
• Physicians and their medical associations should support the phase out of mercury and
persistent bioaccumulative and toxic chemicals in health care devices and products and
avoid incineration of wastes from these products which may create further toxic
pollution.
• Physicians and their medical associations should support legislation to require an
environmental and health impact assessment prior to the introduction of a new chemical or a
new industrial facility.
• Physicians should encourage the publication of evidence of the effects of different chemicals
and plastics, and dosages on human health and the environment. These publications should
be accessible internationally and readily available to media, non-governmental organizations
(NGOs) and concerned citizens locally.
• Physicians and their medical associations should advocate for the development of effective
and safe systems to collect and dispose of pharmaceuticals that are not consumed. They
should also advocate for the introduction worldwide of efficient systems to collect and
dispose of plastic waste.
• Physicians and their medical associations should encourage efforts to curb the
manufacture and use of plastic packaging and plastic bags, and to halt the introduction
of plastic waste into the environment. These efforts may include specific regulations
limiting the use of plastic packaging and plastic bags.
• Physicians and their medical associations should support efforts to rehabilitate or clean areas
of environmental degradation based on a “polluter pays” and precautionary principles and
ensure that moving forward, such principles are built into legislation.
• The WMA, NMAs and physicians should urge governments to collaborate within and
between departments to ensure coherent regulations are developed.
LEADERSHIP
January 2018 SMAC 209/Environmental Degradation /Apr2018/REV
5
The WMA:
• Supports the goals of the Strategic Approach to International Chemicals Management
(SAICM), which promotes best practices in the handling of chemicals by utilizing safer
substitution, waste reduction, sustainable non-toxic building, recycling, as well as safe and
sustainable waste handling in the health care sector.
• Cautions that these chemical practices must be coordinated with efforts to reduce greenhouse
gas emissions from health care to mitigate its contribution to global warming.
• Urges physicians, medical associations and countries to work collaboratively to develop
systems for event alerts to ensure that health care systems and physicians are aware of high-
risk industrial accidents as they occur, and receive timely accurate information regarding the
management of these emergencies.
• Urges local, national and international organizations to focus on sustainable production, safer
substitution, green safe jobs, and consultation with the health care community to ensure that
damaging health impacts of development are anticipated and minimized.
• Emphasizes the importance of the safe disposal of pharmaceuticals as one aspect of health
care’s responsibility and the need for collaborative work in developing best practice models
to reduce this part of the chemical waste problem.
• Encourages environmental classification of pharmaceuticals in order to stimulate prescription
of environmentally less harmful pharmaceuticals.
• Encourages local, national and international efforts to reduce the use of plastic
packaging and plastic bags.
• Encourages ongoing outcomes research on the impact of regulations and monitoring of
chemicals on human health and the environment.
The WMA recommends that Physicians;
• Work to reduce toxic medical waste and exposures within their professional settings as part
of the World Health Professional Alliance’s campaign for Positive Practice Environments.
• Work to provide information on the health impacts associated with exposure to toxic
chemicals, how to reduce patient exposure to specific agents and encourage behaviors that
improve overall health.
• Inform patients about the importance of safe disposal of pharmaceuticals that are not
consumed.
• Work with others to help address the gaps in research regarding the environment and health
(i.e., patterns and burden of disease attributed to environmental degradation; community and
household impacts of industrial chemicals; the effects, including on health, of distribution
of plastic and of plastic waste into our natural environment; the most vulnerable
populations and protections for such populations).
PROFESSIONAL EDUCATION & CAPACITY BUILDING
The WMA recommends that:
• Physicians and their professional associations assist in building professional and public
awareness of the importance of the environment and global chemical pollutants on personal
health.
• National Medical Associations (NMAs) and physician professional associations develop tools
for physicians to help assess their patients’ risk from chemical exposures.
January 2018 SMAC 209/Environmental Degradation /Apr2018/REV
6
• Physicians and their professional associations develop locally appropriate continuing medical
education on the clinical signs, diagnosis and treatment of diseases that are introduced into
communities as a result of chemical pollution and exacerbated by climate change.
• Environmental health and occupational medicine should become a core theme in medical
education. Medical schools should encourage in the training of sufficient specialists in
environmental health and occupational medicine.
§§§
References:
Wiser G, Center for International Environmental Law, UNEP Forum, Sept. 2005
United Nations Environment Programme (UNEP)
http://chm.pops.int/Convention/tabid/54/language/en-US/Default.aspx
Thompson RC, Moore CJ, vom Saal FS, Swan SH. Plastics, the environment and human health: current consensus and
future trends. Philosophical Transactions of the Royal Society B: Biological Sciences. 2009;364(1526):2153-2166.
doi:10.1098/rstb.2009.0053.
Barnes, D. K. A.; Galgani, F.; Thompson, R. C.; Barlaz, M. (14 June 2009). « Accumulation and fragmentation of
plastic debris in global environments ». Philosophical Transactions of the Royal Society B: Biological
Sciences. 364 (1526): 1985–1998. doi:10.1098/rstb.2008.0205. PMC 2873009  . PMID 19528051.
18.04.2018
1
THE WORLD MEDICAL ASSOCIATION, INC.
Document
no:
SMAC 209/Medical Tourism
REV5/Apr2018
Original:
English
Title: Proposal for a WMA Statement on
Medical Tourism
Destination: Socio-Medical Affairs Committee
209th
Council Session
Radisson Blu Latvija Hotel
Riga, Latvia
26-28 April 2018
Action(s)
required:
For
Consideration
Note: This was proposed by the Israeli Medical Association (IsMA)
to the Council in Buenos Aires (April 2016) which decided to
circulate it for comments. At its 205th session in Taipei
(October 2016), the Council decided to re-circulate it for
comments.
The Council in Livingstone (April 2017) considered the
comments from constituent members and the compromise
version proposed by IsMA. After discussion, it was decided to
send the proposal back to the rapporteur for further work. Last
October in Chicago, the Council considered the revised version
(REV4) and decided to send it again to the rapporteur for
additional work.
The changes are highlighted in bold and underlined.
Suggested
Keywords:
Medical Tourism, Foreign Patients, Guidelines, Ethics
PREAMBLE
1. Medical tourism is an expanding phenomenon, although to date it has no agreed upon definition
and, as a result, practices and protocols in different countries can vary substantially. For
purposes of this statement, medical tourism is defined as a situation where patients travel
voluntarily across international borders to receive medical treatment, most often at their own
cost. Treatments span a range of medical services, and commonly include: dental care, cosmetic
surgery, elective surgery, and fertility treatment (OECD, 2011).
2. This statement does not cover cases where a national health care system or treating hospital
sends a patient abroad to receive treatment at its own cost or where, as in the European Union,
patients are allowed to seek care in another EU Member State according to legally defined
March 2018 SMAC 209/Medical Tourism REV5/Apr2018
2
criteria, and their home health system bears the costs. Also not covered is a situation in which
people are in a foreign country when they become ill and need medical care.
3. If not regulated appropriately, medical tourism may have medico-legal and ethical ramifications
and negative implications, including but not limited to: internal brain drain, establishment of a
two-tiered health system, and the spread of antimicrobial resistance. Therefore, it is imperative
that there are clear rules and regulation to govern this growing phenomenon.
4. Medical tourism is an emerging global industry, with health service providers in many
countries competing for foreign patients, whose treatment represents a significant potential
source of income. The awareness of health as a potential economic benefit and the willingness
to invest in it rise with the economic welfare of countries, and billions of dollars are invested
each year in medical tourism all over the world. The key stakeholders within this industry
include patients, brokers, governments, health care providers, insurance providers, and travel
agencies. The proliferation of medical tourism websites and related content raise concerns
about unregulated and inaccurate on-line health information.
5. A medical tourist is in a more fragile and vulnerable situation than that of a patient in his or
her home country. Therefore, extra sensitivity on the part of caretakers is needed at every stage
of treatment and throughout the patient’s care, including linguistic and cultural accommodation
wherever possible. When medical treatment is sought abroad, the normal continuum of care
may be interrupted and additional precautions should therefore be taken.
6. Medical tourism bears many ethical implications that should be considered by all
stakeholders. Medical tourists receive care in both state-funded and private medical
institutions and regulations must be in place in both scenarios. These recommendations are
addressed primarily to physicians. The WMA encourages others who are involved in medical
tourism to adopt these principles.
RECOMMENDATIONS
General
7. The WMA emphasises the importance of developing health care systems in each country in
order to prevent excessive medical tourism resulting from limited treatment options in a
patient´s home country. Financial incentives to travel outside a patient’s home country for
medical care should not inappropriately limit diagnostic and therapeutic alternatives in the
patient’s home country, or restrict treatment or referral options.
8. The WMA calls on governments to carefully consider all the implications of medical
tourism to the healthcare system of a country by developing comprehensive, coordinated
national protocols for medical tourism in consultation and cooperation with all relevant
stakeholders. These protocols should assess the possibilities of each country to receive medical
tourists, to agree on necessary procedures, and to prevent negative impacts to the country´s
health care system.
9. The WMA calls on governments and service providers to ensure that medical tourism does
not negatively affect the proper use of limited health care resources or the availability of
appropriate care for local residents in hosting countries. Special attention should be paid to
treatments with long waiting times or involving scarce medical resources. Medical tourism must
not promote unethical or illegal practices, such as organ trafficking. Authorities, including
March 2018 SMAC 209/Medical Tourism REV5/Apr2018
3
government, should be able to stop elective medical tourism where it is endangering the ability
to treat the local population.
10. The acceptance of medical tourists should never be allowed to distort the normal assessment of
clinical need and, where appropriate, the development of waiting lists, or priority lists for
treatment. Once accepted to treatment by a health care provider, medical tourists should be
treated in accordance with the urgency of their medical condition. Whenever possible patients
should be referred to institutions that have been approved by national authorities or accredited
by appropriately recognised accreditation bodies.
Prior to travel
11. Patients should be made aware that treatment practices and health care laws may be
different than in their home country and that treatment is provided according to the laws and
practices of the host country. Patients should be informed by the physician/service provider of
their rights and legal recourse prior to travelling outside their home country for medical care,
including information regarding legal recourse in case of patient injury and possible
compensation mechanisms.
12. The physician in the host country should establish a treatment plan, including a cost
estimate and payment plan, prior to the medical tourist’s travel to the host country. In addition,
the physician and the medical tourism company (if any) should collaborate in order to ensure
that all arrangements are made in accordance with the patient´s medical needs. Patients should
be provided with information about the potential risks of combining surgical procedures with
long flights and vacation activities.
13. Medical tourists should be informed that privacy laws are not the same in all countries and,
in the context of the supplementary services they receive, it is possible that their medical
information will be exposed to individuals who are not medical professionals (such as
interpreters). If a medical tourist nonetheless decides to avail him or herself of these services, he
or she should be provided with documentation specifying the services provided by non-medical
practitioners (including interpreters) and an explanation as to who will have access to his or her
medical information, and the medical tourist should be asked to consent to the necessary
disclosure.
14. All stakeholders (clinical and administrative) involved in the care of medical tourists must
be made aware of their ethical obligations to protect confidentiality. Where possible,
interpreters, and other administrative staff with access to health information of the medical
tourist should sign confidentiality agreements.
15. The medical tourist should be informed that a change in his or her clinical condition might
result in a change in the cost estimate and in associated travel plans and visa requirements.
16. If the treatment plan is altered because of a medical need that becomes clear after the initial
plan has been established, the medical tourist should be notified of the change and why it was
necessary. Consent should be obtained from the patient for any changes to the treatment plan.
17. When a patient is suffering from an incurable condition, the physician in the host country
shall provide the patient with accurate information about his or her medical treatment options,
including the limitations of the treatment, the ability of the treatment to alter the course of the
disease in an appreciable manner, to increase life expectancy and to improve the quality of life.
March 2018 SMAC 209/Medical Tourism REV5/Apr2018
4
If, after examining all the data, the physician concludes that it is not possible to improve the
patient’s medical condition, the physician should advise the patient of this and discourage the
patient from travelling.
Treatment
18. Physicians are obligated to treat every individual accepted for treatment, both local and
foreigner, without discrimination. All the obligations detailed in law and international medical
ethical codes apply equally to the physician in his or her encounter with medical tourists.
19. Medical decisions concerning the medical tourist should be made by physicians, in
cooperation with the patient, and not by non-medical personnel.
20. At the discretion of the treating physicians, and where information is available and of good
quality, the patient should not be required to undergo tests previously performed, unless there is
a clinical need to repeat tests.
21. The patient should receive information about his or her treatment in a language he or she
understands. This includes the right to receive a summary of the treatment progress and
termination by the treating physician and a translation of the documents, as needed.
22. Agreement should be reached before treatment begins, on the transfer of test results and X-rays,
back to the home country of the patient.
23. Where possible, communication between the physicians in the host and home country
should be established in order to ensure appropriate aftercare and clinical follow-up of the
medical problems for which the patient was treated.
24. The physician who prepares the treatment plan for the patient should confirm the diagnosis,
the prognosis and the treatments that the medical tourist has received.
25. The patient should receive a copy of his or her medical documents for the purpose of
continuity of care and follow-up in his or her home country. Where necessary, the patient
should be given a detailed list of medical instructions and recommendations for the period
following his or her departure. This information should include a description of the expected
recovery time and the time required before travelling back to his or her home is possible.
Advertising
26. Advertising for medical tourism services, whether via the internet or in any other manner,
should comply with accepted principles of medical ethics and include detailed information
regarding the services provided. Information should address the service provider’s areas of
specialty, the physicians to whom it refers the benefits of its services, and the risks that may
accompany medical tourism. Access to licensing/accreditation status of physicians and
facilities and the facility’s outcomes data should be made readily available. Advertising
material should note that all medical treatment carries risks and specific additional risks may
apply in the context of medical tourism.
27. National Medical Associations should do everything in their power to prevent improper
advertising or advertising that is in violation of medical ethical principles, including advertising
March 2018 SMAC 209/Medical Tourism REV5/Apr2018
5
that contains incorrect or partial information and/or any information that is liable to mislead
patients, such as overstatement of potential benefits.
28. Advertising that notes the positive attributes of a specific medical treatment should also
present the risks inherent in such treatment and should not guarantee treatment results or foster
unrealistic expectations of benefits or treatment results.
Transparency and the prevention of conflicts of interest
29. Possible conflicts of interest may be inevitable for physicians treating medical tourists,
including at the behest of their employing institution. It is essential that all clinical
circumstances and relationships are managed in an open and transparent manner.
30. A physician shall exercise transparency and shall disclose to the medical tourist any
personal, financial, professional or other conflict of interest, whether real or perceived, that may
be connected to his or her treatment.
31. A physician should not accept any benefit, other than remuneration for the treatment, in the
context of the medical treatment, and should not offer the medical tourist nor accept from him
or her any business or personal offer, as long as the physician-patient relationship exists. Where
the physician is treating the medical tourist as another fee paying patient, the same rules should
apply as with his/her other fee paying patients.
32. A physician should ensure that any contract with a medical tourism company or medical
tourist does not constitute a conflict of interest with his or her current employment, or with his
or her ethical and professional obligations towards other patients.
Transparency in payment and in the physician’s fees
33. A treatment plan and estimate should include a detailed report of all costs, including a
breakdown of physician’s fees, such as: consultancy and surgery and additional fees the patient
might incur, such as: hospital costs, surgical assistance, prosthesis (if separate), and costs for
post-operative care.
34. The cost estimate may be changed after the treatment plan has been given only in the event
that the clinical condition of the patient has changed, or where circumstances have changed in a
way that it was impossible to anticipate or prevent. If the pricing was thus changed, the patient
must be informed as to the reason for the change in costs in as timely a fashion as possible.
Medical Tourism: Treatments, Markets and Health System Implications: A Scoping Review, Paris:
Organisation for Economic Co-operation and Development (2011)
§§§
March 2017

1
THE WORLD MEDICAL ASSOCIATION, INC.
Document no: SMAC 209/Women in Medicine COM REV2/Apr2018 Original:
English
Title: Proposed WMA Statement on Women in Medicine
Destination: Socio-Medical Affairs Committee
209th
Council Session
Radisson Blu Latvija Hotel
Riga, Latvia
26-28 April 2018
Action(s)
required:
For
Consideration
Note: This is a proposal from the Israeli Medical Association (IsMA). The 206th Council session in
Livingstone (April 2017) considered and decided to circulate it within WMA membership for
comments. The Council session in Chicago (October 2017) considered the compromised
version and decided to circulate it again within WMA membership for comments.
Keywords Women, Gender, Workforce, Male Physician, Female Physician, Pay, Employment
Opportunities, Feminization, Work-Life Balance.
Abbreviation key:
AM Associate Members
AMA American Medical Association
AMV Associazione Medica del Vaticano (Vatican State)
BMA British Medical Association
CMA Canadian Medical Association
March 2018 SMAC 209/Women in Medicine COM REV2/Apr2018
2
CGCM Consejo General de Colegios Médicos de Espana (Spain)
CNOM French National Medical Council
DMA Danish Medical Association
FMA Finnish Medical Association
GMA German Medical Association
JDN Junior Doctors Network
NZMA New Zealand Medical Association
NMA Norwegian Medical Association
SAMA South African Medical Association
SwMA Swedish Medical Association
GENERAL COMMENTS
AM The Associate Members support this document but feel it needs to be stronger emphasizing that the social and cultural changes, especially
about harassment of women, need to be the first and most important part of what needs to happen. We have moved that to the forefront,
emphasizing its importance especially in the current social environment. We have moved some paragraphs around to indicate their relative
importance. We think “family friendliness” could be more specific. We support this document with or without our suggestions.
AMV We appreciate the work done by the Israeli Medical Association and completely agree with this proposal.
BMA Overall this statement is very comprehensive and identifies some important areas where greater support and enforcement of rights offer
major benefit to women doctors. We would like to propose the following changes to ensure the statement has the maximum relevance and
impact for women doctors.
CNOM The CNOM (French Medical Council) thanks the IsMA for the quality and importance of this text and supports it apart from paragraphs 25
and 28.
DMA The Danish Medical Association is still critical towards this draft. We believe that the statement should be adjusted to focus
unambiguously on equal rights and opportunities – rather than on problems and solutions for women in particular.
The authors have already to some extent moved the draft in this direction – but we believe that more needs to be done. For example, we
believe that some of the wording about the increase of the number of women in medicine still has a pejorative ring to it – for example the
use of the phrase “the feminization of medicine”.
Similarly, we believe that a change in title would be helpful. The title should reflect WMA’s goal concerning gender equal rights and
opportunities rather than pointing to women in medicine as a separate issue.
March 2018 SMAC 209/Women in Medicine COM REV2/Apr2018
3
FMA FMA would like to thank the IMA for their work and for a more balanced text. However, we would still like to raise a question, whether
the document could be even further developed and titled as a Statement on Gender Equality in Medicine? Parts of the text already
correspond to this title.
NZMA We welcome the development of this statement and are generally supportive of the fundamental principles. We have proposed a few minor
suggested wording changes as tracked changes in the draft statement (see below).
GMA • The GMA suggests avoiding the term “feminization”, which, according to female leaders in the medical profession, has a negative
connotation in certain contexts and is sometimes used pejoratively. It has been replaced in most instances, but still appears in the
preamble.
• The GMA notes that there is some overlap between the section on Work-Life Balance and the section on Pregnancy and Parenthood
(e.g., paragraph 10 could fit in both categories).
• The GMA also suggests moving paragraph 13 to the Pregnancy and Parenthood section and combining it with paragraph 18.
Paragraphs 19 and 20 are also covered elsewhere in the paper (e.g. in paragraph 18 “Parents should have the right to take maternity or
parental leave without negative consequences…”)
• The GMA recommends that paragraphs 22 and 23 focused on breastfeeding be combined.
NMA Thanks to the Israeli Medical Association for revising this document. The document is improved and it does not only deal with female
physicians, but also with equal rights between the sexes and a family friendly profession. We think the document should be even more
directed towards both sexes and suggest some additions and deletions in the document. We do not agree that certain measures have to be
taken due to the increased number of female physicians in medicine. More female physicians should not be considered as a challenge or a
problem, and the concept feminisation of medicine could be perceived as something negative. Physicians of both sexes have common
interests in developing a working life with equal opportunities for both female and male physicians. The situation is therefore more
complex, and measures and changes in attitudes are necessary to establish good working environments for both male and female
physicians. It must be acceptable also for male physicians to leave at 4 pm to pick up children in the kindergarten and male physicians
should have equal opportunities to take marital leave without any reprisals from the employer.
SAMA SAMA feels that this is an important document, which raises important issues. Further comments have been made in the body of the
document. The current document seems to have lost its emphasis on the issues that affect women in medicine and is now emphasising a
general working environment.
SwMA The SMA feels that this policy would benefit from focusing even more on equal opportunities and rights for female and male physicians,
rather than on perceived challenges due to a larger proportion of women in the medical workforce. We have suggested some changes of
wording throughout the document to try to achieve this.
March 2018 SMAC 209/Women in Medicine COM REV2/Apr2018
4
Numbering will be deleted (or adjusted) when the revised text is adopted.
Proposed Text:
SMAC 207/Women in Medicine
REV/Oct2017
Specific Comments
Additions: bold/underlined
Deletions: lined-out
Comments only: [italic]
Proposed Revised Text by:
IsMA
SMAC 209/ Women in Medicine
REV2/Apr2018
Title WMA Statement on Women in
Medicine
WMA Statement on Medicine in
Medicine
Preamble
New The WMA notes the increasing trend around the
world for women to enter medical schools and the
medical profession, and believes that the study and
the practice of medicine must be transformed to a
greater or lesser extent in order to support all
people who study to become or practice as
physicians, of whatever gender. This is an essential
process of modernization by which inclusiveness is
promoted by gender neutrality. This statement
proposes mechanisms to identify and address
barriers causing discrimination between genders.
[BMA]
The WMA notes the increasing trend
around the world for women to enter
medical schools and the medical
profession, and believes that the
study and the practice of medicine
must be transformed to a greater or
lesser extent in order to support all
people who study to become or
practice as physicians, of whatever
gender. This is an essential process of
modernization by which
inclusiveness is promoted by gender
neutrality. This statement proposes
mechanisms to identify and address
barriers causing discrimination
between genders.
1. The statement highlights the rise in
female physicians and with this the
opportunities and challenges which
arise. The statement recommends
actions in the following areas:
increased presence of women in
academia and management roles,
work-life balance, changes in
Delete parag. [NMA] and [SwMA]
Parag. 1 and 2 to change places [SAMA]
The statement highlights the increase rise in the
number of female physicians and with this the
potential opportunities and challenges which arise
[CMA]. The statement recommends actions in the
March 2018 SMAC 209/Women in Medicine COM REV2/Apr2018
5
organizational culture and long-term
implications of the feminization of
medicine.
following areas: increased presence of women in
academia and management roles, work-life balance,
changes in organizational culture and long-term
implications of the feminization increased
proportion of women in of medicine. [GMA]
The statement highlights the rise in female physicians
and with this the opportunities and challenges which
arise. The statement recommends actions in the
following areas: changes in organizational culture
including the elimination of harassment in training
and the workplace, increased presence of women in
academia and management roles (including
leadership and partnership), work-life balance,
changes in organizational culture, and long-term
implications of the feminization of medicine
workforce changes in medicine. [AM: Please define
the use of “the feminization of medicine” or use
another term]
The statement highlights the rise in female physicians
and with this the opportunities and challenges which
arise. The statement recommends actions in the
following areas: increased presence of women in
academia and management roles, work-life balance,
changes in organizational culture and long-term
implications of the feminization increased
proportion of women in of medicine. [GMA]
The statement highlights the rise in numbers of
female physicians and with this the opportunities and
challenges which that arise. [NZMA]
The statement highlights the rise increase in female
physicians and with this the opportunities and
March 2018 SMAC 209/Women in Medicine COM REV2/Apr2018
6
challenges which arise. The statement recommends
actions in the following areas: increased presence of
women in academia and management roles, work-life
balance, changes in organizational culture and long-
term implications of workforce planning. the
feminization of medicine. [AMA]
….. The statement recommends actions in the
following areas: increased presence of women in
academia and management roles, work-life balance,
changes in organizational culture and long-term
implications of gender neutrality in the feminization
of medicine. [BMA]
2. In many countries around the world,
the number of women studying and
practicing medicine has steadily risen
over the past decades, surpassing 50%
in many places.
Parag. 1 and 2 to change places [SAMA]
Moved after parag. 3 for better flow of the document
[SwMA]
In many countries around the world, the number of
women studying and practicing medicine has steadily
risen over the past decades, surpassing 50% in many
places. Both men and women must have the same
opportunities to do a career in medicine. [NMA]
In many countries around the world, the
number of women studying and practicing
medicine has steadily risen over the past
decades, surpassing 50% in many places.
3. This issue was previously recognized
in the WMA Resolution on Access of
Women and Children to Health Care
and the Role of Women in the Medical
Profession (1997 Hamburg, 2008
Seoul) which, among other things,
called for increased representation and
participation in the medical profession,
especially in light of the growing
enrolment of women in medical
Delete parag. [NMA]
Parag. 3 and 4 to change places [SAMA]
This The issue of women in medicine [SwMA] was
previously recognized in the WMA Resolution on
Access of Women and Children to Health Care and the
Role of Women in the Medical Profession (1997
Hamburg, 2008 Seoul) [SwMA] which that [NZMA],
among other things, called for increased representation
March 2018 SMAC 209/Women in Medicine COM REV2/Apr2018
7
schools. It also called for a higher
growth rate of membership of women
in the NMA’s through empowerment,
career development, training and other
strategic initiatives.
and participation in the medical profession, especially
in light of the growing enrolment of women in medical
schools. It also called for a higher growth rate of
membership of women in the NMA’s National
Medical Associations (NMAs) through empowerment,
career development, training and other strategic
initiatives. [SwMA+AM+SAMA+AMA+BMA]
In many countries around the world, the number of
women studying and practicing medicine has
steadily risen over the past decades, surpassing 50%
in many places. [SwMA: Moved from parag. 2 above
for better flow of the document]
4. This development is in need of
supportive measures including the
following:
Parag. 3 and 4 to change places [SAMA]
This development is in need of supportive measures
offers opportunities for action, including in the
following areas: [SwMA]
This development offers opportunities for
action, including in the following areas:
New • Elimination of harassment against women in
both training and the workplace. [AM]
• Greater emphasis on a proper
balance of work and family life,
while supporting the professional
development of an individual
physician.
• Greater emphasis on a proper balance of work and
family life, while supporting the professional
development of an individual physicians. [SwMA]
Greater emphasis on a proper balance of
work and family life, while supporting
the professional development of
individual physicians.
• Encouragement and actualization
of women in both academia,
leadership and managerial roles.
• Encouragement and actualization of women in
both [CMA] academia and non-academic
practice environments, leadership, partnership,
and managerial roles. [AM]
Encouragement and actualization of
women in academia, leadership and
managerial roles.
March 2018 SMAC 209/Women in Medicine COM REV2/Apr2018
8
• Encouragement and actualization of women in
both academia, senior / leadership and managerial
roles. [BMA]
• Equalization of pay and
employment opportunities for men
and women, the elimination of
gender pay gaps in medicine, and
the removal of barriers negatively
affecting the advancement of
female physicians.
Equalization of pay and employment opportunities for
men and women, the elimination of sex and gender
pay gaps [AMA] in medicine, and the removal of
barriers negatively affecting the advancement of
female physicians. [NMA]
Equalization of pay and employment
opportunities for men and women, the
elimination of gender pay gaps in
medicine, and the removal of barriers
negatively affecting the advancement of
female physicians.
The issue of women in medicine was
previously recognized in the WMA
Resolution on Access of Women and
Children to Health Care and the Role of
Women in the Medical Profession which,
among other things, called for increased
representation and participation in the
medical profession, especially in light of
the growing enrolment of women in
medical schools. It also called for a
higher growth rate of membership of
women in National Medical Associations
(NMAs) through empowerment, career
development, training and other strategic
initiatives.
RECOMMENDATIONS RECOMMENDATIONS
Moved from below, as amended (parag 24-26):
Changes in organizational culture
The medical profession and employers should work to
eliminate not tolerate discrimination and harassment
March 2018 SMAC 209/Women in Medicine COM REV2/Apr2018
9
on the basis of gender and create a supportive
environment that allows for equal opportunities for
training, employment and advancement. Physicians
and staff should be periodically trained to
recognize, respond, and report signs of
discrimination and harassment so that action can
be taken to eliminate them from the workplace.
Employers should have confidential, non-
retaliatory protected programs for reporting
discrimination and harassment. There should be a
separate unbiased independent mechanism for
addressing these reports on both an individual and
systemic level.
Hospitals should recognise that female physicians
have been found to face higher levels of mental illness
and suicide than their male peers and should
investigate and address structural issues within the
workforce that may contribute to this, including but
not limited to organisational culture.
[AM comments: This statement should be footnoted
with data and source, if possible]
Family friendliness should be part of the
organizational culture of hospitals and other places of
employment by providing paid family leave when
indicated.
[AM]
Increased presence of women in
academia, leadership and
management roles.
Delete [NMA] Increased presence of women in
academia, leadership and management
roles.
March 2018 SMAC 209/Women in Medicine COM REV2/Apr2018
10
5. National Medical
Associations/Medical
Schools/Employers should facilitate
the establishment of mentoring
programs, sponsorship, and active
recruitment to provide female medical
students and physicians, guidance and
encouragement necessary to
undertake leadership and management
roles.
Delete parag. [NMA]
National Medical Associations/Medical
Schools/Employers should are urged to facilitate the
establishment of mentoring programs, sponsorship,
and active recruitment to provide female all medical
students and physicians, guidance and encouragement
necessary to undertake leadership and management
roles. [SwMA]
National Medical Associations/Medical
Schools/Employers should facilitate the establishment
of mentoring programs, sponsorship, and active
recruitment to provide both female and male medical
students and physicians, guidance and encouragement
necessary to undertake leadership and management
roles. [NZMA]
National Medical Associations/Medical
Schools/Employers are urged to facilitate
the establishment of mentoring programs,
sponsorship, and active recruitment to
provide medical students and physicians
with the necessary guidance and
encouragement necessary to undertake
leadership and management roles.
6. NMAs should explore opportunities
and incentives to encourage both men
and women to pursue diverse careers
in medicine and apply for fellowships,
academic, senior leadership and
management positions.
NMAs should explore support opportunities and
incentives to encourage both men and women to
pursue diverse careers in medicine and apply for
fellowships, academic, senior leadership and
management positions. [SwMA]
NMAs should explore opportunities and incentives to
encourage both men and more women to pursue
diverse careers in medicine. NMAs should
encourage and women to apply for fellowships,
academic, senior leadership and management
positions. [AM]
NMAs should explore opportunities and
incentives to encourage both men and
women to pursue diverse careers in
medicine and apply for fellowships,
academic, senior leadership and
management positions.
7. NMAs should lobby for gender equal
medical education and work policies.
Deleted paragraph. [SwMA]
NMAs should lobby pro-actively [AM] for gender
equal medical education, and work and responsibility
NMAs should lobby for gender equal
medical education and work policies.
March 2018 SMAC 209/Women in Medicine COM REV2/Apr2018
11
policies [CGCM]
NMAs should lobby for equal sex and gender equal
medical education and work policies. [AMA]
8. Engagement of women in health
policy organizations and professional
medical organizations should be
encouraged.
Engagement of both women and men in health policy
organizations and professional medical organizations
should be encouraged. [SwMA]
Equal engagement of women and men in health
policy organizations and professional medical
organizations should be encouraged. [NZMA]
NMAs should encourage the engagement
of both men and women in health policy
organizations and professional medical
organizations.
Work-Life Balance Work-Life Balance
9. Physicians should recognize that an
appropriate work-life balance is
beneficial to all physicians, however
that women may uniquely face
challenges to work-life balance
imposed by societal expectations that
must be addressed to solve the issue.
Physicians should recognize that an appropriate work-
life balance is beneficial to all physicians, however
that women may uniquely face challenges to work-life
balance imposed by societal expectations that must be
addressed to solve the issue. [SwMA]
Physicians should recognize that an appropriate work-
life balance is beneficial to all physicians, however
and [NZMA] that women may uniquely face unique
challenges to work-life balance imposed by societal
expectations that must be addressed to solve the issue.
[GMA]
Physicians should recognize that an appropriate work-
life balance is beneficial to all physicians, however
that women may uniquely face challenges to work-life
balance imposed by societal expectations concerning
gender roles that must be addressed to solve the issue.
[CGCM]
Physicians should recognize that an
appropriate work-life balance is
beneficial to all physicians, but that
women may face unique challenges to
work-life balance imposed by societal
expectations concerning gender roles that
must be addressed to solve the issue.
March 2018 SMAC 209/Women in Medicine COM REV2/Apr2018
12
10. Hospitals and other places of
employment should strive to provide
and promote access to high quality,
affordable, flexible childcare for
working parents, including the
provision of onsite housing and
childcare where appropriate. These
should be available to male and
female physicians, recognizing the
need for a better work-life balance.
They should provide information on
available services which support the
compatibility of work and family.
Hospitals and other places of employment should
strive to provide and promote access to high quality,
affordable, flexible childcare for working parents,
including the provision of onsite housing and
childcare where appropriate. These services should be
available to both male and female working
physicians, recognizing the need for a better work-life
balance. They should provide information on available
services which support the compatibility of work and
family. [SwMA]
Hospitals and other places of employment should
strive to provide and promote access to high quality,
affordable, flexible childcare for working parents,
including the provision of onsite housing and
childcare where appropriate. These should be
available to male and female all physicians [AM],
recognizing the need for a better work-life balance. As
well as about co-responsibility in personal life.
They should provide male and female physicians
information [CGCM] on available services which that
support the compatibility of work and family.
[NZMA]
Hospitals and other places of employment should be
receptive to the possibility of flexible and family-
friendly working hours, including part-time
residencies, posts, and professional appointments,
where appropriate. particularly in fields in which
women are underrepresented. [NMA]
Hospitals and other places of
employment should strive to provide and
promote access to high quality,
affordable, flexible childcare for working
parents, including the provision of onsite
housing and childcare where appropriate.
These services should be available to
both male and female physicians,
recognizing the need for a better work-
life balance. Employers should provide
information on available services which
support the compatibility of work and
family.
11. Hospitals and other places of
employment should be receptive to
the possibility of flexible and family-
friendly working hours, including
Hospitals and other places of employment should be
receptive to the possibility of flexible and family-
friendly working hours where appropriate, including
part-time residencies, posts, and professional
Hospitals and other places of
employment should be receptive to the
possibility of flexible and family-friendly
working hours, including part-time
March 2018 SMAC 209/Women in Medicine COM REV2/Apr2018
13
part-time residencies, posts, and
professional appointments, where
appropriate, particularly in fields in
which women are underrepresented.
appointments, where appropriate [NZMA].
particularly in fields in which women are
underrepresented. [NMA + SwMA]
residencies, posts, and professional
appointments, particularly in fields in
which women are underrepresented.
12. There is a need for increased research
on alternative work schedules and
telecommunication opportunities that
will allow flexibility in balancing
work-life demands.
There is a need for increased research on alternative
work schedules and telecommunication opportunities
that will allow flexibility in balancing work-life
demand of men and women. [CGCM]
There is a need for increased research on
alternative work schedules and
telecommunication opportunities that will
allow flexibility in balancing work-life
demands.
13. NMAs should advocate for the
enforcement and, where necessary,
the introduction of policy mandating
appropriate paid maternity leave and
parental leave in their respective
countries.
NMAs should advocate for the enforcement and,
where necessary, the [SwMA] introduction of policy
mandating appropriate paid maternity leave and
[CMA + SwMA] parental leave in their respective
countries. The policy should include options for
flexible working hours. [SwMA]
NMAs should advocate for the enforcement and,
where necessary, the introduction of policy mandating
appropriate paid maternity leave and parental leave
and rights in their respective countries. [BMA]
Move to parag. 18.[GMA]
NMAs should advocate for the
enforcement and, where necessary, the
introduction of policy mandating
appropriate paid parental leave and rights
in their respective countries.
14. Medical workplaces and professional
organisations should have fair,
impartial and transparent policies and
practices to give female doctors and
medical students equal access to
employment, education and training
opportunities in medicine.
Medical workplaces and professional organisations
should have fair, impartial and transparent policies
and practices to give female and male doctors and
medical students equal access to employment,
education and training opportunities in medicine.
[SwMA]
Medical workplaces and professional organisations
should have fair, impartial and transparent policies
and practices to give all [NZMA] female doctors
physicians and medical students equal access to
employment, education and training opportunities in
Medical workplaces and professional
organisations should have fair, impartial
and transparent policies and practices to
give all physicians and medical students
equal access to employment, education
and training opportunities in medicine.
March 2018 SMAC 209/Women in Medicine COM REV2/Apr2018
14
medicine. [AMA]
Pregnancy and Parenthood Pregnancy and Parenthood
15. It should be inadmissible for
employers to ask applicants about
family planning in relation to work.
It should be illegal inadmissible for employers to ask
applicants about pregnancy and/or family planning
in relation to work. [BMA]
It should be inadmissible for employers to ask
applicants about family planning in relation to work
or when applying medical school or residency.
[JDN]
It should be illegal for employers to ask
applicants about pregnancy and/or family
planning in relation to work.
New Physicians should have the freedom to choose when
they wish to have children and should not feel
pressures against doing so at a time of their
choosing. [JDN]
16. A risk assessment should be made by
the employer concerning the risks to
pregnant physicians working shifts.
The pregnant physician should have
the right to not work night shifts or
on-call shifts during pregnancy,
especially during the last trimester,
without negative consequences on
salary or progression in residency.
A risk assessment should be made by the employer
concerning the risks to pregnant physicians working
shifts. The pregnant physician should have the right
not to not work night shifts or on-call shifts during the
later part of pregnancy, especially during the last
trimester, without any negative employment
consequences on salary or progression in residency.
[SwMA]
A risk assessment should be made by the employer
concerning the risks to pregnant physicians working
shifts. Considerations for radiation exposure,
hazardous chemicals, environmental exposures,
lifting requirements, access to adequate food and
water, and restroom access should be addressed
and accommodations provided. The pregnant
physician, whether in training or practicing, should
have the right to make schedule accommodations in
Employers should assess the risks to
pregnant physicians and their unborn
children, when a physician has recently
given birth and when she is
breastfeeding. Where it is found, or a
medical practitioner considers, that an
employee or her child would be at risk
were she to continue with her normal
duties, the employer should provide
suitable alternative work for which the
physician should receive her normal rate
of pay. Physician should have the right to
not work night shifts or on-call shifts
during the later part of pregnancy,
without negative consequences on salary,
employment or progression in residency.
March 2018 SMAC 209/Women in Medicine COM REV2/Apr2018
15
order to avoid night shifts or on-call shifts (if
desired), and radiologic and infectious exposure
during pregnancy, especially during the last trimester,
without negative consequences on salary or
progression in residency. Pregnant physicians
should be able to choose which work or training
accommodations best fit their personal and family
needs. [AM]
A risk assessment of the workplace should be made
by the employer concerning the risks to pregnant
physicians and their unborn children, when a
physician has recently given birth and when she is
breastfeeding. where it is found, or a medical
practitioner considers, that an employee or her
child would be at risk were she to continue with
her normal duties, the employer should provide
suitable alternative work for which the physician
should receive her normal rate of pay working
shifts. The pregnant physician should have the right to
not work night shifts or on-call shifts during
pregnancy, especially during the last trimester,
without negative consequences on salary or
progression in residency. [BMA: The statement on
risk assessments for pregnant doctors working shifts
should be widened to include the range of workplace
activities that could put pregnant physicians and their
unborn children at risk e.g. long periods of standing,
lifting heavy items. It should also be broadened to
include new mothers and those breastfeeding.]
17. Pregnant physicians should have
equal training opportunities in post-
graduate training.
Pregnant physicians should have equal
training opportunities in post-graduate
training.
18. Parents should have the right to take Parents should have the right to take maternity or Parents should have the right to take
March 2018 SMAC 209/Women in Medicine COM REV2/Apr2018
16
maternity or parental leave without
negative consequences on their
employment, training or career
opportunities.
parental leave without negative consequences on their
employment, training or career opportunities [SwMA
+ CMA]
Parents should have the right to take maternity or
parental leave without negative consequences on their
employment, training or career opportunities. NMAs
should advocate for the enforcement and, where
necessary, the introduction of policy mandating
appropriate paid maternity leave and parental
leave in their respective countries. [GMA]
adequate parental leave without negative
consequences on their employment,
training or career opportunities.
19. Parents should have adequate parental
leave with fair pay and options for
flexible working.
Delete parag. [GMA + SwMA]
20. Parents should have the right to return
to the same position after parental
leave, without the fear of termination.
Delete parag. [GMA + SwMA] Parents should have the right to return to
the same position after parental leave,
without the fear of termination.
21. Employers and training bodies should
provide necessary supports to any
physician returning after a prolonged
period of absence including inter alia
for parental, maternity and elder-care
leave.
Employers and training bodies should provide
necessary supports to any physician returning after a
prolonged period of absence, including inter alia for
after parental, or maternity and elder-care leave.
(SwMA)
Employers and training bodies should provide
necessary supports to any physician returning after a
prolonged period of absence including inter alia for
parental and/or maternity or caring for older or
disabled relatives and elder-care leave. [BMA]
Employers and training bodies should
provide necessary support to any
physician returning after a prolonged
period of absence including parental,
maternity and elder-care leave.
March 2018 SMAC 209/Women in Medicine COM REV2/Apr2018
17
22. Mothers should be able to breastfeed
(or be given protected time for breast
pumping) during work hours, within
the current guidelines from the WHO.
Mothers should be able to breastfeed (or
be given protected time for breast
pumping) during work hours, within the
current guidelines from the WHO.
23. Workplaces should provide adequate
accommodation for women who are
breastfeeding including designated
areas for breastfeeding, breast
pumping, and milk storage.
Workplaces should provide adequate accommodation
areas for women who are breastfeeding, including
designated areas for breastfeeding, breast pumping,
and milk storage. [SwMA]
Workplaces should provide adequate
accommodation for women who are
breastfeeding including designated areas
for breastfeeding, breast pumping, and
milk storage.
Changes in organizational culture Changes in organisational culture
24. The medical profession and
employers should work to eliminate
discrimination and harassment on the
basis of gender and create a
supportive environment that allows
for equal opportunities for training,
employment and advancement.
The medical profession and employers should work to
eliminate discrimination and harassment on the basis
of sex and gender and create a supportive
environment that allows for equal opportunities for
training, employment and advancement. [AMA]
The medical profession and employers
should work to eliminate discrimination
and harassment on the basis of gender
and create a supportive environment that
allows equal opportunities for training,
employment and advancement.
25. Hospitals should recognise that
female physicians have been found to
face higher levels of mental illness
and suicide than their male peers and
should investigate and address
structural issues within the workforce
that may contribute to this, including
but not limited to organisational
culture.
Delete parag. [CNOM: Unless we can back up this
phenomenon with a reference to the scientific
evidence, we would recommend deleting this
paragraph]
Hospitals should recognise that female physicians
have been found to face be subject to higher risks
levels of mental illness and suicide than their male
peers and should investigate and address structural
issues within the workforce that may contribute to
this, including but not limited to organisational
culture. [SwMA: Please add reference to studies
showing this]
Hospitals and other primary care and work for
women centers should recognise that female
physicians have been found to face higher levels of
March 2018 SMAC 209/Women in Medicine COM REV2/Apr2018
18
mental illness and suicide than their male peers and
should investigate and address structural issues about
hiring policies within for the workforce that may
contribute to this, including but not limited to
organisational culture [CGCM]
[SAMA: Please provide a reference for this
statement]
Replace parag. by: Employers should recognise that
female physicians have been found to face
significant levels of mental illness, from mild to
severe conditions, and suicide [BMA: The statement
on hospitals addressing the issues associated with the
higher risks of mental illness and suicide experienced
by women needs qualification. Whilst there is some
evidence that women doctors in some countries are at
a higher risk of suicide compared to men, the evidence
on mental health is more complex due to factors
including underreporting of mental health issues by
men. It is therefore preferable to highlight and
address the specific mental health issues experienced
by women doctors which are linked to career
pathways, combining work with family and workplace
discrimination. There is a role for all healthcare
employers in tackling these issues, not just hospitals.]
26. Family friendliness should be part of
the organizational culture of hospitals
and other places of employment.
Family friendliness should be part of the
organizational culture of hospitals and
other places of employment.
Workforce planning and research Workforce planning and research
Move parag. 29 below here [AM]
27. Governments should take the
increasing number of women entering
NMA’s should encourage Governments should to
take the increasing number of women entering
NMAs should encourage governments to
take the increasing number of women
March 2018 SMAC 209/Women in Medicine COM REV2/Apr2018
19
medicine into consideration in the
context of long-term workforce
planning. A diverse workforce is
beneficial to the system and to
patients. Organizations delivering
healthcare should focus on ensuring
systems are appropriately resourced to
ensure all those working within it are
able to deliver safe care to patients
and are appropriately and equitably
rewarded. Governments should also
work to counteract negative attitudes
and behaviour, bias, and/or outdated
norms and values from organizations
and individuals.
medicine into consideration in the context of long-
term workforce planning…. [SAMA]
Governments should take the increasing number of
women entering medicine into consideration in the
context of long-term workforce planning. A diverse
workforce is beneficial to the system health care and
to patients. Governments need to take this into
account in the context of long-term workforce
planning. Organizations delivering healthcare should
focus on ensuring systems are appropriately resourced
to ensure that all those working within it them are
able to deliver safe care to patients and are
appropriately and equitably rewarded. Governments
should also work to counteract negative attitudes and
behaviour, bias, and/or outdated norms and values
from organizations and individuals. [SwMA]
Governments and employers should take the
increasing number of women entering medicine into
consideration in the context of long-term workforce
planning. A diverse workforce is beneficial to the
health care system and to patients…. [AM]
entering medicine into consideration in
the context of long-term workforce
planning. A diverse workforce is
beneficial to the health care system and
to patients. Organizations delivering
healthcare should focus on ensuring
systems are appropriately resourced to
ensure that all those working within them
are able to deliver safe care to patients
and are appropriately and equitably
rewarded. Governments should also work
to counteract negative attitudes and
behaviour, bias, and/or outdated norms
and values from organizations and
individuals.
28. Governments should invest in
research to evaluate the long-term
implications associated with the
different approaches of male and
female physicians to patient care.
They should work to identify those
factors that drive women to choose
certain career steps and fields of
specialization early on in their
medical education and training and
strive to address barriers in order to
NMA’s should encourage Governments should to
invest in research…. [SAMA]
Governments should invest in research to evaluate the
long-term implications associated with the different
approaches of male and female physicians to patient
care. They should work to identify those factors that
drive women and men [SwMA] to choose certain
career steps and fields of specialization early on in
their medical education and training and strive to
address any identified barriers [CMA] in order to
NMAs should encourage governments to
invest in research to identify those factors
that drive women to choose certain fields
of specialization early on in their medical
education and training
and strive to address any identified
barriers in order to achieve equal
representation of men and women in all
fields of medicine.
March 2018 SMAC 209/Women in Medicine COM REV2/Apr2018
20
achieve equal representation of
women in all fields of medicine.
achieve equal representation of women and men in all
fields of medicine. [SwMA]
Replace parag. by: Research should be
commissioned to identify those factors that drive
women to choose certain fields of specialization
early on in their medical education and training, so
that women have a broader choice of career and
specialty. [BMA: The statement on research required
to evaluate the long-term implications associated with
the different approaches of male and female
physicians to patient care requires clarification. The
key priority in research and policy focus should be the
barriers which still prevent women being able to
choose and continue their careers in certain
specialties of medicine – e.g. because of a lack of
flexibility, inability to work part time, long/unsocial
hours culture].
Considering the data now available to us which
would enable investigation into the question that
gender could have an impact on the different
approaches of male and female physicians to
patient care or different care models, governments
should invest in research to evaluate the long-term
implications associated with the different approaches
of male and female physicians to patient care.They
should work to identify those factors that drive women
to choose certain career steps and fields of
specialization early on in their medical education and
training and strive to address barriers in order to
achieve equal representation of women in all fields of
medicine. [CNOM]
29. Governments and employers should NMA’s should encourage Governments and NMAs should encourage governments
March 2018 SMAC 209/Women in Medicine COM REV2/Apr2018
21
ensure that men and women receive
equal compensation for
commensurate work and work to
eliminate the gender pay gap in
medicine.
employers should to ensure that men and women
receive equal compensation for commensurate work
and work to eliminate the gender pay gap in medicine.
[SAMA]
Governments and employers should ensure that men
and women and men receive equal compensation for
commensurate work and work to eliminate the gender
pay gap in medicine. [SwMA]
Governments and employers should ensure that men
and women receive equal compensation for
commensurate work and work to eliminate the sex
and gender pay gap in medicine. [AMA]
Move above, before parag. 27 [AM]
and employers to ensure that men and
women receive equal compensation for
commensurate work and strive to
eliminate the gender pay gap in medicine.
*****
06.03.2018