WMA General Assembly

Delegates from almost 50 national medical associations attended the annual General Assembly of the WMA in Bangkok, Thailand from 10 to 13 October. Among the issues discussed were:

DECLARATION OF HELSINKI

The meeting received an oral report on the process of revising the Declaration of Helsinki and plans for two expert conferences, in Cape Town in December and in Tokyo in February 2013. It was hoped to present the first draft revision of the Declaration to the next Council meeting in Bali in April 2013.

ORGAN TRANSPLANTS

Opposition to the idea of a commercial market in organs allowing donors to be paid for donating kidneys and other organs was reiterated. Revised policy document said that the only costs involved should be contributions towards funeral costs given to the family of those who donated after their death. New policy was adopted, setting out ways in which medical associations, physicians and others could increase the number of donor organs available in the world. It said that prisoners and others in institutions should be eligible to donate after death only in exceptional circumstances. Executed prisoners must not be considered as organ and/or tissue donors. Organs or tissue suspected to have been obtained through unlawful means must not be accepted for transplantation and transplant surgeons should refrain from transplanting organs and tissues that they know, or suspect, have not been procured in a legal and ethical manner.

CAPITAL PUNISHMENT

Physicians must not participate in executions and should not assist in the importation or prescription of drugs for execution, according to revised policy guidance. In a development of its policy opposing the use of capital punishment, the Assembly  reaffirmed ‘that it is unethical for physicians to participate in capital punishment, in any way, or during any step of the execution process, including its planning and the instruction and/or training of persons to perform executions’.

It said participation was incompatible with the physician’s role as healer. But the guidance adds: ‘As citizens, physicians have the right to form views about capital punishment based on their individual moral beliefs. As members of the medical profession, they must uphold the prohibition against participation in capital punishment.’

COLLECTIVE ACTION BY PHYSICIANS

New advice on the ethical implications of collective action by physicians was agreed, stating that physicians who take part in collective action are not exempt from their ethical or professional obligations to patients. If involved in collective action, national medical associations should act to minimize the harm to the public and ensure that essential and emergency health services, and the continuity of care, are provided throughout a strike.

Dr. Cecil Wilson, President of the WMA, said: ‘Unfortunately it is a fact that collective action by physicians has become increasingly common in recent years as dissatisfaction with their working conditions has increased. This is always action taken in the last resort.

What this guidance attempts to do is to advise physicians about their continuing duty to individual patients during times of collective action and the inevitable tension between their rights to improve the health system and their own working conditions and their duty not to cause harm.’

VIOLENCE IN HEALTH SECTOR

Healthcare institutions should adopt a zero-tolerance attitude to violence in the workplace, including the right for physicians to refuse to treat previously violent patients,

according to a new policy statement. It stated that healthcare institutions should develop and implement a protocol to deal with acts of violence.

Dr. Cecil Wilson said: ‘Violence against physicians and other health professionals has become a real problem and cannot be tolerated. We are asking healthcare institutions to adopt a zero-tolerance policy for the workplace, with a system of prompt reporting and a mechanism to ensure that employees who report violence do not face reprisals.’

THE PRIORITISATION OF VACCINATION

The meeting called for people to be educated on the benefits of immunisations and how to access services. In a new statement designed to counter recent opposition to vaccination, the WMA said that governments should be encouraged to commit resources to immunisation programmes and they should promote vaccination and the benefits of immunisation, targeting in particular those populations at risk who are difficult to reach.

Vaccination and immunisation had been acknowledged as an effective preventive strategy for several communicable diseases and were now being developed for the control of some non-communicable diseases.

The statement declared: ‘The medical profession denounce any claims that are unfounded and inaccurate with respect to the possible dangers of vaccine administration.  Claims such as these have resulted in diminished immunisation rates in some countries.  The result is that the incidences of the diseases to be prevented have increased with serious consequences for a number of persons‘.

HEALTH CARE IN ARMED CONFLICT

Hospitals and health care facilities must be respected by all combatants during armed conflict and civil unrest, according to revised guidance for physicians. Medical ethics in times of armed conflict were identical to medical ethics in times of peace, and physicians’ primary obligation was always to their patients. Physicians should refuse to obey an illegal or unethical order.

Governments, armed forces and others should comply with the Geneva Conventions during armed conflicts to ensure that physicians could provide care to everyone in need. This included a requirement to protect health care personnel and facilities. Physicians had to be granted access to patients, including patients in detention centres and prisons, and hospitals and health care facilities must be respected by all combatants at all times

STERILISATION

The meeting called for concerted action by national medical associations to advocate against forced sterilisation. It said no-one should be subjected to coerced permanent sterilisation and that the decision to undergo contraception, including sterilisation, must be the sole decision of the individual concerned.

ABUSE OF PSYCHIATRY

The practice of detaining religious practitioners in psychiatric institutions and subjecting them to unnecessary psychiatric treatment as a punishment was condemned as unacceptable. A resolution noted with concern recent evidence of this happening from a number of countries.

Dr. Cecil Wilson said: ‘Detention of this kind and the unwarranted treatment of religious practitioners is abusive, unethical and unacceptable. We urge all physicians and psychiatrists to resist involvement in these abusive practices and call on national medical associations to support their physician members who resist involvement in these abuses.

PRESIDENT AND PRESIDENT ELECT

Dr. Cecil Wilson was installed as President for 2012/13 and Dr. Margaret Mungherera, President of the Uganda Medical Association, was elected unopposed as President-elect.

NEW MEMBERS

The Medical Associations of Myanmar and Sri Lanka were admitted as members of the WMA, bringing the total number of NMAs in the WMA to 102.