Policy Tag: Standards

Adopted as a Council Resolution by the 194th WMA Council Session, Bali, Indonesia, April 2013,
adopted by the 64th WMA General Assembly, Fortaleza, Brazil, October 2013
and reaffirmed by the 217th WMA Council Session, Seoul (online), April 2021 

 

Ensuring patient safety and quality of care is at the core of medical practice. For patients, a high level of performance can be a matter of life or death. Therefore, guidance and standardisation in healthcare must be based on solid medical evidence and has to take ethical considerations into account.

Currently, trends in the European Union can be observed to introduce standards in clinical, medical care developed by non-medical standardisation bodies, which neither have the necessary professional ethical and technical competencies nor a public mandate.

The WMA has major concerns about such tendencies which are likely to reduce the quality of care offered, and calls upon governments and other institutions not to leave standardisation of medical care up to non-medical self selected bodies.

Adopted by the 49th World Medical Assembly, Hamburg, Germany, November 1997,
revised by the 60th WMA General Assembly, New Delhi, India, October 2009 and
reaffirmed with minor revision by the 213th WMA Council Session, Tbilisi, Georgia, October 2019

 

PREAMBLE

The purpose of health care is to prevent, diagnose and treat illness and to maintain and to promote the health of the population. The goal of quality review in health care is continuous improvement of the quality of services provided for patients and the population, and of the ways and means of producing these services. The ultimate goal is to improve both individual patient outcomes and population health.

The obligation to continuously improve one’s professional ability and to rigorously evaluate the methods one uses has long been a fundamental tenet of the ethical codes of physicians. According to these codes, a physician must always strive to maintain and increase his/her knowledge and skills. The physician shall recommend only examinations and treatments that are believed to be effective and appropriate according to the best available evidence-based medicine.

Physicians and health care institutions have an ethical and professional obligation to strive for continuous quality improvement of services and patient safety, as stated in particular in WMA International Code of Medical Ethics, the Lisbon Declaration on the Rights of the Patient and the Resolution on Standardisation in Medical Practice and Patient Safety. These guidelines are intended to articulate the ethical grounds for these obligations and to strengthen quality review practices.

Ethical guidelines for health care quality improvement matter to all physicians, as well as to institutions providing health care services for patients, those providing continuous quality improvement services to assist physicians and organizations, health care payers and regulators, patients, and every other stakeholder in the health care system.

The Obligation to Establish Standards for Good Quality Work

Professionals, by definition, are responsible for specifying the standards that constitute good quality in their work and the processes needed for the evaluation of that quality. Health professionals, therefore, must define high quality health care and determine the best methods of measuring the quality of care delivered.

The Obligation to Collect Data

In order to assess quality of care, it is necessary to obtain reliable data on the patients and populations served as well as on care processes and outcomes. Patient records, whether recorded on paper, digitally or in any other way, must be created written and preserved with care and, with attention to confidentiality requirements in accordance with the WMA Declaration of Taipei. Procedures, decisions and other matters connected with patients should be recorded in a format that will allow information for measuring specific standards to be available on a timely basis when needed.

The Role of Professional Education

Health care professionals should have adequate opportunities to maintain and develop their knowledge and skills by participating in continuing medical education and/or continuing professional development. Clinical guidelines based on professional standards for high quality care should be created and made easily available to those requiring them. Health care training should include specific instruction in quality improvement techniques, including opportunities for hands-on practice in measuring and improving quality. Health care institutions should create quality improvement systems for their own use and to ensure that instructions concerning such systems are followed.

Good quality work requires resources. Every effort should be made to make sure that adequate time and economic means are available for quality work.

Attention to inappropriate use of services

Inappropriate use of health care services includes overuse, underuse and misuse. Quality measurement in health care should include a balanced set of measures in all three areas.

Overuse of services occurs when health care services are provided under circumstances in which the potential for harm exceeds the possible benefit. Physicians can improve quality by reducing overuse, thus sparing patients the unnecessary risk that results from inappropriate health services.

Underuse of services is the failure to provide health care services that would be likely to produce a favourable outcome for the patient. Physicians should strive to expand the use of beneficial health care services that are underused.

Misuse of services occurs when an incorrect diagnosis is made or when an appropriate service has been selected for a correct diagnosis but the patient does not receive the full potential benefit of the service because of a preventable adverse event. Misuse of services can be greatly reduced by using risk management and error prevention strategies.

Monitoring Quality: Clinical Audits

Active participation in critical self-evaluation, usually through clinical audit programs, is a useful mechanism for healthcare professionals, including healthcare administrators and physicians, and the institutions in which they work, to improve the quality of their work. External independent examination and accreditation of the institution can also be of use, when carried out appropriately and with due attention to potential unintended effects.

Healthcare professionals and institutions should systematically record and reflect on adverse incidents and medical error for the purposes of learning and quality improvement. This should occur in an environment of trust (and confidentiality when appropriate) and to actively avoid a blame culture.

Internal and External Quality Assessment

At the individual level, a physician should continuously update their knowledge and skills and subject their level of ability to critical self-appraisal.

In organizations, the quality of health care can be assessed by both internal and external methods.

Health care institutions should create internal quality improvement systems for their own use and ensure that instructions concerning such systems are followed. These systems should include continuous conducting of internal clinical peer review and learning from adverse incidents, review examination and treatment methods and their attendant results, tracking of the organization’s ability to react to quality data, and monitoring of patient feedback.

External quality review initiatives, such as external peer review and audit, should be carried out regularly and with a frequency corresponding to the evolution of the field or when there is special reason for external assessment. Any review should take into account risk adjustment of the patient population under consideration.

Whether internal or external, if the results of any quality assessment carry significant opportunities for benefit or threats of harms for the organization or individual being assessed, special attention must be paid to potential unintended and dangerous consequences of such quality assessments. It is especially important to monitor the results of quality improvement measurement and intervention strategies over time, with attention to their effects on especially vulnerable patient populations.

Protocols to be used for quality review should be replicable and transparent. Appeals mechanisms should be built into the protocols.

Confidentiality of Patient Records

Patient records are an invaluable source of data for quality improvement. As with other uses of individually identifiable patient-based information, consent is usually required from the patient prior to use. If consent cannot reasonably be obtained, then all attempts should be made to ensure that medical records are anonymised or pseudonimised for use in quality improvement efforts. In every case, patient records used for quality improvement must only be accessible to those who need to see them for the purposes of quality improvement.

Confidentiality of Peer Review

For peer review to be most effective, all parties involved must participate and recognize its importance. It is recommended that informed voluntary consent be obtained from those to be reviewed. Within a healthcare team, the work of each physician must be able to be evaluated. Information regarding an individual physician’s evaluation should not be published without the consent of the physician concerned. It is recommended that consent be obtained prior to publishing information regarding an individual physician’s evaluation.

A provider of services may inform his/her patients about the results of quality review.

If reviews are made available to the public, careful monitoring must be undertaken to track the effects, intended and unintended, of such public reporting of performance data.

Ethical Review of Quality Improvement Activities

National codes of medical ethics and ethical principles and guidelines that relate to continuous quality improvement, audit and clinical review must be followed.

Quality improvement should be an ongoing and integral part of the operations of every health care organization. As such, the majority of quality improvement projects will not require specific review by an ethics committee. If there are doubts about specific issues or if a project poses more than minimal risk compared to the existing processes for care, then the project should be referred to an appropriate ethics committee or institutional review board. When such formal ethical review is needed, it should be undertaken by a committee with members who are knowledgeable about quality improvement techniques.

Competence and Impartiality of the Reviewer

Those who conduct performance reviews must be competent in quality improvement techniques and in clinical audit as well as experienced in the clinical field relating to the review. Where medical care is being reviewed, the reviewer should be a physician whose knowledge and experience is accepted by those being reviewed.

The reviewer should be impartial and independent. Whilst he/she must be aware of the activities under review, he/she must be objective in the report and base conclusions on critical evaluation of observation and facts. Commercial or competitive matters should not be allowed to influence the content of the reviewer’s report.

Separation of Quality Reviews and Supervision by Authorities

Quality improvement of services and of health care systems is a requirement for every physician and health care institution. It is not supervision of professional activities by authorities and it must be kept independent of this. The results of performance reviews or audits of physician activities should be used by supervising authorities only subject to a separate agreement between them and the physicians concerned unless national legislation mandates an alternative approach. These activities must be fully cognizant of the local legal framework and must not expose participating physicians to litigation.

Adopted by the 182nd WMA Council Session, Tel Aviv, Israel, May 2009

WHEREAS:

Recent international conflicts, including the Israeli-Palestinian conflict in Gaza, the conflict in Sri Lanka, the conflict in Darfur, and the conflict in the Democratic Republic of Congo, have led to loss of life and the impairment of living conditions; and International standards of medical neutrality must be upheld throughout such conflicts;

THEREFORE, the WMA

  1. Reaffirms its policy, “Regulations in Time of Armed Conflict” and the obligations of physicians stated in this document. The WMA calls on its members to act in accordance with all internationally accepted principles of healthcare delivery in times of conflict.
  2. Reiterates its commitment to the universal right to health, and access to the highest attainable standard of health care. This universal right is not conditional on peaceful existence, although a peaceful existence accommodates greater ability to provide health to all.
  3. Reaffirms the obligation incumbent on all parties involved in conflict situations to abide by the rules of international medical ethics, a swell as the provisions of international humanitarian law, as expressed in the Geneva Conventions, particularly their common article 3, and, specifically, to assure the provision of medical care and/or evacuation of the trapped and wounded and to refrain from targeting medical personnel and medical facilities.

Adopted by the 48th WMA General Assembly, Somerset West, South Africa, October 1996,
revised by the 59th WMA General Assembly, Seoul, Korea, October 2008 and
by the 70th WMA General Assembly, Tbilisi, Georgia, October 2019

 

PREAMBLE

AMR is a growing threat to global public health that transcends national boundaries and socioeconomic divisions. AMR affects human, animal and environmental health. It is a multi-faceted problem of crisis proportions with significant economic, health, and human implications.

Addressing the threat of antimicrobial resistance is a fundamental global health priority, and the responsibility of all countries.

Antimicrobial drugs form an essential component of modern medicine, ensuring that complex procedures, such as surgery and chemotherapy, can be performed with lower risk.

AMR threatens the effective prevention and treatment of an increasing range of infections caused by bacteria, parasites, viruses and fungi.

AMR occurs when microorganisms develop the ability to resist the actions of antimicrobial drugs (such as antibiotics, antifungals, antivirals, antimalarials, and anthelmintics).

Infections caused by bacteria that are resistant to multiple classes of antibiotic are increasingly being documented.

While AMR is a natural evolutionary phenomenon, it is exacerbated by the overuse and misuse of antimicrobials in medicine, as well as in veterinary practice and agriculture, and can be exacerbated when antimicrobials are given as growth promoters in animals or used to prevent diseases in healthy animals.

The emergence and spread of AMR is further enhanced by lack of access to effective drugs, access to antibiotics “over the counter” in some countries, the availability of substandard and falsified products, misuse of antibiotics in food production, increased global travel, medical tourism and trade, and the poor application of infection control measures.

Another major cause of AMR is the release of antibiotics into the environment. This can occur as either as a result of poor manufacturing practices, the improper disposal of unused medication, human and animal excretion, and the inadequate disposal of human and animal corpses.

In many countries, particularly in low-and middle-income countries, access to effective antimicrobials as well as complementary technologies including vaccines and diagnostics continues to remain a significant challenge, furthering AMR.

The ramifications of resistance manifest themselves not just in the impact on human health, but also in potentially heavy economic costs. The World Health Organization (WHO) has warned that resistance has reached alarming levels in many parts of the world, and that a continued increase in resistance could lead to 10 million people dying per year and a reduction of 2-3.5% in global gross domestic product by 2050.

At the rate at which resistance is growing globally, it poses a significant threat to successfully achieving the UN Sustainable Development Goals and undermines efforts to reduce health inequalities. Without harmonized and coordinated cross-sector action on a global, scale, the world is heading towards a post-antibiotic era in which common infections and minor injuries can once again kill.

AMR has reached great prominence at the highest political levels including the UN General Assembly, and the agenda of the G7 and G20.

There is a need for an effective ‘one health’ approach to minimize unnecessary or inappropriate use of antimicrobials and to prevent and control the transmission of existing resistance. A ‘one health’ approach recognizes that action is required across human medicine, veterinary practice and agriculture.

 

RECOMMENDATIONS

Global

  1. The primary prevention of community and healthcare associated infections is necessary to reduce the demand for antibiotics. Addressing the social determinants of infectious disease, such as poor living conditions and sanitation, will have co-benefits of reducing health inequalities and tackling AMR.
  2. Nations have varying resources available to combat antimicrobial resistance, and must cooperate with the WHO, Food and Agriculture Organization and World Organization for Animal Health that support the WHO Global Action Plan on AMR which provides the framework for national action plans.
  3. The World Medical Association and its constituent members should advocate for:
    • investment in the surveillance of drug resistant infections across human health, veterinary medicine, agriculture, fishing industry, and food production, and international cooperation for data-sharing procedures to improve global responses;
    • the WHO and other UN agencies should examine the role of international travel and trade agreements on the development of antimicrobial resistance, and promote measures in those agreements to act as safeguards against the globalisation of drug resistant pathogens in our food supply;
    • the WHO should continue to encourage the use of Trade Related Aspects of Intellectual Property Rights (TRIPS) flexibilities to help ensure affordable access to quality medicines and oppose the proliferation of ‘TRIPS-plus’ provisions within trade agreements, which restrict the use of TRIPS flexibilities and limit their effectiveness;
    • the widespread application of verifiable technology such as track-and-trace systems to ensure the authenticity of pharmaceutical products;
    • equitable access to, and appropriate use of, existing and new quality-assured antimicrobial medicines. This requires effectively applying the Access, Watch and Reserve lists of the WHO Essential Medicines program. For the WHO global action plan and national action plans to be effective, access to health facilities, health care professionals, veterinarians, knowledge, education and information are vital;
    • greater use of vaccinations which will reduce the burden of infectious disease, reducing the need for antibiotics and therefore limiting the emergence of resistance;
    • for global health organisations and governments to scale up their action and coordination in promoting appropriate antibiotic use and work together to reduce AMR using a One Health approach, which recognises that human, animal and environmental health is inextricably linked. to reduce the spread of resistance.
  4. The World Medical Association and its constituent members should encourage their governments to:
    • fund more basic and applied research directed toward the development of innovative antimicrobial agents, diagnostic tools and vaccines (innovative antimicrobial vaccines), and on the appropriate and safe use of such therapeutic tools;
    • ensure parity between financial and technical resources towards the development of innovative antimicrobial medicines, vaccines, and diagnostics as well as innovative infection control and prevention methods across human health, veterinary, and agricultural sectors;
    • support Research and Development efforts for novel antimicrobial agents, vaccines, and rapid diagnostic methods that are needs-driven and guided by the principles outlined in the UN Declaration on AMR, adopted in September 2016, including affordability, effectiveness, efficiency, and equity;
    • initiate regulatory measures to control the environmental pollution that allows the spread of antibiotic-resistant genes across soil, water and air;
    • educate a sufficient number of clinical infectious disease specialists in every country, which is a fundamental requirement for tackling antimicrobial resistance and hospital-acquired infections.

National

  1. National medical associations should urge their governments to:
    • require that antimicrobial agents be available only through a prescription provided by healthcare professionals and/or veterinary professionals and dispensed or sold by professionals;
    • initiate national campaigns to raise awareness among the public of the harmful consequences of overuse and misuse of antibiotics. This should be supported through the introduction of national targets to raise public awareness;
    • support professional societies, civil society, and healthcare delivery systems to pilot and adopt proven behaviour change strategies to ensure appropriate use of antibiotics;
    • ensure access to appropriate and fit-for-purpose point-of-care diagnostics in hospitals and clinics to support decision making and prevent inappropriate prescribing of antibiotic;
    • mandate the collection of data on antibiotic use, prescriptions, prices, resistance patterns, and trade in both the healthcare and agricultural sectors. This data should be made publicly accessible;
    • promote effective programs of antimicrobial stewardship and training on the appropriate use of antimicrobials agents, and infection control;
    • actively pursue the development of a national surveillance system for the provision of antimicrobials and for antimicrobial resistance. Data from this system should be linked with or contributed to the WHO’s global surveillance network;
    • monitoring of antimicrobial use in food producing animals must be sufficiently granular to ensure accountability.
  2. National medical associations should:
    • encourage medical schools and continuing medical education programs to renew their efforts to educate physicians, who can in turn inform their patients, about the appropriate use of antimicrobial agents and appropriate infection control practices, including antibiotic use in the outpatient setting;
    • support the education of their members in areas of AMR, including antimicrobial stewardship, rational use of antimicrobials, and infection control measures including hand hygiene;
    • advocate for the publishing and communication of local information relating to resistance patterns, clinical guidelines and recommended treatment options for physicians;
    • in collaboration with veterinary authorities, encourage their governments to introduce regulations to reduce the use of antimicrobials in agriculture, in particular food producing animals, including restrictions on the routine use of antimicrobials for both prophylaxis and growth promotion, and on the use of classes of antimicrobial that are critically important in human medicine;
    • support regulation that prevents conflicts of interest among veterinarians, such as roles where veterinarians both prescribe and sell antibiotics;
    • consider the use of social media to educate and promote the proper use and disposal of antibiotic medications;
    • encourage parents to comply with the national recommended immunization schedules for children. Adults should also have easy access to vaccines against influenza and pneumococcal infections among others.

Local

  1. Health professionals and health systems have a vital role in preserving antimicrobial medicines.
  2. Physicians should:
    • have access to high-quality and reliable, evidence-based information free of conflict of interest and actively participate in and lead antimicrobial stewardship programs in their hospitals, clinics and communities to optimise antibiotic use;
    • raise awareness amongst their patients about antimicrobial therapy, its risks and benefits, the importance of adherence with the prescribed regimen, infection prevention practices, and the problem of AMR;
    • promote and ensure adherence hygiene measures (especially hand hygiene) and other infection prevention practices.

Adopted by the 48th WMA General Assembly, Somerset West, South African, October 1996
and editorially revised by the 174th WMA Council Session, Pilanesberg, South Africa, October 2006
and rescinded at the 69th WMA General Assembly, Reykjavik, Iceland, October 2018

Recognising that:

  1. The physician has an obligation to provide his or her patients with competent medical service and to report to the appropriate authorities those physicians who practice unethically and incompetently or who engage in fraud or deception (International Code of Medical Ethics); and
  2. The physician should be free to make clinical and ethical judgements without inappropriate outside interference; and
  3. Ethics committees, credentials committees and other forms of peer review have been long established, recognised and accepted by organised medicine to scrutinise physicians’ professional conduct and, where appropriate, impose reasonable restrictions on the absolute professional freedom of physicians; and

Reaffirming that:

  1. Professional autonomy and the duty to engage in vigilant self-regulation are essential requirements for high quality care and therefore are patient benefits that must be preserved;
  2. And, as a corollary, the medical profession has a continuing responsibility to support, participate in, and accept appropriate peer review activity that is conducted in good faith;

POSITION

  1. A physician’s professional service should be considered distinct from commercial goods and services, not least because a physician is bound by specific ethical duties, which include the dedication to provide competent medical practice (International Code of Medical Ethics).
  2. Whatever judicial or regulatory process a country has established, any judgement on a physician’s professional conduct or performance must incorporate evaluation by the physician’s professional peers who, by their training and experience, understand the complexity of the medical issues involved.
  3. Any procedure for considering complaints from patients which fails to be based upon good faith evaluation of the physician’s actions or omissions by the physician’s peers is unacceptable. Such a procedure would undermine the overall quality of medical care provided to all patients.

Approved by the 55th WMA General Assembly, Tokyo, Japan, October 2004,
reaffirmed by the 197th WMA Council Session, Tokyo, Japan, April 2014
and by the 217th WMA Council Session, Seoul (online), April 2021
and revised by the 74th WMA General Assembly, Kigali, Rwanda, October 2023

 

Whereas the WMA:

  1. Recognizes the need and importance for sound global standards for quality improvement of medical education;
  2. Acknowledges the WMA's special relationship with the World Federation for Medical Education (WFME) as one of the founders of the Federation;
  3. Recognizes that it is represented in the WFME Executive Council and in this capacity is co-responsible for the WFME Project on International Standards in Medical Education, conducted since 19971;
  4. Acknowledges the development of the WFME Trilogy of Documents of Global Standards in Medical Education for Quality Improvement, covering Basic Medical Education2, Postgraduate Medical Education3 and the Continuing Professional Development (CPD) of Medical Doctors4;
  5. Recognizes the endorsement5 of the WFME Global Standards at the World Conference in Medical Education: Global Standards in Medical Education for Better Health Care, in Copenhagen, Denmark, March 20036;

It hereby:

  1. Expresses its encouragement and support of the ongoing work of implementing the Trilogy of WFME Documents on Global Standards in Medical Education.

 

References:

  1. The Executive Council, The World Federation for Medical Education: International standards in medical education: assessment and accreditation of medical schools´ educational programmes. A WFME position paper. Med Ed 1998; 32: 549-558.
  2. World Federation for Medical Education: Basic Medical Education. WFME Global Standards for Quality Improvement. WFME, Copenhagen 2003. http://www.wfme.org
  3. World Federation for Medical Education. WFME Standards for Postgraduate Medical Education 2023
  4. World Federation for Medical Education: Continuing Professional Development (CPD) of Medical Doctors. WFME Global Standards for Quality Improvement. WFME Copenhagen 2003. http://www.wfme.org
  5. J.P. de V. van Niekerk. WFME Global Standards receive ringing endorsement. Med Ed, 2003; 37: 586-587.
  6. WFME website: http://www.wfme.org

Adopted by the 54th WMA General Assembly, Helsinki, Finland, September 2003
revised by the 64th WMA General Assembly, Fortaleza, Brazil, October 2013 and
reaffirmed with minor revisions by the 224th WMA Council, Kigali, Rwanda, October 2023

PREAMBLE

Over the last three decades, forensic investigations into the whereabouts and fate of people killed and missing as a result of armed conflict, other situations of violence and catastrophes, have made an important contribution to humanitarian action on behalf of victims, including [the deceased and] bereaved families. Forensic investigations have also helped in achieving justice and reparations for victims.

In 2003 the International Conference on The Missing and Their Families, organized by the International Committee of the Red Cross (ICRC), adopted a set of recommendations to help prevent people going missing, and resolve the cases of those already missing, as a result of armed conflicts and other situations of violence. The recommendations include ethical, scientific and legal principles that must apply to forensic investigations in the search, recovery, management and identification of human remains. These principles have since been further developed and provide a framework for humanitarian forensic action in situations of armed conflicts, other situations of violence and catastrophes [1]. The principles also ensure the dignified and professional management of the dead [2], adherence to cultural and religious practices and help provide answers to the bereaved.

The WMA and its Constituent Members have a role in promoting these principles, encouraging compliance with them, and for ensuring the highest possible ethical, scientific and legal standards in forensic investigations aimed at addressing the humanitarian consequences of armed conflicts, other situations of violence and catastrophes.

RECOMMENDATIONS

  1. The WMA calls upon its Constituent Members to:
    • draw the attention of practitioners to the best practice guidelines produced by the ICRC, the United Nations and Interpol, and recommend or, where possible, require compliance with those standards;
    • help ensure that, when its individual physicians members take part in forensic investigations for humanitarian and human rights purposes, such investigations are established with a clear mandate based upon the highest ethical, scientific and legal standards, and conform with the principles and practice of humanitarian forensic action developed by the ICRC [3] and the United Nations [4];
    • acquire expertise in the principles collated by the different authorities on forensic investigations for humanitarian and human rights purposes, including those developed by the ICRC and the United Nations to prevent new cases and resolve those of existing missing persons, and to assist their members in applying these principles to forensic investigations worldwide;
    • disseminate those principles and support physicians refusing to take part in investigations that are ethically or otherwise unacceptable;
    • help ensure compliance by forensic medical practitioners with the principles enshrined in international humanitarian law for the dignified and professional management of the dead, including taking all measures to ensure their identification, while ensuring respect for their families.
  1. The WMA invites its Constituent Members to be mindful of academic qualifications and ethical understanding, ensuring that forensic physicians practice with competence and independence.

 

[1] The ICRC defines catastrophes as disasters beyond expectations. See: M. Tidball-Binz, Managing the dead in catastrophes: guiding principles and practical recommendations for first responders. International review of the Red Cross, Vol 89 Number 866 June 2007 p.p. 421-442.

[2] Management of the deceased (MotD) refers to a process encompassing different stages that begin with the information or report of death and finalizes with the return of the body to the bereaved, issuance of death certificates and final disposition.

[3] ICRC Guiding Principles for Dignified Management of the Dead in Humanitarian Emergencies and to Prevent them Becoming Missing Persons; Forensic Identification of Human Remains; Management of dead bodies after disasters: A manual for 1st responders; Guidelines for the use of Forensic Genetics in Investigations into Human Rights and International Humanitarian Law Violations

[4] UN Minnesota protocol applicable for the MotD in context of violations of human rights and criminal investigations.